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r 



THE 



NEW ENGLAND 



MEDICAL GAZETTE 



gl (mon<§C^ gouvnaC 



HOMCEOPATHIC MEDICINE. 



'^Dic viildc Mac lit ist grassy 



VOLUME XXXVI. 



BOSTON : 

OTIS CLAPP tSc SON, lo PARK S(,)UARE. 
1901. 



MAY 13 1902 ^^ 




INDEX. 



COMMUNICATIONS. 

Acate Ivaryngitis. By N. H. Houghtoni M.D io6 

Address Delivered Before Graduating Class of 1901 of Boston Uni- 
versity Medical School. By Prof. E. P. Colby, M.D. . 517 
An Involuntary Proving of Antimony. By Fred'k B. Percy, M.D. 585 
Annual Address by President of Boston Homoeopathic Medical 

Society. By Fred. M. Halsey, M.D. 73 

Annual Address by President of Massachusetts Momoeopathic 

Medical Society. By John L. Coffin, M.D 270 

Aseptic Vaccination. By H. H. Powers, M.D 589 

Brief Study of Temperature in Certain Serious Puerperal Compli- 
cations, A. By Sarah S. Windsor, M.D 481 

Case of Chronic Suppurative Otitis Media, A. By F. W. Colburn, 

M.D • ; ^ • ,- • 436 

Catarrhal Children. By.Edwari Beech er looker, M.D. . 532 

Chest Diseases in 1800 and looo. By HY^^-.Glapp, M.D. . . 350 

Complicated Fracture, A. SyNafhani^l W. Emerson, M.D. 565 
Diagnosis and Treatment of Gall Stoae Cases, The. By Horace 

Packard, M.D. 169,336 

Eye Strain Notwithstanding Acute Vision. By D. W. Wells, M.D. 85 

Factor in Wound Disturbance, A. By Wm. F. Wesselhoeft, M.D. 578 
Four Cases of Pernicious Anaemia in Insane Subjects. By S. C. 

Fuller, M.D 441 

Letter From Germany, A. By Horace Packard, M.D. . 421, 469 

Local Use of Arsenic in Malignant Ulceration, The. By George 

L. Van Deursen, M.D. 96 

Maternity Department of the Massachusetts Homoeopathic Hospi- 
tal, The Services of Walter Wesselhoeft, M.D. By J. Emmons 

Briggs, M.D 428 

Medical Registration. By Fred A. Davis, M.D i 

Modern Aids to Accurate Diagnosis. By J. P. Rand, M.D. . 380 
Modern Idea of the Use of Drugs as Medicines, The. By C. Wes- 
selhoeft, M.D 325 

Modern Surgical Technique. By J. Emmons Briggs, M.D. 176, 243 

Modern Surgical Technique. By George H. Earle, M.D. . 454 

Notes on the Waters of Gastein. By Walter Wesselhoeft, M.D. . 571 
Onosmodium Virginianum in Headache from Eye Strain. By A. 

B. Norton, M.D 121 

On the Faith in the Efficacies of Remedies. C. Wesselhoeft, M.D. 476 



4 The New England Medical Gazette. 

On the Therapeutics of Catarrhal and Neurotic Gastric and Intes- 
tinal Diseases. By C. Wesselhoeft, M.D 13 

Report of a Case of Smallpox. By H. H. Amsden» M.D. . 522 

Report of Cases Illustrative of the Association of Crime and In- 
sanity 191 

Report of the Surgical Service of the Massachusetts Homoeopathic 
Hospital, January i to April i, 1901. By Nathaniel W. Emer- 
son, M.D 490 

Report of the Surgical Service of the Massachusetts Homoeopathic 

Hospital, July i to October i, 1900. By Winfield Smith, M.D. 285 

Scleroderma. By John H. Urich, M.D 133 - 

Second Annual Report of the Rutland Sanatorium. By H. C. 

Clapp, M.D. 26 

Serum-Therapy, and the Animal Extracts. By John P. Suther- 
land, M.D 339 

Some Experiences With Bubonic Plague. By W. H. Watters, M.D. 527 

Some Preventable Causes of Mental Diseases. By Ellen L. 

Keith, M.D 183 

Some Reminiscences of the Study of Materia Medica. By N. R. 

Perkins, M.D 139 

Some Throat Symptoms of Lachesis. By Maurice W. Turner, M.D. 229 

Spinal Anaesthesia by the Tuffier Method. By William G. Wil- 
cox, M.D 22 

Surgical Treatment of Tubercular Joint Disease. By Ceorge W. 

Roberts, M.D 373 

Temperature in Puerperal Cases. By Lena H. Diemar, M.D. . 505 

Teratoma of the Parotid Gland. By T. M. Strong, A.M., M.D. . 221 

Treatment of Epithelioma Other Than by the Knife. By John ly. 

Coffin, M.D. 226 

Treatment of Rheumatism, Neuritis, and Neuralgia by Electricity, 

The. By George E. Percy, M.D 540 

Treatment of Tubercular Peritonitis by Abdominal Section and 

Drainage. By William T. Hopkins, M.D 104 

Tuberculosis and the Great Southwest. By Dr. Merrill -391 

Uterine Fibroids from the Practitioner's View Point. By G. For- 
est Martin, M.D. 125 

What is Peritonitis? By Horace Packard, M.D 279 

EDITORIAL. 

dazaar for the Benefit of the Medical School 205 

Case of the Late President, The 507 

Cephalic Hypertrophy 398 

Connecticut Homoeopathic Medical Society Semi-Centennial Cel- 
ebration 595 

Dr. Packard's Letter 458 



^ 



Index. S 

Hahnemann A,9SOciation, The no 

Institute Meeting, The 148 

Legislation 207 

Meeting of the Hahnemann Monument Committee of the Ameri- 
can Institute of Homoeopathy 253 

Pending Legislation 145 

Present Danger, The 549 

Publishers' Announcement 593 

Reproving of the Materia Medica, The 249 

^ Resolution, Western New York Homceopathic Medical Society . 209 

Subject of Over-Study in Our Public Schools, The ... 32 

j. ■ Word to Graduates, A 296 

\ 

EDITORIAL NOTES AND COMMENTS. 

Hampden Homoeopathic Hospital 400 

Medical Curiosity, A 38 

New Site for Detroit Homoeopathic Hospital 458 

Opening of the New Homoeopathic Hospital at the University of 

Michigan 36 

Reproving Drugs 298 

>«- 

SOCIETIES. 

American Institute of Homoeopathy .... 258, 266, 316 
Boston Homoeopathic Medical Society 46. 151, 161, 2(3, 301, 310, 361, 

401, 555, 599- 
Massachusetts Homoeopathic Medical Society 254, 553 

. 408 

. 315 

• 557 

41 » 370 



Massachusetts Surgical and Gynecological Society 
Rhode Island Homoeopathic Medical Society . 
Texas Homoeopathic State Society . . . . 
Worcester County Homoeopathic Medical Society . 



OBITUARY. 

Dr. Galen Allen 113 

Dr. Wm. D. Anderson 252 

Dr. Henry F. Batchelder 149 

Dr. L. Louise Brigham 252 

Dr. Jane K. Culver 296 

Dr. Erastus E. Marcy 113 

Dr. Max Pettenkoper 358 

Dr. Sarah E. Sherman 35 

Dr. Anna F. Smith 298 

Dr. Henry M. Smith 208 



6 The New England Medical Gazette, 

Notes on Pathology 55 210 

Reviews and Notices of Books 59. 115, 165, 215, 261, 318, 372, 409, 467, 

515,558,607-611, 
Reprints and Monographs Received . . . ^ . 322, 561 

Items of Interest 67, 459, 509, 562, 598 

Personal and News Items 71, 120, 167, 218, 265, 323, 372, 420, 468, 516, 

563, 611. 



r 



2 The New England Medical Gazette, Jan., 

Medical Association : " The matter of medical legislation is 
a delicate one from a professional standpoint. The passage 
of medical practice acts has been urged by the medical pro- 
fession, and we have been distinctly misunderstood in our 
attitude toward legislation. There is a feeling in the com- 
munity and on the part of legislators that in some way the 
medical profession wishes to put a fence around the practice 
of medicine, in order that those who are on the inside may 
fatten. It is persistently charged that we wish to create a 
medical oligarchy, to which only the few shall be eligible. 
For selfish, reasons it is said that we desire to limit the num- 
ber of medical men, to the end that we alone may occupy 
the chosen field. To the credit of the better elements in the 
community it must be said that such charges largely eminate 
from those whose interests are identical with the diploma 
mills and the various forms of quackery. The profession 
urges medical legislation, not from selfish and interested 
motives, but in the interest of the public health.' At no 
time has it desired legislation which shall limit the number 
of medical men, but it has insisted that those who pose as 
practitioners of the healing art should be in effect what they 
claim — masters of medical science. 

The government licenses pilots and engineers in the in- 
terests of the public. We merely point out that the same 
precautions should be taken in protecting the individual life, 
that are taken for the many. It is the duty of government 
to ascertain the qualifications of medical men who pose as 
qualified practitioners. This is the attitude of the medical 
profession upon this question, and so far as we are personally 
concerned, we would rather there were no medical practice 
acts, because they are not necessary for our protection, but 
simply for the protection of the public." 

Another objection which has always been urged with great 
force is that it restricts the liberty of the individual. Any 
person has absolute right to select any method of treatment 
in a supposed or real illness that he sees fit, or to choose any 



igoi Medical Registration, 3 

person to attend him that he pleases, and so far as the indi- 
vidual is concerned this may be right, but as far as the com- 
munity is concerned it is essentially wrong ; for the reason 
that no individual has the right to endanger the life of his 
neighbor or the community in which he lives by the failure 
of the medical attendant, whom he chooses to employ, to 
recognize diseases dangerous to the public health. 

We have also heard an objection raised, that you cannot 
by legislation educate people to the necessity of recognizing 
those who have ability and those who have none. That is 
very true, and for that reason registration is necessary. You 
cannot legislate people to be honest, therefore laws are 
passed to punish theft. You cannot legislate people to be 
moral, therefore laws are passed to protect the community 
from immorality. You cannot legislate people against sud- 
den rage or a spirit of vengeance, consequently laws are 
passed against murder and violence. And although you can- 
not by law enact as to what physician, or what class of 
physicians, or what means of skill, medical or otherwise, 
people may choose to employ for the cure of their ailments, 
it is right and proper that registration should be passed, 
protecting the community from the deplorable consequences 
of ignorance in all matters pertaining to the cure of the sick. 
As one of, the many instances where this lack of sufficient 
knowledge has worked irremediable harm, resulting in the 
death of the individual, I cite from the New York Medical 
Journal of March 10, 1900, with editorial comments thereon : 
" A case recorded in the Western Medical Review for De- 
cember 15th, comes, if accurately stated, clearly within the 
limits of criminality. A professing Christian Science Healer 
of Fort Dodge, Iowa, undertook the sole charge of the case 
of a child suffering from post-pharyngeal abscess. The bur- 
rowing nature of this disease is well known, and the impor- 
tance of providing an outlet for the pus is beyond question. 
This was not done, and the consequence was that the child 
died from asphyxia. Mr. Lincoln, the healer in question 



4 Ihe New England Medical Gazette, Jan., 

signed the certificate as the * attendant nurse,' giving the 
cause of death as * spasms.* Many of the cases where 
death ensues under Christian Science treatment are those of 
incurable disease, concerning which, while it is probable that 
proper skilled aid would have ameliorated suffering if not 
prolonged life, it is yet impossible to assert positively that 
such would have been the case, and still more impossible to 
state that Christian Science was in any sense a cause of 
death. But the case now recorded is one in which proper 
treatment would undoubtedly have saved life, and death was 
directly due to its being withheld. Although we believe 
that Iowa is one of the states that have legalized this pestif- 
erous and unscrupulous charlatanry, there should still be a 
remedy in firm application of the law of malpractice." Also, 
in the same issue of the New York Medical Journal^ I cite 
an editorial entitled " Faith Healing and the Law." " Ac- 
cording to the New York Tribune for March 5 th, the aid of 
the law is to be invoked to rescue a young woman in Chicago 
from the criminal folly of the faith healing community. The 
young woman is said to be suffering from * brain fever,' 
which from the reference to her screams of agony we take to 
be tuberculous meningitis, and these wiseacres, led by a 
former * regular physician,' are attempting to cure her by 
casting out devils, anointing the head with oil, and other 
methods." The Humane Society and the health department 
having no legal ground to interfere, a judge has been ap- 
pealed to for an order to commit her to the Detention Hos- 
pital for treatment. The absurd blasphemy of these people 
is exemplified in the following statement, which purports to 
have eminated from one of the before mentioned physician's 
disciples : * Miss Bettison's illness is due to the rapidity of 
her spiritual experience. It is due to the struggle between 
the Holy Ghost and whatever of evil there is in her for mas- 
tery. The Holy Ghost seems to have come to her all at 
once, and it is more than her body can stand. We feel 
sure she will be well in a few days if we are only left alone 



I go I Medical Registration, 5 

and allowed to care for her as Dr. Gentry says/ We are 
no advocate for any undue interference with the personal 
liberty of the individual adult, in full possession of his facul 
ties, to get his treatment in disease done for him as he gets 
his laundry — anywhere and by any method that pleases him. 
But children, who are incompetent to take care of them- 
selves, and adults who are mentally incapacitated, either per 
manently or temporarily, have a right to protection from the 
vagaries of fanatics," As to the right and interest of the 
community to enact laws for sufficient protection in this 
respect, I cannot do better than repeat the words of Mr. 
Justice Field, of the Supreme Court of the United States, 
in the case of Dent vs. West Virginia, in delivering the 
opinion, he said : " The power of the state to provide for 
the general welfare of its people authorizes it to prescribe all 
such regulations, as in its judgment will secure, or tend to 
secure them against the consequences of ignorance and inca- 
pacity, as well as of deception and fraud. Few professions 
require more careful preparation by one who seeks to enter 
it than medicine. It has to deal with all those subtle and 
mysterious influences upon which health and life depend, 
and requires not only a knowledge of the properties of vege- 
table and mineral substances, but of the human body in all 
its complicated parts, and their relation to each other, as 
well as their influence on the mind. The physician must be 
able to detect readily the presence of disease, and prescribe 
appropriate remedies for its removal. Every one may have 
occasion to consult him, but comparatively few can judge of 
the qualifications of learning and skill which he possesses. 
Reliance must be placed upon the assurance given by his 
license, issued by an authority competent to judge in that 
respect, that he possesses the requisite qualifications. Due 
consideration, therefore, for the protection of society may 
well induce the state to exclude from practice those who 
have not such a license, or who are found upon examination 
not to be fully qualified. No one has a right to practice 



6 The New England Medical Gazette, Jan., 

medicine without having the necessary qualifications of learn- 
ing and skill ; and the statutes only require that whoever 
assumes, by offering to the community his services as a 
physician, that he possesses such learning and skill, shall 
present evidence of it by a certificate or license from a body 
designated by the state as competent to judge of his qualifi- 
cations.*' 

The general recognition of the necessity for registration is 
evidenced by the fact that of all the civilized countries, China 
and Japan are about the only ones without any special law. 
From an article of Julius Schwabe, editor of the Diietsche 
Medicinische Wochenschrift^ we learn that the following 
countries have regulations governing the practice of medi- 
cine : "No special laws. i. China and Japan. 2. The 
requirement of a diploma or certificate authorizing the holder 
to practice in his own community — many states in the 
United States and some states in Africa. 3. The passage 
of a state examination — some states in the United States, 
Austria and Turkey. 4. The passing of a state examina- 
tion, with some concessions as to preliminary examinations 
— Argentina, Denmark, France, The Netherlands, Spain, 
Sweden. 5. Regular courses in the community's own 
schools — Belgium, Greece, Italy and Portugal. 6. The 
same, with evidence of preliminary education — Germany, 
Russia and Switzerland. 7. Denial of all foreigners of the 
right to practice — Luxemborg and Servia." The earliest 
legislation of which we have any record, as far as I have 
been able to learn, was passed by the legislature of Virginia 
in 1639, in regard to regulating fees. Out of thirteen colo- 
nies there were only two where laws were enacted in regard 
to defining the qualifications of a physician. In 1 840 laws 
were enacted by nearly all the legislatures of the United 
States to protect the citizens from the imposition of quacks. 
Between 1840 and 1850, however, the cry of monopoly was 
raised, and most of these laws were repealed or lapsed into 
"innocuous desuetude." In 1859 North Carolina passed a 



190 1 Medical Registration, 7 

law creating a State Board of Medical Examiners, and in 
1874 Kentucky enacted a law creating district examining 
boards, but this soon became a dead letter. In 1875 Nevada, 
and in 1876 California and Texas legislated upon the sub- 
ject. In 1877 Alabama established a State Board of Medi- 
cal Examiners, and Illinois passed a Medical-Practice act, 
the execution of which devolved upon a State Board of 
Health, created by a separate enactment. Within the next 
two years only two other states took action — Kansas in 
1879 (repealed in 1 881) and New York in 1880. In 1881 
nine states and one territory enacted medical practice laws, 
viz. : Arizona, Arkansas, Colorado, Connecticut, Florida, 
Georgia, Nebraska, New Jersey, Pennsylvania and Wis- 
consin ; in 1882 Louisiana, Mississippi, New Hampshire, 
New Mexico, South Carolina, West Virginia and Wyoming ; 
in 1883 Delaware, Michigan, Minnesota, Missouri; in 1884 
Dakota and Virginia. 

Thirty-two of the states now require an examination before 
permission to practice is obtained, the mere holding of the 
medical diploma not conferring the right to practice. Many 
efforts have been made from time to time to enact legisla- 
tion in our own state, but not until 1 894 was definite legisla* 
tion enacted. This law, at present, as you all know, renders 
an examination before the State Board of Medical Registra- 
tion requisite for a permission to practice medicine, but the 
law does not prescribe definitely any preliminary education. 
In some states a diploma from a chartered medical school is 
accepted as sufficient evidence of ability. This is not so in 
this state, and a perusal of the reports of the various exam- 
inations, to which we shall refer later, shows that this pro- 
vision is a wise one. The practical working of the law in 
this state, however, is essentially handicapped by the exemp- 
tion of all • clairvoyants, hypnotists, magnetic healers, mas- 
seurs. Christian scientists, osteopaths, or any other method of 
healing,' so long as they do not advertise themselves as 
physicians. While nominally forbidding this class of people 



8 The New England Medical Gazette. Jan., 

to practice medicine, it practically leaves a wide open door 
for an imposition upon the public to a full extent of all forms 
of charlatanry. 

What is essential to any law is not only that such people 
should not have the right to use the title of doctor, but that 
they should be obliged to give evidence of sufficient knowl- 
edge of disease to enable them to recognize diseased condi- 
tions dangerous to the public health. 

As the law stands at present, should a physician from 
neglect or any other cause, fail to report to the proper 
authorities a disease dangerous to the public health, he is 
subject to a penalty ; while similar failures on the part of the 
clairvoyant, Christian scientist, etc., etc., is subject to no 
penalty whatever. That is, we have a law for protection 
which does not protect. The modifications of our present 
state law for the remedying of this condition of affairs, is 
absolutely and immediately imperative. 

An examination of the various reports of our present State' 
Board, and especially the results of the examinations hereto- 
fore held, showing as they do a large per cent, of applicants 
who have been refused permission to practice, illustrates one 
of two things — either that a large proportion of those who 
apply are not graduates of a medical school, or that the 
standard of the requirements for graduation from our medi- 
cal schools is not sufficiently high or else not rigidly en- 
forced. As evidence of this, permit me to give briefly a few 
results of various examinations held within the past four 
years: In 1897 there were 492 applicants and 152 rejec- 
tions, an average of 31 per cent, rejected. In 1898 total 
number of applicants 489, 1 34 rejected, making an average 
of 25 per cent, rejected. In 1899 the applicants numbered 
480 and 141 were rejected, an average of nearly 26 per cent, 
rejected. In 1900, out of 428 applicants, 136 were rejected, 
an average of 3 1 per cent. Thus, in the past four years, of 
1889 applicants, 563 have been rejected who would otherwise 
be practicing medicine today. 



IQOI Medical Registration. 9 

It may also interest you to hear a brief sample of some of 
the questions and answers, showing if these are a fair sample 
of the papers excluded, the examination ks by no means too 
rigid. These questions and answers are taken from the 
report of the State Board of Registration of Massachusetts 
for 1899 and 1900. They are in every case taken from the 
papers presented by graduates of medical schools, and each 
answer is exact as to spelling, punctuation, capitalization and 
phraseology, and no one student is quoted more than one : — 

Q. Acute iritis, — diagnosis and treatment ? 

A. With this trouble there is trouble in the sight owing 
to the inflamation which causes a blur of the sight the 
treatment would be to treat the system internally and then 
send to an optician and have the eyes fitted with proper 
glasses. 

Q. In the second stage of labor what conditions would 
require the application of forceps ? 

A. I think a transverse position would require the use of 
forceps. 

Q. Differentiate infanticide from foeticide ? 

A. The first is an instance in which the mother kills the 
new born, the next is an instance in which the child is born 
alive, but immediately upon birth dies as a result of its own 
strange conduct. 

Q. Describe operation and after treatment for amputation 
of the leg at any point of election } 

A. In operating the leg at the middle of the thibia I will 
first put my rubber band little below the knee, made a cir- 
cular incision to cut the skin, made my flap, saw the thibia 
and ulna attach the thibial and ulnal arteries, stop the others 
little hemorrhages by compression and made an antiseptic 
dressing with iodform gauze. 

Q. Describe a thrombus and tell how it is produced ? 

A. A thrombus is a foreign substance detached from 
some remote organ carried through the circulation, occluding 



lO The New England Medical Gazette, Jan., 

the lumen of the vessel. It may be a detached piece of the 
valvular structure of the heart. 

Q. Of what value is sugar as a food ? 

A. The sugar by the glycocenic function of the bile is 
transformed in glucose and is the principle component of the 
blood. 

Q. Describe the two main cavities of the body and 
name the organs contained in each } 

A. The body is formed by two cavities the thorax and 
abdomen. The thorax is a cavity surrounded in front by the 
sternum and behind the spine laterally the ribs external is 
covered by the epidermis connective and interstitial tissues is 
divided by the abdomen by the diaphram. 

The organs which contains is the heart, lungs, stomach. 
The abdomen is a cavity composed externally by epidermis 
and internally by a membrane called the omentum." 

Comments upon such results of medical education are 
unnecessary. 

The recent lengthening of the course of study from three 
to four years in all the best medical schools of the country 
is undoubtedly a move in the right direction, but improve- 
ment should not stop here. More attention should be paid 
to the preparation for entrance to a medical school. 

The Johns Hopkins Medical School demands not only the 
diploma of the Bachelor of Arts degree, but also evidence of 
ability to read French and German, and of laboratory train- 
ing in physics, chemistry and biology. 

The Harvard Medical School accepts the A. B. diploma as 
evidence of fitness to pursue professional studies, requiring 
only that the holder shall possess an adequate knowledge of 
inorganic chemistry. It also provides for the admission, by 
a vote of the faculty, of young men not holders of an A. B. 
degree, who may furnish satisfactory evidence that they have 
obtained an equivalent education, and that they are conse- 
quently able to profit by the instruction which the school has 
to offer. Collegiate training as a preparation for a profes- 



190 1 Medical Registration, 11 

sional career, is undoubtedly of great value, but nevertheless, 
a properly conducted examination for admission is a better 
test of fitness to pursue the study of medicine than the pos- 
session of a diploma, the value of which varies so much 
according to the college bestowing it and the mental capacity 
of the holder of the diploma. Many young men who are 
unable to bear the expense of a literary college course, by 
close application to private study, prepare themselves for a 
professional career better than many holders of the A. B. 
degree. 

Usually the first year of a medical college course is spent 
in a course of study which should have been taken before 
entering the college. On the other hand, a great many of 
the holders of the A. B. diplomas are young men who have 
simply frittered their time away during their college course, 
and who are graduated more because they have gone through 
the prescribed course than from any special effort upon their 
part to thoroughly discipline their minds. 

I have chosen the medical departments of the Johns Hop- 
kins and Harvard Universities as being the two institutions 
generally recognized as the leaders in medical education in 
this country. 

But to return briefly to the subject of registration, an 
examination of the reports of the various state examining 
boards shows a marked discrepancy, both in the means 
required and in the results obtained. Thus, many states 
requiring an examination in a large range of subjects, often- 
times show a smaller percentage of rejections than other 
states nominally requiring much less. Consequently, under 
the present condition of affairs, reciprocity between the dif- 
ferent states is hardly practicable. 

So far as the practical working of the present registration 
law in our own state is concerned, we believe it to be one of 
the best. The question of favoritism in any individual case, 
or discrimination in favor or against any institution, is abso- 
lutely out of the question, as is evidenced from the fact that 



12 The New Etigland Medical Gazette, Jan., 

no applicant is known at the time of the examination or dur- 
ing the criticism of his paper, by the individual members of 
the examining board, as he is simply known by his number. 
The essential difficulty with our law is not in its practical 
application, but the fault is inherent in the law itself. 

To summarize briefly, the following facts are deduced : 
That there is a general wide-spread recognition of the neces- 
sity of a law governing the practice of medicine ; and that 
there is some law in existence in every state in the Union 
governing medical registration. That the laws in different 
states vary to such a degree in the standard required, that 
it makes reciprocity between the states, under this condition 
of inequality, an impossibility. That the beneficent results 
of the impartial and rigorous application of the law in our 
own state is evidenced by the abolition of several fake med- 
ical schools. By the fact that since the operation of the law 
more than 2000 persons have been compelled to drop the 
title of Dr., and also by the rejection of 563 unfit applicants 
since 1897. 

The inherent defects in the law itself seem to be, first, 
that it does not define the practice of medicine ; secondly, 
that it does not require every person who undertakes the 
cure or healing of disease to show by proper examination 
before the board, sufficient medical knowledge to protect his 
patients from imposition and the community from the spread 
of contagious diseases. 

I would demand that every clairvoyant, faith curist. Chris- 
tian scientist, osteopath, and every other fake, be compelled 
to pass an examination before the State Board which should 
show that he has sufficient knowledge to diagnose diseased 
conditions in the individuals submitting themselves to his 
care, and thereby protect the patient and the public, and 
they should be subject to the same laws and penalties as 
regards the reporting of contagious diseases to the proper 
authorities, as members of the regular profession. Person- 
ally, I believe that no one is more cognizant of defects in the 



IQOI Catarrhal^ Gastric and Intestinal Diseases. 13 

present law than the present board of registration ; no one 
is more desirous of its improvement or more zealous in their 
efforts to bring it about. But it cannot be done by them 
alone. They must receive the full support and hearty co-op- 
eration of every member in all branches of the profession. 
Each and every physician, among his clieritelle and the com- 
munity in which he lives, must constantly use his influence 
to educate the people to this necessity. It is a duty which 
every physician owes to himself and the public, and a duty 
which he cannot in safety neglect. 

THE BROTHERHOOD OF MAN. 
" No man is born unto himself alone. 
Who lives unto himself, he lives to none. 
The World's a body, each man a member is 
To add some measure to the public bliss. 
Where much is given, there much shall be required ; 
Where little, less." — Francis Quarles. 



ON THE THERAPEUTICS OF CATARRHAL AND NEU- 
ROTIC GASTRIC AND INTESTINAL DISEASES. 

C. WESSELHOEFT, M. D. 
[Read before Boston Horn. Med. Society, Nov. i, 1900.] 

I feel very much tempted to say a good deal about the 
diseases of the digestive organs, but I wish only to devote a 
short paper to the homoeopathic therapeutics of those affec- 
tions. Diseases are not so easily recognized as would appear 
from text books. I desire to repeat this here and suggest 
that inflammation of the oesophagus, acute catarrh of the 
stomach, phlegmonous gastritis, ulcer, cancer of the stomach, 
are all distinguished well enough in books, but that they are 
not so readily differentiated in actual practice from those 
forms of so-called dyspepsia which present themselves there 
very often — I may say every day — while the acute cases 
occur rarely compared with the ordinary chronic dyspeptic 
cases. 

It is the neurotic dyspeptic to whom I refer ; he is always 



14 The New England Medical Gazette, Jan., 

in evidence ; in the office of the general practitioner, or the 
specialist of the eye, the throat, or of any other organ, and 
the patient of this kind is governed in the choice of his 
specialist or general practitioner entirely by the notion or 
theory which that patient has formed in his own mind. If 
he fancies that his* eyes are affected he will seek relief at the 
hands of the proper specialist ; if he thinks that his stomach 
or liver is out of order, he goes to a stomach or liver spec- 
ialist, if there is any, or as very often happens to the general 
practitioner, who in these days might as well call himself a 
stomach specialist, or specialist for dyspepsia, so numerous 
are the patients of that kind. 

Now, in all these cases it is of vital importance always to 
make very sure of whether we are dealing with an actual 
inflammatory or degenerative disease of the stomach, or 
whether we are dealing with a neurosis more or less deep 
seated, not in the stomach, but in the brain or in the great 
sympathetic itself. 

It will now be understood why I think differentiation of 
ga.stric disorders difficult, and why it is very difficult to con- 
vey to students the real relationship of these disorders. 

Of the actual acute forms, the treatment by diet and medi- 
cine suggests itself more readily than it does in the neurotic 
forms, (but I will say first that in the December number of 
1890, of the North American Journal of Homoeopathy will 
be found an article entitled " Observations on the Pathology 
and Therapeutics of certain cases of Dyspepsia,'' comprising 
observations gathered from thirty-two tabulated cases.* ). 

This paper is only intended to supplement some points of 
the paper just mentioned, chiefly concerning homoeopathic 
remedies. In considering the acute forms of gastritis, catar- 
rhal, phlegmonous, and the catarrhal symptoms induced by 
ulceration and cancer, there is one remedy to which I would 
draw your attention and that is Rhus, 

* See also articles on " Habitual and Neurotic Constipation," Am. Journal 
of Homoeopathy, Sept., 1895, and Oct., 1896. 



IQOI Catarrhal y Gastric and Intestinal Diseases. 1 5 

In ''Hughes' Cyclopaedia" we find the following gastric 
symptoms caused by Rhus radicans and Toxicodendron^ con- 
sidered identical. Soreness of the throat, with intense burn- 
ing extending to the stomach. Irritation extends to the 
mucous membranes, redness and swelling of the throat, 
. . . great thirst, irritable cough, nausea and vomiting, 
. . . colicky pains throughout abdomen, especially dur- 
ing the nights and aggravated by eating and drinking. 
Diarrhoea frequently comes with tenesmus and the stools are 
often bloody. 

These observations are fully corroborated by other provers 
named in the cyclopaedia. Although each prover of case of 
poisoning adds some minor features to the gastric symptoms 
of Rhus, it is evident not only from these, but also from the 
violent form of inflammation which Rhus excites on the skin, 
that it ought to promise relief if applied according to the 
homoeopathic maxim in various forms of inflammation of the 
stomach, and so it does. 

I have used it frequently in acute gastritis of children and 
adults where arsenic is usually given without result because 
it is not indicated. Rhus suits best where there is loss of 
appetite, bitter taste gradually increasing to nausea and 
vomiting with pressure in the stomach, nocturnal colic, diar- 
rhoea, etc., as we have seen. 

Rhus is not usually selected as a remedy for gastric 
diseases because it is not fashion. But where it seems to 
tne to promise much would be in those rare forms of phleg- 
monous gastritis. Nor is it necessary to wait for simple 
catarrhal inflammation, for the very symptoms I have enum- 
erated above also occur in cancer, as well as in ulceration 
(ulcusrotundum, etc.) of the stomach. "It is best to use it 
not lower than 3x, or even above to the fifth. 

Among the other remedies such as Pulsatilla^ Nnx vom- 
icay Arsenic y there is another which fashion has very much 
overlooked in cases of acute gastritis and that is Cantharis. 
This, like many other toxic substances, is supposed to act 



1 6 The New England Medical Gazette. Jan., 

only upon the bladder and kidneys, and is under the ban of 
fashion. A fashion once set will endure for a long time. 
Some one will say that Calendula cures all soreness (I 
believe it is said to be indicated in incised wounds) ; it has 
become the fashion ; its tincture is sold by the gallon, I 
presume it is grown in fields and harvested with the mowing- 
machine, while if its pathogeny be referred to, there is noth- 
ing to account for its popularity.* So it is with Baptisia, our 
commonest pasture weed, once said to be good for typhoid, 
is now regularly given and sworn by ; when neither its 
pathogeny nor proving indicate any activity of that drug at 
all, its symptoms bearing on typhoid being the result of the 
alcohol of the tincture (See N. E. Med. Jour, of Feb., 1891.) 

Such is fashion ; while medicines whose pathogeny is 
quite indicative of useful results are left out of sight. Thus 
Cantharis is one of the remedies which should not be over- 
looked in certain forms of acute gastritis. For among the 
effects of Cantharis there appear cutting pains in the 
stomach and umbilical region and epigastrium ; burning 
pain in the throat and stomach — (usually associated with 
irritation of genital organs) nausea, vertigo, burning in mouth 
and throat, violent retching and vomiting — ardent thirst 
(the kidneys and bladder always primarily affected.) I have 
found Cantharis most useful in violent attacks of acute gas- 
tritis and have, therefore, called attention to this very incisive 
remedy. It should be given not lower than the 3 and will 
act high as the fifth and beyond. 

I will not say that either of these medicines will supersede 
Nux vomica. This is always indicated in obstinate retching 
and vomiting of a cramp-like nature, when the inflammatory 
process is not so marked as the nervous irritation, chiefly 
marked by empty ineffectual retching, little or no thirst. 

This powerful and most useful polychrest is so well known 

* One prover Franz ; no information as to dose and repetition, and un- 
corroborated by others. Hughes, Vol. IV., p. 730. 



190 1 Catarrhal, Gastric and Intestinal Diseases, 17 

that I omit its details for the present but shall refer to it 
again if I have time. 

I will not take up too much of your time with acute cases, 
which are comparatively easy to reach and usually of short 
duration, but I wish to emphasize the axiom once for all, 
that no medicinal application is of the slightest value unless 
the diet is regulated by proper restrictions in the first place. 
To say this metaphorically, dieting in acute gastritis means 
to rest the stomach, just as you would rest a broken limb, the 
least use of which prevents union. In acute digestive dis- 
turbances abstain from food as much as possible and return 
to it slowly. 

I still wish to say something about our friends, the chronic 
dyspeptic. They will be our friends if we can give them 
relief. If I describe one of them you will recognize them as 
a class. This patient is generally above middle age, gener- 
ally somewhat anaemic, anxiously scanning you to see if in 
your face he can detect the right doctor, whom as yet he has 
n^ver found. If asked how long he or she has been ailing, 
the answer will be several months if not years. All food 
distresses ; it seems to lie heavy in the stomach ; there are 
uncomfortable sensations which pass from epigastrium to the 
back ; there may or there may not be nausea, generally there 
is none ; but the symptom the patient dwells most on is 
"wind or gas in the stomach.'* The tongue is often not 
coated and the bowels are usually regular enough. What 
the patient wants is to get rid of that gas, and he will often 
proceed to give you an exhibition of the quantity of it in his 
stomach by a process of eructation (known in horses as a bad 
habit called cribbing, which they show by a noise they make 
in their throats while trotting and also in the stalls.) It con- 
sists of swallowing air into the stomach and then ejecting it 
by eructation. Examination shows the patient's stomach 
not to be distended at all. 

There is no doubt that he has many bad feelings, oftien 
very voluminous ; but when we come to the disentanglement 



1 8 The New England Medical Gazette. Jan., 

of the whole case we find that the patient has no dyspepsia 
at all. What food he takes is properly digested, as indicated 
by the fecal discharges ; his appetite is good but he does not 
dare to eat for fear that the food will hurt him and cause the 
gas to bloat him. 

If in such cases we find constipation, it is simply absence 
of regular stools from insufficient food which the patient 
fears. But the stools indicate digested food, and when that 
is the case, dyspepsia is not present. 

The whole condition is caused first by a hereditary predis- 
position traceable to a hypochondria of a parent or two. If 
not this, to overwork, mental anxiety and business and family 
cares. I do not know which are the most difficult to treat. 
First comes the question of diet ; the patient must be per- 
suaded to eat, and not abstain too long from food. " But it 
will hurt me and cause gas," will be his reply. It is now 
that the doctor must resort to argument adapted to the 
patient's understanding, to the effect that he must put up 
with a certain degree of pain, for there is every evidence 
that the food digests ; that he must not allow his stomach to 
dominate, but give it the work to do, by taking moderate 
quantities of food rather oftener than three times a day. 
After regulating this matter, comes the selection of the 
appropriate medicine. I need not look far in my note book 
to find a case. October 24, J. A. was here two years ago 
for headache, gas, etc., was benefitted and wants to be again. 
His case now is : Gas after eating. Headache in the morn- 
ing, dull, heavy, does not want to rise ; bad taste in mouth ; 
sedentary work, no exercise. Last time Nux vomica 3x 
cured him ; he has the same again with strict injunction to 
saw wood, or ride a wheel, or walk an hour every day. 

October 23d, Th., Mrs. — 30 : Neurasthenic and hypo- 
chondriacal to prostration ; could write page after page of 
distressing symptoms most of which she refers to abdomen ; 
claims to have terrible distress there from diarrhoea. Feels 
as if her head, her eyes, her heart were all affected ; spends 



190 1 Catarrhal, Gastric and Intestinal Diseases. 19 

most of her time in bed, fearing diarrhoea. This is the only 
positive symptom she has, and amounts to two or three 
rather loose stools a day, with some tenesmus and mucous 
discharge. She has had Mercurius v., 3x, one tablet every 
three hours, and is now much better of her bowel trouble^ 
but quite as disconsolate as before. She continues Mercu- 
rius v., but has to be much encouraged and made hopeful. 

I will not weary you with cases of this kind, but refer 
briefly to a few remedies which, after encouragement, are 
applicable in neurotic cases. There are three species of 
neurosis which are very often associated with what the 
patient calls dyspepsia — flatulence, pressure, fear of food, 
while stools, etc., show digestion to go on properly. These 
forms are Hypochondria, Hysteria and Neurasthenia. The 
hypochondriacal man or woman dwells on his or her disease ; 
thinks of it, tries to find its cause ; is sometimes melancholic 
but usually dyspeptic. Hysteria is characterized by lack of 
self control ; Neurasthenia by want of muscular and mental 
endurance, tiredness.. 

These forms are often associated with each other. The 
hypochondriacal woman is generally neurasthenic ; men some- 
times but rarely ; or she is apt also to be hysterical ; but all 
these forms, combined or uncombined are in a majority of 
cases associated with neurotic dyspepsia, but our remedy 
should be directed mostly toward the symptoms presented 
by the nervous system, of which the semblance of dyspepsia 
is only a part. It is in our case the most prominent part, 
and the most prominent symptom which should guide us in 
seeking for its remedy. 

In an article written six years ago * I have endeavored to 
point out the class of remedies to choose from in cases of 
neurasthenia, including hypochondria and hysteria, without 
reference to dyspepsia. Now the same class of remedies has 
a very strong bearing on cases of neurotic dyspepsia. 

In this as in my former lectures on the study of the 

* Therapeutics of Neurasthenia, N. E. Med. Jour., Dec, 1894. 



20 The New England Medical Gazette. Jan., 

materia medica, I still adhere to the principle that medicines 
should be studied according to their botanical and chemical 
groups, which resembling each other in this respect, will also 
resemble each other toxicologically. 

At the head of the list stand Nnx vomica and Ignatia 
(belonging to the order of Loganiaceae). It is certainly 
unnecessary to enumerate the indications for either, espec- 
ially for the former. 1 can only briefly give the indications 
upon which I prescribe Nux vomica : Great worry about 
patient's condition ; he is anxious and wants to know the 
cause of this or that sensation ; ascribes it all to his stomach 
which feels to him as if " bloated with gas," thinks he can't 
digest his food because the gas in his stomach causes so 
much pressure. He eats little, and has irregular stools. So 
in addition there is nausea, costiveness, headache in the 
morning with coated tongue, why, then, the case is clear 
enough. 

Conium Macnlatum is strongly indicated in the symptom 
of gas in the .stomach where there is no gas ; but where the 
patient has loud and long eructations often cultivated by 
habit, and the mental conjecture that he must get rid of that 
gas. Constipation associated with hypochondriacal intro.spec- 
tion, or hysterical loss of self control and nervous palpitation. 

The relationship of Conium to certain forms of nervous 
dyspepsia might lead us to think that Cicuta would also be 
indicated here ; but this is so .strongly related to the spasm- 
producing drugs, decided epileptic form attacks being fre- 
quent among its effects, that we find no place for it in 
nervous dyspepsia. 

Helleborus comes very near to it (in the class of Hellebo- 
rineae). It is a remedy to which I owe much gratitude. Its 
.severe cerebral symptom .s, approaching actual meningitis, 
point out its sphere of action, not only in its relation to the 
cerebral membranes, but to the cerebrum itself. I use it in 
cases where there is melancholic depression, dullness of the 
senses ; where patients complain of great pressure upon the 



190 1 Catarrhal^ Gastric and Intestinal Diseases > 21 

vertex ; vertigo, flickering, qualmishness, nausea, empty eruc- 
tations, burning pain in stomach, prostration. 

If these symptoms are the result of actual acute cerebral 
irritation, Helleborus is undoubtedly indicated ; and when 
they arise from a general neurotic condition simulating acute 
disease, Helleb. relieves very well indeed. In fact it appears 
to me as if a deep-seated hypochondriacal condition, with 
melancholic tendency were pathologically due to a chronic 
meningeal inflammation which sooner or later might end in 
actual degenerative disease, and I do not hesitate to give 
that remedy when these cases are ushered in by or take the 
form of chronic dyspepsia, always bearing in mind that I 
must distinguish between the purely neurotic and the actual 
catarrhal form. I am inclined to think that Helleborus is 
related more to the former than to the latter. 

Hydrastis Canadensis is commonly used only in catarrhal 
affections of the fauces and bronchial tubes, but it has a 
much wider range than that, its sphere extending to the 
digestive tract producing cutting pains in the bowels, con- 
stant dull aching in the stomach, umbilical pains and stool, 
along with obstruction of the nose and coryza. Scattered 
throughout its provings are many neurotic symptoms, which 
should point to that remedy in cases of neurotic digestive dis- 
turbances associated with catarrh of the fauces, larynx and 
bronchia. 

Cimicifuga Racemosa (or Actaea r.) is much more far- 
reaching than Hydrastis. The neurotic element largely pre- 
vails among its effects, together with digestive disturbances. 
The dull pain in the vertex appears quite often in its provings, 
faintness in epigastrium and nervous uneasiness ; often with 
neuralgic pain in the eyeballs. Abdominal fullness ; excruci- 
ating pain in the bowels, much rumbling of wind. Thin, 
dark, offensive stools. With these go mental depression and 
suicidal tendency ; internal tremors in stomach ; cannot fix 
attention ; nervous uneasiness, interpreted by compilers (see 
Bering) to mean that the prover " declares she will go 



22 The New England Medical Gazette, Jan., 

crazy." I can find no such expressions in authentic prov- 
ings, and think that it means nothing serious, and only that 
the prover has got into a nervous state. But it is just this 
nervous condition combined with the digestive disturbances 
which suggests the use of Cimicifuga in neurotic dyspepsia. 

If I have not used it often I ought to have done so, and 
think that in that case I should be able to report favorable 
results derived from that medicine. 

There are many others. Pulsatilla is well known, but it 
needs supplanting by other medicines where thus far it has 
been expected to do most of the work alone. 

I must also add Cocculus and Agaricus to the list ; the 
latter with its derivative muscarine^ is a very far-reaching 
poison producing great nervous weakness and exhaustion with 
manifold digestive disturbances, whence it should be used in 
neurasthenia and neurotic dyspepsia. 

This does not exhaust the list nor the subject. I could do 
little more than to point out a few of the overlooked remedies 
which can help us out in those tedious and distracting cases, 
and have preferred to do it in this way instead of detailing 
clinical cases from my practice. 



SPINAL ANAESTHESIAS BY THE TUFFIER METHOD. 

Buffalo, N. Y., Nov. 19, 1900. 
Editor of The New England Medical Gazette^ Boston^ Mass : 
Dear Doctor, — As the profession generally is quite in- 
terested in the results of Medullary Narcosis (Spinal Cocain- 
ization) I take the liberty of sending you (as well as other of 
our journals) a report of my first case, (the first I understand 
to be reported from Buffalo.) Mr. Curtiss, a patient of 
Dr. Chadwick's, sixty years, entered the Homoeopathic Hos- 
pital November 9, for a removal of a tumor of the thigh. 
Being the attending surgeon he came under my care. He 



1 go I Spinal AncBsthesias, 23 

had suffered a slight apoplectic stroke one year ago, leaving 
his speech affected slightly, but not impairing in any way his 
tactile sense. Height, five feet, eight inches ; weight, one 
hundred pounds ; general condition, good ; previous narcosis, 
none ; respiratory and circulatory system, normal ; tempera- 
ture on morning of operation, 99.2 ; pulse 100; urine, slight 
trace of albumen ; knee terk exaggerated ; pupillary reac 
tion normal. 

The method of injecting the cocaine into the sub-dural 
space was practically the same as that recommended by 
Tuffier. Patient sat on the edge of the operating table, back 
to the light. The articulation of the fourth and fifth verte- 
brae was located by drawing a line from one illiac crest to 
the other ; such line crossing slightly above the articulation. 
The needle used was such as belongs to the ordinary aspirat- 
ing syringe, about two and one-half inches long and of a 
calibre three tirne that of an ordinary hypodermic needle. 
The long bevel had been filed down reducing the bevel 
length one-half. Dr. Critchlow, pathologist to the hospital, 
had in charge the preparation of the cocaine solution. It 
was intended to have used a freshly prepared solution, made 
by first boiling the water in a test tube, then adding three- 
tenths of a grain of the cocaine crystals to fifteen minims of 
this sterile water, but owing to the absence of the crystals a 

2 per cent, drug store preparation of indefinite age was 
rendered sterile, and fifteen minims of this was drawn into a 
sterile syringe. The point selected for the insertion of the 
needle was three-eighths of an inch to the right of the 
median line and midway in the interspace, caused by the 
fourth and fifth vertebrae being pulled apart when the patient 
bent forward. The needle having been rendered thoroughly 
sterile, and the back of the patient being well scrubbed, he 
was directed to bend forward in the " scorcher's position." 
The needle detached from the syringe was inserted at the 
point mentioned, being directed upward and inward, passing 
slowly through the structures. It pas.sed two and one-half 



24 The New England Medical Gazette. Jan., 

inches without the escape of the spinal fluid. The patient 
being thin, I felt confident a needle of that length was suf- 
ficiently long. No fluid appearing, the needle was with- 
drawn and inserted on the left side at a corresponding 
distance and angle ; no fluid escaped. The space between 
the fifth vertebra and sacrum was then selected, but the 
needle could not be inserted more than one and one-half 
inches. Selecting a point not more than one-fourth inch 
from the median line and between the fourth and fifth verte- 
brae, the needle was inserted at a very slight angle to the 
spine; in fact, were the patient sitting straight upright, the 
needle would be at a right angle with the spine and but 
slightly directed from without inward. Again it was pushed 
in slowly, and at a depth of two and one-fourth inches the 
spinal fluid escaped. Two drops of clear fluid showing un- 
questionably that the sub-dural space was reached. The 
syringe was then attached (all instruments having been ren- 
dered sterile) and fifteen minims of a 2 per cent, solution 
was slowly injected, allowing forty seconds for this pro- 
cedure ; the needle was then withdrawn and puncture, sealed 
with collodion. 

Patient was placed on his back on the operating table, and 
close observations were taken by Drs. Groesbeck and Critch- 
low every few minutes. The following is their report : — 

Administration of cocaine 12 o'clock, 32 minutes, 30 seconds. 
12.30 P.M. (before injection), pulse it6, temperature 992-5; 
12.36 P.M., pulse 126; 12.43 P.M., pulse 134; 12.48 p.m., pulse 
78 ; 12.51 p. m., pulse 68 ; 12.55 p« m-» pulse 86 ; i p. m., pulse 90 ; 
1.05 p. M., pulse 97 ; 1.07 p. m., operation completed. 

Partial anesthesia first appeared in thigh 12.36, six min- 
utes after the injection ; sensation still present in the feet ; 
slight tremors through the legs. 12.43, anesthesia complete 
below the lumbar puncture. Operation begun. 

12.46, when asked if felt pain, said, felt some pulling at 
seat of operation. 12.50, anterior crural nerve exposed, and 
when pinched or pricked with knife patient complained of 



I go I Spinal A nasthesias. 2 $ 

sharp pain ; otherwise he complained of no sensation what- 
soever during the entire operation. 

The operation consumed thirty-two minutes from the first 
incision until the complete closure of the wound. The anes- 
thesia lasted from 12.38, when dullness to pin prick was 
first noticed in the thigh until 1.15, when it had almost en- 
tirely passed away. A total of thirty-seven minutes. The 
operation consisted in making an incision down the thigh 
from the ranus of the pubes for a distance of five inches. 
The tumor was encapsulated and embedded beneath the 
rectus and adductor longus muscles and attached to the 
pubes. Branches of the anterior crural nerve were cut, as 
well as a number of small blood vessels. 

During the operation the patient talked freely and said he 
felt very comfortable, not complaining of nausea once ; 
although he looked pale throughout the operation. He had 
regained complete sensation in his feet within two hours 
after the operation. He passed a comfortable night and felt 
the next morning like getting up, no nausea or vomiting fol- 
lowing. He has continued to do well (now the fourth day) 
since the operation. 

Some points to be gained from even this one case are, first, 
that although the patient was susceptible to cocainization, yet 
he took it well and rallied quickly from its effects, unusually 
so in fact, as the majority of cases reported where they have 
been influenced at all by fifteen minims of two per cent, solu- 
tion have remained under its effects from forty to seventy 
minutes. Second, the difficulty of reaching the canal by fol- 
lowing the carefully worded instructions of Tuffier ; I was 
unable to reach the medullary space by three repeated punc- 
tures, but when I started the needle nearer the spinal process 
and directed it more nearly at a right angle with the length 
of the spine and but slightly from without inward, I secured 
the fluid at once. Third, that had the operation required an 
hour or more, I should, in his case, have been obliged to repeat 



26 The New England Medical Gazette, Jan., 

the cocaine injection or resort to chloroform because the 
effects lasted less than forty minutes. 

Just what this method is going to do for us both in sur- 
gery and obstetrics remains to be seen, but it promises suf- 
ficient to induce us to make the most practical investigation 
concerning its employment. 

Dr. Wm. G. Wilcox, 

Buffalo, N. Y. 



SECOND ANNUAL REPORT OF DR. H. C. CLAPP, 
OF RUTLAND SANATORIUM. 

Sept. 30, 1900. 
To the Trustees of the Massachusetts State Sanatorium : 

Gentlemen, — My first annual report was made to end on 
Oct. 10, 1899, because that date was exactly one year from 
the day when the Sanatorium (then called Hospital) refceived 
its first patients. 

To conform, however, to the other reports, my second 
annual is made to end on Sept. 30, 1900, which makes the 
period to be covered, and now under consideration, less than 
a full year by about ten days. 

During this time there have been admitted to the Sanato- 
rium under my care 143 patients. These, with the TJ 
remaining at the time of my last report, Oct. 10, 1899, make 
a total of 220 patients treated during the year. Out of this 
number 144 (69 males and 75 females) have been discharged. 
Of these discharged patients 1 2 had remained in the Sana- 
torium, for one reason or another, less than one month, which 
was, of course, too short a time to warrant deductions as to 
the efficacy of treatment, although some of them manifestly 
improved. Of these 1 2 one entered the Sanatorium in prac- 
tically a moribund condition, and died in a very few days. 
She had been accepted on examination three or four weeks 



I go I Annual Repqrt of Dr. H, C, Clapp, 27 

previously, but did not come to Rutland when requested to 
do so, because, as she afterwards explained, she was suddenly 
taken sick at home. At last she forced herself to take the 
journey, but on reaching the Sanatorium, was too much ex- 
hausted by the acute miliary tuberculosis (which had mean- 
time complicated her disease) to allow of her being sent 
home. A regulation has since been adopted requiring a 
second examination of "passed" applicants, who do not 
enter for two or three weeks or more. 

Leaving out of consideration these 12, we have 132 dis- 
charged patients, whose cases will be considered statistically 
in this report. Of these cases 82 on admission were incipi- 
ent, 40 were moderately advanced, and 10 were far advanced, 
according to the definition of these stages given in my report 
of one year ago. 

By incipient cases are meant those which present evidence 
of a small tubercular deposit in one or both lungs, but with- 
out very decided constitutional disturbances. By moderately 
advanced cases are meant those where the tubercular deposits 
are larger and are beginning to soften, and the constitutional 
disturbances are prominent ; or where, without an extensive 
infiltration; the pronounced rational symptoms indicate a 
greater susceptibility of the system to the poison. Far ad- 
vanced cases require no definition. 

The average length of stay of these patients was six 
months and six days. Only 14 remained longer than one 
year. 

The results of treatment are clearly shown by the follow- 
ing tabular view, not only for the 82 incipient cases, but also 
for the 40 moderately advanced and the 10 far advanced 
cases, under the headings of Apparently Cured or Arrested, 
Improved, Not Improved and Died. The reasons for the 
selection of these headings were given in my last report. 
Finally, the results for all stages of the disease combined 
appear under the same headings. 



28 



The New England Medical Gazette, 



Jan., 



In the latter line, of the 49 improved, 28 were certainly 
very much improved. 

132 patients who remained for i month to 19 2-3 months. 

Condition on Admiuion. Apparently Cured or Arrested. Improved. Not Improved. Died. 

82 Incipient cases • • 53 28 i o 

40 Moderately advanced cases, 6 18 15 i 

10 Far advanced cases .0 361 

Total (132.) 59 49 22 2 

From these tables the following very favorable percentages 
may be obtained : — 

Of the Incipient Casks There Were 



Apparently cured or arrested .... 

Improved (including also greatly improved) . 

Not improved (worse) 

Of the Moderately Advanced Cases 

Apparently cured or arrested 

Improved (including also greatly improved) . 
Not improved (including worse) . . : . 
Died 

Of the Far Advanced Cases. 

Improved ........ 

Not Improved (worse) ...... 

Died 

Of All the Cases in Mv Service 

Apparently cured or arrested .... 
Improved (including much improved) 
Not improved (including worse) .... 
Died 



Per Cent. 
64 >i 

34-1- 

i-l- 



15 
45 
37 J4 

2>^ 



30 
60 



45 
37 



As in my last report, the expression apparently cured 
indicates cases in which the phthisical cough, fever, etc., are 
practically gone, no tubercle bacilli being found in the 
sputum (or there being no expectoration), and the physical 
signs either having entirely disappeared, or if any remain, 
indicating a healed lesion. 



igoi Annual Report of Dr. H. C. Clapp. 29 

Tubercle bacilli were found in the expectoration of 1 1 7 of 
my patients and were not found in 1 5 cases. The sputum 
from the whole of the Sanatorium has been sent indiscrimi- 
nately to the pathological laboratories of the Boston Uni- 
versity and of the Harvard University Medical Schools, 
sometimes to one and sometimes to the other, just as it hap- 
pened. Of the 1 5 cases in which no tubercle bacilli were 
found, seven had no sputum to examine. Of these seven, 
three had had hemorrhages, one had a tubercular knee (which 
has since been operated on at one of our hospitals in Boston), 
two had decided physical signs, and the last had constitu- 
tional symptoms which made it at least very suspicious. 

Of the 8 cases where sputum existed, but contained no 
bacilli, three had had hemorrhages, one was so far advanced 
that the patient died at the CuUis Consumptives' Home 
within a few weeks after leaving the Sanatorium ; one was 
an old and well-marked case of fibroid phthisis, and the 
other three were incipient cases with physical signs and 
symptoms fairly well marked if not absolutely conclusive. 

The greatest weight gained by any one patient discharged 
during the year was 49 pounds. Of the 132 patients, 127 
gained weight during their stay, and the average gain was 
1 3 2-3 pounds. Five lost weight, and the average loss was 
4 pounds. This is certainly a very satisfactory showing. 

The better results obtained this year, as compared with 
last, are undoubtedly owing, to a great extent, to the fact 
that more applications for admission having been received a 
more judicious selection of patients, as to physical condition, 
could be made. Still more satisfactory work could be done 
if the applications were so numerous that only incipient 
cases could be admitted. One practical difficulty now in the 
way of our admitting only such cases is to be found in the 
fact that very frequently persons in the early stages of con- 
sumption are either unaware of their condition, or on being 
informed, are very reluctant to believe it, and persistently 
refuse to do the right thing, because they deem it unneces- 



30 The New England Medical Gazette, Jan., 

sary, or else because they feel that they cannot afiford to 
give up work in order to attend to themselves. When, how- 
ever, they have pursued this policy long enough to become 
incurable, they are willing enough and anxious enough to do 
anything, whether it be in their power or not. The large 
number of such applicants, many of whom have exhausted 
all, or nearly all, of their resources, is. exceedingly distressing 
and pitiable indeed, and constantly calls attention to the 
great need which exists for some suitable provision for this 
unfortunate class of advanced consumptives, to be made 
either by our commonwealth, or perhaps better by districts,, 
counties, cities or towns. 

An erroneous idea prevails ^to some extent among certain * 
physicians in Massachusetts, that our rejection of an appli- 
cant necessarily means incurability. This is far from being 
the case. We endeavor to select from among the applicants 
those who seem most likely to improve, and that to the 
greatest extent and in the shortest time, so that the beds can 
be occupied by as many patients as possible in succession, 
and can thus do the most good to the greatest number. The 
standard of admission may vary somewhat from time to time, 
according to the number and physical condition of the 
appHcants. 

An effort has lately been made to ascertain, as far as pos- 
sible, the present condition of the 29 patients who were 
reported as apparently cured or arrested in my first year of 
service, and who are now more or less widely scattered. A 
carefully drawn up letter, with numerous questions designed 
to elicit information as to the presence or absence of import- 
ant symptoms, the ability to work, etc., was printed and sent 
to these former patients, and all but one replied. To my 
great gratification, the answers indicated that 24 or 25 out of 
the 29 still remained up to that time in pretty good condi- 
tion, in spite of the fact that in some cases it was impossible * 
for them to avoid unhygienic surroundings. Of about one- 



IQOI Annual Report of Dr. H. C. Clapp, 31 

third of these patients I was able to make a physical exam- 
ination which corroborated these conclusions. 

Very likely some allowance is to be made for optimism in 
the report of those not thus examined ; but not, I think, 
sufficient to influence the results very materially. 

As if to compensate for these relapses, four of those who 
had been reported only .as improved when discharged in the 
first, year, were found to have advanced in health, as a result 
of a careful outside continuance of the treatment initiated at 
at our Sanatorium, sufficiently to warrant the change of 
designation to apparently cured or arrested. 

It may not be out of place to add that your physicians are 
eagerly looking forward to the erection of the hall for recrea- 
tion, religious services, and other public gatherings, which is 
sorely needed, as well as the administration building, with 
proper examination and waiting rooms, laboratory, throat 
room, etc., also the new dining hall, all- of which will be valu- 
able additions to the equipment of the institution. 

I desire to record here my continued satisfaction with the 
work of my assistant. Dr. D. P. Butler, Jr., who has been 
very faithful in the performance of all his duties. The 
nurses, too, as last year, have been very efficient. 
Respectfully submitted, 

Herbert C. Clapp, M. D. 



32 The New England Medical Gazette. Jan., 



EDITORIAL. 

Contributions of original articles, correspondence, etc., should be sent to the publishers, (^tis 
Clapp & Son, Boston, Mass. Articles accepted with the understanding that they appear only in 
the Gazttte. They should be tyjiewritten if possible. To obtain insertion the following month, 
reports of societies and personal items must b* rtc*iv*dby the 15th c/ the month preceding. 



The subject of overstudy in our public schools, and more 
particularly the damage done children by the night study 
necessitated thereby, has again come somewhat prominently 
to the front. It is a subject in which every physician is 
interested, and therefore we feel we are justified in quoting 
from the opinions of two of our representative physicians, 
one of each school, as recently published in a Boston daily 
paper. 

Dr. Geo. L. Walton, one of, if not the leading, neurologist 
among the old school in Boston, says : — 

** I should think that average children of 12 or 1 3 years 
could stand a certain amount of home work, unless occupied 
with other outside duties, as music, dancing lessons, or house- 
hold cares beyond their years, or in attending parties and 
entertainments. The more such sources of exhaustions are 
added the less the ability to stand the school work either in 
or out of regular hours. 

" With regard to evening work, the question is largely one 
of artificial light, and with children, as well as with adults, 
great care should be taken, not only that proper light be 
used, but also that glasses be worn when needed, for eye 
strain is often a potent factor in brain fatigue. 

" I have not been able to satisfy myself that nervous ex- 
haustion as a result of school work is prevalent among chil- 
dren in this vicinity, and should be inclined to think that 
inability to keep up the work occurs largely among children 
either exceptionally delicate or occupied by other wearying 
pursuits than those connected with the school." 



I go I Editorial, 33 

As one who deservedly commands attention among profes- 
sional men of our own faith, Dr. Sutherland, the Dean of 
Boston University School of Medicine, says : — 

" The question of home study is one to which I have given 
serious thought, and I have come to the conclusion that 
there should be no night study for children under 14 years 
of age. I will go farther, and will say under 16 or 17 years 
of age. Then it should be confined to one or two hours. 
After a student enters college it is a different matter. The 
body has then attained its growth, and systematized study 
will do no harm. 

" It is a grave fault in modern education that growing chil- 
dren are so crammed with study that their minds are forced 
to the detriment of the body. Better results would be ac- 
complished with a strong, healthy body and a well regulated, 
not an overtaxed, brain. 

" Not only should there be no study at night for growing 
girls and boys, but there should be a proper amount of fresh 
air and physical exercise in the afternoon as well. If this 
and home study cannot both be accomplished, the work 
should be sacrificed for the salvation of the body. Let such 
children learn what they can in the school room, and let the 
rest go rather than have them grow up to find themselves 
with wrecked constitutions when they are called upon to per- 
form the strenuous work of life. 

" Why is it that men are stronger than women as a rule } 
There is a prevalent opinion that they are healthier by 
nature. Such is not the case. Women are weaker than 
men because of their bringing up. While the boys are 
turned out to romp, to play, in short to become athletes, 
their sisters have their duties about the house ; they are 
taught to sew, to sing, to play, to dance, in order that they 
may be graceful. But wouldn't it be better to be strong 
first } 

" It is considered necessary for a girl to have so many 
accomplishments. To the cultivation of these her education 



1 



34 The New England Medical Gazette, Jan., 

is turned. She sits at the piano and practises, while her 
brothers, shouting over their game of ball or whatever it 
may be, are building up hardy, robust bodies. That is why, 
when they come to maturity, their constitutions can stand 
the strain of life work better than the average woman can. 

" So much for children when they are growing. When 
they enter college and become men and women the face of 
the matter changes. Night work must be done then, and 
can be done without injury. In the post graduate courses in 
the scientific schools, the law schools and the medical schools, 
there are from 24 to 36 hours of lecture work a week, with a 
proportionate amount of outside study. In my own depart- 
ment in the Boston University the students have from 32 to 
36 hours a week in the lecture rooms and laboratories. Be- 
yond this they must find the time to study and perform the 
required outside work. 

" Is is imperative that they should devote to their profes- 
sion many hours of the night, yet my experience has been 
that these men and women are in a better physical condition 
when they complete than when they commence their four 
years* course. Their bodies have reached maturity, however, 
and can stand the strain of night work. There is the 
difference." 

Although there seems to be some difference of opinion 
here expressed, we are inclined to think it is more apparent 
than real. The fact is both are right. ' Dr. Walton says if 
outside matters, such as dancing parties, music, etc., are not 
indulged in, the study does no harm ; and Dr. Sutherland 
says these things do harm, largely because the girl especially 
must have, in addition to studies, accomplishments acquired 
at the expense of time which should be given to the building 
up and strengthening of the body. The question is a com- 
plex one. Many elements such as individual abilities and 
idiosyncrasies, hereditary tendencies, home influences and 
atmosphere must be taken into account, and these vary to 
such a great extent that absolute conclusions are impossible. 



190 1 Editor iaL 35 

Each physician's opinion must be largely based on the chil- 
dren with whom he comes most in contact and whose physi- 
cal welfare he has had much to do with. For this reason 
we believe that the well founded opinion of a conscientious 
and observant general practitioner is of more value than that 
of the speciajist. From our own observation, made during 
several years in general practice, during a part of which we 
had to do somewhat with school management, we certainly 
were convinced that children from the years of 12 to 16 
were often over taxed by their school work, in addition to 
what was demanded of them in other directions ; in other 
words the attainment of accomplishments. One or the other 
should certainly be modified, and we should not attempt any 
longer to make a girl of 18 or 20 an educated ( ? ) and 
accomplished young lady. 

Again the courses of study are altogether too diffusive. 
We believe it taxes the mind during the developmental 
period much more to be constantly diverted from one topic 
to another than if it was held more continuously to one line 
or branch of study until it was thoroughly mastered. Every- 
body cannot know everything. It would be better if our 
public school system turned out somebody who knew some- 
thing and knew it thoroughly. 



OBITUARY. 

Dr. Sarah E. Sherman, of Salem, died recently. She was 
bom in Fayton, Vt., April 28, 1845. After graduating from 
school, Miss Sherman taught school for a while. Later she 
began to study for the practice of medicine, and was gradu- 
ated at Boston University Medical School in 1876. 

In the fall of that year she went to Salem and began to 
practise, being the first woman physician in Salem. For 
many years she had a large practice. She was a member of 



36 The New England Medical Gazette. Jan,, 

the school board for several years, and one of the originators 
of the Salem Woman's Club, and its first president. Miss 
Sherman was a member of the American Institute of Hom- 
oeopathy, and at the time of her death lecturer on anatomy 
at the Emerson College of Oratory. She was a trustee of 
that institution and of Boston University. 



EDITORIAL NOTES AND COMMENTS. 



The exercises in connection with the opening of the new 
Homoeopathic Hospital at the University of Michigan began 
Thursday, December 6, and continued through Saturday, 
December 8. The detailed programme was. as follows : — 

THURSOAV AFTERNOON. 

Operative clinic, surgical amphitheatre. Dr. Claudius B. 
Kinyon, professor of obstetrics and gynaecology in the hom- 
oeopathic department of the University. 

THURSDAY EVENING. 

Exercises in Sarah Caswell Angell Hall, Women's Gym- 
nasium. 

Prayer, Prof. Martin L. D'Ooge, LL.D., professor of 
Greek in the University. 

Introductory, presenting James B. Angell, Lt.D., presi- 
dent of the University, who presided, Prof. Wilbert B. Hins- 
dale, M. D., dean of the homoeopathic department. 

Remarks, President James B. Angell, LL.D. 

Address, Prof. Charles E. Walton, M. D., Cincinnati, O., 
president of the American Institute of Homoeopathy. 

Address, the Hon. Henry S. Dean, Ann Arbor, chairman 
of homoeopathic committee of the Board of Regents of the 
the University of Michigan. 



190 1 Editorial Notes and Comments, 37 

Address, Malcolm C. Sinclair, M. D., Grand Rapids, presi- 
dent of the state board of registration in medicine. 

Address, Prof. Charles Gatchell, M. D., Chicago, formerly 
professor of theory and practice in the homoeopathic depart- 
ment. 

Address, Rolin C. Olin, M. D., Detroit, member of the 
first graduating class of the homoeopathic department. 

Address, Prof. Royal S. Copeland, M. D., Ann Arbor, 
president State Homoeopathic Medical Society. 

Reception by the ladies of the faculty of homoeopathic 
department in the women's gymnasium, for the speakers of 
the evening, alumni and friends of the department. 

FRIDAY FORENOON. 

Lecture in medical lecture room, Willis A. Dewey, M. D., 
professor of materia medica and therapeutics in homoeopathic 
department. 

Surgical clinic, surgical amphitheatre. Perry W. Cornue, 
M. D., acting professor of surgery and clinical surgery. 

FRIDAY AFTERNOON. 

The new hospital will be open to the public for general 
inspection. 

FRIDAY EVENING. 

Commencement of the Training School for Nurses, hos- 
pital lecture room, address by DeWitt G. Wilcox, M. D., 
Buffalo. Reception in new nurses' home. 

SATURDAY FORENOON. 

Lecture, medical lecture room, Prof. Wilbert B. Hinsdale, 
M. D., dean of the homoeopathic department and professor 
of the theory and practice of medicine and clinical medicine. 

SATURDAY AFTERNOON. 

The hospital will be open for public inspection — Xew 
Michigan News. 



38 The New England Medical Gazette, Jan., 

A riEDICAL CURIOSITY. 

The following *' antique " may be of interest to some of 
our readers : — 

West Medway, Mass., Oct. 31, 1900. 

Dr. John L. Coffin, Editor New England Medical 
Gazette, Boston, Mass : 

Dear Doctor, — I have a little old book (just how old I 
don't know) that I send you an extract from. I thought it 
would interest some other doctor as it has interested me. 

The capitals, punctuation aiid spelling are the same as in 
the book. Many of the s's are printed life f's. I have tried 
to write them in that way. Italics are underlined. 

The cover is of wood, leather covered, about 4x6 inches 
in size. Is entitled '^the Englifh Phyfitian Enlarged." Has 
285 pages. No date of publication or name of author, but 
on the first page is written with pen, a name, and then fol- 
lowing it, " Ejes Libor AD 1781 

The Englifh physitian 
Enlarged 
By 
Nicholos Culpeper M D. 

I think it was published in the last part of 1600 or the 
early part of 1700, as I have seen somewhere in the book a 
reference to some other book of his writing in 168 1. If you 
wish to use this extract at any time it is yours. 

Alvin Boyce. 

Henrane. 
Defcription 

Our common Henbane hath very large, thick, foft, wooly Leaves 
lying upon the ground, much cut in or torn on the edges, of a dark 
ill grayifh green colour, among which arife up divers thick and 
fhort ftalks two or three foot high, fpread into divers fmaller 
branches with leffer Leaves on them, and many hollow Flowers 



190 1 Editorial Notes and Comments, 39 

fcarce appearing above the Husks & ufually torn on the one fide, 
ending in fine round points growing one above another, of a dead- 
ish yellow colour, fomewhat paler towards the edges, with many 
purplifh veins therein, & of a dark yellowish purple in the bottom 
of the flowers with a fmall pointel of the fame colour in the middle* 
each of them ftanding in a hard clofe husk, which after the Flower 
is paft, gtoweth very like the Husk of Afarabacca, and fomewhat 
fharp at the top points, wherein is contained much fmall feed very 
like the Poppy feed, but of a duskie grayish color. The root is 
great, while & thick, branching forth divers ways underground so 
like a Parfnip Root (but that is not fo white) that it hath deceived 
divers. The whole Plant more than the Root hath a heavy ill 
foporiferous fmell fomewhat ofTenfive. 

Place, It commonly groweth by the way fides, and under hedge 
fides and Walls. 

Time, It flowreth in July^ and fpringeth again yearly of its own 
Seed. 

I doubt my Authors miftook/z^/y ior /u?ie, if not for May, 
Government aiid Virtues, I wonder in my heart, now Aftrologus 
could take on them to make this an Herb of Jupiter^ and yet 
MizalduSy a man of a penettrating Brain, was alfo of that Opinion 
as well as the reft : the Herb is indeed under the Dominion of 
Saturn^ and I prove it by this Argument. All the Herbs which 
delight moft to grow in Saturnine places, are Saturnine Herbs. 
But Henbane delights most to grow in Saturnine places, and whole 
Cart- Loads of it may be found near the places where they empty 
the common Jakes, and fcarce a Ditch to be found without it grow- 
ing by it. Ergo 'tis an Herb of Saturn. 

The Leaves of Henbane do cool all hot Inflam- Infla^nma- 
mations in the Eyes, or any other part of tne //^,^ 

Body ; and are good to affwage all manner of Cods 
fwellings of the Cods or Womens Breafts, or elfe- 1 Wojuens 
where if they be boiled in Wine, and either applied I Breafts 
themfelves or the Fomentation warm ; it alfo ass- I (Joiit 
wageth the pain of the Gout, the Sciatica, and all Sciatica, 
other pains in the joynts which arife from an hot | foyyits. 
Cause, And applied with Vinegar to the Forehead I 
and Temples, helpeth the Head-ache and want of , 



40 



The New England Medical Gazette. 



Jan., 



fleep in hot Feavers, The juyce of the herb or ! Deafnefs 
feed, or the Oil drawn from the Seed doth the like. Noise in the 
The Oil of the Seed is helpful for the Deafnefs, Ear, 

Noise, and Worms in the Ears, being dropped 
therein; the juyce of the herb or root doth the 
the fame. The Decotion of the Herb or Seed or 
both killith Lice in- man and beaft. The fume of 
the dried Herb, Stalks and Seed, burned quickly 
healeth Swellings, Chilblains, or Kibes in the Hands 
or Feet by holding them in the fumes thereof. The Remedy to 
help thofe that have taken Henbane, is to drink Goats Milk, 
honeyed Water, or Pine Kernels, with fweet Wine : Or in the 
abfence of thefe Fennel feed. Nettle feed, the feed of Creffes, Muf- 
tard, or Raddish, as also Onions of Garlick taken in Wine, do all 
help to free them from danger, and reftore them to their due 
temper again. 

Take notice, that this Herb might never be taken inwardly ; out- 
wardly, an Oyl, Oyntment, or Plaifter of it, is most admirable for the 
Gout, to cool the Veneral heat of the Reins in the | French 
French Pox, to ftop the Tooth-ach being applied to \ Pox 



the aking fide, to allay all Inflammations, and to 
help the Difeafes before premifed. 



Tooths 
ach 



Galvanism in Pelvic Inflammatory Lesions. — Galvan- 
ism properly applied offers to the conservative gynecologist 
the very best means of allaying pelvic inflammations. Electro- 
therapy is worthy of all the study you can give it ; but recol- 
lect that the possession of a hammer and anvil does not make 
a blacksmith, nor an amputating case, a surgeon ; and do not 
think because you have the most approved electrical appara- 
tus in your office, it will make you an electro-therapeutist. 
Study its physiological and polar effects, prove it as you would 
any of your remedies, and you will find, as others have, that 
it has the widest range of all. — Dr. C. S. ]^eiswangerin Min- 
neapolis Iloniceopathic Magazine, 



igoi Societies. 41 



SOCIETY REPORTS. 



WORCESTER COUNTY SOCIETY. 

The Thirty-fourth Annual Meeting of the Worcester 
County Homoeopathic Medical Society was held at Worces- 
ter, Nov. 14, I goo, at the Y. W. C. A. Rooms, Chatham St. 
The meeting was called to order promptly at 10 A. m, by the 
President, Dr. Amanda C. Bray. The records of the pre- 
vious meeting were read and accepted ; the annual report of 
the treasurer was read and ordered placed upon the records 
of the society. The following applications for membership 
were presented, and by vote of the society, referred to the 
board of censors : Albert E. Cross and Edwin Roy Leib, of 
Worcester ; George Van Deusen, of Lowell ; David P. But- 
ler, of Rutland, and David W. Wells, of Boston. 

The election of officers resulted as follows : President, 
Dr. J. F. Luscombe, Fitchburg ; Vice-President, A. J. At- 
wood, Townsend ; 2nd Vice-President, Dr. G. H. Wilkins, 
Palmer ; Secretary and Treasurer, F. R. Warren, Worcester ; 
Librarian, A. E. P. Rockwell, Worcester; Censors, E. A. 
Fisher, . Worcester ; Amanda C. Bray, Worcester, and Dr. 
R. G. Reed, Woonsocket, R. I. 

The business session concluded, the meeting was placed in 
charge of the Bureau of Clinical Medicine and Pathology, 
Dr. Carl Crisand presiding. The first paper was read by 
Dr. H. A. Gibbs, and was entitled, " What shall we do with 
the Drunkard ^ '* The writer believed that institutional 
treatment, especially for the confirmed inebriate, was essen- 
tial for a complete cure. He also believed most thoroughly 
in mental suggestion in treating these cases ; in restoration 
of the bodily functions and in the promotion of sleep and 
entire rest of the nervous system. For remedies he would 
suggest nitrate of strychnia and the salt of sodium and gold 
chloride. He uses apomorphia in doses of from 1-30 to i-io 



42 The New England Medical Gazette, Jan., 

of a grain, for its physiological effect and also for its relaxing 
effect upon the nervous and circulatory system. 

Dr. G. G. Shelton, of New York, was unable to be present 
and his paper, " Typhoid Fever, its dietetic and therapeutic 
treatment," was read by title. This subject, however, was 
the topic for a very interesting discussion, opened by Dr. 
Frederick B. Percy, of Brookline. Dr. Percy spoke of the 
different methods of feeding in typhoid. These methods 
embraced : i, an abstemious diet ; 2, a modified milk diet ; 3, 
a diet of meat broths, with or without the addition of barley, 
sago, etc. ; 4, a liberal diet, such as rice, eggs, farina, arrow- 
root, cocoa, etc. His method is to use the modified milk 
diet in most cases ; in some cases, however, he believes a 
more liberal diet can safely be allowed, and that it often 
shortens convalescence. He mentioned the different thera- 
peutic methods employed in typhoid, including the Brandt 
method, the antiseptic treatment of Woodbridge and Hom- 
oeopathic medication. He believes fully in the hydro-thera- 
peutic measures. For remedies, he has used with most suc- 
cess, Bapt. Tine, Mer. Dulc, and Cupras Arsen 2x. 

Dr. C. L. Nichols believes in milk diet, and at the end of 
second week usually gives some beef preparation and 
whiskey, in addition to the milk. 

Dr. De Witt G. Wilcox believes that that most dread com- 
plication of typhoid — intestinal perforation, with resulting 
hemorrhage and inflammation, should be treated by surgical 
means. 

Dr. E. A. Fisher reported a fatal case of typhoid fever, in 
which, at the autopsy, large and numerous perforations were 
present, yet there had been no evidence of blood in the 
stools. 

The next paper on the program was by Dr. Wm. Morris 
Butler, of Brooklyn, N. Y., and entitled " Puerperal Insanity 
and its Homoeopathic Treatment." This paper dealt with 
the etiology symptoms and homoeopathic medication of this 
form of mental derangement. He believes that a large per 
cent, of the mental troubles of women arise from mental 



IQOI . Societies. 43 

derangement during the puerperal state. In the treatment 
of this, condition, the writer mentioned as essential, a com- 
petent nurse, pleasant and well-ventilated apartments, plenty 
of healthy exercise and bathing. For remedies he advises 
the use of belladonna, hyoscyamus, platina, strychnia, stramo- 
nium, ignatia, etc. 

Dr. Frank C. Richardson, of Boston, in opening the dis- 
cussion, said that he believed the cause of the trouble must 
be removed before a cure could be expected. An examina- 
tion of the blood or of the gastric secretion often revealed a 
cause of trouble which must be corrected before the patient 
could improve. Dr. De Ette Brownell had in some pro- 
longed cases, where the tendency was toward dementia, used, 
with good success. Thyroid Extract. It seemed to exert a 
beneficial influence upon the mental condition of the patient. 

The next paper was by Dr. De Witt G. Wilcox, of Buffalo, 
N. Y., entited "Pelvic Inflammation." Dr. Wilcox spoke of 
the necessity of an early recognition of the causes which 
may lead to a pelvic inflammation, and of the responsibility 
of the family physician to whom these cases nearly always 
come in the begmning. An apparently slight inflammation 
of the meatus urinarius or of the vagina, will, if let alone, in 
an incredibly short time, extend to the uterus, tubes and 
peritoneum ; hence, the quicker the primary cause is cor- 
rected and removed, the less damage will result to the gen- 
eral pelvic peritoneum. The treatment must be according to 
the extent of the disease. If a specific vaginitis only is 
present, the patient should be given a hot vaginal douche, 
followed by an application of a r per cent, argonine or pro 
tagol solution. She should then be put to bed and a 
bi-chloride douche given every three hours. 

If the disease has extended a little farther and an endo- 
cervicitis is present^ the same vigorous treatment must be 
pursued. The bi-chloride solution must be freely used and 
the cervical canal thoroughly cleansed. Finally, the canal 
should be painted with tr. of iodine by means of an applicator. 
Under no circumstances should a probe be passed through 



44 ^/'^ New England Medical Gazette. Jan., 

such a canal, for fear of infecting a healthy uterine mucous 
membrane. If the disease has progressed still farther and 
an endometritis is present, we must resort to surgical meas- 
ures. The patient should be anaesthetised, the uterine canal 
dilated and sterilized. This should be followed by a 
thorough curretage and intra-uterine douching. If the 
disease has extended to the pelvic peritoneum, in addition to 
the treatment of the endometritis present, the writer advised 
irrigation and drainage of the pelvic cavity through an 
incision in the posterior cul de sac. 

Dr. Solomon C. Fuller presented an interesting paper on 
" A case of Uretastic Carcinoma of the Liver," illustrating 
his remarks with macroscopic and microscopic specimens of 
the growth. 

Dr. J. M. Barton presented a clinical report of a case of 
"Carcinoma of the Lungs," and Dr. E. A. Murdock of a 
case of *' Diphtheritic Paralysis." 

A paper entitled " Prevention and Cure of Renal Calculi," 
by A. M. Cushing, was read by Dr. Crisand, in Dr. Cushing's 
absence. The author gave his experience with this condi- 
tion and advocated the use of appocynum andros, which he 
had found to be almost .04 specific. 

This paper closed the scientific session, and the society 
adjourned to Hotel Newton where fraternal greetings and 
dinner occupied the members and their guests, to the num* 
ber of fifty-five, until 2.30 p. m. Dinner over, the toast- 
master, Dr. G. Forrest Martin, of Lowell, called for order, 
and for nearly three hours there was *'a feast of reason and 
a flow of soul," such as the society has seldom been privi- 
leged to enjoy. 

In his opening remarks, Dr. Martin spoke of a tendency 
among young graduates of homoeopathic institutions to grow 
rather ashamed of their chosen school .of medicine, seeming 
to lack reasons for their belief and arguments in defense of 
it. This tendency is lamentable, and young physicians were 
urged to stand strong in their faith, knowing well the firm 
principles which they advocate. 



190 1 Societies. 45 

Dn Bray, the retiring president, in her address, urged upon 
physicians the importance of realizing their .responsibilities 
as educators, and cited many cases in which a conscientious 
physician might have large influence for right solution of 
many every day problems. 

Dn Wm. M. Butler, of Brooklyn, gave a most interesting 
address on "The Homoeopathic Institutions in the State of 
New York," showing the great success which has followed 
the long years of hard work necessary to found these institu- 
tions. 

Dr. John L. Coffin, of Boston, compared Homoeopathy of 
today with its standing thirty years ago, showing the wonder- 
ful progress and success of "the new school." 

Dr, F. B. Percy gave as an ideal example of "The Family 
Physician," one with principles of truth, love, patience, 
honesty of purpose and true living, strong and well-defined. 

Dr. Wilcox, of Buffalo, treated his subject, "The Scalpel," 
with a wit as keen and sharp as that instrument itself, con- 
stantly amusing his listeners by his clever puns, bright sallies 
and apt illustrations. In more serious vein. Dr. Wilcox em- 
phasized the importance of only true-hearted, strong-pur- 
posed men using "the scalpel" in difficult surgery — men 
who thoroughly understand their work, and who operate for 
the good of mankind rather than for the pleasures of scien- 
tific and surgical study. 

The topic " Nerves," was of necessity very briefly treated 
by Dr Richardson, as time had passed rapidly, and he, with 
other guests from the eastern part of the state, were obliged 
to leave at this point in the session. 

Remarks were made* by Dr. Rockwell on "The Micro, 
scope," and by Dr. Rand on "The Country Doctor." The 
meeting was adjourned after a unanimous vote of the society 
that the Thirty-fourth Annual Meeting had been one of the 
most profitable and enjoyable ever held. 

F. R. Warren, Secretary. 



46 The New England Medical Gazette, Jan., 

HEDICAL SOCIETY OF THE 5TATE OF NEW YORK. 

The Ninety-fifth Annual Session of the Medical Society of 
the State of New York will be held in Albany, Jan. 29, 30, 
31, 1901. 

The meetings of the Society have always been replete in 
scientific work as becomes the representative society of the 
medical profession of the Empire State — and it is con- 
fidently expected that this meeting will equal those which 
have preceded it. 

This circular letter is sent to every member of the Society 
with the request that those who desire to read papers will 
communicate at once with the Chairman of the Business 
Committee, Dr. Frank Van Fleet, 63 East 79th Street, New 
York City, or with the President, Dr. A. M. Phelps, 62 East 
34th Street, giving the title of the paper and such other 
information as the author desires. 

As there will be a great many papers offered, and the 
time necessarily limited, it is suggested that papers be con- 
densed as much as possible in reading, as they can be pub- 
lished more fully in the transactions. Arrangements for 
reduced fares can be made when purchasing railroad tickets. 

A. M. Phelps, A. M., M. D., 
62 East 34th St., New York. 



BOSTON HOMOEOPATHIC SOCIETY. 

BUSINESS SESSION. 

The regular meeting of the society was held at the Boston 
University School of Medicine, Thursday evening, Dec. 6,. 
1900, at 8 o'clock, the President, F. W. Halsey, M. D., in the 
chair. 

The records of the last meeting were read and accepted. 

The following physicians were proposed for membership : 
C. C. Morrison, 1740 Beacon St., Brookline; John F. Wor- 



igoi Societies, 47 

cester, 405 Washington St., Dorchester ; David P. Butler, Jr., 
State Sanatorium, Rutland, Mass. ; Robert W. Southgate, 2 
Commonwealth Ave., Bpston ; Walter J. Graves^ yy King 
St., Dorchester ; Bertha L. Hoskins, 97 Francis St., Brook- 
line. 

The Resolution providing for the appointment of a Stand- 
ing Committee on Legislation was taken from the table, and, 
in its revised form, was adopted. The Resolution, as adopted, 
reads as follows : — 

STANDING COMMITTEE ON LEGISLATION. 

Resolved, the President shall appoint a committee of 
four, one member to serve one year, one for two years, one 
for three years, and one for four years. After the year 190O 
one member shall be appointed each year, by the President, 
to serve four years. The President shall be chairman of this 
committee, ex-officio^ and said committee shall have in charge 
all legislation or other interests which may affect the prac- 
tice of homoeopathy in Boston, 

The Committee appointed to draw up resolutions on the 
death of Dr. Benj. H. West, reported as follows : — 

Whereas, our Nestor, Dr. Benj. H, West, has been re- 
moved from us by death at the ripe age of four score and six, 
therefore, 

Resolved, that in his death homoeopathy has lost one of 
its earliest exponents in this part of the country, as well as 
one of its most earnest advocates. 

Resolved, that although he has been in retirement from 
active practice for about thirty years, yet he has never on 
this account lost his interest in the cause, but has always 
been eager to attend our meetings, to lend his assistance 
when its interests seemed to be assailed or when aggressive 
action seemed to be needed. At such times, although his 
venerable appearance and long flowing white hair and beard 
picturesquely suggested the dignified patriarch, yet the fiery 
impetuosity of his speech and his sustained eloquence were 
convincing proof that in spirit he kept as young as the 



48 The New England Medical Gazette, Jan., 

youngest. A man of the highest character and of kindly 

disposition, he will long be missed. 

H. C. Clapp, 
C. Wesselhoeft, 
H. B. Cross, 

Com^nittce, 



The resignation of Dr. Henry F. Batchelder, of Danvers, 
was accepted. 

The following committees were appointed by the Presi- 
dent : — 

To nominate officers of the society for the ensuing year : 
Drs. John L. Coffin, Herbert C. Clapp and Emma J. Peasley. 

Sjtanding Committee on Legislation : Drs. S. H. Calder- 
wood, four years; John L. Coffin, three years; T. Morris 
Strong, two years, and Frederick A. Davis, one year. 

SCIENTIFIC SESSION. 

Dr. Horace Packard exhibited a beetle 3-4 inch long and 
1-2 inch wide, which he had extracted from a man*s ear. Its 
presence had caused intense pain due to the front legs 
scratching the tympanic membrane. 

Dr. H. P. Bellows exhibited a number of instruments which 
he had obtained in Florence, Vienna, and other European 
cities, while abroad last summer. A cap made of tape, to 
be used in binding down the ears when they project in 
infancy. A neat, compact box for utilizing the Edison cur- 
rent, which can be easily moved and placed anywhere, in 
clinics, could be put on the wall and furnishes a brilliant 
light for illuminating the field of operation. A strictly 
aseptic syringe, which can be perfectly cleansed, and works 
admirably. Three mirrors for examining the attic. A for- 
eign body extractor. Two new instruments for the extrac- 
tion of the anvil. A vibrating fork for producing low tones. 
A new instrument to assist the hearing, made of aluminum, 
can be attached to the ear or can be used for conversation. 



1 90 1 Societies. 49 

Report of the Section of Ophthalmology, Otology, 
AND Laryngology. 

N. H. Houghton, M. D., Chairman. 
Eliza B. Cahill, M. D., Secretary. L. H. Kimball, M. D.. Treasurer. 

The President appointed Drs. M. E. Mann, L. D. Miller 
and F. P. Batchelder, a committee to nominate sectional 
officers for the ensuing year. The committee reported as 
follows : Chairman, T. Morris Strong, M. D. ; Secretary, 
G. A. SufFa, M. D., and Treasurer, Emma J. Peasley, M.D. 

programme. 

1. Eye Strain, Notwithstanding Acute Vision. David W. 
Wells, M. D. Discussion by G. A. Suffa, M. D., and L. H. 
Kimball, M. D. 

2. Tumor of the Parotid Gland (a case). T. M. Strong, 
M. D. Discussion by George B. Rice, M.D. 

3. A Case of Chronic Suppurative Otitis Media. Fred- 
erick W. Colbum, M. D. Discussion by Howard P.' Bellows, 
M.D. 

4. A Differentiation (Eye). J. M. Hinson, M. D. Discus- 
sion by John H. Payne, M, D. 

DISCUSSION. 

I. Dr. Wells stated that 75 per cent, of all headaches were 
due to eye strain, though this did not preclude there being 
other factors, the correction of any one of which would re- 
lieve the difficulty, and that it would be a great help to the 
general practitioner if he had the means of discovering cases 
of eye strain. 

Dr. SufFa : Dr. Wells, in his most interesting paper, has 
brought out in a clear manner important facts in regard to 
eye strain and its early recognition and correction, most of 
which I heartily endorse, and even desire to enlarge upon 
the advice that not only all backward children and those 
showing some well recognized evidence of eye strain merit 
examination, but that all children at the time of first enter- 



50 The New England Medical Gazette, Jan., 

ing school (if not previously examined) have their eyes care- 
fully tested so as to be sure that they are not handicapped 
at the beginning of their career, often to a permanent 
detriment. 

It is a well recognized fact that practically all children are 
born hyperopic, and that it is a normal evolution to outgrow 
this hyperopia during the growing period. Also that the 
accommodative power and the associated muscular action 
convergence are controllfid--%y--thL§ third nerve, and that 
nerve stimulation (A\X!^^^ fUnetidpiN^nd the centres of 
action are intimat6p related to eacnryo^er, so that when 
accommodation rdceive^AN/envo ifAm^seTt^ focus rays from 
an object at a givqp distance that th^^oSn verging muscles 
receive a corresponding amount ^ n^e force, but on 
account of the phvsiJm id^RtA fe e^pia. it becomes self- 
evident that this relation has become disturbed in the ma- 
jority of children, thereby causing a waste of nqrve energy at 
a time when the system can ill-afford to lose it, to say noth- 
ing of the disturbances often produced in the eye-balls and 
their addenda during this period of evolution. To control 
and often prevent these local disturbances would well repay 
the trouble of making these examinations, even if no further 
benefits were derived. But I think I am safe in saying that 
the general benefit to the system, if this method were 
adopted, would be of inestimable value, and when this, fact is" 
fully recognized by the profession and the laity, and become 
an established system, which I fully believe it will in time, 
then will one great step have been taken to benefit mankind 
in controlling a condition seriously hindering nature to de- 
velop physically and mentally healthy individuals ; and per- 
haps, who knows, thereby in time, so perfect the human 
ocular system that children will make their appearance with 
emmetropic and not hyperopic eyes. 

While I am thoroughly in accord with the writer ihat all 
cases of chronic headache merit ocular examination, I cannot 
accept the statement that eye strain does not have its charac- 
teristic headaches, not alone in form and location, but often 



190 1 Societies, 51 

in time of occurrence. Careful observation in this line has 
proven to me conclusively that frontal and occipital head- 
aches, especially if precipitated by attending public places, 
etc., or upon near use of the eyes, are positive evidence of 
eye strain, even if visual acuity is normal, and I am not alone 
in this opinion as most modern writers agree on this point 
(Fuch, Miles Standish and Stevens). Neither am I willing 
to allow the discouragement of the general practitioner (to 
go unchallenged), to ascertain as much as possible of the 
visual and muscular conditions, as well as to question care- 
fully the nature of the headaches, their time of occurrence 
and aggravations, always bearing in mind the characteristic 
forms before recommending an oculist^ This exception is 
taken for two reasons. First, because the time has arrived 
when the family physician is consulted and expected to pass 
judgment whether or not it is necessary to consult an oculist. 
Second, because if these visual and muscular examinations 
are made, familiarity of ocular action obtained during these 
examinations will place the physician in a pbsition to more 
readily recognize the nature of inflammatory eye diseases, 
and to differentiate between the comparatively harmless in- 
flammation and those more serious imflammatory troubles, 
where valuable time is often irretrievably lost in not institut- 
ing prompt local medication or operative measures. 

In the report of the 100 cases of eye strain, the statement 
is made that only those cases were omitted that showed 
some well recognized symptom of eye strain. As the doctor 
previously positively stated that there was no characteristic 
eye headache, and as 50 per cent, of these cases had nominal 
visual acuity, I would like to inquire what he considers well 
recognized symptoms of eye strain. 

Dr. Kimball : I shall take but a few moments of your 
time tonight, as I do not really see much I can say supple- 
mentary to what has already been so well said. And what 
little there is I shall entrust to paper as my pen is always a 
decidedly more trustworthy servant than my tongue. 

Dr. Wells is to be congratulated, not only on his excellent 



52 The New England Medical Gazette, Jan., 

paper, but also on the selection of a subject which should be 
of interest to the general practitioner as well as the specialist. 
And that is not so easy a thing to do, especially when the 
ground has been so thoroughly covered, as it has been in the 
so-called specialties. 

My experience coincides with Dr. Wells in regard to the 
point which he wishes to emphasize, viz. : that normal vision 
in far distance (tees not always mean perfect eyes. This is 
contrary to the general belief among the laity. It is a very 
common occurrence for patients sent to an oculist for an ex- 
amination, to insist that there can be nothing the matter 
with their eyes since they have vtxy far sight ; indeed, they 
take pride often in the fact that they can see farther than 
many of their acquaintances, and so use this as an argument 
to forestall the necessity of glasses, which they think the 
logical result of a visit to an oculist. 

Following the line of Dr. Wells' classification, I have 
looked up the records of 5CX) consecutive cases examined for 
eye strain, with this result : 

Class I. Vision practically normal. 
" I. 240 cases or 48 per cent. 

" 2. Vision normal in one eye, reduced in the other. 
** 2. 65 cases or 13 per cent. 
'* 3. Vision reduced in both eyes. 
195 cases or 37 per cent. 

From the two series then we can reasonably infer that 
practically normal vision for distance exists in about 50 per 
cent, of the cases sent to an oculist for an examination. 

Dr. Suffa : I would like to ask Dr. Kimball what was the 
age of the cases referred to by him -^ 

Dr. Kimball: Thirty-six to forty years. 

Dr. Klein : I agree perfectly with Dr. Wells. I think eye 
specialists sometimes go too far. I think chronic spinal 
meningitis is often forgotten as a cause of eye strain. I 
have seen cases which have been sent from dispensary to 
dispensary and to oculists, cured by a homoeopathic physi- 



IQOI Societies, 53 

cian as simple spinal meningitis. There are lots of diseases 
which could cause eye strain. I think we should differenti- 
ate between eye strain and diseases which cause or produce 
eye strain. All simple headaches should not be considered 
due to eye strain. 

Dr. Wells : The question of examining the eyes of school 
children I hesitate to take up. Last year I read a paper 
upon the need of examining the eyes of school children, em- 
phasizing at that time the importance of such examination. 
I stated such examinations were in vogue at Wellesley, 
Brookline and Waltham. Somerville has just adopted the 
plan. Hyde Park will do so. 

In regard to the location of headache being a guide to the 
presence of eye strain, I think my point is well taken. 

Criticism of Statistics. My idea of well recognized eye 
strain and its disappearance after glasses are fitted, I think is 
correct. Dr. Kimball's record of 500 cases and finding such 
close results, as he has given, strengthens my position. 

Dr. Klein takes exception to the statement that 75 per 
cent, of the cases of chronic headache are due to eye strain. 
This leaves a good 25 per cent, of headaches which may be 
due to other causes, and the fact is here noted, as a caution 
of the oculist, tnat eye strain may be due to some lesion or 
pathological condition elsewhere, 

2. " Tumor of the Parotid Gland (A Case)." Dr. Strong's 
paper detailed an operation successfully performed upon a 
tumor in the pharynx, which prpbably originated in the par- 
otid gland. Healing was good and there has been no return 
of the growth. 

Dr. Rice : So much has been said, and so well said, there 
is very little that I can add. Dr. Strong was so kind as to 
send me his paper, I have never seen anything like this 
tumor and had little idea what the growth was, as the history 
did not seem to point to a cancerous growth. I looked up 
the literature, but found very little of service. One surgical 
journal spoke of a mucous tumor, but nothing was said of 
this kind of tumor being seen in the throat, as before it had 



54 The New England Medical Gazette, .Jan., 

occurred exteriorly. The operation was cleverly done and 
was eminently successful. 

3. "A Case of Chronic Suppurative Otitis Media." Dr. 
Colburn, in his paper, reported an operation which he had 
performed for the relief of an obstinate case of neuralgia, 
complicating suppurative otitis media. The operation was 
the usual mastoid one, with curettment of all diseased tissue, 
and was entirely successful. 

Dr. Bellows : I want to ask Dr. Colburn whether in the 
course of operating he found considerable tissue. 

Dr. Colburn : Very little, and what there was was loose 
and decidedly soft. 

Dr. Bellows : This case is one Dr. Colburn may well feel 
very proud of. I saw the patient before I went abroad, he 
was a very sick man. The diagnosis was well made and the 
difficult operation was certainly carried out in a very success- 
ful manner, the result being all that could be desired to sur- 
geon and patient alike. 

4. "A differentiation (Eye).*' Dr. Hinson's paper went 
minutely into* a differentiation between hoodoralum and chal- 
azion, both as regards diognosis and treatment, and it was fol- 
lowed with marked attention by the Society. 

Dr. Paine : I will not take but a moment of your time. 
I have not noticed in Dr. Hinson*s paper any reference to a 
little fibrous tumor which occurs outside of the tarsal cartil- 
age, and I have been in the habit of cautioning all my pupils 
to differentiate between it and Meibomian cyst The surgi- 
cal interference with the first would have to be from the out- 
side and cicatricial contraction might disturb the lids. Mei- 
bomian cyst is always operated upon from the inside of the 
lid, I am surprised that these crises should need surgical 
treatment, as they are much more readily reached by internal 
treatment. Pulsatilla and Staphisagoia will oftentimes cure 
cases more readily than any other. Belladonna is good when 
the swelling is considerable. Frequently I have found that 
surgical interference, when used upon the Meibomian gland, 



IQOI Notes on Pathology. 55 

is followed by inflammation of neighboring glands, and a suc- 
cession of attacks result. I think surgical treatment should 
be taken as a last resort. 

Dr. SuflFa : I have tried remedies very often and have seen 
results only in the early stages, and then only from Sulph. 6x. 

Dr. Payne : Pulsatilla and Belladonna have proved bene- 
ficial in my practice. 

Dr. Klein : I agree with Dr. Payne. My way is to pre- 
scribe and recommend massage. I believe in absorption. 

Sometimes I give a simple prescription, oxide of mercury 
to be applied to the lid. I think you get more results from 
massage than anything else. I recommend medicine, and if 
it does not do any good, I operate. When operating, instead 
of dissecting, I take out the whole sac. 

Adjourned at 10.10. Edward E. Allen, 

Secretary. 



NOTES ON PATHOLOGY. 

CONDUCTED BY S. C. FULLER, M.D., PATHOLOCIIST TO THE 
WESTBORO INSANE HOSPITAL. 



Two Cases of Acute Hasmorrhagic Pancreatitis. 

Bryant {Lancet XIX. of Vol. 2, 1900, p. 134) reports two 
cases of this disease. In one of his cases there was extra- 
peritoneal, as well as intra-peritoneal fat necrosis. The 
extra-peritoneal necrotic areas were found in the mediastinal 
fat and pericardial fat. Although Williams* succeeded re- 
peatedly in producing extra-peritoneal fat necrosis in cats by 
introducing small pieces of sterile cat's pancreas subcu- 
taneously, if the fat necrotic areas found by Baslerf in the 

' *Jour. Exper. Med. III. 6, p. 585. 
tCited by Flexner in Con. Science Med. Dedicated by his pupils to 
William Henry Welch on the 25th anniversary of his doctorate, p. 743. 



S6 The New England Medical Gazette. Jan., 

medulla of bones, and in the heart be excepted, this case of 
Bryant's is believed to be the first one clinically observed. 
FitzJ has found that ''disseminated fat necrosis in the ab- 
dominal cavity is comparatively infrequent in the suppura- 
tive forms of pancreatitis, while it is relatively common in 
the haemorrhagic and the gangrenous variety." The his- 
tological changes of fat necrosis have been especially con- 
sidered by Langermans;§ and Flexner|| has materially 
contributed to the knowledge of fat necrosis by his experi- 
ments. In the case of Bryant's which showed the extra- 
peritoneal fat necrosis, the pancreas in its gross appearance 
consisted apparently of blood of a dark chocolate color. Mi- 
croscopically there was present the characteristic interlobular 
fat necrosis, intense inflammatory reaction, granular and 
cloudy degeneration of the cells and failure of the nuclei to 
take the stain. 

Both cases clinically presented the appearance of perforat- 
ing gastric ulcer, and both were operated. In the case cited 
above the diagnosis of haemorrhagic pancreatitis and fat 
necrosis was established from the operation. In the other 
case the diagnosis from the operation was negative. In each 
case the peritoneal cavity contained a considerable amount 
of bile stained fluid, which proved to be sterile, a condition 
which, of course, negatived perforation. At the autopsies, in 
addition to fat necrosis and pancreatitis, gall stones were 
found. They were not, however, in either case obstructing 
the passage of bile, neither was there rupture of any of the 
ducts. The bile ducts and the liver tissue about the ducts, 
and in one case the gall bladder were as described, by Dr. 
Bryant, in a "sodden and inflammatory condition." This 
condition he thinks permitted the escape of bile, which gave 
to the ascitic fluid the color noted at the operation. 

jThe Middleton-Goldsmith Lecture cited by Flexner. 

§Virchow's Archiv. CXXII. 252, 1890. 

Iljour. Exper. Med. II. 4, p. 413, and Con. Science Med. Loc. cil. 



190 1 Notes on Pathology. 57 

A Case of Prolonfi^ed Sleep of 5even Months' Duration, 
caused by Tumor of the Hypophysis. 

F. Soca {Nouvelle Iconographie de la Salpitriere 13th 
year, No. 2, March-April, 1900, p loi, Cited in Periscope of 
Jour. Ment. and Nerv. Diseases) reports a case of this condi- 
tion in a young woman 18 years old with no history of 
Syphilis. The somnolency supervened upon a sudden attack 
of unconsciousness. Blindness developed rapidly, double 
optic atrophy and dilated pupils not reacting to light were 
observed on opthalmological examination. Inability to walk 
and incessant vomiting of a cerebral character soon devel- 
oped. Following this a tendency to sleep was the chief 
symptom, and lasted for seven months. She could only be 
roused with difficulty to take nourishment. At the necropsy 
the base of the brain was found to be held firmly to the 
skull by a new growth. The growth covered the sella 
turcica and was in the tract of the first pair of cranial nerves. 
The olfactory peduncles were spread out but otherwise un- 
changed. The optic nerves were adherent to the tumor, 
and posteriorly the growth involved the third and fourth pair 
of nerves, but there were no adhesions. The neoplasm was 
sarcomatous. There were no symptoms of compression. 
This was explained by the soft character of the growth. 

It is interesting in this connection to recall the studies of 
Brooks* on acromegalia. He maintained that the " so-called 
sarcomata of the hypophysis in acromegalia are lacking in 
two rather prominent traits of Sarcoma . . . metastasis 
and comparatively rapid growth." He is of the opinion that 
the apparent sarcomatous processes have been misinter- 
preted. He cites a case of McAlpin's in which there was 
extensive sarcomatous involvement of the hypophysis with no 
symptoms whatever of acromegalia. Brooks further main- 
tains that the process is a simple hyperplasia — a true ade- 
noma. In this case of Soca's we are not led to refer from 
the review that there were symptoms of acromegalia present. 

*Archv. Neurol, and Psycho-Path. Vol. i, 4. 



58 The New England Medical Gazette, Jan., 

Such extensive sarcomatous involvement as is reported with- 
out acromegalia would at least. seem to bear out Brooks* con- 
tention. However, as is seen, aside from disturbances that 
may be produced by destruction or alterations in the func- 
tion of the hypophysis, enlargements of any character are 
capable of producing most profound pathological changes by 
mechanical pressure, because of the proximity of important 
structures. 

Necrotic Broncho-Pneumonia with Streptothrix. 

Norris and Larkin {Jour, Exp. Medicine V. 2, p. 154) re- 
port two cases of this rare affection. Both lungs presented 
at autopsy the lesions of broncho-pneumonia in addition to 
the presence of whitish masses resembling actinomyces 
granules in the mucous membrane of the trachea and bronchi, 
and similar though smaller masses scattered through the 
lungs. Culturally a streptococcus and a streptothrix were 
isolated, the latter producing similar lesions when introduced 
into the trachea and into the ear viens of rabbits, The or- 
ganism grows best under* aerobic conditions. The authors 
consider it a true streptothrix and not a pleomorphic bacillus, 
and think " it identical with " or " at least closely related to ** 
Streptothrix Israeli,* and to the species isolated to by 
Kruse.f 

The Leukocyte Count in Serous Pleurisy. 

Morse {Am. Jour, Med. Sciences CXX. No. 6, p. 658) re- 
ports the results of 224 leukocyte counts in serous pleurisy. 
The investigation was made at the Boston City Hospital 
with the purpose of determining the diagnostic value of a 
leukocyte count in this disease and whether or not any in- 
formation could be had as to the extent of the exudation. It 
is interesting that only 13 counts out of the 224 showed an 
increase of leukocytes per cubic millimetre. Nine cases 

♦Virchow's Archv. 1891, CXXVI. p. 11, cited by Norris and Larkin. 
tMunch. Med. Wochenschr 1899, P- 749» ^'ited by Norris and Larkin. 



I go I Reviews and Notices of Books, 59 

presented positive tubercular conditions, and in only one of 
these was there an increase of leukocytes. This case later 
came to autopsy and showed a secondary pneumococcus in- 
fection. The leukocytosis was of an intermittent character. 
There was observed no relation between the temperature and 
the counts, nor between the amount of fluid and the counts. 
The conclusion is therefore drawn, that primary serous pleu- 
risy is not accompanied by an increase of leukocytes, except 
rarely, and then intermittently, and when accompanied by 
secondary inflammatory complications. In this it differen- 
tiated from pneumonia and empyema, conditions which show 
decided leukocytosis. 

Primary Carcinoma of tlie Parovarium. 

Talmey {Medical Record LVIII. No. 12, p. 452) reports a 
case in which both parovaria were the seat of primary car- 
cinoma. The woman had been previously operated for carci- 
noma of the pylorus. At the autopsy, the seat of the left 
ovary presented a tumefaction the size of an apple and the 
right another the size of a fist. Four cm beneath the tube, on 
the left side an oval outgrowth 3 x 2 cm projects and on the 
right side 3 4 cm below the tube a similar outgrowth projects. 
Microscopically these outgrowths prove to be the ovaries 
which are beginning to be infiltrated with carcinomatous 
cells. The tumefactions proved to be carcinomata of the 
parovaria. Talmey considers each tumor a primary one. 



REVIEWS AND NOTICES OF BOOKS. 

A Treatise on Fractures and Dislocations. By Lewis A. Stimp- 
son, B. A., M. D., Professor of Surgery in Cornell University Med- 
ical College, etc. Illus. Philadelphia and New York : Lea 
Brothers & Co. 1900. pp.842. Price, cloth, $5 net; leather, 
J6 net; half-morocco, S6.50 net. 
The original two volume work appeared in one in 1 899, when the 



6o The New England Medical Gazette. Jan., 

different sections were entirely recast; nevertheless, the present 
edition shows numerous and innportant changes. Prominent among 
them is that representing the advance of our knowledge of trau- 
matic haematomyelia, and the light it has thrown upon the prognosis 
and treatment of injuries of the spinal cord, and the judgment it 
permits concerning the supposed efficacy of surgical interference in 
such cases. 

What the author has to say on operative treatment of fractures of 
the spine is, also, worthy of much consideration. This is a most 
interesting topic to the surgeon, many of the most experienced 
operators advocating early surgical interference in fractures of the 
vertabrae, possibly excepting the cervical. 

Dr. Stimpson seems to think an operation "not likely to do 
harm," but other writers claim the mortality in such cases is fully 60 
per cent. In his discussion of the subject, however, he is for the 
most part very conservative. 

There are fifty- eight chapters in this book, and every variety of 
fracture and dislocation is explained, with the cause, pathology, 
symptomatology complications, diagnosis, prognosis, and treatment. 
There are many good reproductions of skiagrams, and other illustra- 
tions. The bibliography, while not too extended, will prove helpful 
to the studiously minded. 

A Text- Book on Pathology. By Alfred Stengel, M. D., Professor 

of Clinical Medicine in the University of Pennsylvania, etc. Illus. 

pp. 848. Philadelphia and London : W. B. Saunders & Co. 

Cloth, $4 net; half morocco, $5. 

In the preface Dr. Stengel announces that considerable parts of 
the book were first prepared and used as the basis of demonstra- 
tions upon clinical pathology for students of medicine, and that 
prominence is therefore given to pathologic physiology, while dis- 
cursiveness and citations of authorities have been avoided. 

This is certainty the way in which, a work intended for a text- 
book should be built up from actual oral instruction and clinical 
demonstrations. How successful the author has been is attested 
by the wide acceptance of this volume. 

Its contents are divided into two parts. Under Part I., General 
Pathology, are chapters on the etiology of disease, disorders of 
nutrition and metabolism, disturbances of the circulation of the 



1 90 1 Reviews and Notices of Rooks, 6 1 

bloody retrogressive processes, inflammation and regeneration, 
progressive tissue changes, bacteria and diseases due to bacteria, 
anima] parasites and diseases caused by them; under Part II., 
Special Pathology, are chapters on diseases of the bones, the lym- 
phatic tissues, circulatory system, respiratory system, gastro-intesti- 
nal tract, of the ductless glands, urinary organs, reproductive organs, 
of the joints, voluntary muscles, of the brain, spinal cord, and of 
the peripheral nervous system. 

Too many books on pathology are mere compilations prepared 
chiefly from the writings of others, and we are glad to see one that 
attempts to give as much of original work as possible. Portions of 
it have been rewritten and amplified, especially the sections on 
pathologic physiology and neuro- pathology. 

The illustrations are numerous and excellent. Wider margins 
would have improved the appearance of the book, and a wider back 
margin made consultation of the text easier. The general make up 
is, however, praiseworthy. 

Manual of the Diseases of the Eve, for Students and General 
Practitioners. By Charles H. May, M. D., Chief of Clinic and 
Instructor in Ophthalmology, Eye Department, College of Physi- 
cians and Surgeons, Medical Department, Columbia University, 
New York. Illus. New York: William Wood & Co. 1900. 
pp. 406. Price, $2. 

Ophthalmology is a branch of medicine not very familiar, as a 
rule, to the average practitioner. To such, a small practical manual 
like the above will be welcome, as where so many new books claim 
the time and money of the physician it can hardly be expected that 
he will purchase very voluminous works on the eye alone. 

Dr. May's book really contains the fundamentals of ophthal- 
mology in the twenty-six brief chapters he has written. In them 
will be found an account of all the common, and some of the rare, 
diseases of the eye, together with instructions for their diagnosis 
and treatment. Instruments and operative measures are described, 
and indications and contraindications for the latter outlined. 

When it is remembered that the eye is not an isolated organ, but 
one very intimately associated with the rest of the body, the impor- 
tance of being able to discover deviations from the normal must be 
recognized. A careful study of this book will give a good acquaint- 



62 The New England Medical Gazette. Jan., 

ance with all essential points, and supply a foundation for further 
knowledge which may be acquired at leisure, and as necessary, from 
larger text-books. 

Saunders' Question Compends-Esseniials of Histology. By 

Louis Leroy, B. S., M. D., Professor of Histology and Pathology 

in Vandcrbilt University, Medical and Dental Departments, etc. 

lUus. Philadelphia and London : W. B. Saunders & Co. 1900. 

pp. 231. Price, fi, net. 

That nothing succeeds like success may be said of Mr. Saunders' 
Quiz Compends, their popularity apparently increasing with every 
new addition to the series. The latest on histology is a worthy 
successor to those on other subjects which have preceded it. 

Jt bnilgs out the essentials in bold relief, and by a general resume 
in the form of questions at the close of each chapter, makes memo- 
rizing easy. The illustrations could not be better if prepared for a 
far more elaborate work. It is very evident that they have largely 
been taken from original sketches, made from specimens most 
carefully selected. 

It is a pity that a carelessness, most unusual in publications from 
this house, should have spoiled the appearance of many pages by 
folding and binding them so unevenly. 

Modern Surgery, General and Operative. By John Chalmers 
Da Costa, M, D., Professor of Practice of Surgery and Clinical 
Surgery, Jefferson Medical College, Philadelphia, etc. lUus. 
London and Philadelphia : W. B. Saunders & Co. 1900. pp. 
911. Price, cloth, I4 net; half morocco, $5 net. 
In order to avoid dealing too superficially with surgery in genera! 
in a single volume, the author has thought it best to omit all discus- 
sion of such branches as ophthalmology, gynecology, rhinology, 
otology and laryngology. It is, of course, quite true that these are 
subjects more nearly related to the work of specialists. Few men, 
however, who devote themselves to surgery to any extent fail to find 
that gynecological work, at least, gives them frequent employment. 
Nevertheless, a book the size of the present one could be devoted 
to the surgical work of the gynecologist, and as it is essential that 
such work should be treated of at length, its omission here is less to 
be regretted. 



igoi Reviews and Notices of Books, 63 

Dr. Da Costa's manual contains instruction in the fundamental 
principles, the chief operations, and the accepted methods of 
modem surgery as a whole, and so far avoids on the one hand the 
fault of being wordy and cumbrous and on the other that of being 
too brief and incomplete. 

The first chapter is given to bacteriology, the author being de- 
sirous of impressing upon the minds of students the relation 
between the science of micro-organisms, and the application of 
aseptic and antiseptic methods. 

It is impossible to refer individually to all the prominent sections 
of this book ; two, however, deserve special mention, viz., that on 
orthopedic surgery which gives much valuable information about 
such conditions as the surgeon or general practitioner frequently 
has to care for, — hip joint disease, club foot, Pott's disease A the 
spine, flat foot, etc., and the section on fractures and dislocations, 
which contains an interesting and extended discussion of their 
treatment. 

In a word this is a good one volume surgery, well gotten up, fully 
illustrated and copiously indexed, and a desirable addition to the 
professional library of the all round surgeon. 

The New Lippincott Magazine. Christmas number. December, 

1900. 

Readers of the "New Lippincott " will find many good things in 
the December holiday number. Amelia E. Barr contributes her 
latest novel, "Sones of Passage.'* Agnes Repplier is represented 
by a clever essay, "As Advertised;" George Hibbard has a bright 
one-act drama, "As Others See Us." 

Two important papers, one on '* The Strategic War Game at the 
U. S. Naval War College," by Lieut. J. M. Ellicott, U. S. N., and 
one on "An Anti-Masonic Mystification," by Henry C. Lea, LL.D. 
occupy several pages, while stories and verses, jests and anecdotes 
furnish entertainment and pleasure for all " New Lippincott' s " 
friends. . 

The Pathology and Surgical Treatment of Tumors. By N. Senn, 
M. D., Ph.D., LL.D. Philadelphia: W. B. Saunders. 1900. 
Price, cloth, $5. 
The subject matter of this second edition is treated in thirty 

chapters ; the first twelve of which are devoted to the consideration 



64 The New England Medical Gazette. Jan., 

of the general subject of tumors, their pathology, etiology, clinical 
aspects, diagnosis, prognosis, treatnaent and classification, the re- 
maining chapters treat in detail of the various forms of tumors, 
their pathology, etiology and treatment. To those conversant with 
the first edition of this work comment on this is hardly necessary. 
Both as a text- book and treatise it is unsurpassed. 1'he diction is 
explicit and comprehensive, operative measures are treated in detail 
and the work is profusely and superbly illustrated. The make up is 
consistent with the high standard established by this publisher. 

Stringtown on the Pike. A tale of Northernmost Kentucky. By 
By John Uri Lloyd. New York : Dodd, Mead & Co. 1900. 
This is the author's second story. The narrative deals with 
country life in Kentucky and especially with the superstitions of the 
negro race and the profound motives they furnish for action. The 
book is interesting and instructive from start to finish. It is written* 
close to actual life, and teams with incidents sometimes intensely 
dramatic. To quote from the Boston Transcript " In ' String- 
town on the Pike ' the author has given us one of the strongest 
books of the season. A book that pulsates with life from cover to 
cover. An intensely human book and one that will soon not be 
forgotten." 

The chapters dealing with the conviction of a man for murder on 
expert testimony and the subsequent proving of a possibility that 
the expert evidence was at fault will be of especial interest to the 
profession. 

A Text- Book upon the Pathological Bacteria. By Joseph 
McFarland, M. D. With 142 illustrations. 3rd edition, enlarged 
and revised. W. B. Saunders. Philadelphia. 1900. 
The popularity of this work is attested by the appearance of a 
third edition so close upon the second. The work does not at- 
tempt to deal with all known bacteria, but as its title implies only 
the pathogenic bacteria are considered, and these in full. The re- 
vision and enlargement brings the work up to date with the 
advancements in this line which have taken place since the appear- 
ance of the prior edition. The text wilF readily commend itself to 
the physician and student of medicine, for the clearness with which 
it is expressed. 



190 1 Reviews and Notices of Books, 65 

The work is arranged in two parts : Part I. General Considera- 
tions^ and Part II. Specific Diseases and their Bacteria. In Part I. 
the biology of bacteria, infection, intoxication, and immunity and 
susceptibility are considered ; the technique for cultivating and the 
recognition of bacteria, and the methods for animal experimenta- 
tion are described. Part II. is subdivided into A, The phlogistic 
diseases, acute and chronic inflammatory diseases ; B, The tox- 
semias ; C, The Bacteremias, and D, Miscellaneous. 

The work fully justified its title, and the practitioner as well as 
the student will find it a reliable guide. 

The typographical work is well executed. 

Pathology and Morbid Anatomy. By T. Henry Green, M. D., 

F. R. C. P. Revised and enlarged by H. Montague Murray, 

M. D., F. R. C. P. Ninth American edition revised from the 

Ninth English edition. By Walton Martin, Ph.B , M. D. Lea 

Brothers & Co. Philadelphia and New York : 1900. 

The ninth edition of this work brings it thoroughly up to date. 

For a long time Green's Pathology and Morbid Anatomy has been 

before the profession. Although many minor changes have been 

made in the classification of tumors since this work first appeared, 

the classification by Green remains a classic. Especially to be 

commended are the sections on infective diseases, diseases of 

special organs, the pathology of the nervous system, and the chapter 

on malaria. 

We question, however, if the section on bacteriology could not 
have been left out with propriety. There are many standard works 
on bacteriology, and a part of the space occupied by this subject 
could have been well given over to the enlargement of the chapter 
on technique. 

The work is replete with cuts which aptly illustrate the text. The 
matter is most readable and the typographical work is good. 

The Ready Reference Handbook of Diseases of the Skin. By 

Geo. Thomas Jackson, M. D., with seventy -five illustrations. 

Third edition, revised and enlarged. Lea Lrothers & Co. New 

York and Philadelphia : 1899. 

As the title implies, this is not a treatise, but a book for quick 
ready reference by the practitioner who wants to find something 



66 The New England Medical Gazette. Jan., 

and find it right away. This is the best book we know of for that 
purpose. The diseases are arranged alphabetically ; the symptom- 
otology is terse and plain ; the differential diagnosis explicit and 
the treatment of the best. It is to be well recommended. 

Prefac:e lo THE History of American Institute of Homoe- 
opathy. By Benhood W, James, A. M., M. D., LL.D. 
The membership of the American Institute of Homoeopathy, hav- 
ing grown to quite large proportions, and inasmuch as back num- 
bers of the Transactions, except for the last few years, cannot now 
be obtained, I have thought it well to write up the history of the 
Institute, from its inception, making use of my own full set of 
volumes for reference and then publishing the history, for the bene- 
fit of the profession at large, as well as for the use ot the present 
membership of the Institute and medical friends of the organization 
as well as all those who are interested in the progress and success 
of Homoeopathy in this country. The work involved a vast amount 
of reading, but it has been my aim to cull the most interesting facts 
and thoughts of the active members of the Society as presented 
from year to year, and to show the arduous work of the founders, 
many of whom have now passed away, but whose doings in the 
noble cause of Homoeopathy stand recorded in the various volumes 
of the Society's Transactions. 

It is intended to run this history in chapters through the Homoe- 
opathic Recorder, after which a few copies will be thrown together, 
into two volumes, the first covering the period of time from the 
inception of the Institute to about 1870, and the second volume 
covering the remaining years to date. 

It is a work that gives a bird's eye view of the thoughts and 
labors of the members of one of the oldest and most influential 
societies of the new school of practice. 

The Author. 



I go I Items of Interest. 67 



ITEMS OF INTEREST. 



In cases of nervous exhaustion, debility or other impov- 
erished and depleted conditions resulting in lowered vitality, 
something more than a mere chalybeate tonic or other 
medicinal preparation is required to obtain a quick response 
to its administration. It is necessary that the agent selected 
shall have a highly nutritive value, in a form which is easily 
and rapidly assimilated, while at the same time exhibiting 
permanent tonic and reconstructive properties. 

Alboferra is a new product of the laboratories of Otis 
Clapp & Son which they think meets the requirements enum- 
erated above. The nutritive properties are represented by a 
concentrated extract of finely flavored juicy beef, rich in 
soluble albumen, and constitutes fifty per cent, of the prepa- 
ration. Albumen is said by an eminent authority to be ** the 
most important single element of food," while another noted 
physician remarks that " whatever tends to increase the fatty 
and albuminoid materials in the system is worthy of atten- 
tion in these (nervous) diseases." As the extract used in 
Alboferra contains upwards of twelve per cent, of soluble 
albumen, it will be recognized that it meets the requirements 
for a highly nutritive article. 

The value of chalybeate tonics as reconstructives is uni- 
versally recognized by the medical profession. Dr. Hugh 
Campbell, Licentiate of the Royal College of Physicians, 
states that iron " exercises a peculiar influence on the trans- 
formation of food into blood, and facilitates its conversion 
into brain and nerve tissue." 

The nutritive ingredients of Alboferra are scientifically 
combined with an organic salt of iron, prepared by a new 
and improved process, which is free from the objections 
exhibited by most iron preparations. It is soluble, easily 
assimilated and palatable, with no injurious effects upon the 



68 The New England Medical Gazette, Jan., 

organs of digestion. The combination of this form of iron 
with the beef -album en is superior to albumen ate of iron, 
being perfectly stable and not susceptible to decomposition 
under ordinary conditions, while it is much more palatable. 

The addition of an aromatic stimulant makes of this prep- 
aration a superior nutrient cordial and reconstructive agent 
which may be used with much benefit, not only in ordinary 
cases of nervous exhaustion or debility, atonic dyspepsia, 
anaemia, chlorosis and the various neuralgias due to derange- 
ments of the nervous system, but also to all conditions de- 
pendent upon mal-nutrition or mal-assimilation following 
severe illnesses. Messrs, Otis Clapp & Son believe that a 
trial of Alboferra will prove it to be not only a valuable 
nutritive and medicinal preparation but also an elegant phar- 
maceutical .product pleasant to take and agreeable to sight 
and taste. 

Price at retail, ^i per bottle. Price, to physicians, 75 cts. 
per bottle. 

HoMCEOPATHY IN THE Transvaal. — The Bocrs who live 
scattered over the high plateau of the republics, as also the 
foreign farmers, are almost without exception faithful and 
obedient adherents of the Hahnemanian curative method. On 
every farm the Boer keeps in readiness a larger or smaller 
collection of homoeopathic domestic remedies as a refuge in 
cases of disease in his family. Arnica and preparations of 
eucalyptus occupy a leading place in their medicine-boxes. 
They are seldom without a vade macum of homoeopathic prac- 
tice for men and animals, written in Dutch. The general 
stores in the leading centres of the various districts of both 
the republics have of late taken to keeping homoeopathic fam- 
ily medicine chests on hand, with 60-150 remedies in a pol- 
ished wooden case, fluctuating in price from 50 to 75 dollars. 
These are largely of British or American make, but the qual- 
ity of these preparations does not always agree with their 
noisy advertisements seen in all railroad depots in excellently 
executed posters. The makers of these medicines save in the 



190 1 Items of Interest, 69 

preparation of their remedies the large sums they waste for 
advertisements. The more intelligent people, therefore, buy 
in preference medicine boxes of responsible pharmacists. 

The preachers of the Dutch Reformed Churches always 
have on hand such medicine chests and also separate medi- 
cines. So, when the Boers of the district gather together to 
celebrate the holy communion or for other festivals, frequently 
coming sixty miles or more on horseback or in their well- 
known wagons drawn by eighteen oxen, they never fail to re- 
plete their collection of homoeopathic medicines. The medi- 
cines most sought after are remedies for snakebites and for 
the cure of rheumatism. The leaves of eucalyptus globules 
are pressed out to secure their oil, which is considered infal- 
lible in its antiseptic effects in wounds ; while a powerful spe- 
cific is prepared from the fat of the Iguana, a gigantic lizard ; 
this is used, e.g., in rubbing the hips of parturient women. 

The monastery of the trappists, situated at Mariann Hill, 
has also lent itself to the dissemination of homoeopathic rem- 
edies ; the Jesuit fathers in Johannesburg, as also the Marists 
in Rustenburgh, possess extensive homoeopathic medicine 
chests, which they dispense also to the citizens of these towns. 
— The Indian Homoeopathic Review. 

Paranoia. — The term "paranoia** covers a wide range of 
mental conditions, some of them variably classified under 
special names, but all more or less similar and probably aris- 
ing from the same diseased condition. We describe it 
as intellectual (or reasoning) monomania; a primary 
or chronic form of insanity arising from various causes, in- 
cluding the results of acute disease, and marked by hallucina- 
tions and delusions, which are systematized, i.e., exhibit a 
logical connection and sequence, so that a patient from his 
perverted ideas, in which he firmly believes, draws logical and 
coherent inferences. This is one of the most difficult forms 
of insanity with which we have to deal, as upon all subjects 
except the hallucinations and delusions the patient may 
reason with clearness and logical accuracy and appear per- 



JO The New England Medical Gazette, Jan., 

fectly sane. Brought before a jury the intelligence displayed 
in logical reasoning and correct answers to questions may 
convey the impression of perfect sanity, and yet within 
twenty-four hours, under the influence of a fixed delusion or 
an hallucination, may be guilty of any crime, even murder. 
In the history of the Reformation a case is given where a 
man said to his brother, " Jack, put your head on that log and 
close your eyes." With one blow of the axe the head was 
severed. When asked why he killed his brother, his reply 
was, " In obedience to the voice of God, coming to me direct 
from the sky." A patient in the Middletown insane hospital 
appeared so perfectly sane as to deceive an eminent lawyer, 
who said he should take steps to liberate him ; but when re- 
quested to ask the patient a question about his wife, and be- 
ing told she was an adulteress and had cohabited with the 
Archangel Gabriel, he changed his mind. The records of the 
case showed that, acting under this delusion, he had attempted 
to kill his wife. This paranoiac condition may last for years, 
but sooner or later the whole brain becomes involved and the 
patient more or less demented. — Medical Times. 

HoMCEOPATHic Societies and Colleges. — Of learned and 
scientific societies our school is abundantly supplied. We 
have 28 national societies and two sectional societies of which 
the Missouri Valley is one. There are 33 state societies and 
94 local societies. There are 42 medical clubs therein and 
three miscellaneous associations. We have Sj general and 
68 special homoeopathic hospitals and institutions with a ca« 
pacity of 12,688 beds. 

Besides there are 55 homoeopathic dispensaries where, dur- 
ing the preceding year, over 606,000 prescriptions were given 
to 223,000 patients. 

There are 21 homoeopathic medical colleges and an alumni 
numbering 12,329. Also there are published in the United 
States 28 medical journals. These statistics are collected un- 
der the auspices of the Institute and are authentic. One may 
marvel at the increase of the school, and until these figures 



1 90 1 Personal and Nc%vs Items. 7 1 

are reviewed again and again it is difficult to grasp the growth 
they imply. — Medical Arena, 

The Alvarenga Prize. — The College of Physicians of 
Philadelphia announces that the next award of the Alvarenga 
Prize, being the income for one year of the bequest of the 
late Senor Alvarenga, and amounting to about $180, will be 
made on July 14, 1901, provided that an es^^ay deemed by the 
Committee of Award to be worthy of the prize shall have 
been offered. Essays intended for competition may be upon 
aiiy subject in medicine, but cannot have been published and 
must be received by the Secretary of the college on or before 
May I, 1901. Each essay must be sent without signature, 
but must be plainly marked with a motto and be accompan- 
ied by a sealed envelope having on its outside the motto of 
the paper and within the name and address of the author. It 
is a condition of the competition that the successful essay, or 
a copy of it, shall remain in possession of the college ; other 
essays will be returned upon application within three months 
after the award. The Alvarenga Prize for 1900 has been 
awarded to Dr. David De Beck, of Cincinnati, Ohio, for his 
essay entitled, " Malarial Diseases of the Eye." — Medical Re- 
view of Reviews, 



PERSONAL AND NEWS ITEMS. 



New Home for J. B. Lippincott Company. 

An important transaction has just been concluded by 
which a number of old-fashioned dwelling houses on East 
Washington Square have passed from the ownership of the 
heirs of the famous lawyer, Horace Binney, and will soon be 
torn down to make way for a fine building to be occupied by 
J. B. Lippincott Company, whose old home on Filbert Street, 
above Seventh, was burned down some months ago. Posses- 



72 The New England Medical Gazette, Jan., 

sion is to be given by September 14, and it is expected that 
the demolition of the old structures will begin soon after. 
The site is considered a very eligible one for the Lippincott 
Company, as it has light on three sides, is very central, and 
they will be enabled to promply issue and increase their 
excellent line of medical publications by standard authorities. 
By the way, their new catalogue, just issued, is handsomely 
illustrated with excellent portraits of many of America's 
leading medical writers. 

Many historic recollections cluster about the properties 
just sold. They stand on the ground once occupied by the 
old Walnut Street Prison, built before the Revolution, and in 
which during the struggle the English confined American 
prisoners during the former's occupation of Philadelphia. 

Dr. Mary E. Mosher, class of '87, B. U. S. of M., has 
returned from her two years and a half of practice at the 
Klondike, and has opened an office at No. 719 Boylston St , 
Boston. 

Dr. Robert F. Hovey has removed from Belchertown, 
Mass., to Springfield, where he is associated in practice with 
Dr. J. H. Carmichael. Dr. Arthur Warren has taken his 
practice at Belchertown. 

Dr. R. Burleigh Parkhurst has bought the practice of 
Dr. John F. Worcester at Clinton. Mass., and has located in 
that city. 

Dr. L. a. Stewart, class of '95, B. U. S. of M., has re 
moved from West Brooksville, Maine, to Clinton, Mass. 

Dr. E, H. Durgin, class of '89, B. U. S. of M., and form- 
erly located at Searsport, Maine, has removed from West 
Side, Cal., to Cupertino, Cal. 



THE NEW ENGLAND 

MEDICAL GAZETTE 



No. 2. FEBRUARY, 1901. Vol. XXXVI. 



COMMUNICATIONS. 



ANNUAL ADDRESS BY PRESIDENT BOSTON HOHCEO- 
PATHIC SOCIETY. 

BY FRED M. HALSEY. 

Members of the Boston Homoeopathic Medical Society: 

Ladies and Gentlemen, — One year ago tonight we 
were assembled in this room to listen to the address of our 
retiring pre.sident, Dr. Windsor, and as her interesting and 
thoughtful words drew to a close, we doubt if one there was 
amongst us, who failed to feel a sense of personal pride in 
our comradeship, and in the fact that our Boston University 
was sponsor for so worthy a representative of her sex. Suc- 
ceeding so acceptable a president, while carrying with it its 
own embarrassments by comparison, should and we trust has, 
provided a healthy stimulus to earnest service. If doubt 
existed in the doctor's mind one year ago as to the closure of 
the Nineteenth Century, that doubt is surely now dispelled, 
and from now on the Twentieth Century is in full swing, 
and we are off with the old and on with the new. The time, 
then, is peculiarly fitting for both introspection and retro- 
spection. In one sense this is the oldest but one. Homoeo- 
pathic Medical Society in America, and is so classified in 
the American Institute reports. Its regular organization 



74 The New England Medical Gazette. Feb., 

was perfected in 1873, but its existence, as also our State 
Society as well, was the legitimate outgrowth of the banding 
together of four men. Doctors Gregg, Flagg, Wild and 
Spooner, in an organization known as the Massachusetts 
Homoeopathic Fraternal Association. Starting with an or- 
ganization of four physicians, with nothing behind it but a 
principle, it has enjoyed an existence of sixty-one years, and 
as we look around us its virility seems quite assured. The 
past year of 1900 will always be a memorable one, not alone 
for its closure of the past century, but as the year in which 
the Homoeopathic Physicians of the United States paid lov- 
ing tribute to the man to whom they owe their existence, 
Samuel Hahnemann. All honor to that little coterie of men 
headed by Dr. McClennan, of Philadelphia, who have strug- 
gled valiantly these many years to compass the erection of 
this monument in memory of the founder of Homoeopathy. 
Disappointments and discouragements in the raising of 
money, disheartening embarrassments in the failure to 
arrange for a fitting site, harsh and often unjust criticisms as 
to the feasibility of the whole plan or the methods of carry- 
ing it out, are forgiven and forgotten in the long delayed 
completion and dedication of the monument itself, and as we 
view this beautiful creation of granite and bronze, it should 
prove an inspiration for better, more earnest and unselfish 
labor, as we call to mind the genius and noble character of 
the man in whose memory it is erected. Here in Boston, 
the triumphs and achievements of the closing years of the 
past century will be tinged with sadness, when we recall 
the passing from amongst us of Dr. Talbot, a tower of 
strength to homoeopathy, not alone to New England, but to 
the whole world. To whose indefatigable and untiring 
capacity for work and unselfish devotion to the cause, the 
homoeopathic profession owes more possibly than to any one 
man since the death of Hahnemann himself. He gave his 
life to the cause, and our society, our college, our hospital, 
are in one sense his monuments. 



190 1 Address of President Boston Horn, Society. 75 

Sixty-one years have passed since this society's organiza- 
tion ; what has been accomplished by our branch of the 
profession during this time ? We find in the United States 
21 regularly chartered Medical Colleges with an alumni of 
over 13,000. Of General Hospitals we have 85, many of 
these with liberal endowments; we wish we might say the 
same of the colleges. Of Special Hospitals we find 67. 
Our National Societies number 9, State Societies 33, Local 
Societies loi, Medical Clubs 42, Medical Journals 30, Dis- 
pensaries devoted entirely to charity 58. Reports from 42 
of these show a record of nearly 600,000 patients treated 
during the year 1899. The service rendered at these insti- 
tutions by the profession is, as it should be, entirely gratui- 
tous, the expense incurred in their maintenance comes almost 
entirely from private sources. These are most creditable 
figures surely. Now a word about the character of the work 
done at these institutions. We have 21 Medical Colleges; 
what as to their standards and requirements } We point 
with pride to the fact that our college, the Boston University, 
was the first college in our school to require a three years' 
graded course. Other schools soon followed our lead. Once 
again was the standard raised by Boston University making 
a four years' graded course compulsory. Many colleges, in- 
cluding Harvard University, have followed this example; it is 
to be regretted that all have not done so. Harvard now 
goes a step farther requiring an A. M. or a B. A. before ad- 
mission. The wisdom of this step has not been fully deter- 
mined, but we feel sure the future will justify it. We have 
182 Hospitals under Homoeopathic management; what are 
their records ? Many of those present will recall with pleas- 
ure the kind and manly remarks delivered in the session of 
the legislature by Dr. Geo. N. Munsell, of East Boston, a 
member of the committee to whom the bill for appropriating 
nearly $200,000 of the State's money to build a new surgi- 
cal wing to our hospital was referred. The doctor, an allo- 
path, openly and violently opposed the bill when it was first 



j6 The New England Medical Gazette. Feb., 

presented. His duty as a member of the committee 
required him to visit the hospital. This he did one morning, 
and instead of spending half an hour there he stayed all day. 
Every department was carefully inspected, operations were 
in progress in the amphitheatre and he spent several hours 
there. When the report of the committee to whom the bill 
had been referred came up in regular order, the doctor arose 
and said that although he was a member of the opposite 
school and opposed to the bill primarily he had visited the 
hospital in question, spending nearly the whole day there, 
that every facility was given him for a thorough inspection, 
that with quite a long experience at home and abroad he had 
never visited one better appointed or conducted, that the 
surgeons appeared to understand their business ; and in 
short he was completely converted in favor of the bill and he 
should vote for it. It was a most generous and unpred- 
judiced action, and without doubt did much to assist the 
passage of the bill as pass it did, and it gives us great pleas- 
ure to recall the incident this evening. Since then exten. 
sive alterations, involving the expenditure of a large amount 
of money, have been made, and today our hospital stands for 
one of the best equipped institutions in the country. What 
is true of our own will apply with equal force and truth to 
almost all throughout the whole country. In many of our 
cities and suburban towns the two schools are represented in 
the same hospital, and only exceptionally has there been any 
friction. After so many years of struggle and work, with 
such results to our credit as we have shown, is our status 
with the dominant school of medicine any better than it 
was twenty-five or more years ago } It is commonly heard 
nowadays amongst the laity that the two schools are losing 
their bitterness towards each other, that they are both yield- 
ing some points, and that they are really getting closer 
together. Is this true } We believe it is true in a measure 
yet there is a gulf. It is true that in this city of Boston, as 
in many other cities and large towns, there are many broad- 



I go I Address of President Boston Horn, Society, yy 

minded and liberal physicians in the dominant school who 
meet us on the same plane, having only the welfare of suffer- 
ing humanity at heart, causing us to forget for the time that 
such a thing as separate schools exist ; indeed they have 
been known to not only meet us, but to use us in council as 
well, in defiance of their code of ethics* We fear that 
amongst the rank and file of the old school however, the 
same feeling of intolerance prevails as existed when Drs. 
Talbot, Clapp, Chase, West and others, all graduates of the 
dominant school, were forced out of the society because they 
dared to stand up and say that they wished to test the truth 
of these new laws as formulated by Hahnemann. No in- 
timation that they wished to advertise or even call them- 
selves by any distinctive name was given, simply the right 
to use these new remedies prescribed on new lines, to do it 
openly and report results. The ruling spirits in the society 
would have none of it, they were cut off from all association 
with their fellows, and asked to flock by themselves. After 
fifty years of life, having endured all the obliquy which has 
been possible to heap on us, with the only result which ever 
happens to a just cause from persecution, now that we are 
beginning to see light, we are told by this dominant school 
that if we will simply drop this hateful word homoeopath, 
that they will take us in even now. This is a liberal offer 
surely, yet we fear that their arms are not open wide enough 
under the circumstances for us to get in without crowding. 
While no opportunity for sneers, inuendoes and covert 
attacks on us as a school is lost, by many of their lecturers 
in the medical colleges throughout the country, the breech is 
not lessened. While we read in their addresses given many 
times by representative men, sentences in which homoeo- 
paths, osteopaths, Christian scientists and mental healers are 
classed together and equally entitled to consideration, the 
days of drawing together have not fully arrived. While they 
use our remedies prepared by our methods, using the small 
dose and given on purely homoeopathic lines almost every 



78 The New England Medical Gazette. Feb., 

day, giving us no credit thereby, but denying that they do 
so, while almost all their leading chemists prepare a line of 
drugs put up in infinitesimal doses and recommend their use 
on purely homoeopathic principles, it ill becomes them as a 
school to prate on our dishonesty, and claim we do not live 
up to our professions. The younger members of the domi- 
nant school of medicine graduated within five years or so, 
take a broad and lofty plane, they are not allopaths (and out 
of deference to them you will notice we scarcely use the 
term tonight) or homoeopaths or any other path, they are 
physicians in the broad sense of the term, having the right 
to use anything and everything for the good of the patient. 
This not only sounds well to the laity but it has an element 
of danger in it to us. It would imply that the physician 
graduated in the allopathic school of today was educated in 
all known methods for treating the sick, that he was pre- 
pared to use any and all of them if he so desired. This they 
know and we know is absolutely false ; he not only knows 
nothing of homoeopathy, but what teaching he gets on that 
subject tends to convince him that the whole system is an 
absolute fraud, and that the men and women who practice it 
are conniving to hoodwink the public, and are necessarily 
knaves in so doing. The American Institute of Homoeo- 
pathy recognizing this danger, has adopted a definition as to 
what constitutes a homoeopathic physician, formulated by 
Dr. E. H. Porter, of New York, a definition so broad and so 
good we will quote it : "I define a homoeopathic physician, 
as one who adds to his knowledge of medicine a special 
knowledge of homoeopathic therapeutics, all that pertains to 
the great field of medical learning is his by tradition, by in- 
heritance, by right." We recognize that this is a very broad 
subject, and one most diflficult to arrive at any satisfactory 
conclusion, but we trust the society will bear with us a few 
moments. 

You will pardon me if I take advantage of the poiiition, as 
your president and the opportunity offered in this address, to 



I go I Address of President Boston Horn. Society, 79 

descend to the personal for a brief moment. Graduated 
from the old school in 1871, and practising a short time 
before launching out in homoeopathy, the thirty years which 
I have passed as an humble disciple of Hahnemann, have seen 
my faith in this system strengthened year by year. During 
this time, however, it has grieved me sorely that our school 
should be so maligned, misrepresented and misunderstood, 
as it often is, and we so impotent to prevent. Proselytes 
are often the most rabid partisans, and if any strictures or 
criticisms are made in the words already said or which are to 
follow, I pray you will attribute it to over zeal rather than a 
wish to hurt the feelings of any one thinking differently from 
myself, for that is farthest from my wish. We believe that 
it is possible for our position to be rendered absolutely unas- 
sailable, when we can live up to this admirable definition as 
to what constitutes a homoeopath, in letter as well as in 
spirit. Wherein does our college course differ from Harvard 
or any other regular (so-called) school } Look over the cur- 
riculum and you will find the subjects taught chair by chair 
almost identical, the graded course, the four years allotted 
time before graduation; wherein then is the difference? 
Simply in materia medica and therapeutics. What change 
could be suggested ? To our mind this : Make the course 
in materia medica and therapeutics in our college so full and 
comprehensive that a student graduating therefrom would 
know all taught at the other schools and in addition the 
materia medica we believe in, how to study it and how to 
improve it. Hereon hinges the progressiveness, yes, the 
very life even of homoeopathy. There is a body of physi- 
cians in our school who believe that with the discovery by 
Hahnemann of the law of similars, the dynamization of drugs, 
and the selection of the remedy from the totality of the 
symptoms, that the end has been reached. They discard 
everything discovered before or since which conflicts in the 
slightest degree with these premises. They have no need 
for accurate diagnosis for it does not help them in the selec- 



8o The New England Medical Gazette, Feb., 

tion of the proper remedy. They throw over pathology, as 
Hahnemann in his bitterness of spirit induced by his perse- 
cution was inclined to do when he found he had discovered a 
law which he believed could be depended on.* If they use 
the thermometer, the stethoscope, the opthalmoscope, the 
sphygmograph, the various specula, or any of the numerous 
aids to diagnosis, they have no excuse for so doing, for they 
are all products of a later period than Hahnemann and they 
in no ways aid them in a selection of the similar. When 
strictures are taken against us as a profession for our indif- 
ference to pathology and accurate diagnosis, our lack of pro- 
gressive spirit, our dogmatism, are we not always judged 
from the standpoint of these extremists } When we reflect 
that the proportion of these Hahnemannians, as they fre- 
quently call themselves to the whole school, is scarcely five 
per cent., we feel these criticisms to be hardly fair. 

Fortunately for homoeopathy, we believe the large body of 
our profession are progressive, they realize the imperfections 
existing in our materia medica, and the pressing need for its 
readjustment. 

The danger signal has been sounded, what has been ac- 
complished } State societies appoint committees year after 
year. Our institute has a committee whose duties are to 
devise ways and means looking towards a reform in this 
direction. Dr. Coffin, in his able presidential address before 
this society a few years ago, called attention to the crying 
need of provings on more scientific lines. What steps have 
been taken to this end } If any, we have failed to note 
them. Our society devotes one evening each year exclu- 
sively to the discussion of this subject, and although many 
interesting papers are brought out, we all know how much 
and how little is being done along these lines. Now, we in 
no wise flatter ourselves that we are a " Daniel come to 
judgment " or have solved a problem which brighter and 
deeper minds than ours have struggled over in vain. We 
have all agreed that something should be done. We will 



'igoi Address of President Boston Horn, Society, 8i 

content ourselves with going one step farther and that in the 
form of a simple suggestion. Why should, not these new 
provings be made in our medical colleges and be included in 
the course of instruction ? Who so likely to lend himself to 
this cause as the enthusiastic medical student, and if under 
proper supervision where could these provings be better con- 
ducted ? The prover need by no means be a student him* 
self, suitable material could be provided from without. Here 
the prover could be subjected to all the tests known to the 
science of the present age. The modifications and changei* 
in all the organs and tissues while under the influence of the 
drug, as recognizable by the stethoscope, opthalmoscope, and 
all other modern aids to diagnosis, the microscopical changes, 
if any, of all obtainable fluids and excreta of the body could 
be noted, unreliable and phantastic symptoms could' be 
weeded out, and the result ought to be for great good. The 
objection that the curriculum is so full now that time could 
not be given to it, should have no weight whatever. Cut out 
some branches which the student should have knowledge of 
on entrance to college, if there are any such, and strike off 
some or parts of some he should really get in post-graduate 
work. If another year must be added to the course to 
accomplish this, let it be done. If money is necessarj' to 
make this possible, let us go to work and raise it. We have 
able and progressive teachers who have shown by their 
broadness in treating these important branches that they 
fear nothing by comparison of methods, and who are pecu- 
liarly fitted for the carrying out of such a plan were it 
thought advisable to attempt it. We are not practicing old 
school therapeutics today because we believe their methods 
to be more empirical than scientific, and we are what we are, 
because we believe we are right. Let us make this claim 
good absolutely. It is in no degree a weakness in faith in 
our principles to manifest a desire for better and more scien- 
tific provings, but on the contrary should prove a strength ; 
for, if with the imperfect and often puzzling mass of provings 



82 The New England Medical Gazette. Feb., 

at our command, we have been able to accomplish results so 
gratifying in the. seventy odd years past, what can be done 
in the next twenty-five years, if all scientific knowledge thus 
far gained can be taken advantage of in the rearranging of 
our materia medica } 

An interesting and suggestive editorial a few weeks ago 
in the Philadelphia Medical Journal entitled, " Medical 
Hatred," will bear careful reading. In it homoeopathy is 
given the credit of doing effective work in reducing the dose 
of medicine given, and modifying the medical practice of the 
time, but holds us responsible for opening the door for this 
Medical Hatred to come in. It also brings forward three 
ludicrous contradictions to which we expose ourselves. A 
perusal of the article will show how easy it 'is for a man 
predjudiced as is the editor of this journal (?) well known to 
be, to pervert and twist facts to suit his purpose. And yet 
it does not become us to place ourselves on too lofty a pedes- 
tal abrogating to ourselves all the scientific truths and deny- 
ing the possibility of anything good unless it comes through 
our channels. We are not combating the crude and empiri- 
cal medical practice of the eighteenth century, but a vigor- 
ous, alert, progressive and scientific body of men, and a most 
attractive form of practice (and this is due to our existence 
we think). We should deplore internal dissensions and jeal- 
ousies. We need a united front and we must have it, other- 
wise we will be distanced in the race. 

What of our books and journals ? While our list of 
journals is a fairly creditable one, our list of good books is 
by no means very long. This can be accounted for in sev- 
eral ways. In the first place, during the early years of our 
existence, the materia medica engrossed the attention of 
most of our able writers to the exclusion of almost every 
other subject. Another reason may have been not only the 
certainty of no emolument following such efforts, but the 
fear of great personal expense being incurred in the publish- 
ing, for our numbers being so small the circulation must 



IQOI Address of President Boston Horn, Society, 83 

necessarily be limited. Each year as our ranks enlarge, 
these conditions will not prevail to the extent they have in 
the past, thus we can certainly look with hope to the future- 
We are making history every year; are we properly pre- 
serving the records of the same .^ Year books, or more 
properly speaking yearly compendiums containing every- 
thing new and of interest, are published by our friends, " the 
enemy." What do you find of the brilliant records of our 
surgeons or physicians contained therein ? Not a word. How 
are these records being kept ? Where can they be found 
and consulted ? Possibly you know, we do not. Would not 
some such year book edited by one of our Boston men meet 
this want, and is not this thought worth considering } We 
have a very creditable medical library in Boston called the 
Boylston Medical, but it is not for us, we are not even eligi- 
ble to membership. Is not this something of a reproach to 
us as progressive physicians, and is not the time ripe for the 
remedy to be applied } We have here in the library con- 
nected with the college a very fair nucleus for as large and 
complete a collection of books as we will to make it. 
Under the accurate and skilful methods of Dr. Lovering, 
order has been brought out of chaos, and nearly 3,000 vol- 
umes have been catalogued by card index. The books we 
have are now rendered available for use by the students and 
the profession, and yet a beginning has but been made. 
With slight effort and pecuniary sacrifice on the part of the 
physicians of Boston and vicinity a librarian can be per- 
manently retained. Without such supervision the old order 
or disorder will once more prevail, and all the work accom- 
plished during the past six months will go for naught. A 
well appointed, comfortably heated and lighted room contain- 
ing now a fair number of standard books is at the service of 
the profession, rent free. It can be filled with all the best 
journals, and within a few years is susceptible of being made 
a library which will not only be a credit to our city but 
which will reflect credit on the whole profession. Is not 



84 The New England Medical Gazette, Feb., 

this worth thinking of? and should an opportunity present 
itself to any of you to aid this cause, do not turn it aside. 

Regarding the unnecessary and often unjust discrimina- 
tion against our school in national, state and municipal 
matters, in our judgment these are mostly political, and 
must be met by political methods. Nothing worth having is 
obtained without work. When we, as a school, have given 
the attention to politics, which we should do if we expect to 
influence legislation, reforms favoring us may be obtained. 
Politics is an unknown science to most of us and will bear 
better and closer study. If nothing else has been accom- 
plished during the past year your president will recall with 
satisfaction the appointment of a working committee to look 
after these matters. A committee from whom much is 
expected, whose duties are not merely perfunctor}' but who 
will watch the progress of medical affairs with an alert and 
jealous eye, and we hope will report from time to time, 
formulating means and methods by which we as a school 
can become a recognized power in politics. Having become 
so, just and reasonable requests, when properly presented, 
will receive full recognition. Reforms in the management 
of our hospitals, schools, health boards, and other depart- 
ments in which we are, or ought to be, interested will then 
be possible. Then, if ever the time does come in which 
both schools can join hands cordially and fearlessly, throwing 
all their influence politically for good, we may hope to see a 
legislation which will throw a safeguard around our children 
growing up and going out into the world. A legislation 
which will not only punish vice, but will protect virtue. One 
which will be powerful enough to not only punish that class 
of wholesale murderers commonly known as abortionists, but 
will also reach out and prevent these people from flaunting 
their vice before us in the daily papers, in text so plain that 
"he who runs may read." Nor do we need to wait for the 
dawn of the millennium for the accomplishment of these 
things. We believe they can all come in our day. We feel 



I go I Eye Strain, 85 

ourselves to be earnest and sincere in our convictions. Our 
standards of education for our students are so high that a 
large number of the dominant school are impressed with our 
honesty of purpose and are inclined to give us full credit for 
all we are doing. Let us then progress with our ideal a 
little beyond, until the majority of the profession has been 
won over and forced to admit, what many of them now 
believe, that there is truth in our law and honesty in our 
purpose. 

" Lose this day loitering 't will be the same story 

Tomorrow, and the next more dilatory ; 

The indecision brings its own delays, 

And days are lost lamenting over days. 

Are you in earnest? Seize this very minute. 

What you can do or dream you can, begin it. 

Boldness has genius, power, and magic in it. 

Only engage, and then the mind grows heated, — 

Begin, and then the work will be completed." 



EYE STRAIN NOTWITHSTANDINQ ACUTE VISION, 

BY DAVID W. WKLLS, M.D. 

Eye strain may be defined as a disturbance of the sympa- 
thetic nervous system, caused by excessive effort to overcome 
some abnormality, either in the form of the eye ball or in 
the power of its muscles. 

Naturally most of its manifestations are functional neu- 
roses, yet we have the best of evidence to show that pathologi- 
cal lesions are not rare. 

Among these may be mentioned, in the order of their 
frequency, conjunctivitis, red and crusted lids, styes, lid 
tumors, corneal ulcers. 

Extravagant statements of the production of pathological 
states in distant organs are often made by enthusiasts. 
For example, it has been claimed that a number of cases of 



86 The New England Medical Gazette, Feb., 

diabetes have been cured by correcting a tendency of the 
muscles to deviate. The explanation given is this : Diabetes 
can be produced by puncture of the floor of iv ventricle. 
Here are also located the centres which control the external 
recti. Abnormality in action of external recti may possibly 
cause an irritation of this region of the floor of the iv. ventri- 
cle sufficient to give rise to the disease. Be that as it may 
there is no reason to doubt that eye strain causes 75 per 
cent, of all chronic headaches, while migrane, vertigo, in- 
somnia, chorea, epilepsy and nervous dyspepsia are often 
attributable thereto. 

This does not preclude there being other factors in the 
case, the correction of any one of which might be sufficient 
to effect a cure. For example, a case of headache may have 
a lacerated cervix and a well marked astigmatism. 

It is conceivable that the nervous system might be able to 
rise above either one of these disturbances but be overcome 
by both. 

This case could be cured by either the gynaecologist or 
the oculist ; while another case exactly like this may require 
the services of both. 

There is also present in many cases the "vicious circle." 

Just as defective vision may cause a nervous dyspepsia, so 
digestive disturbance often gives rise to ocular manifesta- 
tions, described by the patient as blurring, or floating spots 
before the eye, or there may even be an inflammation. 

Any general consideration of the ocular manifestations of 
other diseases is beyond the scope of this paper ; but the 
fact is here noted as a caution to the oculist lest he forget 
the possibility of eye symptoms being a reflex from some 
functional derangement elsewhere. 

It would certainly be a great help to the general prac- 
tioner had he some simple means of determining the exist- 
ence of eye strain in a given case. 

To this end many physicians have a card of test letters, 
by which it is easy to determine if the sight is up to the 



I90I 



Eye Strain, 



87 



normal, and equal in the two eyes. Any inequality or 
lowered acuity is suspicious and appeals to both physician 
and patient as sufficient reason for consulting an oculist. 

At the last meeting of the State Society Dr. Suffa called 
attention to the Cover test for discovering a tendency for the 
eyes to deviate from parallelism. This consists in covering 
one eye with a card and having the other eye look at a small 
object across the room. The patient is directed to watch 
carefully the object and the card is quickly moved to the 
other eye. If any motion of the eye which is thus suddenly 
uncovered is noticed it shows that there is some tendency of 
the eyes to depart from parallelism. If the deviation be 
great considerable motion is seen, but practise is necessary 
to detect the lesser errors. 

Any of these conditions, reduced or unequal sight, or a 
tendency to deviate, are presumptive evidence of eye strain, 
but it is the purpose of this paper to show that their absence 
does not exclude eye strain. Normal visual acuity does 
preclude near sight and that is all. 

In order to emphasize the fact it may be well to briefly 
review the physiology of vision, and to show how eye strain 
is produced. 

The normal eye is. so formed that in a state of rest (that 
is with no stimulation to the ciliary muscle) parallel rays of 
light (P P Fig. i) are brought to a focus on the retina. 




Fig. I. 



Practically a pencil of light from a point 20 feet distant, 
entering the pupil, is considered as made up of parallel rays. 



88 



The New England Medical Gazette. 



Feb, 



The diameter of the average pupil is about 4 m.m., ancj the 
angle between the outermost rays which can enter this, size 
aperture from a point distant 20 feet is 30 small as to be 
insignificant. 

A pencil of rays starting from a nearer point (N Fig. i) 
would come to a focus behind the retina at the point O Fig. 
I were it not for the power of accommodation. 

Traction upon the ciliary muscle allows the anterior sur- 
face of the lens to bulge forward, thus increasing its con- 
vexity or refractive effect. In Fig. i the dotted lines show 
this changed shape, also the changed course of the rays 
coming from N, making their point of meeting on the retina 
coincident with the focus of the parallel rays P F when the 
lens was in its resting shape. 

This is so nicely adjusted as to be just sufficient to restore 
the focus to the retina. This function is very properly 
named accommodation. 

The far sighted eye (Fig. 2) is abnormal in being too 
short in its autero-posterior diameter, that is, with the eye at 
rest parallel rays are brought to a focus behind the retina as 
in a normal eye are the deverging rays from a near point. 

far ^i^/iti»d £i/ff 



J\for/naf £ye 



Aear fSiS^ted£'ye 



Fig. 2. 




The accommodation of increased convexity of the lens is 
here required not only for objects at less than 20 feet, but 
constantly. 



igoi Eye Strain, 89 

While this accommodation is operative and the proper ad- 
justment of the lens maintained, this eye sees just as well 
as the normal eye. And unless the ciliary muscle has 
become actually unable to maintain the tonic tension, the 
far sighted eye has normal visual acuity. This far sighted 
eye reads the distant test type just as well as the normal 
eye, but how? by constantly maintaining a tension on the 
ciliary. 

The near sighted eye (Fig. 2) is too long from front to 
back, and parallel rays are brought to a focus in front of 
the retina. 

As the lens has no power to reduce its convexity, this eye 
cannot accommodate for distant objects and unless some 
other defect be associated is not subject to eye strain, but has 
lessened visual acuity. 

If objects are brought near enough to the near sighted 
eye vision is even better than the normal eye, as by this 
form the retinal image is larger that usual. 

This need of accommodation in the far sighted eye and 
needlessness of accommodation in the near sighted eye are 
shown by the excessive development of the ciliary in the one 
case, and its lack of development in the other. 

It was stated that the near sighted eye seldom suffered from 
e}'e strain unless there be associated some other defect, and 
unfortunately both near and far sighted eyes have frequently 
an irregularity of curve known as astigmatism, or this error 
may exist alone. Although there exists an astigmatism of 
the lens, that of the cornea alone will be considered. 

There is a wide spread opinion among the laity that astig- 
matism means that the two eyes are unlike, and at the risk 
of being tedious an attempt will be made to explain this 
most commom cause of eye strain. Fig. 3, from Thoring- 
ton's " Refraction." 

Astigmatism has to do wholly with the front of the eye, 
nothing at all with its length. The terms "far" and "near 
sighted " astigmatism are really misnomers. 



90 



The New England Medical Gazette, 



Feb, 



The cornea is not round, not a segment of a sphere, but 
spheroidal or egg shaped. Fig. 3 illustrates a case of sim- 
ple astigmatism. The vertical curve is normal and rays of 
light entering, in that plane (V V Fig. 3) focus on the retina 
at V, and the eye being in other respects normal, the eye 
sees normally in that plane ; for instance, one line of a 
capital T, but the horizontal curve (shaded in Fig.. 3) is less 




Astigmatism. — Fig. 3, from Thoking- 
tom's '• Rbfmaction." 



QsV\c\mcvti.JtTi 




•tobCon&l*^VeftTtall«j 



Astigmatism. — Fig. 4, from Thorington's 
" Refraction. '• 



rounding, so that in this plane the eye is similar to a far 
sighted one, the focus falls behind the retina (H' Fig. 3). 
Now just as the far sighted eye can by accommodation 
secure good vision, so this inequality can be overcome by an 
unequal contraction of the lens in the same meridian as the 
defect of the cornea, and the patient may see as much as the 
normal eye. Even fairly high degrees of this variety of 
astigmatism may be overcome by an active accommodation. 

There is a limit to this irregular accommodation, so that 
in the higher degrees of this form of astigmatism the vision 
is reduced. 

There is also the variety (Fig. 4) when one meridian of 
the cornea (Fig. 4 the vertical V V) may be too convex. 
This causes light entering the eye in this meridian to come 
to a focus in front of the retina at V Fig 4. 

As the ciliary has no power of reducing the convexity of 
the lens beyond the normal traction of the Zonule of Zinn, 



I go I Eye Strain, 91 

accommodation is impossible, and certain lines of a radiat- 
ing chart must be blurred, and the vision reduced. 

But it is the common experience of all oculists to find the 
most serious cases of eye strain among those who can, by 
a contortion of the lens, overcome the deformity and secure 
good vision. It is not the lessened sight which causes the 
strain, but the nerve energy wasted in securing better sight. 
So it is that the high degrees ef error, which the ciliary can 
in no way overcome, cause less strain than the lesser errors. 

Instead of saying that eye strain exists notwithstanding 
normal visual acuity, it would be more exact to say of these 
cases that eye strain exists because of normal visual acuity. 

Instinctively we endeavor to secure a clear retinal image. 
As nature adhors a vacuum, so the retina abhors blurred 
outlines. " Good vision does not necessarily mean good 
eyesT 

So far we have been speaking of t;he single eye, but the 
fact that ability to see does not exclude eye strain must be 
much more apparent when it is remembered that normal 
sight is binocular. 

Each eye sees separate pictures, and unless the two eyes 
are so directed that the image falls upon corresponding parts 
of the two retinas, double vision is the result. 

True binocular vision requires the co-ordination of the six 
muscles which turn each eye, and the two ciliary muscles. 

When each eye accommodates for a near object, the inter- 
nal recti must converge the eyes till the visual lines meet at 
the point looked at, A Fig. 5. Failing in this there occurs 
either double vision, shown by dotted lines Fig. 5, or a ten- 
dency toward doubling, which causes pnore or less blurring. 

Normally the brain abhors double vision with the confu- 
sion which it occasions. 

Any tendency of the eyes to turn in a wrong direction is over- 
come by excessive nerve energy to the lagging muscle which 
*' whips ** the eye into line. This not only occasions a waste 
of nerve energy, but seriously disturbs the primary visual 



92 



The New England Medical Gazette. 



Feb., 



centres which preside over the co-ordination. These patients 
are often conscious of the excessive effort to fix the eyes on 
a given object for any length of time. 

This function of co-ordination has through development been 
relegated to the sub-conscious. This leaves the higher nerve 
centres free for their proper cerebration. Now when these 
higher nerve centres are obliged to exercise a conscious con- 




FiG. 5, FROM Thorincton's " Rbfraction." 



trol over sub-conscious functions, it is as disastrous to 
the proper economy of energy as when the manager of a 
great business is obliged to attend personally to details 
which he had delegated to subordinates. Let it not be 
forgotten that each eye separately may be absolutely per- 
fect and may possess normal visual acuity, and yet a 
lack of balance of these muscles which turn the eyes 
cause severe strain. Unfortunately, a refractive error in 
each eye often co-exists with a tendency of the eyes to devi- 
ate. It should be borne in mind that when one eye is 
noticeably turned, binocular vision no longer exists except 
in cases of sudden paralysis. 



igoi Eye Strain, 93 

The tendency to turn is like the fractious horse which 
never completely frees himself from his mate but gives his 
driver no end of trouble to make the team " pull together.'* 

Lenses for the correction of eye strain relieve by supply- 
ing in a glass lens the necessary refractive power, leaving 
the accommodative function to do only its normal amount of 
work. 

For astigmatism the correcting lens produces its effect 
only in the direction of the defective meridian. Deviating 
tendencies are corrected either by gymnastics, prismatic 
lenses, or by operative measures. The latter include sec- 
tions of the strong, or advancement of the weak muscles. Just 
as an eye strain may exist without any reduction of vision, so 
lenses may give perfect relief without any improvement of 
vision. Moreover, it is necessary in certain conditions to 
prescribe glasses which cause an actual blurring of distant 
objects. These two facts go hand in hand and emphasize 
the statement that has been previously made that neither 
eye strain nor its correction depend upon the amounf seen, 
but the effort expended in the act of seeing. 

A simple means of excluding eye strain is much to be 
desired, and it is to be regretted that such a thing is abso- 
lutely impossible. It requires just as much technical skill 
to decide this point as to prescribe;^ the necessary lenses for 
its correction. Patients with large pupils are very suscepti- 
ble to ocular disturbances. The dilator muscle of the iris is 
enervated by the sympathetic, and any irritation of the sym- 
pathetic system may cause dilation. Moreover, peripheral 
portions of the cornea are very irregular, and any error of 
curvature is much more noticeable in a large than a small 
arc. The small pupil acting as a diaphragm, " stops down " 
the lenticular system. It is frequently noted that the cor- 
rection of slight refractive errors is very important if the 
case presents large pupils. Inattention and backwardness 
in school children is often indicative of faulty vision, and this 
symptom alone justifies a thorough examination. A case 
referred to me by Dr. Batchelder a few weeks ago is a good 



94 The New England Medical Gazette, Feb., 

illustration. Freddie C. Very backward at school, frequent 
complaints being sent to the parents. Distant vision was 
nearly normal but the boy complained that the "words 
jumped round." Glasses for far sightedness gave almost 
immediate relief. Not only did the complaints from the 
teacher stop, but in less than three weeks he brought home 
a special note of commendation of his progress. 

There are certain facial expressions which may lead one 
to suspect that vision is not accomplished easily. Spas- 
modic working or twitching of the face or a wrinkling of the 
forehead are quite common. It is not claimed that each 
particular disease has its characteristic "facies" but that a 
certain trouble, worried or pained expression is often indica- 
tive of some form of eye strain. 

To advise the general practitioner when to send his 
patient to an oculist is perhaps a rather delicate matter, and 
the writer's only excuse for assaying the role is his daily 
experience of curing by optical means some case of long 
standing, where eye strain was not suspected. The eye 
headache is usually a dull pain, generally referred to fore- 
head temple on occiput, but any attempt to differentiate 
headaches and to decide by the location and character of the 
pain, whether it be a reflex from eye strain or not, would 
seem to be thoroughly impracticable. Every case of chronic 
headache, whether temporal, frontal, vertical, or occipital, 
merits ocular investigation. The same may be said of every 
case of migrane though the cure of this malady is not so 
general. Every case of epilepsy, preferably before it gets 
beyond the stage of petit mal should be examined, not only 
with the usual care, but a paralysis of the accommodation 
insisted on, lest tjiere be some latent error. Intractible 
cases of chorea, insomnia, vertigo and dyspepsia should be 
examined. All children whose vision is below .7 of the nor- 
mal, or who are extremely irritable or backward and inatten- 
tive at school, even if the "sight is perfect." All children 
with atrabismus, if possible, while it is periodic. All forms 
of inflammation of the eyes which do not quickly yield to 




Fig. 6 is a case of mixed astirmatism lite two photos were taken upon the same day, two 
weeks after he began to wear glasses. Simply leaving off the glasses for a few minutes caused 
a return of the old scowl. 




Fig. 7, Harold G. Both corneas scarred by old ulcers. Keratometry showed a high degree 
of astigmatism. Even with glasses %'ision was only .3 normal, and yel there is complete relief of 
the old" strain." 



96 The Nezv England Medical Gazette. Feb., 

medicinal treatment, and especially all chronic and recurrent^ 
cases like red and crusted lids, and styes. 

In order to get some definite data the writer has looked 
over 100 consecutive cases of eye strain. Patients over 36 
years of age were not considered, and only those cases counted 
where consultation was had on account of headache, pain in 
eyes, or some well recognized symptom of strain. Of the 
100 cases thus considered 36 had normal visual acuity; 14 
had .9 normal visual acuity ; 50 had reduced visual acuity. 

A majority of the 14 had normal visual acuity in one eye, 
so that it would be fair to say that in nearly one-half of the 
cases the acuity test would not have suggested the diagnosis. 
It might, on the other hand, have been really misleading if 
one did not appreciate fully that strain is entirely indepen- 
dent of the amount one sees. It may be that a large num- 
ber of cases might show somewhat different results, but as 
the purpose of this paper is not so much to give exact per- 
centages as to establish the fact, it seems fair to conclude 
that eye strain is just as liable to exist if the patient pos 
sesses good vision as when the sight is poor. 



THE LOCAL USE OF AR5ENIC IN MALIGNANT 
ULCERATION. 

KY GEORGE L. VAN DEURSEN, M. D., LOWELL, MASS. 
[Read before Boston Horn. Med. Society, Oct. 9, 1900.] 

In our present age of brilliant surgical work, where the 
skilful operators may be counted by the score, instead of 
marking here and there a solitary individual who has 
achieved distinction in this direction, we ^e many times 
inclined to call in the services of the knife in conditions 
where the proper medicinal treatment would give more per- 
manent if less immediate results. 

In malignant growths of the epithelial class, Epitheliomas, 



190 1 Local Use of Arsenic, 97 

Carcinomas, etc., where they come to us sufficiently early to 
permit of their complete excission, the operative treatment is 
generally advisable ; but in that large number of cases where 
the patients consider their trouble as only a simple matter, 
till ulceration is far advanced and the surrounding tissue 
deeply infiltrated with the growth, or in case of recurrence 
after removal, we must look to medicine rather than to surgi- 
cal interference. . 

In the use of arsenic in these conditions I have nothing to 
present which is either original or novel. You are all 
familiar with the general therapeutic action of the remedy 
and with its specific action on the skin. 

My only excuse for this paper is to recall the method of 
employment introduced and advocated by one of the most 
careful observers of our school (I refer to Dr. J. S. Mitchell, 
of Chicago), and to record several cases which have been 
successfully treated by that method. 

Dr. Mitchell is not the pioneer in the local use of arsenic, 
nor does he claim any such position, for the drug has been 
used in pastes and powders since the beginning of the prac- 
tice of medicine. His only claim to originality is in "the 
use externally of homoeopathic triturations of sufficient power 
to cause disintegrating effects, combined with continuous 
internal medication." 

The relation existing between arsenic and various forms of 
epithelial hyperplasia, malignant ulceration and tubercle 
formation has been understood and noted by writers of all 
schools of practice, but it has remained for the fathers of our 
own school to properly interpret this relationship and to 
apply the remedy according to the law of similars, where 
properly indicated. 

Whether the continuous use of arsenic will produce true 
cancer, as has been claimed by some eminent old school 
authorities, is not essential, but the provings of the drug 
show unmistakably the tendency to ulceration and gangren- 
ous sloughing, accompanied by the intense stabbing, burning 
pains which characterize carcinomata and kindred growths. 



98 The New England Medical Gazette, Feb. 

In addition to this intense action of the drug we have the 
milder manifestations seen in the waxy parchment like skin, 
so closely simulating the late cancerous cachexia, and the 
dry, scaling, itching eruptions with which we are all familiar. 

Allen, in his "Handbook of Materia Medica,'* says: 
'* Arsenic is above all a tissue drug, ranking with phos. and 
antimony. An irritant poison . . . the skin is irritated, 
and violent itching and burning are followed by eruptions 
and finally ulceration. Glandular action is first excited then 
diminished." 

In studying the symptomatology of the drug we find, 
" Skin white and pasty, or dark and livid, dry and rough. 
Eruptions around the mouth, burning and painful, itching, 
worse from scratching. Red herpetic eruptions around the 
mouth. Ulcers on face with burning pain. Fleshy excress- 
ences spring from ulcers, soon became gangrenous. Ulcers 
with thin bloody pus coming from under thin scab. Indura- 
tions and tumors becoming ulcerative." 

Farrington, in his wonderfully written " Clinical Materia 
Medica," tells us that arsenic alters the blood. It is useful 
in low types of disease when blood changes are serious. 
The inflammations of this remedy are characterized by their 
intensity and by the tendency to the destruction of tissue. 

In these locial inflammations of ars. you will find burning, 
lancinating pains the characteristic sensations. It tends to 
produce induration or hardening of the skin, rendering it a 
valuable remedy where there is thickening of the skin with 
copious scaling." 

With such authorities before us the homoeopathic use of 
the drug in these cancerous conditions is readily understood. 

It is not necessary at this time to go into any of the 
various theories in regard to the cause of epithelial growths ; 
the fact which does concern us is that there are certain new 
growths springing from embryonic tissue, developing to a 
certain''point, then undergoing retrograde changes instead of 
going on to full development. . 



IQOI Local Use of Arsenic, 99 

In the treatment of these growths many methods have 
had their advocates — the knife, chemical or actual cautery, 
pastes, ointments, internal and external medication. 

In many cases of primary growths where the affection is 
well localized, a clean incision, involving sufficient of the 
healthy tissue to preclude the probability of recurrence, may 
be effective; but even then the constitutional condition 
needs correction by proper medication. 

The actual cautery and the stronger caustics are extremely 
painful, they involve a large area of healthy tissue in connec- 
tion with the growth, and their employment does not prevent 
recurrence. 

The caustic pastes are open to the same objections and 
the irritation produced by them in many cases causes the 
growths to take on a new activity. 

Electricity in its various forms has been used to a greater 
or less extent, but its practical utility has not been fully 
demonstrated. 

The method to which I wish to call your attention, and 
with which many of you are no doubt familiar, is the use of 
a homoeopathic trituration of arsenic, giving the 3x intern- 
ally, usually about three times a day, and applying the 2x 
locally, three to six times a week according to the conditions. 

It is advisable to cleanse the surface thoroughly with per- 
oxyde of hydrogen, then apply carbolized linseed oil freely 
over the raw surface and dust on the 2x trit., covering all 
ulcerating tissue. The carbolized oil is a preparation of one 
part pure carbolic acid in twenty parts linseed oil. It is 
recommended by Dr. Mitchell for cleansing and disinfecting 
purposes and helps hold the powder in place. In places 
where an outside dressing is required, after dusting on the 
powder cover with a layer of gauze, moistened with carbol- 
ized oil, and over this a layer of absorbent cotton held in 
place by adhesive straps. 

Dr. Mitchell speaks of the use of hoang. nan, chloride of 
chromium, and other remedies to assist the action of. the 



lOO The New England Medical Gazette, Feb., 

arsenic in some cases, but in the following cases it was not 
necessary to call on any of these supplementary agents. 

Case I. W. T. Expressman. When first seen was suf- 
fering with an epithelioma of the right side of the lower lip. 
It was a typical "smoker's cancer," having undoubtedly 
been caused by the irritation of the heated clay pipe held 
constantly in the one position. 

He came under observation the first week in January, 
1 894. At that time the growth involved nearly one-half of 
the lower lip, the ulceration exposing an area as large as a 
quarter of a dollar, and the surrounding induration caused a 
thickening of the lip to at least five-eighths of an inch. The 
sanious discharge had been weeping down over the chin, set- 
ting up a severe irritation and threatening a general spread- 
ing of the condition. The ulcerating surface was at once 
cleansed with peroxyde of hydrogen followed by a thorough 
application of carbolized linseed oil and a free dusting with 
ars. 2x trit. As the ulceration extended over on to the 
inside of the lip, pieces of cotton saturated with peroxyde 
were placed between the lip and teeth to prevent the irrita- 
tion from the teeth and to keep the surfaces as clean as pos- 
sible. These were renewed several times a day as conditions 
required. 

Internally he was given tablets of ars. 3x tid., and was 
furnished with a vial of the carbolized oil and another of the 
2x trit. with instructions for its local use at home. He re- 
ported at the end of a week, at which time the growth 
showed noticeable improvement. It was again cleaned care- 
fully with the peroxyde of hydrogen and the oil and ars. 
applied as before. 

He was seen twice after this at periods of two weeks ; 
improvement was marked at each time and he was dis- 
charged, cured, the latter part of February, having been 
under treatment, practically, two months. He was given 
another vial of the tablets and continued taking one every 
day. for about a month. The growth was entirely removed, 



igoi Local Use of Arsenic. loi 

all induration absorbed and the reddened scar tissue soon 
faded to normal color. 

He has been seen frequently in the six and one-half years 
since then, and there has never been any indication of recur- 
rence. 

Case 11. L. M. Weaver. Native of Quebec. Age 47. 
About twelve years ago noticed a small growth on right side 
of nose about size of a pea. It grew very little till he began 
treatment. About six years ago it was removed by actual 
cautery, but returned in about four weeks and was soon 
twice the size of the first growth. A year later he had it 
cut out, followed by recurrence in four or five weeks, larger 
than before. • 

Two years ago he had it removed by a plaster. The 
treatment was very painful, but it healed perfectly and gave 
no trouble for about six months, at which time it began to 
grow at upper margin of the old cicatrix. It grew slowly 
for about a year then began to ulcerate ; scabs would form 
and remain for two or three days then loosen, and from 
beneath it would come a thin muco-purulent discharge. 

When he came to me for treatment, Aug. 28, 1899, there 
was an open ulcer nearly the size of a ten-cent piece 
covered with a scab, which on removal showed an excavation 
that would have taken a large marrowfat pea. The edges of 
the ulcer were hard and raised. After cleansing the cavity 
and surface with peroxyde of hydrogen, the carboliz^d oil 
and ars. 2x trit. were applied and 3X tablets given, as in the 
previous case. Dressing was done twice a week at first, 
later four times a week. 

By the last of September the growth was sloughed out, 
except at the upper border, and the excavation was filling 
rapidly with healthy granulations. It was now dressed only 
twice a week, applying the arsenic only to the points where 
the growth seemed to persist and dressing the remainder of 
the wound with calendulated boracic acid powder. 

Improvement was steady, the excavation filled to a smooth 



I02 , The New England Medical Gazette, Feb., 

surface, and the patient was discharged Nov. 24, 1899, cured. 

There has been no recurrence up to the present time, and 
the patient was seen within the past week looking well. 

Case III. Mrs. H. R. American. Age 42. History 
on father's side negative. Mother's sister died of consump- 
tion. Another sister died from cancer of breast. 

Patient always delicate, had usual diseases of childhood. 
Always troubled with neuralgia. Was married at 18, has 
not lived with husband for 21 years. During this time gen- 
eral health good. 

Four years ago had trouble with heart, palpitation, short- 
ness of breath, and a persistent hoarseness. She was under 
treatment for these troubles by several of the best physi- 
cians of our city with partial relief. 

In December, '98, first noticed a small lump in upper lip 
near left nostril, which seemed to be between the skin and 
inside of the lip. This gradually enlarged, and in course of 
two or three months extended to right nostril and ulceration 
began. She used iodoform, carbolic salve, and other " home 
remedies," under the advise of friends. 

During this time she was under the care of one of our best 
surgeons (not of our school however), who tried to console 
her by telling her " not to be frightened till he was," while 
he prescribed some simple healing lotion. Aug. 17, 1899, 
came to my office for treatment. At that time the entire 
upper lip was involved. It was thickened to about three 
times its normal proportions, the color was a dark livid, and 
ulcerated patches covered the greater part of the surface, 
extending into the mucous membrane at the lower border 
and above, involving both nostrils for a distance of three- 
quarters of an inch or more. To the left of the nose it 
spread upward on to the cheek and nodules could be found 
just below the internal can thus. 

She complained a great deal of burning and some sting- 
ing pain. Treatment was begun at once, employing the 
same method as in the other cases. It was dressed twice a 



I go I Local Use of Arsenic, 103 

week, usually, sometimes three times, and the 3x tablets of 
arsenic were given internally. 

Improvement was noticeable after a few dressings, and 
continued rapidly over the lower portion of the growth, but 
for a time there was a tendency to spreading at the upper 
border, causing some anxiety as to the possible effect on the 
eye should extension in that direction continue, this was 
finally checked, however, before any serious results occurred. 

This treatment was continued till near the last of Decem- 
ber, *99, at which time the ulceration was entirely healed, 
the induration and thickening almost gone and her general 
condition much improved. The purplish livid color had 
changed to a brighter hue more like normal scar tissue ; she 
was given some of the carbolized oil for local use at home, 
and the internal administration of the arsenic was continued. 

About the middle of January a small nodule made its 
appearance a little way inside the left nostril, but one appli- 
cation of the ars. 2x, followed by the application of the oil 
for a few days caused its rapid disappearance. 

The patient has reported about once a month since she 
was discharged, and up to the present time it seems to be a 
complete cure. The lip has regained its normal color, and 
it is only on close inspection that some small lines of cicatri- 
cial tissue can be seen. She says she is feeling better than 
for years, and works regularly at her old place in one of our 
large mills. 

Three cases cured, or benefitted, do not prove the applica- 
bility of the treatment to all conditions of this general class, 
they do show its usefulness in some of these destructive 
lesions. 

I regret that I have no personal experience to relate re- 
garding its use in those cases of malignant ulceration of the 
breast, which we are too often called upon to treat, owing to 
the neglect of an early operation. 

In one case of deep ulceration of the posterior lip of ^le 
cervix, involving the entire posterior vaginal fornix and 



104 T^f^^ New England Medical Gazette. Feb., 

threatening perforation of the cul-de-sac, it has seemed to 
retard the progress of the disease, and at times to almost 
promise some slight improvement, but this case is still under 
treatment, and it is too early to report any definite result. 

This was one of those unfortunate cases where a radical 
operation was advised more than a year ago, but refused. 
The case went elsewhere, received so-called 'Mocal treat- 
ment," with the result of steady progress of the disease. 

When she again came under observation the condition had 
gone too far to render operation, advisable and the " Mitchell 
treatment** was resorted to only as a paliative measure. 



THE TREAXnENT OF TUEBRCULAR PERITONITIS BY 
ABDOniNAL SECTION AND DRAINAGE. 

BY WILLIAM T. HOPKINS, M.D., LYNN, MASS. 
[Read before Mass. Horn. Med. Society Oct. lo, 1900.] 

Upon this subject little can be offered which is new, and 
any practitioner who devotes a large share of his time to 
surgery is doubtless as well informed upon this as upon 
other surgical diseases, but some recent experiences have 
led me to conclude that the general practitioner who gives 
little or no time to surgical practice may not be fully aware 
of the advantages of this method of treatment in certain 
cases of peritonitis of tubercular origin. This is my excuse 
for taking a share of your time today. 

Since the accidental application of this method of treat- 
ment in the year 1 862, abdominal section has been consid- 
ered by nearly all surgeons although but few had the 
courage to advocate and practice this treatment until the 
decade now drawing to a close. 

With the present improved technique and the application 
of asepsis the chance of recovery is much improved and the 
confidence of the surgeon correspondingly increased. 



190 1 Tubercular Peritonitis, 105 

The Paris thesis of Aldibert, produced in 1 892, is probably 
the best exposition of tubercular peritonitis ever given to the 
profession and to portions of this work I will briefly refer. 

He recognized three varieties (a) the ascitic, (b) the 
fibrous, and (c) the ulcerative form. The ascitic is a miliary 
tuberculosis of the peritoneum which may be confined to a 
single locality but is more commonly general. This may be 
acute, sub-acute, or chronic. The acute cases generally 
show a clear serum, but those of longer duration disclose a 
more turbid, dirty green fluid which is occasionally semi- 
purulent or bloody. The chronic cases, too, are more apt 
to be sacculated. Some fibrin is seen but the amount is 
inconsiderable compared to that encountered in the so-called 
fibrous forms which may also show some ascites which 
appears to have no tendency to become purulent. Occa- 
sionally large tubercles are found throughout the peritoneum 
without adhesions and without a.scites, but the adhesive 
variety of the fibrous form shows an extensive matting 
together of the coils of intestine and a glueing of the intes- 
tines to the solid viscera. 

The progress of the fibrous form is very slow and the 
opinion is still prevalent that these cases show an attempt 
at repair. 

The ulcerative form is simply the breaking down of 
tubercular deposits, and if this caseation sets up sufficient 
inflammation the suppurating focus may be walled off from 
the general cavity. 

Numerous pockets of serum or pus may be found in such 
cases. Clinically, it is not always possible to differentiate 
the various forms, and even to make a diagnosis of tuber- 
cular peritonitis is not at all times easy, but if the patient 
suffers from malaise, emaciation, capricious appetite, indi- 
gestion, vomiting, diarrhoea, or constipation, fever, moderate 
in the morning with a considerable rise at night or in the 
afternoon, night sweats, together with tender enlarged abdo- 
men, -which ; may show the even dulness of ascites or may 



106 The New England Medical Gazette. Feb., 

present areas of both dulness and tympanites, the case is 
pretty clearly tubercular. 

Of the various forms it is important to distinguish the 
fibrous alone since this is the only one in which recovery 
may be looked for without operation. 

Of the chance of survival with operative treatment, the 
least sanguine opinion gives a mortality of 25 per cent. 

This includes all cases which die within a few weeks, 
whose demise may reasonably be regarded as hastened by 
the operation. The direct mortality of the operation itself 
is only about three per cent. Of the seventy-five per cent, 
of recoveries about one-fourth may be regarded as perma- 
nent, so of all operative cases we may look for nearly twenty 
per cent, of permanent cures. 

The operation consists in opening the abdomen by a 
rather long incision, admitting air and light freely and drain- 
ing with gauze wicks for a few days. Drainage may be 
preceded in some cases by flushing out the cavity with a 
normal salt solution, but not in those cases in which, by so 
doing, a localized peritonitis may become general. 



ACUTE LARYNGITIS. 

BY N. H. HOUGHTON, M.D., BOSTON, MASS. 
[Raad before Boston Horn. Med. Society.] 

It is not within the scope of this paper to include all acute 
diseases of the larynx, but to limit the subject to a consid- 
eration of Acute Catarrhal Laryngitis. 

In this disease the inflammation may be vivid in character 
and involve only the mucous membrane of the larynx, giving 
rise to slight hoarseness and cough, or it may reach the 
deeper tissues, be more severe, and become dangerous to 
life, especially in children. 

The causes of acute catarrhal laryngitis are such as favor 



IQOI Acute Laryngitis. 107 

inflammation of mucous surfaces in general. It is very 
frequently a continuation of an inflammation existing some, 
where in the upper portion of the respiratory tract, or a 
rhinitis, or a noso-pharyngitis. Diseases of the stomach and 
intestines may predispose one to attacks of laryngitis. In- 
dividuals, especially children, who are kept in doors much of 
the time, and those in whom the general health is poor, are 
susceptible to the disease. Cold and exposure, wetting of 
the feet, wearing damp clothing, improperly ventilated rooms, 
alcoholic drinks, excessive use of tobacco, and straining the 
voice in speaking, or in singing, are not uncommon causes. 
Obstructive lesions of the nose and noso-pharynx, causing 
mouth-breathing, inhalations of dust, irritating fumes and 
vapors, and foreign bodies in the larynx may induce the 
disease. Acute catarrhal laryngitis may accompany the 
eruptive fevers, especially measles, scarlet fever, small-pox, 
typhoid and typhus fevers, erysipelas, also influenza, hay 
fever, and rheumatism. 

Usually the ' earliest symptom is impairment of the voice, 
which may be hoarse or completely lost, dependent largely 
upon the amount of inflammation present. Dryness, tickl- 
ing and cough are nearly always to be found. A sensation 
of roughness and constriction in the throat, and in children 
sensitiveness to palpation may exist. In the second stage 
the secretion of mucous considerably relieves the dryness 
and cough, which becomes less metallic. An examination 
by the laryngoscopic mirror reveals the extent of the inflam- 
mation which may include the whole mucous membrane 
lining the larynx, or the hyperacenia may be confined to a 
certain portion, as the epiglottis or the ventricular bands. 
At times the ventricular bands may be so swollen as to 
nearly occlude the vocal bands from view. Children may 
appear during the day to have no serious illness but at night 
may be awakened with violent suffocative attacks of cough- 
ing. The respiration is embarrassed and efforts to breath 
are marked by an audible, stridulous sound. These attacks 
are probably occasioned by the drying of the accumulated 



io8 The New England Medical Gazette, Feb., 

mucus in the larynx. The child is compelled to breathe 
through the open mouth, with the result that the inspired 
air is not moistened by the secretion of the nose, as in nor- 
mal respiration, consequently the dry air causes rapid evap- 
oration of the water of the laryngeal secretions with the 
effect of causing them to dry upon the vocal bands until 
they become a positive obstacle to the inspired air. How- 
ever, this mechanical explanation is not satisfactory to all 
for there are some authors who consider these attacks due 
to a spasm of the adductors of the vocal bands. CEdema 
occurring in the course of a laryngitis constitutes a grave 
complication since it may give rise to a fatal stenosis. Acute 
catarahal laryngitis though not always a serious condition 
yet from the location of the inflammation and the tendency 
to oedema with subsequent dyspnoea, calls for prompt and 
energetic treatment. Here the laryngoscope is an impor- 
tant factor, not only as an aid to the diagnosis, but in ascer- 
taining the extent and severity of the inflammation, and 
whether oedema is present or absent. The e>camination with 
the mirror should be made if possible, and almost always is 
successful in adults, but in children it is often attended with 
difficulty and sometimes impossible. 

All applications which are made to so delicate an organ 
as the larynx should be administered in such a way as to do 
the least possible harm. Direct local applications of powders 
and solutions should be avoided as their mechanical irritation 
does more harm than good. Throat and cough lozenges in 
numberless variety which laden the counters of the drug 
stores, and which are so indiscriminately used, should be 
condemned. Most of them contain opium and are made of 
sugar and candy, are of large size, and are not only inappli- 
cable to inflammation but cause impairment of digestion and 
appetite. It must also be remembered that gargles do not 
reach the larynx and are only beneficial where there is some 
pharyngeal involvement. Any diseased conditions of the 
upper respiratory tract should receive proper treatment. 
Strumuous, lymphatic children should be toned up by the 



I go I Amte Laryngitis. 109 

use of cod-liver oil and by the indicated remedy, such as one 
of the calcareas. Another prophylactic measure is the em- 
ployment of the cold sponge bath combined with brisk rub- 
bing. In treating the disease in children, the patient should 
be put in bed m a well-ventilated room of a temperature of 
about 70 degrees. The air should be kept moist by generat- 
ing steam or slaking lime. The croup tent should be used 
in severe cases. Nightly exacerbations should be antici- 
pated by using every means to soften and expel the dried 
mucus, and to moisten and soothe the dry, irritable mem- 
brane by the use of the hot bath, hot fomentations and steam 
inhalations, and failing in these excite free emesis by tickl- 
ing the fauces with the finger or brush. Early in the attack 
benefit may result from wrapping the throat in a towel, the 
end of which has been dipped in cold water. In people, 
other than small children, inhalations of steam medicated 
with oil of pine, oil of tar, oil of. eucalyptus, and compound 
tincture of benzoin are highly beneficial. The use of oil 
sprays, such as liquid vaseline, one ounce, oil of sandal wood 
six drops and oil of tar three drops, or a three per cent, solu- 
tion of camphomenthol in . albolene, or Neorgari's sabalal 
spray which consists of saw palmetto, eucalyptus and menthol 
in an oily menstruum, may be of great help when inhaled 
from ambulizer. These preparations are not astringent, 
but stimulating, and thus they promote secretion and relieve 
the congested blood vessels. For the relief of the oedema 
the swollen tissue must be punctured and the watery fluid 
allowed to escape. Rarely intubation and tracheotomy may 
be demanded. For the early symptoms, such remedies as 
aconite, belladonna, ferrum phos. and ammonium muriate 
will give prompt relief, while later iodine, bromine, spongia, 
calciiod, hepar sulph., guiac, phosphorus, sanginaria and 
apis should be consulted. 



I lo The New England Medical Gazette. Feb., 



EDITORIAL. 

Contributions of original articles, correspondence, etc., should be sent to the publishers, Otis 
Clapp & Son, Boston, Mass. Articles accepted with the understanding that they appear onlv ii) 
the Gazttte. They should be typewritten if possible. To obtain insertion the following month, 
reports of societies and personal items must b* rtctived by iht tsth o/th« m^ntk preceding. 



THE HAHNEMANN ASSOCIATION. 

The annual meeting of the Hahnemann Association was 
held at Young's Hotel on January 14, and was enthusiastic 
enough to encourage us all. Addresses were made by Dr. 
Horace Packard, secretary of the Association, setting vigor- 
ously forth the needs of the medical school and the reasons 
why the necessities are more pressing than ever at this time ; 
by Col. Chas. R. Cod man concerning the Massachusetts 
Homoeopathic Hospital and its dependence on the medical 
school ; by the Hon. Alden Spear, chairman of the* Board 
of Trustees of the Westboro Insane Hospital, showing the 
inter-dependent relations existing between that institution 
and the School of Medicine ; while Mr. W. M. Dickinson 
spoke most eloquently on the necessity of endowment of 
medical schools, and showed that of all professional schools, 
those pertaining to the study of medicine were least often 
and indeed very rarely endowed. 

The Association has already been of very material assist- 
ance to the school, and already has plans under way whereby 
■ it will be of still further help, but this work should not be 
left to the Association alone, it should be the duty of every 
homoeopathic physician in New England to do what little or 
what much he can, not by his purse, but by his influence to 
raise sufficient endowment to place the medical school 
beyond financial embarrassment. 

What are the problems with which we are confronted 
today and how are they to be solved } 

First, The standards both for admission to and gradua- 



I go I Editorial, 1 1 1 

tion from medical schools must be raised. The time for dis- 
cussion on this subject has gone by ; no sane physician can 
deny it ; the standards are already raised by the best 
schools, and Boston University must do the same, and at 
once, if she would be in the van in the future as in the past. 

Second. The immediate result of raising the entrance 
requirements especially, is a marked falling off in the num- 
ber of students. 

Third, The school is almost entirely dependent upon the 
student for its support ; a reduction in students means re- 
duction of income to a point which may seriously embarass 
the institution. 

Fourth and last. If we remember correctly, the last 
census shows one physician in Massachusetts to between 
every four and five hundred inhabitants, a proportion so 
great that the immutable law of supply and demand will 
soon bring it about that fewer men and women will study 
medicine ; hence, unless the individual fees are enormously 
raised, the student income will be entirely inadequate to 
furnish proper instruction, for, of all the professions medicine 
is the most expensive to teach and the most expensive to 
study. 

What is the remedy } We can see none but endowment, 
and we believe this to be not only possible but just and 
right. 

It is just and right because their is no profession on earth 
which does more good to the race, which does more to uplift 
its fellow-man, if followed along those lines of honor and 
integrity which make it the noblest of all professions. Be- 
cause taken as a class there are no men and women who lead 
cleaner lives, sacrifice more and receive less in proportion to 
capital invested than does the conscientious, upright physi- 
cian. It is possible because the wealth of our beloved Com- 
monwealth has never yet been appealed to in vain for any 
worthy cause. 

Let it be well understood by those upon whom the Lord 



1 



112 ■ The New England Medical Gazette. Feb., 

has placed the responsibility of wealth, that the medical 
school is in need, that the professors for the most part labor 
and have labored for the best part of their lives at personal 
sacrifice, and entirely without any pecuniary recompense (a 
fact heretofore not generally known) ; that the proper en- 
dowment of the school will render possible the selection 
only of those fitted both by education and by natural en- 
dowment to study medicine, and enable such to be so thor- 
oughly drilled as to ensure only the best results, then we 
are sure the endowment will be forthcoming. This knowl- 
edge must come to the laity through the physician princi- 
pally, it can come in no other way ; and let every member 
of our profession do his duty in this direction be it ever so 
little. 

If you can't put the case well enough yourself, send to the 
Secretary of the Association for a copy of Mr. Dickinson's 
speech, and read that to your constituents who are interested. 
It is not necessary to beg, let the facts be known and the 
response will come. Apropos of this, and to comfort the 
doubting, let me append what Booker Washington says in 
his " Up from Slavery," as quoted in the editorial column of 
the Boston Transcript of January 22. He says: — 

*' In the city of Boston I have rarely called upon an indi- 
vidual for funds without being thanked for calling, usually 
before I could get an opportunity to thank the donor for the 
money. In that city the donors seem to feel, in a large 
degree, that an honor is being conferred upon them in their 
being permitted to give. Nowhere else have I met with, in 
so large a measure, this fine and Christlike spirit as in the 
city of Boston, although there are many notable instances of 
it outside of that city. I repeat my belief that the world is 
growing in the direction of giving. I repeat that the main 
rule by which I have been guided in the collection of money 
is to do my full duty in regard to giving people who have 
money an opportunity to help." 

This is true not of Boston alone but of all New England. 



I go I Editorial, . 113 

OBITUARY. 

Dr. Galen Allen, whose death occurred at Red Wing, 
Minn., Dec. 25, 1900, was a native of Chelsea, Vt., where he 
was born Aug. 2, 1833. He removed to Acworth, N. H., 
with his parents when a small child, and that town was his 
home during his youth and early manhood. He was edu- 
cated at Dartmouth College, graduating in the clasi> of '62. 

For some years he was engaged in teaching, and for seven 
years was the principal of the high school of Bath, Me. 

While residing in Bath, he engaged in the study of medi- 
cine with the late Dr. William E. Payne, then one of the 
foremost physicians of New England. He attended medical 
lectures at Dartmouth College and Boston University, receiv- 
ing the degre/s of M. D. from the latter institution in 1875. 
He moved to Red Wing, Minn., in thd "autumn of 1875, 
where, with the exception of a few months, he afterwards 
resided, engaged in the practice of his profession. He 
leaves a widow and three children. 



PHYSICIAN AND AUTHOR GOISE. 

Dr. Erastus E. Marcy died at his residence in New York, 
Dec. 28, 1900. He was born in Greenwich, Mass. He en- 
tered Amherst College, and was a classmate of Henry Ward 
Beecher and of the late Archbishop Bailey. He took his 
medical degree at the University of Pennsylvania, and during 
ten years practised with great success as an allopathic physi- 
cian in Hartford, Ct. 

At that time he was a strong opponent of homoeopathy, 
and was appointed by the medical societies to investigate it. 
He went to Paris, and studied the original manuscripts of 
Hahnemann, became a convert, and, returning to America, 
at once took rank among the most prominent physicians of 



1 14 The New England Medical Gazette. Feb., 

the new school. He went to New York, where he acquired 
an extensive and lucrative practice. 

Dr. Marcy also achieved a considerable reputation as a 
writer. He edited the North American Journal of Homoeo- 
pathy 1 3 years, and wrote numerous essays. He was during 
many years an annual visitor to Paris and Hamburg, and 
companion and physician to the late A. T. Stewart, and one 
of the witnesses to the Stewart will. He was also physician 
to Mme. Patti, with whom he was acquainted from her child- 
hood. Gen. Randolph B. Marcy was his brother. 

Brought up as a Presbyterian, Dr. Marcy finally became a 
Roman Catholic. In 1867 he published ** Christianity and 
Its Conflicts," of which several editions were published, and 
subsequently another book, entitled " Life Duties." 



EDITORIAL NOTES AND COMMENTS. 



Dr. Samuel Floersheim, 218 East 46th Street, New York, 
is preparing a second paper on the use of the suprarenal 
capsule in organic heart disease, and desires to receive re- 
ports from physicians of cases, giving, I. The condition of 
the heart, pulse and pulse rate. II. The effect on the 
heart, pulse and pulse rate within ten minutes after the 
suprarenol powder, three grains, is chewed and swallowed 
without water, by the patient. 

The doctor's first paper appeared in the New York Medi- 
cal Journal iox Oct. 6, 1900. 



Convalescent Hospital in the Philippines. — A con- 
valescent hospital is about to be established in the Philip- 
pines. It is to be located at Beago de la Trinidad, near 
Manila, about 4,700 feet above sea level, the thermometer 
never rising above 75 degrees in the daytime, the nights 
being cool and exhilarating. 



I go I Reviews and Notices of Books, 1 1 5 

REVIEWS AND NOTICES OF BOOKS. 

The Chloride of Silver Dry Cell Battery Company, of Baltimore, 
Md., has recently sent us a copy of its new *' Supplemental Issue to 
Catalogue No. 8/* This publication is quite in keeping with the 
high class advertising matter invariably sent out by the Chloride of 
Silver people, and from cover to cover, throughout its entire twenty 
pages, it cannot prove otherwise than intensely interesting to the 
electro-therapist. A large number of entirely new and improved 
electrodes and accessories have been added to their already im- 
mense stock, and the enterprising manufacturers anuounce that 
they are still busily engaged in preparing other patterns, which for 
the lack of time, they have thus far been unable to catalogue. 

We would advise all who employ electricity in their practice, no 
matter what form of apparatus they employ to generate a current, 
to write to Otis Clapp & Son, i o Park Square, Boston, Mass., for a 
copy of the Chloride of Silver Dry Cell Battery Company's new 
Supplement, as it is certain to prove of interest and value. 

An American Text- Book of Physiology. Edited by William H. 
Howell, Ph.D., M, D., Professor of Physiology in the Johns 
Hopkins University, Baltimore, Md. Second edition. 2 vol. 
Philadelphia: W. B. Saunders & Co. 1900. Price, cloth, J3 
net ; sheep or half- morocco, I3.75 net. 

The present edition of this publication appears in two volumes, 
and forms 'by far the most complete work of the kind yet offered 
the student. It is unique, in that it presents a collection of trea- 
tises, as it were, written by a group of competent teachers, individ- 
ual knowledge and research being concentrated exclusively upon 
the special topics assigned or chosen. 

The advantage of this plan to the student, lies in the avoidance 
by this method, of a common tendency to give a disproportionate 
amount of space and mention to two or three subjects, and a mere 
perfunctory consideration of others of less interest to the author. 
Where there are collaborators, each naturally wishes his work to 
compare favorably, at least, with that of his associates, and to that 
end puts forth his best energies. 



1 1 6 The New England Medical Gazette, Feb., 

We do not find evidences of that lack of homogeneity and con- 
tinuity of thought which might, perhaps, be expected, and which 
would furnish the most obvious reasons for criticism. We realize 
that the last word has yet to be written upon the greater part of the 
subdivisions of modern physiology, and scientists and teachers of 
equal ability and prestige will sometimes reach varying conclusions. 
It would seem, however, that the authors of the " American Text- 
Book of Physiology" have written with much unanimity. 

The description of the various constituents of the human body 
are most minute and comprehensive, and all the functions are care- 
fully described. The principal subjects discussed in Vol. I. are the 
blood, lymph, circulation, chemistry of digestion and nutrition, 
movements of the alimentary canal, bladder^ and ureter ; respiration. 
Of Vol. II., muscle and nerves, central nervous system, special 
senses, special muscular mechanisms and reproduction. 

The work is one well adapted for general reference, as well as for 
a student's text-book ; gives the best and most reliable information, 
and the most authoritative deductions from the results of modern 
study and research. 

Messrs. Herbert S. Stone & Co. have in press the following im- 
portant work : A Text- Book of Special Surgery. By Dr. Franz 
Koenig, and translated from the most recent German editon by 
Arthur B. Hosmer, M. D. This is the authorized translation^ and 
will consist of three handsome octavo volumes. 

Disinfection and Disinfectants. By H. M. Bracken, M. D. 
Trade Periodical Co. Chicago, 111. . 

This is a little work which gives in small compass excellent and 
explicit direction for disinfecting rooms, clothing, etc., as well as 
for the conduct of physicians and nurses having contagious diseases 
under their charge. The book is well illustrated. 

Modern Medicine. By Julius L. Salinger, M. D., Demonstrator of 
Clinical Medicine, Jefferson Medical College, Philadelphia, and 
Frederick J. Kalteyer, M. D., Assistant Demonstrator. Illus. 
Philadelphia and London : W. B. Saunders & Co. 1900. 
pp. 801. Price, cloth, ?4 71c t ; half- morocco, $5 net. 



190 1 Reviews and Notices of Books, 1 1 7 

<< Modern Medicine " is certainly a pleasing and a promising title 
for a work on practice, and the book which bears it is well named, 
for it takes cognizance in an unusual degree of the more recently 
developed departments, which now must be included under the one 
general heading in order to ensure a comprehensive view of this 
vast subject. 

It is hardly to be expected that a work in one volume which en- 
deavors to present the gist of symptomatology and semciology, 
physical diagnosis, clinical bacteriology and laboratory methods, as 
well as infectious diseases, diseases of the circulation, respiratory 
system, digestive tract kidneys, of the blood and of the ductless 
glands, of the nervous system, of the muscles, constitutional 
diseases, intoxications and sunstroke, and diseases due to animal 
parasites should not suffer somewhat from condensation. This 
must be so more or less when the scope of such an undertaking is 
considered. It shows, then, great discrimination and discretion on 
the part of the authors, that this characteristic should not militate 
against the real value of the work to any considerable extent. 

We could have wished that more space could have been given to 
hygiene, prophylaxis, and kindred topics, which today properly take 
an important place in the study of diseases and their remedy. In 
regard to treatment, also, certain limitations of usefulness are ob- 
servable, even waiving the therapeutic question from the homoeo- 
path's standpoint. But this work is a great injprovement over many 
older ones not yet considered obsolete, for much valueless matter 
has been eliminated. The style is olear if terse, and the text well 
arranged. 

A Praciical Treatise on Medical Diagnosis for Sivdeni-s and 
Physicians. By John H. Musser, M. D., Professor of Clinical 
Medicine in the University of Pennsylvania, etc. Fourth Edi- 
tion. lUus. Philadelphia and New York : Lea Brothers & Co. 
1900. pp. 1 105. Price, cloth, $6 net ; leather. J7 net ; half- 
morocco, I7.50 net. 

No one will dissent from the assertion that the demands made 
upon the physician today are far greater than they were even a few 
years ago. Confining the application of this truth simply to diag- 
nosis, it is evident that the multiplication and extension of methods 
tor determining the nature of disease make it imperative that medi- 



1 1 8 The New England Medical Gazette, Feb., 

cal graduates and under graduates both, should be constantly enlarg- 
ing their techinal knowledge, otherwise they will be at a great 
disadvantage. 

While theoretical acquaintance with scientific methods must pre- 
ceed practical work, a treatise which will render their combination 
possible almost from the beginning is highly desirable. Such a 
work Dr. Musser furnishes the profession in his "Medical Diag- 
nosis." It is extremely comprehensive and complete, every helpful 
means of arriving at just conclusions being called to the reader's 
attention. 

Part J. deals with General Diagnosis, the knowledge of the case 
derivable from intelligent observation, careful questioning of the 
patient, and the use of all the most approved instruments, etc., 
together with the significance and importance of the data obtained. 

Instruction in laboratory work is given in detail. 

Part II. is devoted to Special Diagnosis of the diseases of indi- 
vidual parts and organs of the body. This section occupies about 
two-thirds of the book, and is written in a clear and painstaking 
manner. 

Considerable space is assigned to differential diagnosis, and this 
is particularly helpful as affording immediate comparisons, without 
the necessity for prolonged search for the descriptions of different 
diseases. 

Altogether it is a ver>' exhaustive work on the subject of medical 
diagnosis, and if we were asked to mention its chief characteristic 
we .should assuredly emphasize* its thoroughness, and the attention 
given to minutiae too frequently overlooked or disregardad. 

Home Treatmeni and Care of the Sick. Including chapters on 
Approaching Maturity, Marriage and Maternity. By A. Temple 
Lovering, M. D. Boston and Providence : Otis Clapp & Son. 
1901. 

This is the best book of the kind we have yet seen, and this 
book is a good kind too. The subject matter is considered in two 
parts. Part I., in seven chapters, treats of the Preservation of 
Health, Home Nursing, Diseases in General and tjieir Treatment 
Accidents and Emergencies, and Leading Remedies: Their Ad- 
ministration s^nd Indication for Use. 



190 1 Reviews and Notices of Books. 1 19 

Part II. Marriage and Maternity; The Baby, in Health and 
Sickness ; Diseases of Childhood, Approaching Maternity ; Suitable 
able Food for the Sick. 

The short description of the more common diseases is pertinent 
and plain, and the remedies given with their indications are such as 
have been found by practice to be most reliable. 

The charm about the rest of the book is that there is no attempt 
at a display of learning. The subjects are treated in such plain, 
simple language that a child of average intelligence could under- 
stand them easily, and herein lies the evidence of the abundant 
knowledge behind, for only those thoroughly conversant with a sub- 
ject can write of it simply. The chapters on approaching maturity, 
and marriage and maternity should be read by every mother and 
by every boy and girl sixteen years of age or over. While the 
topics of which these chapters treat are spoken of with a plainness 
that brooks no mistake, they are treated with a dignity and moral 
standard which will command the absolute respect of all who read. 

We confidently believe that an edition of this book, minus the 
chapter on diseases and remedies, would be a much better book to 
put into our public schools than many that are used there now on 
the subjects of hygiene and physiology. 

Messrs. Boericke & Runyon Co. have just published a work by 
Dr. M. E. Doughlas, of Baltimore, Md., entitled Characteristics 
OF Homoeopathic Materia Medica. This book contains nearly 
1,000 pages, and is bound both in cloth and half-morocco; {5 net 
for the former, and t6 net for the latter. 

This firm also has in press Dr. Selden H. Talcott's Mental 
Diseases and Their Modern Treatment. Dr. Talcott is well 
known as the superintendent of the Middletown, New York State 
Homoeopathic Hospital for the Insane. The price of the book 
will be {2.50. 

Chinese Therapeutics. — Among examples of their ther- 
apy, is a plaster to fractured leg ; for a poultice, a live duck is 
cut up longitudinally, and half applied to the affected part ; 
for fever, the duck's blood is smeared over the temples, face 
and neck, which with magic, mythical rites and incantations, 
constitute a large part of the Chinese medico's armamenta- 
rium.— £r^^«^^. 



1 20 The New England Medical Gazette, Feb. 

PERSONAL AND NEWS ITEMS. 



For Sale. — Avery desirable practice in a New Hamp- 
shire town of 3000 inhabitants. Satisfactory reasons for 
selling, and the present owner will thoroughly introduce the 
purchaser. An excellent opportunity for the right party. 

Address "M. M. D.," Care Otis Clapp & Son, 10 Park 
Square, Boston, Mass. 

Physicians owning the ** Cyclopaedia of Drug Pathogen- 
esy,** Hughes and Dake, may not be aware that the Reper- 
tory .to this work, compiled by Dr. Richard Hughes, is now 
on t,he market. It is printed in four parts, paper binding, 
and subscriptions may be sent to Otis Clapp & Son, 10 Park 
Square, Boston, who act as agents for the American Insti- 
tute of Homoeopathy in the disposal of the sets subscribed 
for by that body, who fill orders for the Repertory by having 
the work sent by mail direct from London at exact cost to 
the institute, and who also have a few sets of the work bound 
in cloth and half-morocco which they are supplying at exact 
cost. 

Dr. E. C. Williams, of Richmond, Va., has removed to 
Hot Springs, Va. Previous to Dr. Williams' going there, no 
homoeopathic physician was located at the latter place. 

Dr. Walter F. Adams, class of 1900, B. U. S. of M., has 
located at 558 Main St., Waltham, Mass. 



Resolutions adopted by the Homqiiopathic Medical 
Society pF Chicago. — That the Society instruct its legisla- 
tive committee to prepare and introduce a bill creating medi- 
cal examining boards distinct from the State Board of Health, 
one each for the three recognized schools of medicine, viz., 
the allopathic, Homoeopathic and electric schools ; to enlist 
the aid of the legislative committee of the State Homoeopa- 
thic Medical Society ; and, to use, not only their own personal 
efforts, but also those of all members of the profession who 
can aid in its enactment. 



THE NEW ENGLAND 

MEDICAL GAZETTE 



No. 3. MARCH, 1901. Vol. XXXVI. 

COMMUNICATIONS. 

oNosnoDiun virqinianuh in headache FROn 

EYE-STRAIN. 

BY A. B. NORTON, M. D., NEW YORK. 
[Read before Boston Horn. Med. Society Oct. q, iqpo.] 

This remedy during the last ten years has taken a very 
prominent place among the every day drugs of the oculist. 
A very large percentage of the cases consulting the oculist 
are patients suffering from headaches due to eye-strain, and 
while the correction of their refractive and muscular errors 
is, of course, an absolute necessity in the permanent cure of 
the patient, yet the use of the homoeopathic remedy is a 
mo.st essential feature in a prompt relief of the annoying 
symptoms. I should judge that at lea.st 75 per cent, of all 
my patients come to me on account of asthenopic symptoms 
and headaches, and while no one remedy is a cure all, yet 
onosmodium seems to cover more of these cases than any 
one other remedy. 

The characteristic head and eye symptoms of this drug 
are taken from a proving made by Dr. W. K. Green, of 
Little "Rock, and are as follows : The Ophthalmoscope shows 
a hyperaemia of the optic disc, and an engorgement of the 
retinal vessels, worse in the left eye. This symptom is very 
frequently found in the class of cases we are now consider- 



122 The New England Medical Gazette, Mar., 

ing, and is usually due to a long strain from long use of the 
eyes at close work with some refractive error uncorrected. 
The irregular and constant action of the accommodation 
causing an irritation and congestion of the retina and optic 
nerve. 

The characteristic subjective symptoms of the drug are 
heaviness and dullness of the eyes, feeling as though had 
lost much sleep, pains in the left side of the head and over 
the left eye. Dull, heavy pains in the occiput pressing 
upward with a dizzy sensation. Great muscular prostration 
and tired feeling over the entire body. The muscles feel 
unsteady and treacherous. Soreness in the eyeballs. Tense, 
drawn, tired feeling in the ocular muscles. 

While a distinctly left sided headache is the characteristic 
headache of onosmodium yet I have frequently found the 
remedy to promptly relieve a headache of the right side if 
accompanied by the sense of general muscular weakness. 
Whenever you have patients coming to you with that tired 
feeling that is popularly supposed to indicate Hood's Sarsa- 
parilla, always think of onosmodium, as that great muscular 
prostration has always been a keynote to me in the use of 
this drug. 

Given a case of full, heavy pain over the left eye and left 
side of the head extending down into the occiput, together 
with a general feeling of muscular weakness, and onosmo- 
dium will relieve your patient every time. We will find the 
same dull pain in the left side of the head extending down 
to the occiput under cimicifuga, but that general prostration 
of onosmodium is lacking. 

Ruta is another most excellent remedy for these asthe- 
nopic cases. The ruta patient, however, complains more of 
a sense of heat and aching in and over the eyes with a blur- 
ring of vision and the letters in reading seem to fun to- 
gether. It seems to be more useful in cases of accommoda- 
tive asthenopia due to weakness of the ciliary muscle. 
(Natrum mur. on the other hand is of more service in asthe- 



IQOI Onosmodium Virginiattum in Headache. 123 

nopia due to weakness of the internal recti muscles). The 
ruta patient, however, complains more of the eyes them- 
selves, having no characteristic headaches and is also without 
the prostration of onosmodium. 

Senega closely resembles onosmodium in the feeling of 
general weakness, though perhaps not as great a feeling of 
prostration as the latter. Its eye and- head symptoms are 
not as pronounced and seem to be more frequently referred 
to the right side. Senega has been of very marked service 
in cases of paralysis of the superior and inferior recti 
muscles. 

The symptoms of onosmodium are always worse on the 
left side, yet frequently the dull, heavy occiputal headache 
when associated with a heaviness and dullness of the eyes, 
will promptly disappear from its use. All the characteristic 
pains of this drug are of the dull, heavy, sore, aching variety 
which indicates the sphere of the remedy to lie in the head- 
aches and strained feeling of the eyes from over use. It is a 
remedy that I never think of in inflammatory troubles of the 
eye where the pains are apt to be more severe, sharp, cutting, 
etc. 

The use of the remedy can, perhaps, be better indicated 
by one or two illustrative cases, as for example : Miss S. 
complained of a tired, strained feeling of the eyes followed 
by a dull, heavy headache at the occiput coming on after a 
few minutes* use of the eyes. Examination showed the 
vision to be but slightly hyperopic, but there was a decided 
exophoria, or insufficiency of the internal recti muscles. 
Exercise of the weakened muscles with prisms was advised, 
but as she was unable to follow up this treatment at this 
time onosmodium was given. One month later she reported 
that the medicine gave her very decided relief as long as it 
lasted. She was given another prescription with the same 
result, and continued on in this way for several months, when 
she was finally able to follow up the prism treatment with a 
permanent cure. In this case, while the remedy could not 



1 24 The New England Medical Gazette » Mar., 

cure the cause of her headaches, I am sure it gave her very 
great relief until such a time as she could undertake the 
necessary treatment to a permanent cure. 

Mr. J. B. H., bookkeeper, came to me for a constant dull 
aching pain over the left eye. He had suffered from this 
pain almost continually for two years. Had consulted two 
oculists before coming to me, each of whom had given him 
new glasses which would relieve him for a short time. This 
had been going on so long that, as he expressed it, he was 
all played out, felt tired and weak and as though he could 
hardly go through his day's work. At times slight attacks 
of vertigo, and by evening an all gone, prostrated feeling. 

He was wearing at the time cross cylinders for mixed 
astigmatism. My examination showed a lower degree of 
myopic astigmatism than the glasses he was wearing. 

Believing all the trouble to be due to a spasm of the 
accommodation, I refused to change his glasses until an ex- 
amination under a mydriatic. As he was unable to give up 
his work at that time in order to have such an examination 
made, and as the indications were so clear for onosmodium, 
I consented to prescribe for him temporarily, with the agree- 
ment that he should have an examination under atropine as 
soon as he could take a week's vacation. Under onosmo- 
dium the temporal pain was relieved, and he was able to 
continue his work for three months in far better shape than 
he had been before. At the end of this time examination 
showed it to be a case of simple hyperopic astigmatism, and 
a change in his glasses made a new man of him. 

One other case, that of Miss L. A., who consulted me 
for a left sided headache, a heavy dull aching pain extending 
from over the left eye down to the occiput. The whole left 
side of the head felt sore to the touch. She was weak, 
anaemic and low spirited. I. could discover no cause for her 
headaches in the eye, and simply prescribed onosmodium. 

This gave her very prompt relief of her headaches, and 
subsequently she informed me that since taking the remedy 



190 J Uterine Fibroids. 125 

she had been relieved of a dysmenorrhoea that had troubled 
her for a long while. 

In speaking of this case to my friend, Dr. Custis, of Wash- 
ington, he told me that he had frequently found onosmodium 
a most excellent remedy in uterine disorders. 

This latter point may be well known to you all, but would 
call your attention to it again. 



UTERINE FIBROIDS FROM THE PRACTITIONER'S 
VIEW POINT. 

KY C. FOKRKST MARTIN, M. 1). 
[Kead before Mass. Horn. Med. Society Oct. lo, 1900.] 

About six weeks after my Alma Mater had granted me a 
diploma, and the State of New York a license to practice 
the healing art, I was called in great haste to stop a haemor 
rhage from a woman of 54, who had just arrived for a visit 
to the village where I had opened an office. While she was 
yet upon the cars severe abdominal pain set in, followed by 
profuse flowing. 

This became so bad that she fainted, and, as she was 
obliged to travel nearly five miles in a hack after leaving the 
train, she was almost moribund when I reached her. Exam 
ination showed a tumor the size of an average fcetal head, 
presenting in the os uteri, around the edges of which a 
steady flow of blood persisted. Hot douches, gauze packing, 
abdominal counter-pressure and secale internally gave tern 
porary relief and time to collect my wits, and the following 
morning I did my first operation. 

A dining room table, two neighboring physicians, a small 
pocket case of instruments, a pair of obstetric forceps, and 
two heavy curved needles, which I was fortunate enough to 
find in the office of one of my assistants, and a piece of 
rubber tubing, constituted my working force and armamen- 
tarium. 



126 The New England Medical Gazette. Mar., 

The obstetric forceps proved very useful to deliver the 
tumor, which was done after the true obstetric fashion — the 
uterus, however, being inverted in the process. The pedicle 
proved to be one and one-half inches in diameter, and 
attached at the fundus. This pedicle and the surrounding 
mucous membrane were carefully cleaned, and the two 
curved needles were then inserted through the pedicle at 
right angles to each other, after long silk threads had been 
tied in the eye of each. Their points were covered with a 
piece of cork wrapped in gauze, and the rubber tubing was 
tied tightly behind the crossed needle. It broke ! Tied 
again ! Broke again ! The third time it held as I had by 
this time taken its measure. The tumor was now cut off, 
the stump cauterized with a kitchen poker heated in the 
coals, a large packing of iodoform gauze was put over it, and 
the uterus carefully turned ** inside in ** again and replaced. 
W^en I found an artery of considerable size entering the 
tumor, I trembled for my improvised elastic ligature. But it 
held ! Most of the packing was removed on the third day 
to allow the uterus to contract, and the remainder on the 
fifth day. One needle came away on the fourteenth day, 
and the other on the seventeenth, gentle traction having 
been used for several days previous. The stump sloughed 
off with no haemorrhage. The patient sat up on the twen- 
tieth day and in two weeks more was about the village. In 
the fall she returned to her home here in Boston, practically 
well, and she is here yet. 

This was my first introduction to fibro-myoma of the 
uterus. Because of neglect on the part of this woman's 
physician, to carefully examine and diagnose the existing 
condition when repeated haemorrhages had occurred, she 
was sent by him on a 400 miles' journey which might easily 
have proved fatal. It is the belief that many such cases are 
being daily overlooked that prompts me to touch upon this 
well worn topic today. It is a subject concerning which the 
writings and discussions have been very voluminous. 



I901 Uterine Fibroids. 127 

It is a big theme, and I am not so ambitious as to attempt 
to discuss it from all its aspects. Then let us dwell only 
upon those phases of the topic which the general practitioner 
is liable to run up against in his daily work, and particularly 
try to bring out some of the diagnostic points which will 
sen'e to assist him in avoiding error. I may offer nothing 
that is new, and to the surgeons who are handling such 
tissues daily, there will be no interesting features in the 
specimens that I have prepared.. But I trust there may be 
a few here to whom they will offer a clear illustration of the 
points under discussion. Recently, in a single week, the 
three cases I will now briefly outline, came up in the ordi- 
nary course of my every day practice. None of them con- 
sulted me as a surgeon, and not one suspected that any such 
trouble existed when they came for advice. 

Case 2. — Miss T., age 55, history of good health until 
eight years ago, since which time there has been much 
uterine pain and very profuse haemorrhages at the menstrual 
epochs, which still continue to come every three weeks. 
Has been curetted eleven times by six different phyScians. 
Examination showed a uterus with a small cervix, but much 
elongated and tortuous canal, and increased firmness to the 
touch in the uterine body. Diagnosis — fibroid uterus, and 
operation for extirp^ition advised. Operated May 8 without 
special incident, and the sample marked No. 2 shows the 
conditions found. You will notice that the entire uterine 
wall is converted into fibroid tissue. The various kinds of 
tumors are also well illustrated. With this exhibit are also 
two cysts which were dissected off from the surface of the 
ovaries. The latter appeared normal, and hence were left in 
place in accordance with conservative methods. I shall 
refer to this case once more later. 

Case 3. — Mrs. S., age 31, married ten years, one child 8 
years old, and a severe labor. Never pregnant since. Al- 
ways menstruated regularly and usually profusely. In Octo- 
ber last had an unusually profuse menorrhagia lasting ten 



128 The New England Medical Gazette. Mar., 

days. Each month since then this has been repeated. I 
was called Sunday, April 29, and found her in pain and 
blanched from loss of blood. This had been coming away 
in cupfuls, as she described it, for two weeks. 

Examination showed os dilated to the size of a quarter, 
and a round mass of firm consistence in the opening. Under 
anaesthesia the cervix was split on one side, and the tumor, a 
pediculated sub-mucous fibroid, pulled down, its pedicle 
pierced with a needle threaded with strong silk, tied and cut 
off. 

No arterial circulation was found entering the tumor, as 
you see. Cervix was sewed up and uterus elevated to place. 
Recovery was prompt, and since the operation the menstrua- 
tion has been perfectly regular, painless and normal in 
amount. 

Case 4. — Mrs. G., age 41, mother of two children, 10 and 
8 years old. Never pregnant since, though very desirous of 
having children. Very profuse menstruation lasting ten or 
twelve days, and coming as often as every three weeks for 
the pa^t six years. Has had no treatment for it. No men- 
struation since February, and she considered herself as preg- 
nant. May 8 taken with flooding worse than ever. Exam- 
ination showed shreds, resembling early foetal substance. 
Prepared to dilate and curette. Found a broken up foetus 
and many large clots to remove, and a distorted cavity. 
The finger touched a round, hard mass within the cavity. 
Tenaculum forceps were applied and the specimen marked 
No. 4 was removed. The uterus was now thoroughly cureted 
and washed out with H,.0,. This seems to be an intersti- 
tial fibroid which has been entirely extruded into the cavity 
by muscular contractions, and there acted as a foreign body, 
preventing the existing pregnancy from continuing to term. 
Recovery in this case was prompt and has been followed by 
regular and normal menstrual epochs. 

Now, I would not be understood as advocating operation 
for every case of uterine fibro-myoma, or even for the major- 



I go I Uterine Fibroids, 129 

ity of cases. There are unquestionably thousands of them 
which are never suspected until their presence is discovered 
accidentally, in examining or operating for some other condi- 
tion. But I have tried to illustrate the fact that operation is 
the thing, and the only thing, for many of these cases. And 
I would urge a full and thorough examination in every 
patient who presents the symptoms which characterize this 
disease. Unless this is done, many cases will be prescribed 
for as simple functional menorrhagia, or what is more likely, 
unless the physician is on the alert, the patient will lay the 
whole thing to the •* change of life," and accept the suffer- 
ing, as I know that many women do, as something which it 
is their lot to bear at this age. 

Menorrhagia and all such troubles should be considered 
solely as symptoms and not as diseases, and the conditions of 
which they are only a part should be conscientiously sought 
for. 

In describing these tumors there is considerable confusion 
of terms. As we are seeking for a clear understanding of 
their nature, a little definition work will not prove amiss. 
" The tumors of the uterus commonly known as fibromas, 
myomas, fibro-myomas, or simply as fibroids, consist of the 
same histological elements as the uterine walls themselves, 
viz. : unstriped muscular fibres and connective tissue. The 
proportions vary largely. If mainly muscular, we have the 
pure myoma. If connective tissue predominates, either pri- 
marily, or as a result of secondary fibrous induration, we 
have the fibroma. The latter class is far the more common. 
The former will grow much the faster. As a practical fact, 
the two tissues are almost invariably combined, and a dis- 
tinct division into fibromas and myomas is not advisable." 
The English writers have a habit of speaking of "white 
fibroids," and of "red or fleshy fibroids," terms which seem 
to convey our meaning readily. The latter are more richly 
supplied with blood vessels. The former are more distinct, 
and inclosed in a sort of capsule, and are hence easier to 



1 30 The New England Medical Gazette. Mar., 

remove. The anterior and posterior uterine walls are the 
commonest seats, then the fundus, lateral walls, and more 
rarely the cervix. The original position has a marked in- 
fluence upon the future course and growth, and also upon 
the development of troublesome symptoms. 

In examining a patient where any trouble of this character 
is suspected, I would urge that not only the bi-manual touch, 
in the usual locations of vagina and abdominal wall should 
be used, but that the rectal exploration should be added. 
Sub-serous or intra-ligamentous fibroids will often be discov- 
ered in this way which have entirely escaped the finger in 
the vagina, and their shape and consistency, and relations to 
the uterus and ovaries much better outlined. 

Now let us look a little farther for diagnostic points which 
will help to a clear understanding of what our examinations 
should reveal. The concensus of opinion is that these 
tumors usually grow very slowly. They usually cease to 
grow, and may even atrophy, after the meno-pause. But in 
this connection another point is worth remembering. This 
is that their presence in the uterine substance retards the 
date of that event. Five years has been claimed by some 
writers as the average additional period of menstruation, due 
to this cause. 

The two symptoms which most frequently CcCll our atten- 
tion and indicate operation for fibroids are haemorrhage and 
pressure. When haemorrhage occurs from a fibroid uterus, 
it is probably never from the tumor itself, but from the 
hypertrophied and diseased mucous membrane. This condi- 
tion arises from pressure, and we thus see how the pressure 
and haemorrhagic symptoms are corelated. From the same 
cause muco-purulent discharges between the haemorrhages 
are frequently present. Barring these two symptoms of 
pressure and haemorrhage, the mere presence of these 
tumors causes little trouble, unless degenerative or inflam- 
matory changes set in. Sarcomatous degeneration is rare, 
but probably well proven. Calcareous degeneration is com- 
mon. 



I go I Uterine Fibroids. 131 

Oedema in the tumors, especially the soft variety, is not 
unusual, and inflammatory attacks often occur. The latter 
probably originate, not in the tumor, but in its peritoneal 
covering or mucous capsule. 

Interstitial or mural fibroids are situated entirely within 
the muscular walls of the uterus. These may push out into 
the abdominal cavity and become sub-serous, or into the 
uterine and become sub-mucous. The latter usually have a 
distinct root or pedicle, but may be entirely extruded and 
covered only by mucous membrane. Cases 3 and 4 illus- 
trate these two varieties. Now, when these sub-mucous 
fibroids begin to be extruded into the uterine cavity, they 
act as does any other foreign body in that locality, and set 
up muscular contractions in its walls. They are thus forced 
in the direction of the least resistance, into the cervix. 
Should the pedicle be a strong one, and of high attachment, 
the uterus may thus be inverted by its own efforts. This 
procedure has been dubbed " the birth of the polypus." 

Increased depth of the uterine cavity, and marked dis- 
placements of its body are common results of fibroid growths. 
The canal of the uterus shows these various flexions, as well 
as the protrusion of the various nodules into its lumen. For 
these examinations I have found the Jennison's sound very 
useful, but all sounds must be used with the utmost caution 
in these cases, as injuries of the delicate capsule may lead to 
a sloughing of the tumor later on from interference with its 
nutrition. 

The sub-serous variety may reach a considerable size be- 
fore any symptoms are apparent, as they have much space in 
which to develop. And in this connection a point worth 
remembering is the tendency which they have, in their 
upward growth, of drawing the uterus up with them, greatly 
lengthening its cavity at times. The cervix may thus be 
pulled beyond the reach of the examining finger. On the 
other hand, if the tumor is small and the pedicle a long one, 
the bunch may be found low in the cul-de-sac, while the 



132 The Nexv England Medical Gazette, Mar., 

original attachment is high up on the fundus. This variety 
often becomes immovably wedged or adherent, and very 
troublesome. It is very easy to mistake an adherent fibroid, 
in this location, for a sharply retro-flexed uterus. Here the 
sound and the rectal examination will clear up the condition. 

The cervix, too, may be the seat of origin of either sub- 
mucous, sub-serous, or mural fibroids, and they are apt to be 
an especially troublesome variety, particularly in case of 
pregnancy. They do not have to grow very large at any 
time, before pressure symptoms appear. When sub-mucous, 
they push readily into the vagina, and if large, even through 
the vulva, and are liable by their weight to pull the uterus 
well down. The bunch must not. be mistaken for a pro- 
lapsed or inverted uterus, a blunder which has frequently 
been made. It may be of interest to note here that the 
opposite error has been made, and an inverted uterus cut off 
for a polyp. The patient recovered ! 

So long as the interstitial or sub-mucous tumors remain 
small, the only change that we may be able to detect in the 
feeling of the uterus, will be a slight enlargement and more 
globular form, and some increase in consistency. We thus 
have a condition at this stage which presents the picture of 
chronic metritis. When the tumor is located near the os, 
the vaginal portion of the os is much shortened as a rule. 
The direction of the cervical canal may help us to locate our 
tumor in these cases, as the growth occupying one lip, will 
naturally push the opening towards the opposite side. Evac- 
uation of the bladder with a catheter will prove a help where 
extensive examination is to be made. It must be remem- 
bered, too, that fibrorpa may be located in the bladder wall 
itself, and closely simulate an ante-verted uterus. I have 
recently seen such a case, where the fibroid was three inches 
in diameter, and apparently had never had any uterine 
attachment. 

I promised a word more aboiit Case 2. She pursued a 
perfectly normal course for eight days, her temperature and 



1901 Scleroderma, 133 

pulse never reaching over 99^ and 85 respectively, after the 
extirpation. She slept well, ate heartily, and the bowels 
and kidneys were working well. On the eighth morning fol- 
lowing the operation she took a glass of milk at 7 a. m., at 
which hour she waked from a perfect night's rest. At 7.05 
she called for the bed pan and had a natural stool. At this 
time she joked and laughed with the nurse, and expressed 
herself as feeling well. At 7.15 a nurse passing her door 
heard heavy breathing, entered, and found her unconscious. 
At 7.20 she was dead. One pupil was widely dilated and 
one contracted, and the face was drawn to one side. 

Evidently a cerebral embolus had done its work suddenly. 
Friends of this patient informed me after her death, that she 
had suffered from a '* shock " and paralysis of one side seven 
years ago, and had entirely recovered. She made no n)en- 
tion of this fact, either to me or to the house physician, and 
there was nothing in her condition to show it. We both 
made careful physical examinations before suggesting anaes- 
thesia. The possible connection between this cerebral clot 
and the sudden stopping of her previous haemorrhages by the 
operation, may be a profitable field to speculate in, but I 
firmly believe that she would. have died without the operation, 
and that it in no way influenced the date of death. Never- 
theless, a spirit of fairness compels me to report failures as 
well as successes. 



SCLERODERflA. 

BY JOHN H. URICH, M.I)., HUSTON, MASS. 

The word is partly of Greek and partly of Latin origin — 
Skloros — hard, dry, and derma, skin. 

Scleroderma is usually described by neurologists and der- 
matologists, but the diffuse form is perhaps more frequently 
seen by the general physician whom the victim consults for 
rheumatism or disability. The disease is fortunately rare. 



1 34 The New England Medical Gazette, Mar., 

The pathology of the disease is fully discussed in the works 
on dermatology, yet we know really nothing of the essential 
causes, and the data are not yet at hand upon which a satis- 
factory theory can be based. The disease is variously re- 
garded as a tropho-neurosis dependent upon changes in the 
nervous system ; a perversion of nutrition analogous to 
myxoedema, due to disturbance of the thyroid function ; a 
sclerosis following widespread endarteritis. The first of 
these theories is the one most generally held. 

Symptoms. 

Rheumatismal pains and cutaneous sensations of tingling, 
pricking and formication, muscular cramps and neurotic 
sensations may precede the outbreak of the disease. There 
are two stages characteristic of this disease : The perjod of 
infiltration, where the oedema is firm, involving the subcu- 
taneous tissue, and at first pitting, upon strong pressure, with 
finger, but later becoming so indurated and tense as hard 
leather. The face is expressionless. The lips are opened 
with difficulty. The chest, shoulders and arms are either 
immobile or movable with great difficulty. The abdominal 
surface is seldom attacked. This condition may come on 
very insidiously, and may require months or years for its full 
development, or the progress may be rapid. The upper ex- 
tremities are sometimes so affected that the fingers resemble 
curved talons. The helplessness of some patients is so ex- 
treme that they require to be dressed and fed, even when 
they can travel with relative comfort. 

The second or atrophic stage : The oedematous or infil- 
trated areas undergo induration and contraction. The skin 
becomes more tightly drawn over the underlying structure, 
and becomes dry, scaling, fissured, or ulcerated ; muscles 
waste considerably. The teeth may fall. The fingers may 
be permanently flexed into the palm, or forearm on arm. 
Patient who may have enjoyed a fair degree of health, now 
suddenly experiences rheumatical pains and neuralgias, ma- 



1 90 1 Scleroderma, 1 3 5 

rasmiis takes place, which frequently ends fatally with renal, 
cardiac, or pulmonary symptoms. 

report of case of scleroderma recurring anthri- 

tis before onset tubercular complication. 

Family History. 

Miss B., age 52. — Father died at 79 of apoplexy. He 
was in active business during greater portion of his life, but 
was almost totally disabled from muscular rheumatism. A 
brother — the only other member of family — has rheumatic 
gout. Two of father's brothers still living disabled from 
same disease. 

Mother's family very intellectual. Mother died of a 
disease similar to the one to be described. 

Personal History. 

I knew this lady personally for about twelve years, and 
excepting occasional attacks of rheumatism and neuralgia, 
she apparently enjoyed most excellent health. Her weight 
was 185 pounds; florid complexion. She said many times 
during her final illness that she never knew what sickness 
meant. She was inclined to worry a great deal. 

Present Illness. 

Although her declining health covered a period of about 
four years, during two and one-half years of this time, there 
were no particularly marked symptoms indicating any alarm- 
ing condition. The most prominent indication of failing 
health was the gradual emaciation, yet so insidious was this 
condition that instead of causing fear on the part of patient, 
she was somewhat delighted to think that she was becoming 
reduced in flesh, in many respects feeling more comfortable. 
The only other noticeable feature during these two and one- 
half years, were the more frequent attacks of neuralgia and 
rheumatism, usually confined to left shoulder and right hip. 



1 36 The New England Medical Gazette, Mar., 

The attacks were usually brief and the suffering conse- 
quently mild. 

From this time on the disease made more rapid progress. 
During the fall of '98 there was hardly a day but that patient 
did not experience some pains of the character mentioned in 
both arms, chest and right leg, attacks lasting from several 
days to a week, during which time she had to remain quiet. 
The joints were frequently hot and sore, but no swelling. 
During the intervals of these attacks, lasting from two to 
three weeks, she was able to be about. Considerable stiff- 
ness resulted from these attacks. About this time a cough 
developed, which continued nearly during remaining period 
of disease, accompanied with profuse expectoration. Micro- 
scopical examinations revealed no tubercle bacilli, but tissues 
from bronchial tubes and large quantities of saliva. There 
were occasional attacks of fever. It might also be of in- 
terest to note that up to this time, menses appeared at regu- 
lar intervals of three weeks, at the age of 52. During the 
spring of '99, when the warm weather approached, there 
was some improvement, so much so that she decided to take 
a western trip to see whether she might possibly derive 
some benefit. She remained in California eight weeks, re- 
turning in August in worse condition than when she left. 
Still not satisfied, she went to Vermont to visit some rela. 
tives, thinking that possibly it might do her some good. She 
remained about three weeks, returning in September in still 
worse condition. 

The symptoms now began to look more alarming. At 
this time the menses suddenly stopped, and with the suppres- 
sion of menses, there began an attack of arthritis, assuming 
a different form from any previous attack. Intense pain 
began on ulnar side of right wrist, extending through car- 
pal articulations, involving especially the carpo, metacarpal 
articulation of thumb. Swelling immediately followed oedema, 
extending over entire back of hand and fingers, being most 
marked along course of pain. Immediately over the seat of 



1 ^ I Scleroderma, 1 3 7 

pain, the skin was red, while other parts were white, easily 
pitting upon pressure, shiny, moderately tense. Simulta- 
neously with the swelling in hand, a similar condition began 
in torsal articulations of right foot ; the principal swelling 
being towards the median line about midway between in- 
ternal malleolus and torso, metatorsal articulation of great 
toe, oedema extending over entire dorsal surface of foot, and 
like hand the skin was red and shiny over seat of pain. Two 
weeks later, a similar condition commenced in ankle of left 
foot, swelling covering external malleolus and extending 
along outer side of foot. One week later, the elbow of 
left arm was similarly attacked, swelling extending over 
external condyle. The swelling at this point was most 
marked, as well as pain and stiffness. All four points of 
attack indicated infiltration. As the acute symptoms sub- 
sided, the conditions following were similar. The oedema 
very slowly receding, the skin became shrunken, thinned, 
depressed and scar-like. It was firmly adherent to the sub- 
jacent tissues, excepting at the points where pain began. 
The fingers of right hand were contracted and held in flexed 
position. There was very slight movement in the meta- 
carpo phalangeal joints. The fingers looked thin, the skin 
was drawn, smooth and glossy, and could nowhere be picked 
up. The skin became so tightly drawn over these points, 
that the original points of attack appeared so prominently that 
patient would refer to them as ^^ earners htimps^ The most 
marked contraction was in the left elbow, the forearm being 
semiflexed and could not be extended. The movements at 
shoulder joint were limited. The arms could not be lifted to 
level of shoulder. The stiffness did not seem to be so much 
in the joints as in the skin. Patient was finally unable to 
feed herself ; could only with difficulty, by using both hands, 
hold an object. It might be of interest to note that when 
these joint symptoms developed, the cough stopped, and ex- 
pectoration was very slight. There was, however, a continu- 
ous temperature. 



1 38 The New England Medical Gazette. Mar., 

I would like to call particular attention to these four points 
of attack and results following. From the beginning of 
swelling in right hand to the time swelling in the left elbow 
commenced, covered a period of about four or five weeks, 
and although the elbow was the last to begin to swell, it was 
the first to break down, possibly owing to the fact that this 
elbow was the part upon which she was dependent for sup- 
port in changing position in bed. 

The discharge was of a yellowish green color. Microscop- 
ical examination revealed only ordinary pus germs. At first 
it seemed as though it must be a very deep-seated inflamma- 
tory condition, yet- at the very height of the swelling the 
joints were fairly movable, and had no apparent effect upon 
aggravating pain. The reason for this was evident as soon 
as the pus was discharged. Instead of being deep-seated, it 
extended only to the muscular tissue. For a few days 
sloughing ensued until an opening about an inch in length 
and half an inch in width was formed. 

The ulcer did not increase in size, neither did it show any 
tendency towards healing. There was very little discharge 
after the first evacuation. The other points of attack pur- 
sued a similar course. The slowly accumulated pus was 
evacuated ; sloughing ensued for a few days, then remained 
stationary ; discharge very slight. The opening at these 
places had no particular effect upon movement of joints, only 
to say as time passed on, the skin became more contracted 
and stiffness more aggravated. 

The skin of face had a drawn look, particularly about 
mouth, the angles of which were drawn down. The eyes 
could be opened and closed fairly well. There was very 
great restriction of movement of lips and of muscles of face. 
The gums were shrunken so that teeth became loose. 

The skin of right foot was greatly involved. (Just over 
the instep of right foot, at same place where pain began, 
was a red patch, circular in outline, about the size of silver 
half dollar, which had been there about four years. There 



IQOI Study of Materia Medica. i 39 

were no accompanying symptoms). The toes looked thin, 
skin very hard and drawn. The movements, especially in 
ankle, was very much restricted. There did not appear to 
be any special thickening of the joints themselves, but the 
skin over them was glossy and hide-bound. 

Insomnia was the most marked nervous symptom. The 
examination of abdominal viscera was negative. The heart 
was in good condition. The urine had a specific gravity of 
1024, and neither sugar nor albumen was found in it. 
Patient never complained of headache ; never had nausea 
and vomiting, bowels were regular. 

Treatment. 

Treatment was unsatisfactory. At no time was any per- 
manent improvement manifested, although nearly everything 
possible was done in regard to hygienic conditions. Change 
of climate, out-door exercise, massage and electricity were 
employed. Most careful attention to diet was observed. 
Tonics such as maltine and Cod Liver Oil were tried. Many 
remedies were also used, and often they afforded great relief 
but no improvement. Marasmus continued, and ended 
fatally Jan. 29, 1900. 



50MB REMINISCENCES OF THE STUDY OF HATERIA 

MEDICA. 

BY N. R. PERKINS M.D., BOSTON, MASS. 
[Read before Boston Horn. Med. Society, Oct. 9, 1900.] 

The first prescription I ever made was in my student days, 
and it was for a stye. The remedy was pulsatilla. My next 
effort in the healing art was graphites, for a moist erruption 
behind the ears, in a teething baby. Both of these cases 
were soon well with no return of the troubles. My precep- 
tor was a thorough homoeopathist, with him materia medica 
was the back- bone of homoeopathy. A man of firm convic- 



140 The New England Medical Gazette, Mar., 

tions and a fine sense of discrimination, who prescribed his 
remedies after careful study, and the results he obtained I 
have seldom seen equaled. From him I got my first impres- 
sions of materia medica. I refer to Dr. J. H. Jones, of 
Bradford, Vt. In the old Hahnemann of Philadelphia I had 
the opportunity of listening to the lectures of Dr. Hering. 
A few indications as given by him may not be amiss, but 
may bring to mind things we had forgotten, and those who 
had never heard Dr. Hering may get a new stimulus to 
study materia medica on purely homoeopathic lines. In his 
lecture on cofFea he gave the symptoms of severe toothache 
relieved by holding ice cold water in the mouth, while in 
manganium, anything cold makes the toothache worse. A 
one sided headache as from a nail being driven into the head, 
he said, was characteristic. Colic with feeling as if the stomach 
would burst, cannot bear the clothes tight. Colic relieved 
from having the clothes tight, nit. acid. 

In his lecture on cuprum he said it had the greatest 
amount of nausea of any of the metals. Vomiting relieved 
by drinking cold water, vomiting whenjever he moves or 
drinks, veratrum. With cuprum, complaints begin on the 
left side and go to the right (similar to lachesis). Cuprum 
with him was one of the principal remedies in cholera. 

Under the cough symptoms of kali bichromicum, he men- 
tioned the stringy, tough mucus that sticks to the tongue and 
lips and has to be wiped off. Cases of tuberculoses with 
this system as a guide to the selection of the remedy have 
been cured by kali bichromicum, at least the bacteriological 
examination of the sputum before and after has so demon- 
strated. Dr. Hering said that one of the best remedies 
when labor was slow, on account of ineffectual pains, is 
natrum muriaticum. The symptoms of fever blisters on the 
lips in intermittant fever as being an indication for natrum 
muriaticum he underscored as being good. This symptom 
has been verified by many of us. For the cracking of the 
skin under and between the toes, and inflammation under 
the toe nails, the nails grow too thick, he gave sabadilla. 



190 1 Study of Materia Mciiica. 141 

Dr. Hering said all women prone to abortion should cake 
sepia and zinc. He did not say that these remedies would 
keep them away from the abortion shops. Under veratrum 
album he gave these symptoms : cough comes on from drink- 
ing, especially cold water ; escape of urine when coughing. 
He also said look up cantharis in gastric derangements of 
pregnant women, a hint which has helped many times in the 
selection of the remedy. Cantharis, too, he said was more 
useful to women who are sterile. Besides Dr. Hering in the 
Philadelphia school, there was Dr. Lippe, whom Dr. Lilien- 
thal called "the old war horse, grand Count Lippe;" Dr. 
H. N. Gurnsey, who taught characteristics and the use of 
extreme high potencies. He said, one day when considering 
lachesis in diphtheria, when the disease begins on the left 
side and goes to the right, give one dose of lachesis 40m. 
The next day the patient will be worse and will continue to 
be worse for four days, when the patient will be better and 
will recover. He laid particular stress on not repeating the 
remedy while the patient was growing worse. Dr. H. N. 
Martin taught key notes ; Dr. Rowe, pathology and special 
indications, careful close prescribers all, men whose memory 
is cherished by all who received instruction from them. 
When one speaks of materia medica in connection with our 
own Boston University we involuntary think of the lamented 
Dr.* J. Heber Smith. It was in the early years of his teach- 
ing, and perhaps his best years that I learned so much from 
him. We all remember his genial ways, his method of impress- 
ing the symptoms of drugs on our memories. Who will 
forget his description of the diarrhoea symptom of antimony 
crudum } the old man with the alternate diarrhoea and con- 
stipation cannot control himself. He said when you go to 
make the call on that old man, and on getting in sight of 
the house and sec several pairs of trousers hanging on the 
line and remember that you have no ant. crud. in your case, 
your visit will be in vain. And when lecturing on muriatic 
acid he said, in regard to the symptom in typhoid fever, 



142 The Neiv England Medical Gazette, Mar., 

"the patient slides down in bed," that when a patient got in 
this condition he would usually keep on sliding.' He told us, 
too, that ruta would cure housemaid's knee, and that in the 
early years of his practice he was fortunate in having several 
boarding-mistresses that had this affection, and that when he 
had cured one, he felt it incumbent on him to change his 
boarding place for new fields of conquest. 

Cheledonium with him was a great liver remedy, catarrhal 
jaundice, headache from liver trouble. ' He mentioned crot- 
tig as an antidote to rhus poisoning, and the painless, watery 
diarrhoea, he said it came like water from a hydrant. He 
gave these as the skin symptoms of crot. tig., the psoric indi- 
vidual, salt rheum and popular diseases, dandruff,* itching of 
the skin under the beard. I remember especially his speak- 
ing, when lecturing on gelsemium, of one pupil dilated the 
the other contracted. I know today the modern pathologist 
will say that this is due to a brain laision in nearly every 
case and not amenable to treatment. Yet the next case of 
this kind you have try gelsemium and cure it. 

The sensation of a sliver in the throat, and also of a sliver 
in the eye in the morning are hepar symptoms of the early 
provers, verified by Dr. Smith. The snaky tongue, as he 
expressed it, of lachesis, he puts it out quick with a dart. 
All symptoms worse after sleeping. When all symptoms 
are worse at night, mere viv ; and if in connection with this 
there is perspiration, increased amount of saliva in the 
mouth. Of gastric symptoms, bitter vomiting before mid- 
night, mere viv ; after midnight, arsenicum. When children 
who perspire easily involuntarily pass urine at night, mere 
viv. 

Nux moschata was always to be thought of in stomach 
disorders with flatulency, pregnancy, hysteria, especially if 
there was a morbid appetite. The rheumatism of nux 
moschata is relieved by dry, warm clothes, while the rheu- 
matism of rhus is relieved by cold. Gelsemium is the anti- 
dote for poisoning by nutmeg. The name of Dr. J. Heber 



1 901 Study of Materia Medic a. 143 

Smith will always be held in the highest esteem by the 
students of Boston University. Dr. Conrad Wesselhoeft 
was an associate of Dr. Smith. We did not get the witi- 
cisims from him that made the impressions that we did from 
l>r. Smith, but we got the best thoughts from his deep study 
and research. His power of analysis, his way of separat- 
ing the wheat from the chaff and then of giving us only the 
wheat, was what made his teaching valuable. In his lecture 
(m Hell he spoke of the high, piping voice where Lippe gave 
it as " a rough voice with nasal sound." And as a remedy 
in coxalgia with the burning pain in the hip joint, worse at 
night, aggravated by the least contact. And epileptic 
spasms followed by nausea and vomiting would be helped much 
by belladonna. I am a little cautious in saying much in 
regard to Dr. Wesselhoeft's lectures for I know his memory 
is good and he may bring me to task should I misquote him. 
I well remember some good advice given the class by 
Dr. E. P. Colby in regard to the gathering of the leaves of the 
rhus toxicodendron. He had described the plant fully, had 
told us the part of the plant to use, and the right season in 
which to gather it to get the best medicinal effect ; how to 
protect our hands and face, and finally said we had better 
get a boy to gather it for us, especially if the boy might be 
a prospective patient. Dr. Colby always had the wellfare 
of the students close to his heart. And, too, one cannot 
recall the early days of Boston University but there comes 
the memory of a Talbot, a Dr. Gersdorff, a Thayer, a 
Jackson, a Clark. Although they were not connected with 
the chair of materia medica, they were true homoeopaths, 
and as such could not hold within themselves the truth of 
the homoeopathic materia medica and the law of similars. 
In those days I think more attention was given by the 
students to the study of materia medica. Today, with the larger 
corps of professors and advanced methods of teaching, the 
opportunities for study are better, but is there a corresponding 
increase of knowledge of the materia medica } A method of 



144 '^^^ New England Medical Gazette, Mar., 

generalization has crept into our practice ; you, my colleagues, 
and I indulge in it ; and by so doing we are undermining 
that foundation which was laid deep and well by the fathers 
and given us as a heritage upon which to build the super- 
structure, beautiful and perfect in all its lines and propor- 
tions, strong in every portion so that it should be as lasting 
as the eternal hills. Have we kept the trust sacred or must 
future generations wonder where is the house beautiful .^ 



Superiority of Vaginal or Supra-Vaginal Methods.— 
It would appear that most of the opposition against the vag- 
inal method is by men who have had but little experience in 
operating by this route ; hence the arguments are largely the- 
oretical. The vaginal method seems to be especially indicated 
in most cases of carcinoma uteri, in small fibroid tumors, and 
in many cases of pelvic abscess. 

The opposition to this method because the operator can 
not see the structures he is removing will not bear the test of 
practical experience ; for if the operator adopts the correct 
technique and avoids the use of a multiplicity of retractors — 
often using none — he will find that with few exceptions he 
can see every structure he deals with more clearly than he 
can in many cases by the suprapubic route. The selection of 
the method, however, depends upon the nature of the disease 
to be removed, and upon the experience of the operator. 

If all surgeons understood the technique of surgery per 
vaginam as well as they do the technique in operations by 
the suprapubic method, there would be no further discussion 
upon the relative merits of the two methods, each having its 
own legitimate sphere, and in many instances one method 
may supplement the other. — Editorial, American Practitioner 
and Neivs, 



190 1 Editorial. 145 



EDITORIAL. 

Contributions of original articles, correspondence, etc., should be sent to the publishers, Otis 
Clapp & Son, Boeton, Mass. Articles accepted with the understanding that thejr appear only in 
the GoMtiit, They should be typewritten if possible. To obtain insertion the following month, 
reports of societies and personal items mutt at rgctived by the t^k oftk* m^nth prectdmg. 



PENDING LEGISLATION. 

There are at least three matters pending the action of the 
Legislature which should be of interest to every physician. 
First, a bill to permit the granting of diplomas, with degree 
of doctor of physiological optics, by a college where only, so 
far as we are able to learn, is taught that branch of medi- 
cine which pertains to the eye and its diseases. Second, an 
amendment, known as House Bill No. 863, to the present 
law governing registration in medicine, whereby those claim- 
ing to treat persons by clairvoyance, hypnotism. Christian 
science and osteopathy, shall not be exempt from the pro- 
visions of the law as heretofore. Third, a petition, known 
as House Bill No. 936, asking for an . amendment to present 
registration laws, whereby graduates from any legally char- 
tered medical school shall be granted a license to practice 
without examination. It would be difficult to imagine more 
pernicious legislation than that aimed at in the first and third 
of these bills. That embodied in the second proposition 
should have been done long ago, but will probably be put off 
for a long time to come. Such is the inherent passion of 
the public to be fooled, even at a good deal of risk to them- 
selves and the community. Verily, "What fools these 
mortals be." 

The bill to establish a college of physiological optics, with 
permit to grant degrees, is essentially class legislation of the 
worst kind, and is the outgrowth of the pernicious custom 
which has been in vogue for years, of opticians prescribing 
as well as fitting and manufacturing glasses. If there is to 



146 The New England Medical Gazette. Mar., 

be any legislation on this subject it should be to prevent this 
work being done by opticians. Every practitioner of medi- 
cine, who has been properly educated knows, that the vary- 
ing conditions of defective sight, eye-strain, etc., are to a 
very large degree in many cases due to conditions of ill- 
health elsewhere in the economy, which the mere correction 
of optical defects will not cure ; on the contrary, the full cor- 
rection of the optical defect alone will not infrequently 
aggravate existing abnormal conditions. The educated pub- 
lic is just beginning to learn that the proper treatment of 
imperfect or diseased eyes necessitates a proper prescription, 
made not alone from the conditions revealed by examination 
of the eye, but from that supported by an examination and 
knowledge^ of the whole body as to whether it is in a condi- 
tion of physiological equilibrium or not. Such knowledge 
cannot be obtained except by such thorough training as one 
gets in a medical school. Many eyes have been permanently 
injured by glasses prescribed by the optician, and this bill 
will tend to increase rather than diminish the danger. 
Meanwhile some of .our best oculists have difficulty in find- 
ing one optician who can properly make the glasses that are 
prescribed. It is no uncommon thing for glasses to be 
returned to the optician for correction because they do not 
mechanically fulfil the prescription. We would suggest that 
they perfect themselves in their legitimate business. 

House Bill No. 863 aims to enlarge the scope of the 
present registration laws so as to include with those subject 
to its provisions the clairvoyants, magnetic healers. Christian 
scientists and osteopaths. This is much needed legislation, 
but we doubt if the general intelligence of the General Court 
is sufficiently developed along this line to ensure its passage. 
Whenever legislation of this character has been attempted 
in the past, the hearings have been crowded with a motley 
mob, who through able counsel raise a mighty howl that 
personal rights and liberty are being restricted, whereby 
everybody has an inalienable right to employ any person or 



1 90 1 Editorial. 1 4 7 

thing he sees fit to cure his ills ; that it is an effort to estab- 
lish a gigantic medical trust, that doctors only experiment 
on people any way, and kill as many or more than they cure, 
etc., ad libitum^ ad nauseam^ and straightway the Legisla- 
ture is convinced apparently and fails to legislate. 

It does seem strange that such a mighty noise and fustian 
should have any effect on such an intelligent body, but it 
seems that it does. The real point at stake is lost sight of 
entirely. It is not that these people who believe in these 
various tenets of cure should be denied the right or excluded 
frorii the privilege of practising as they see fit, but it is that 
these people should be suflficiently educated, medically, to 
know whether the person coming to them for treatment has 
any disease which is dangerous to the public health, and if 
so, they should be obliged, as is the holder of a medical 
degree, to report the case to the authorities and be subject to 
the same control and penalties. The knowledge that they 
are so able to recognize dangerous ailments can only be in 
evidence by subjecting them to the examination of the State 
Board of Registration, and that knowledge* once obtained, 
and the parties licensed and subject to the control of the 
health authorities. We do not believe the doctor of average 
intelligence cares a tinker's commission whether they cure 
their patients by Christian science, or anything else, or 
whether they cure them at all, so long as they do not by 
their ignorance spread disease. 

House Bill No. 936 is a very sly endeavor to practically 
cripple the present Board 9f Registration entirely. It calls 
for the licensing as a physician by the Board any person 
graduating from a legally chartered medical school without 
any examination by the Board. An examination of the 
reports of the Board of Registration since its establishment 
should in itself be sufficient to convince any fair-minded 
reader that .the proposed amendment is thoroughly bad. 
The experience of the Board shows conclusively that practi- 
cally bogus medical schools acting under a legal charter have 



148 The New England Medical Gazette. Feb., 

been possible even in Massachusetts, and that some of the 
medical schools of good repute and standing, do somehow 
graduate students who, in subsequent examination by the 
Board of Registration, show themselves totally unfit to hold 
a degree. The very fact that this legislation is asked is in 
itself suspicious and contains within itself the germ of its 
own destruction ; for if the " legally chartered medical 
schools " educate and graduate students up to the standard 
that they ought, no graduate will hesitate a minute in being 
perfectly willing to be examined by any suitable board of 
examination. It is only those improperly and imperfectly 
qualified who are afraid to appear before the State Board, 
and this legislation is designed to help them. The gist of 
the whole business is that those qualified have no fear of the 
examinations Those unqualified, whether graduates of medi- 
cal schools or not, have no business in the profession. Wc 
believe the present Board of Registration in Medicine has 
done and is doing thorough, conscientious, valuable work, and 
they should be cordially and heartily supported by every 
physician in the State. We urge, then, that each of our 
readers in Massachusetts make it their duty at once to see 
his or her representative to the General Court, and endeavor 
to interest him in these various matters pertaining to medical 
legislation, that he may be persuaded to look thoroughly into 
them, and judge of them fairly on their intrinsic meritsi 
according to his best intelligence. 



THE INSTITUTE MEETING. 

We are in receipt of a circular from the Executive Com- 
mittee of the American Institute asking for votes on the 
most desirable location for the next meeting. 

Wc supposed the matter was all settled by vote of the 
Society, but from the circular it seems the Executive Com- 



. igoi Editorial, 149 

mittee were given discretionary powers, but notwithstanding 
feel, rather delicate about exercising their discretion, and so 
want a new vote of the whole Society to back them up. 
Their chief contention seems to be that because of the 
proximity of the Buffalo Exposition, the hotels at Niagara, 
the place selected by the Society, will be uncomfortably 
filled, and besides the Pan-American Exposition will prove 
too attractive for the good of the Institute. We supposed 
that Niagara was chosen at this time partly on account of 
the Exposition, so that both could be enjoyed at same time. 
We still believe Niagara to be the best place, and that the 
proximity of the Exposition will attract many members to 
the Institute who would otherwise stay at home. 



OBITUARY. 

Dr. Henry F. Batchelder died February 15, at his home 
on the corner of Locust and Oak Streets, from cerebral 
meningitis, the development of a severe attack of the grip. 

Dr. Henry F. Batchelder was born in Middleton, Oct. 10, 
1 860, being descended from Joseph Batchelder, who came to 
this country in 1636, the Batchelder ancestry being of the 
oldest and highest standing recorded in genealogy. He was 
the son of John A. and Laura A. Batchelder. He was edu- 
cated in the Salem public schools, graduating from the high 
school in that city in 1879, and in Boston University Medi- 
cal School, where he obtained the degree of C. B. (Bachelor 
of Surgery) in 1882 and M. D. in 1883. 

He began practice in his native town and shortly after- 
ward came to Danvers, where his recognized skill and great 
popularity secured for him an extensive and high class pat- 
ronage. He had been a member of the school board for six 
or seven years, and belonged to Amity Lodge of Masons, 
Holten Chapter, Winslow Lewis Commandery and other 



150* The New England Medical Gazette. Mar., 

fraternal organizations. He was a member and has been an 
officer in several medical fraternities, including the American 
Institute of Homoeopathy, Massachusetts Surgical and 
Gynaecological Society and Essex County Homoeopathic 
Society. He was Republican in politics, but was never 
actively partisan. On April 30, 1884, he was married to 
Miss Caroline E. Taft, of Dedham. 



Physiologic Action of Senecio Jacob.^.. — J. L. Bunch, 
London, reports in the British Medical Journal oi September 
28, 1900, the results of his experiments with this drug upon 
dogs, illustrating his text with several tracings, showing the 
effect upon the heart and carotid artery. His conclusions are 
as follows : (i) Injection of an alcoholic extract of the entire 
plant into the circulation of a dog, in small doses, causes a 
rise of general blood pressure, with constriction of peripheral 
vessels and of vessels of the intestinal area. This effect is 
accompanied by a diminution in the magnitude of the con- 
tractions both of auricle and ventricle. (2) Large doses 
(0.8-1.0 gm. for a dog of 7 kilos) of the drug cause a fall of 
general blood pressure with dilatation of the intestinal blood 
vessels and inhibition of the contraction of the intestinal coat. 
(3) After several injections of small doses, or after one large 
dose of the alcoholic extract, further injections produce a fall 
of blood pressure, with slowing of the heart, and this effect is 
repeated unless a considerable interval is allowed to elapse 
before any further injection of the drug, which then again 
causes some rise of general blood pressure. (4) The entire 
plant therefore contains two substances with distinct physio- 
logic actions ; but they have not been isolated. (5) Watery 
extracts of the residue obtained by evaporating the alcoholic 
extract produce a fall of blood pressure and cardiac inhibition 
due to the action of the drug on the nerve terminations in 
the heart and not to direct action on the muscular fibres of 
that organ. (6) The substance which causes a rise of blood 
pressure is not contained in such watery extract, or, if pres- 
ent, only in small quantities. — Medical Review of Reviews. 



IQOI Societies. 151 

SOCIETY REPORTS. 



BOSTON HOnCEOPATHIC MEDICAL SOCIETY. 

An adjourned meeting of the Society was held at the 
Boston University School of Medicine, Friday evening, Jan. 
18, 1901, at 8 o'clock, the President, T. Morris Strong, M. D., 
in the chair. 

The President stated that the change in the date of the 
meeting had been made by the executive committee, because 
one of the speakers could not be present on Thursday even- 
ing. 

SCIENTIFIC SESSION. 

Dr. David W. Wells exhibited a microscopic section of a ' 
myopic eye, mounted in a peculiar way in glycerine jelly, by 
Dr. Swan, of Chicago, and showing the diseased conditions 
with the iris pressed forward. 

Report of the Section of Sanitary Science and 
Public Health. 

Fkank E. Ai.kard, >f« n., Chairman. 
Chas. L. Fakwbli., M. D., Secretary. H. D. Bovn, M. I)., Treasurer. 

1. Milk Inspection of the State Board of Health. Albert 
E. Leach, analyst of the Massachusetts State Board of 
Health. 

2. Modified Milk. Halsted Yates, Walker Gordon Labo- 
ratory. 

3. Milk from Producer to Consumer. Simeon C. Keith, Jr., 
bacteriologist, H. P. Hood & Sons, Milk Contractors. 

4. Milk Direct from Dairy to Consumer. H. G. Jordan, 
Jordan Farm, Hingham, Mass. 

"Milk Inspection of the State Board of Health." Mr. 
Leach stated he knew all were familiar in a general way with 
the fact that the quality of milk supply is looked out for by 
various systems of state and municipal inspection, but sup- 



152 The New England Medical Gazette. Mar., 

posed it could be assumed that all were not familiar with 
what the Board of Health is doing along this line. Massa- 
chusetts was the first state to engage in the systematic 
inspection of food and drugs, and, indeed, was for many 
years the only state, now there are five or six others, New 
Jersey, Pennsylvania, Michigan, Wisconsin and Ohio. A 
great many have laws by which the adulteration of food con- 
stitutes a misdemeanor, but in 1883 the State Board of 
Health first began the systematic inspection of drugs and 
foods. An appropriation of $11,500 was made to carry on 
the work, and has been appropriated every year since, and 
with the exception of one or two years the work has been 
done within the appropriation. Chemical work was then, 
and was for many years, done by private laboratories ; but in 
1892 it was thought best to combine all the chemical part of 
the work under one head, and a laboratory was put up for 
the use of the department, temporarily, in the Harvard Medi- 
cal School, and later in the Columbia Theatre Building ; for 
the last six . years the work has been done at the State 
House, where there are good arrangements for doing it. 
Three-fifths of the appropriation has been spent in the collec. 
tion and examination of milk and milk products, such as 
cream, condensed milk, butter and cheese. 

In 1883 the number of samples of milk inspected amounted 
to only 218, and at that time 84 per cent, were found to be 
below the standard, while at the present time 6,000 to 7,000 
samples are examined with a ratio of 28 per cent, below the * 
standard. 

There are three collectors, or inspectors, whose duty it is 
to travel through the state and buy in the open market milk 
which they bring in for inspection. They divide the terri. 
tory among them, and their visits are made at irregular 
times. Each inspector is provided with a large box, which 
will hold fifteen to twenty-five half-pint jars, in which the 
samples are put. He means to be on hand when the milk- 
men are going their rounds. Though authorized to take the 
milk, it is generally purchased, as that establishes a sale. A 



IQOI Societies. 1 53 

record is made in a book of the number assigned to each 
sample. He also visits stores, purchasing milk and drugs, 
arriving at the office before the middle of the day. 

Precautions are taken to render all liability of tampering 
with the samples impossible, so he can testify that no one 
has had access to them. As the samples are designated by 
number only, the chemist does not know when or where 
they were obtained, and, therefore, is perfectly unbiassed 
and can testify truthfully. After analysis, he reports result 
to the State Inspector. If it is the first offence, or there are 
extenuating circumstances of any sort, the milk man is noti- 
fied that his milk is below the standard, and that a repetition 
will make him liable to be brought into court. If prosecu- 
tion is decided upon, inspector and analyst go into court ; 
the two conduct the case, as a rule, without the aid of a 
lawyer, because the long experience of the inspector in the 
work (ten to sixteen years) makes him familiar with the laws 
governing adulteration. The inspector takes milk also from 
the stores and from producers, and sometimes he takes milk 
of known purity. Such samples were taken before fixing 
the standard, which has been criticized as being very high 
and as higher than elsewhere. The usual standard now is 
iii per cent, solid matter (at first it was 13 per cent); in 
May and June 12 per cent. The legislature has fixed the 
standard for six months of the year from October to March, 
inclusive, 13 per cent. ; April to September, inclusive, 12 per 
cent. The standard is high and there is no question, but 
there are cows which give milk below this standard. Milk 
from a mixed herd is almost sure to be above the standard 
fixed by law. The ratio in the laboratory does not represent 
the fair condition of common milk, especially samples taketi 
in December and June. 

We analyze samples of milk both for solids and fats with a 
view to averaging the results and noticing what they will be. 
The analysis of 403 samples of milk, brought in from twenty- 
five cities in December, showed an average of 13.2 per cent, 
solids, and the 99 samples from towns an average of 13.4 per 



1 54 ^^^ Neiv England Medical Gazette. Mar., 

cent., both well above the standard. In June 311 samples 
from the cities averaged 12.67 per cent., those from the 
towns averaged 12.65 per cent. In making the averages, if 
the winter and summer months are taken together, the 
mean would be almost exactly 13 per cent. 

Until 1900 all samples of milk, which were below 'the legal 
standard, were considered adulterated, no distinction was 
made between foreign ingredients and deliberate watering. 
The minimum fine for the first offence is $50, second offence 
5100, and fine and impri.sonment for subsequent offences. 
Now milk has got to be below the very lowest figure before 
it is considered adulterated. Beside watering and skimming 
we have the addition of foreign substances, usually added for 
preserving or for coloring. As a usual thing, milk is colored 
to conceal evidence of water. It is first watered, then col- 
ored. Annatto is the coloring matter used, giving the milk 
a cream-like appearance. Lately a vegetable color is used 
Caramel has been used for a long time, but it is not an ideal 
color, as it is too dark. Two drops will give an intense color 
to a quart of milk. For five years a record of colored milk 
has been kept; out of 151 samples less than one per cent, 
were found to contain foreign coloring. The use of preserv- 
atives is greatly on the increase. Last year about 1 1 per 
cent, of the samples contained an added preservative. We 
analyze all milk brought in for total solids, and those below 
the standard examined for foreign coloring matter. We 
find that formalin is usually employed as a preservative, and 
will keep milk sweet ten days which would curdle in a day 
and a half. It is usually sold in weak solution. 

The sentiment is changing a little among chemists, instead 
of preservatives being harmful to the digestion, they try to 
argue that their use in milk should be legalized. It is a 
question how far adulteration should be allowed. Boraj: 
changes only the lactic acid form of bacteria, but allows 
others to increase. Aside from the injury to digestion, it is 
a question whether old milk should be sold instead of fresh, 
because milk five or six days old, while it is perfectly sweet, 



190 1 Societies. 155 

is sure to have undergone some sort of decomposition. Car- 
bonate of soda has fallen into disuse because it does not 
exercise an appreciable preservation. 

Inspectors confine their attention mostly to towns and 
cities outside of Boston. Cambridge has an efficient system. 
Lowell has had one for a number of years, also Brookline. 
In all cities of any size they have milk inspectors, who 
usually issue milk licenses, but exercise no inspection over 
the milk itself. 

As the law reads now any one is found liable if adulterated 
milk is found in his possession. A man does not always 
know the quality of the milk, and sells it just as be bought 
it. Of course, much hardship is caused in carrying out the 
law. In a sense a milk man has the means of establishing 
his innocence. He can prove it sometimes in this way. If 
he purchases his milk of a large contractor, it is sometimes 
possible for him to trace the milk to a particular dairy, and if 
he can, he states his case to the inspector, who will delay 
the case and inform the State Inspector, who will send to 
the producer and take samples from all his cans for analysis. 
If the milk is found to be poor, it is prima facie evidence 
that the milk man is innocent, and the producer is brought 
into court. 

Dr. Tower : Is the object of coloring milk always adultera- 
tion } 

Mr. Leach : No. The milk man adds orange color be- 
cause others do, and he wishes to have his milk as good a 
color as that of other dealers. 

"Modified Milk." Mr. Halsted Yates, representing the 
Walker Gordon Laboratory, stated that the Walker Gordon 
modified milk is made from perfectly fresh cows* milk, is 
suited to any digestion of invalids and infants and resembles 
a perfectly fresh milk. It is prepared from a physician's 
prescription only, giving percentage of fats, proteids, sugar 
and water, and quantity of feeding; is furnished in such 
quantities as desired. The food supply is delivered daily in 
the bottles from which it is to be fed. Experience has 



1 56 The Nezv England Medical Gazette. Mar., 

proved that no single formula can do the work. The consti- 
tution of the properties of the milk are considered and the 
ingredients adapted to the needs of the child. Proportions 
can be changed to be like cow's milk. The greatest trouble 
we have found has been the digestion of the proteids. We 
have been able to change the proportions, thereby producing 
a more easily digested milk and one adapted to the require- 
ments of each case. The problem of infants' food is to 
obtain the elements of food separately and then combine 
them so as not to be injurious. The amount of milk and 
cream used conveys no definite idea. By our method the 
physician knows just what he is getting. Our system has 
been so thoroughly tested that I have no hesitation in mak- 
ing this statement. When first started, samples of the modi- 
fied milk were taken to an analyst and found to be just what 
the physician ordered. 

The milk and cream used is from cows on the farm and 
reaches the laboratory about i p.m., where the prescriptions 
are prepared, and placed in cold storage until delivery the 
next day. Prescriptions received from 7 a.m. to 11 a.m. 
will be filled in the afternoon. Most perscriptions can be 
filled within three hours after receipt. Each prescription is 
prepared in turn and the tubes tightly corked with sterile 
cotton. When needed for use, the stopple is removed and 
a nipple is placed over the tube. In this way the milk is not 
exposed to the air after being poured into the tubes. Each 
tube contains a single feeding, and no tube is used a second 
time. All the empties are returned at once to us and steril- 
ized, and are sterilized again before being used. Methods 
like these require experienced men and they must be careful 
men. The only objection is the additional expense. They 
cannot, necessarily be cheap men, nor can modified milk be 
furnished cheaply. It would mean a lowering of the stand- 
ard, which we are not willing to do. 

These methods are pursued in all of our eighteen laborato- 
ries situated in the United States, Canada and London. 

Dr Tower : Was the cost stated } If so, I did not hear it. 



igoi Societies, 157 

Mr. Yates : The price is according to the number of feed- 
ings furnished. The price for two feedings is 20 cents a 
day ; for eight, 40 cents ; anything above that is 5 cents 
a day additional. 

Mr. Leach : If a child were brought to your laboratory, 
would you furnish milk for it according to his age.^ 

Mr. Yates : We furnish no modified milk except on a 
physician's prescription. We do not know what the child 
wants and insist upon a prescription. 

"Milk from Producer to Consumer." Mr. Simeon C. 
Keith, Jr., said he thought it would interest those persons 
present to know how the milk is brought to the consumers. 
He drew a sketch of the ordinary country barn, showing the 
relative positions of the stock, feed bins, silo, and the unsan- 
itary conditions in which the stock was kept during the cold 
months. 

As to the grade of cows, there are very few pure blooded 
cows, 3^5 pure and JJ something else, which they term com- 
mon red cows, or natives. Then there are a good many 
crosses. The Holstein is a big producer. The cow is 
virtually a machine, some do good work and others do not. 
It makes a great difference what they have to eat, not so 
much as to quality but as to quantity. It is rather to be de- 
plored that farmers look at it only from the producer's 
standpoint. The care of milk is of great importance, and up 
to a few years ago very little was done in that direction. 
The cans were put down the well until train time, then put 
in the cars. Within the last five years farmers have been 
induced to build ice houses, for without ice it is almost im- 
possible to keep milk in good condition. Of course the con- 
ditions there are not ideal, although they have the advantage 
of fresh air. The stables are close and there is not as much 
breathing space as the cows ought to have. It is usually 
two miles and a half from the farm to the car. On arrival 
the cans are put into the cars, each car holding about 800 
cans. As soon as the milk arrives, it is sold to local dealers 
put up in quart and two quart cans for the trade. The laws 



158 The New England Medical Gazette. Mar., 

of the State require a milk of a certain standard quality, and 
the milk, as produced by farmers, is not of standard value, 
ninety-nine cases out of one hundred it is just as it comes 
from the cow, but is not of equal quality. It is the custom 
of dealers to mix it, and then run it into cans. The objec- 
tion I have to this is that the milk, as it arrives in the city, 
is not all good, but all has to be tested. We have expert 
tasters who can tell the exact time a can can be kept, if one 
escapes, it spoils all the others. The dangers arising from 
the use of milk are very much exaggerated. 

Mr. Keith exhibited a number of stereopticon slides, show- 
ing views of the Hood farm and herd at Derry, N. H., also 
magnified sections of the uddtr, showing the glands active 
and inactive. 

Dr. Tower : I have had some little experience with typhoid 
fever traced directly to the milk supply. Could the germs 
be detected in the milk ? 

Mr. Keith : That they are in the milk is certainly true. 
Up to a few years ago we were not successful in detecting 
the germs, and at the present time, it is very difficult, 
because they exist in such small numbers and resemble 
others so much. 

Dr. Spalding: Has Mr. Keith made the experiment of 
placing typhoid fever germs in pure, freshly strained milk 
and found that they had been destroyed ^ 

Mr. Keith : I have never performed any such experiment, 
but it seems to me that freshly strained milk is not different 
from that which has not been strained. I have been able to 
keep milk without change ten days. Milk, when coagulated, 
will change exceedingly quickly. We know of no change 
except bacterial change. The great infection of milk takes 
place when the cow is milked, the udder is not clean, and 
impurities escape into the milk at that time. If it is true 
that the bacilli will be destroyed we should not have to 
sterilize. 

Dr. Colby : I would like to ask if any differential study 
has been made of the physical characteristics of different 



1 90 1 Societies, 1 5 9 

cows from the same breed, or cows from different breeds ; 
characteristics of the fat corpuscles, their size and thickness 
as shown by their easy coalescence. Whether separation of 
fat by centrifugal force alters the physical condition of the 
fat so that it becomes more or less digestible. 

Mr. Keith : The first question I cannot, perhaps, answer 
as you would like to have me. I have made only a few tests 
of the size of the fat corpuscles. They vary greatly. In the 
Jerseys they are the largest and in the Holsteins the small- 
est, taken as a whole. It is well known that cream stirred 
into milk will not rise as well again. I will say that I have 
noticed quite a difference between the tub set cream and 
separator cream. The latter seems to cause the coalescence 
of these fat corpuscles so that we get a buttery layer on top. 

Mr. Yates : In regard to the size of the fat corpuscles. In 
purchasing our cows, we rather incline to the Holsteins for 
this reason, because the fat corpuscles are smaller than other 
breeds and therefore more digestible. 

In regard to cream, whether centrifugal force or gravity 
method is the more digestible, I cannot say, we leave 
this to the physicians. We furnish both. At one time 
there was a certain buttery layer on the top when the milk 
was delivered, and a series of experiments were conducted to 
find what was the difference. The results were that, so far 
as could be seen, there was no practical difference either in 
the appearance of the milk or its digestibility by the child. 

Replying to the question how the modified milk is pro- 
duced, Mr. Yates stated that the cows are specially selected 
as to health, and must be of special grades. They are not 
put into the herd until quarantined, then they go into the 
herd, and are fed regularly with selected food, harns must 
be kept perfectly clean. At milking time each man puts on 
a clean white suit, which has been sterilized, the pail has 
also been sterilized, and when full is carried to a separate 
building, there the milk is strained through eight thicknesses 
of cotton and run into the cooling vat, and from that into a 
large sterilized tin pitcher and the bottles are filled from it. 



i6o The New England Medical Gazette, Mar., 

No one except the bottler is allowed in this building. When 
filled, the bottles are carried to the laboratory. The night's 
milk is received at 12 p.m. of same day; the morning milk 
about I P.M. The men are under the supervision of a physi- 
cian. Any man who has a sickness in his family, or is ill 
himself is released from duty. In New York and Philadel- 
phia our places are under the direction of physicians, who 
send their representatives to us, without warning, to see that 
everything is clean. 

Milk Direct from Dairy to Consumer." Mr. H. G. Jordan, 
of Jordan Farm, Hingham, said he felt somewhat out of place 
as his life had been spent in the coal business. He con- 
sidered that the Society was doing a kindness to every 
family in taking up this subject. The work of the State is 
interesting, but it does not go far enough. Very little has 
been said about the inspection of the barn and of cows 
before milking. In many instances the cows are milked 
where they have been standing for days and perhaps weeks ; 
the feed is exposed to the manure, and the cattle eat food 
which has practically had their breath for weeks. A great 
many of these New Hampshire barns have no conveniences. 
The State should inspect the barns particularly. I have 
considered that milk is a naturally pure product, and if it is 
found unclean some one is to blame. If it was possible to 
draw milk from the udder of a perfectly healthy cow, such 
milk should be free from bacteria. Milk from a healthy cow 
and well aerated, bottled and delivered to the customer is the 
proper way to deliver milk. It seems to me that the first 
thing for a dairyman to do is to select a thoroughly healthy 
herd of cows ; next, they should be properly and regularly 
fed ; milked at the same hour each day ; barns cleaned and 
bedding changed so that the cows will be comfortable. The 
Board of Health has not visited my farm since I have been 
in the business. There are a number of regulations for the 
sale of milk, but our State Board of Health has no control 
over milk brought into the State. 

Dr. Spalding asked in regard to the bacteria in cows. 



190 1 Societies, 161 

Last winter I was in Paris and there made quite a little 
study of the milk situation. I found that in the city of Paris 
and in the suburbs, the cows were allowed to stay in the 
stables from the time they were bought until they were sold, 
without any exercise. The stables stand as close as it is 
possible for them to, and one physician at the hotel said 
he knew that a great deal of the disease contracted came 
from the milk supply. In Boston I think we are far ahead of 
any other city in the milk supply. I think the care of our 
dairy is far ahead of any city both here and in Europe. 

A unanimous vote was passed thanking the gentlemen, 
who had favored the Society with their papers, and express- 
ing appreciation of their kindness. 

Adjourned at 10 : 30 

Edward E. Allen. 

Secretary. 



BOSTON HOMCEOPATHIC HEDICAL SOCIETY. 

BUSINESS SESSION, 

The regular meeting of the Society was held at the Bos- 
ton University School of Medicine, Thursday evening, Feb. 
7, 1 90 1, at 8 o'clock, the president, T. Morris Strong, M. D., 
in the chair. 

The records of the last meeting were read and approved. 

Franklin S. Wilcox, M. D., of West Newton, was proposed 
for membership. 

Dr. Frederick W. Halsey was appointed a member of the 
Standing Committee on Legislation in place of Dr. T. Mor- 
ris Strong, who is now a member ex-officio, and Dr. Eliza B. 
Cahill, Chairman of the Section of Ophthalmology, Otology 
and Laryngology, in place of Dr. Strong. 

The resignation of Dr. C. W, Nordstrom, Maiden, was 
read and accepted. 

Edwin B. Harvey, M. D., Secretary of the State Board of 



1 62 The New England Medical Gazette. Mar., 

Registration in Medicine, called the attention of the Society 
to several matters just introduced at the General Court, 
which he considered of interest to the medical profession, — 
bills relating to vivisection and the granting of degrees. 

The bill pertaining to anti-vivisection, if passed, will pre- 
vent medical schools making experiments with animal life 
unless an agent of the M. S. P. C. A, is present. It is the 
old matter which was rehearsed and defeated at the State 
House a few years ago. 

An effort is being made to amend the present law so as to 
apply to hypnotists, mind healers, laying on of hands, etc. 
A number of corporations are asking the State to authorize 
them to confer degrees with a title, as Doctor of Osteopathy, 
etc., after but a few weeks' study, either in person or by cor- 
respondence. Of course, the whole object is to get permis- 
sion from the State to Use the title doctor, because of its 
influence with the ignorant layman. If the medical schools 
are represented at the hearing, I think the bill can be 
defeated at once, as the measure has not a large following. 

At present the Board has difficultly in maintaining a prose- 
cution, owing to the different interpretations by the courts 
as to what constitutes a physician ; what is considered suf- 
ficient evidence in one county is not so considered in an- 
other. The Board is trying to get the State to regulate 
matters so that the man who practises or attempts to prac- 
tise medicine in any of its branches holds himself out as a 
physician. It is also endeavoring to have uniform State 
registration. 

Dr. Harvey asked for the co-operation of the Society in 
the work of the Board. When recommendations have been 
made by the Board in previous years, the legislative com- 
mittee have inquired if anyone other than the State Board 
was interested in this matter? Now, if the Board can show 
petitions, not only from the profession, but from laymen, in 
support of their recommendations, the measure is much 
more likely to be favorably considered. 

Dr. J. M. Hinson called the attention of the Society to a 



1 90 1 Societies, 163 

bill to be introduced by the friends of the New England Op- 
tical Institute. The object of the bill is to permit said 
institute to confer the degree of Bachelor of Optics and 
Doctor of Optics. 

These several matters were referred to the Standing Com- 
mittee on Legislation with full power. 

Dr. H. E. Spalding : Would it not give this committee a 
better standing before the Legislature if this body had 
authorized it to defeat this bill ? 

Dr. N. Emmons Paine : The State Board of Registration 
in Medicine ought to feel that this Society upholds them in 
carrying out the present law, and have only properly edu- 
cated and graduated persons practise medicine in this State. 
If there are any practising who are not, we want to know it. 

Dr. Hgirvey : I am glad to hear Dr. Paine make the state- 
ment as plainly as he has, but the Board as a Board has felt 
that to be the case. It is a composite Board, but as yet not 
a word of difference has arisen between the different schools 
represented, and it is the right kind of Board to have. I am 
glad that the course of the Board meets your approbation. 
Unify the laws, and have one composite Board working in 
harmony. 

SCIENTIFIC SESSION 

Dr. S. C. Fuller, Westboro, exhibited two brains showing 
hemorrhage, one into the lateral ventricle, well defined, and 
one much more diffusive involving the base and internal cap- 
sule. Also a microscopical specimen showing the pyramidal 
cells of the cortex. 

Report of the Section of Mental and Nervous 
Diseases. 

W. N. Emery, M. D., Chairman. 
M. G. Champlin, M. D., Secretary. D. J. Hanlon, M. D., Treasurer. 

The President appointed* Drs. D. W. Wells, F. E. Allard 
and E. P. Colby, a committee to nominate sectional officers 
for the ensuing year. The committee reported as follows : 



164 The New England Medical Gazette, Mar.) 

Chairman. N. R. Perkins, M. D., Secretary ; Caroline Y. 
Wentworth, M. D. ; Treasurer, Granville E. Hoffses, M. D. 

PROGRAMME. 

1. Demonstration of the Conference System as Applied 
to Instruction in Clinical Neurology in Boston University 
School of Medicine. Frank C. Richardson, M. D., and 
members of the senior class. 

2. Some Preventable Causes of Mental Diseases. Ellen L. 
Keith, M. D. 

3. The Classification of Insanities. George S. Adams, 
M. D. 

1. "Demonstration of the Conference Sytem as Applied 
to Instruction in Clinical Neurology in Boston University 
School of Medicine.'' 

Dr. Richardson said he thought it might be of interest to 
the Society to know something of the character of the work 
being done in the school, and that every effort is being made 
to turn out men and women better prepared than in previous 
years. The study of nervous diseases is not taken up until 
the senior year, and nothing was known of the subject before 
October last. The method of instruction about to be dem- 
onstrated had been pursued this year with great satisfaction. 

Two members of the senior class, Messrs. Padelford and 
Sproull were called upon to make the demonstration. Mr. 
Padelford examined the patient before the Society in a 
thorough and scientific manner and finally reached the diag- 
nosis. Mr. Sproull was responsible for the pathology of the 
case, and his explanation and demonstration made it evident 
that he not only understood the case, but also that the class 
was being well grounded in the pathology of nervous diseases 
generally. 

2. '' Some Preventable Causes of Mental Diseases.*' Dr. 
Keith not being present her paper was read by Dr. Emery. 

3. Dr. George S. Adams's paper on "The Classification of 
Insanities" was read by Dr. Klopp. 

Owing to the lateness of the hour, the papers were not 
discussed. 

Adjourned at 10 o'clock. 

Edward E. Allen, Secretary, 



190 1 Reviews and Notices of Books, 165 

REVIEWS AND NOTICES OF BOOKS. 



Enijirged Tonsils Cured by Medicine. By J. Coipptoo Burnett, 

M. D.y London, England. Philadelphia: Boericke & Tafel. i9X>i. 

The authoi's views of the function of the tonsils are interesting 
in the extreme. On page 53, he says, "They are placed on either 
side of the fauces for the primary purpose of lubricating the food 
as it passes down the gullet into the stomach proper.' ' Again on 
page 54> he writes, " The tonsils lie at the top of the digestive tube, 
and whenever certain parts or portions of the body have to deal 
with something harmful, the same is passed along the circulation to 
the tonsils to be cast out, and the tonsils then act vicariously for 
said parts from elsewhere. A great advantage in having it cast out 
at the top of the gullet is that what is cast out at that part may be 
rolled up in the food and so rendered harmless, and if it is disposed 
to decay, it is disinfected by the gastric juice. In fact, an evil-dis- 
posed paiticle of anything sent by the economy to the tonsils to 
be dealt with, has a very poor chance of doing any harm in its 
journey from throat to anus." 

He further writes, "The tonsils are also capable of curing 
phthisis by the formation of series of abscesses each going through 
the various stages of heat, swelling, and bursting.'' On page 75, 
the following theory is advanced : " The more I watch the behavior 
of the tonsils, the more I am convinced that they are charged with 
an excretory, a defecatory function, and that they excrete things 
out from the organism, casting them out both at the time of swal- 
lowing food and also as a kind of lubricating trickle ; such excre- 
tions pass with or without food, down the oesophagus like com 
down a shute. Moreover, I think the bulk of the private troubles 
of the tonsils, i. ^., their diseases are vicarious for the mucous lining 
of the body. I am satisfied from my observation that the tonsils 
are capable of sacrificing themselves on the altar of the economy 
by ulceration, till neatly or quite all the tonsillary tissue is gone." 

In the last fifteen pages of the book there is a dissertation on the 
«* Anatomy and Physiology of the Glands." Here are found quota- 
tions from the writings of Drs. J. H. Clark, Bennett, Carr, Routh, 
Pidoux and Martiny. Dr. Bennett does not claim that the tonsils 
are true lymphatic glands, but he says that they are closely allied to 



1 66 The Neiv England Medical Gazette. Mar., 

them, and therefore he believes the physiological function of both 
to be practically the same. 

A series of cases are given showing the great efficacy of bacilli- 
num, in a high potency, of Luct C. Thuja 30, Calc. fluorica, Calc. 
carb, Tub. test. C, Baryta carb, Vaccinin, etc. The plain straight- 
forward prescribing for the totality of the symptoms according to 
the law of similars is evidently too easy. The writer is not content 
with this, he must first clear away with bacillinum C a " tuberculosic 
quality," or with thuja or silica a "vaccinosic quality," with sulphur 
some other mysterious dyscrasia, before the indicated remedy can 
be given. Even then one must follow certain fanciful methods 
before the remedy can be properly selected, and the gentleman 
believes that sane intelligent thinking physicians will call the state- 
ments made in the book scientific truths to be accepted and 
diligently followed. 

If the statements in the book are accepted, we must believe that 
the thousands and ten thousands of children who have in the past 
years had their tonsillar hypertrophies removed by surgical methods 
are rendered more liable to serious danger from disease, particularly 
tuberculosis. 

Dr. Johnathan Wright, of Brooklyn, after many years of study 
and observation, says, ** The tonsils are pathological entities when 
they can be demonstrated clinically." 

In the "1 901 Year Book of the Nose and Throat," we find 
numerous theories expressed regarding the function of this small 
mass of lymphoid tissue between the faucial pillars. Thus Labb^ 
thinks the tonsils take an active part in blood formation. Masini 
believes that they have an internal secretion. Packard believes 
that investigation has demonstrated that healthy tonsils can be 
invaded by micro-organisms, but that they can quickly rid them- 
selves of these sources of disturbance. This author thinks that 
their function is to offer a barrier to the entrance of organisms 
into the deeper tissues. 

Fry asserts that the tonsil is a retograde structure and has no func- 
tion in man. Most authorities agree, however, that there exists 
physiologically in children small masses of lymphoid tissue in the 
naso-phar)'nx, between the faucial piilars, and at the base of the 
tongue. 

VValdeyer*s lymphatic ring, as it is now frequently called; but 



1 90 1 Personal and Neivs Items. 1 6y 

that in the normal throat this tissue cannot be easily demonstrated. 
It is also, agreed that the tonsils, if enlarged, with the exception of 
the lingual tonsil, undergo a process of atrophy from the eighth to 
the fifteenth year. 

Granted that the normal tonsil has a function. Now what takes 
place in the process of hypertrophy. From microscopical studies 
of many hundred specimens, we find in most instances that this 
lymphoid tissue undergoes a process of degeneration^ that there are 
formed pus pockets, calcareous secretions, with a large admixture of 
fibrous and connective tissue. This, the author would say, is 
nature's method of sacrificing the tonsillar tissue, that the internal 
organism might be protected. Let us admit for the sake of argu- 
ment that this is so, that this tonsillar tissue has been sacrificed, 
leaving in its place a tumor containing pus, perhaps lime, the har- 
boring place of different forms of bacilli, adherent too, and restrict- 
ing the movements of the palatal muscles. An hypertrophied mass 
causing nasal obstruction which in time occasions certain definite 
and fixed changes in the formation of the superior maxillary bone 
and its adjacent structures. Middle ear disease consequent upon 
obstruction to the eustachian orifices is also common, to say nothing 
of effects upon the local circulation. 

What of this ? Shall we spend years in efforts at their absorption 
rather than to operate? What is the experience of hundreds of 
physicians all over the world who are doing or having this operation 
performed? It is that patients are benefited in a way which is 
little short of miraculous, and that the benefit obtained, if followed 
by intelligent constitutional treatment, is permanent. Probably in 
ten per cent, of the cases the operation fails to produce this bene- 
ficial change, but because of this, we should not deprive the ninety 
per cent, of this new lease of life. The science of homoeopathy is 
not advanced by the unsupported statements of individual experi- 
ences, or by refusing to profit by the observations of those whose 
conclusions do not coincide with these experiences. 



PERSONAL AND NEWS ITEMS. 

Dr. David P. Butler, Jr, house physician at the Rut- 
land Sanitarium, Rutland, Mass., has opened an office at 
No. 102 Charles Street, Boston, where he can be consulted 
on Tuesdays and Wednesdays between 1.30 and 3,30 p. m 
Telephone, Hayraarket 6413. 

Dr. Thomas E. Chandler, class of '00, B. U. S. of M., 
has located at 1 5 Sparhawk Street, Brighton, Mass. 






1 68 The New England Medical Gazette. Mar., 

Wanted. — An homoeopathic physician for the town of 
Southington, Connecticut, practice formerly held by Dr. J. R. 
Osborne (deceased). Dr. Orborne was the only homoeo- 
pathic physician within a radius of several miles, and today 
many of his patients go to New Haven for treatment. Dr. 
Osborne is said to have had a large and lucrative practice. 
For further particulars address Mr, Walter Pratt, Box 626, 
Plantsville, Ct. 

Notice. — To the Deans of the Homoiopathic Medical 
Colleges and the Editors of leading Homoeopathic Journals 
of the United States : 

Gentlemen, — A competitive examination for interns of the 
Rochester Homoeopathic Hospital will be held in Rochester 
on the third Sattitday of March, 1901. Candidates will 
please report at the hospital, 224 Alexander Street, at 10 a. m. 
There will be two vacancies occurring May 15, next, and the 
term of service is for two years. Address all correspondence 
to Herbert W. Hoyt, M. D., Secretary of the Staff of the 
Rochester Homoeopathic Hospital, 75 South Fitzhugh Street. 

New York Skin and Cancer Hospital, Second Av- 
enue, Cor. 19TH Street. — The governors of the New York 
Skin and Cancer Hospital announce the following course of 
clinical lectures on "Syphilis." by Members of the Visit- 
ing and Consulti g Staffs, on Wednesdays, at 4. 1 5 p. m. : 

March 6, Syphilis as a Disease ; Modes of Infection ; Ex- 
tra-Genital Syphilis, by L. Duncan Bulkley, M. D. 

March 13, Skin Manifestations of Syphilis, by L. Duncan 
I^ulkley, M. D. 

March 20, Infantile Syphilis, by A. Jacobi, M. D. 

March 27, Syphilis of the Mouth, Nose, Throat and 
Larynx, by D. Bryson Delavan, M. D. 

April 3, Syphilis of the Eye and Ear, by David Webster, 
M. D. 

April TO, Syphilis of the Nervous System, by Edward D. 
Fisher, M. D. 

April 17, Syphilis of Internal Organs, by Edward G. Jane- 
way, M. D. 

April 24, Syphilis of the Bones, and Surgical Relations of 
Syphilis, by Willy Meyer, M. D. 

May I, Synopsis, Conclusions, and Treatment of Syphilis, 
by L. Duncan Bulkley, M. D. 

Free to members of the medical profession on presentation 
of their professional cards. 

WiM.iAM C. Witter, 
Chairman of Executive Committee. 



THE NEW ENGLAND 

MEDICAL GAZETTE 



No. 4. APRIL, 190C. Vol. XXXVI. 

COMMUNICATIONS. 



THE DIAGNOSIS AND TREATMENT OF GALL STONE 

CASES. 

BY HORACE PACKARD, M. D., UOSTON, MASS. 

[Read before Mass. Horn. Med. Society.] 

INTRODUCTION. 

What error in hygiene the human family is guilty of, which 
makes possible the formation of gall stones, is unknown. 
As far as the writer has been able to learn through reference 
to comparative pathology they are never found in the lower 
animals. 

In the human family a singular divergence exists in the 
two sexes. Gall stones are found in women far more fre- 
quently than in men. In seven years following 1 880 Reck- 
linghousen found in autopsies performed by him, that of the 
gall stone cases, 4 per cent, were in men and 20.6 per cent, 
in women, — five times more frequent in women than in men. 
All statistics bear out the fact that cholelithasis occurs in 
females in proportion of 4 or 5 to i in males. The child- 
bearing period is the most prolific part of woman's life in the 
production of gall stones. According to Schroeder, 90 per 
cent, of females in whom biliary calculi were found, had 
borne children. 

It is useless to waste valuable time in speculating upon 



1 70 The New England Medical Gazette. Apr., 

the possible cause of gall stones. Every imaginable in- 
fluence has been dwelt upon in medical literature, from cor- 
set wearing to bacteria, without settling the question. What 
are gall stones } In simple terms they are cholesterin and 
bile pigments. These substances are natural ingredients of 
bile, and are held in solution in bile of normal fluidity. The 
fluidity of the bile depends upon the amount of water avail- 
able to dilute it. An habitual scarcity of water in the daily 
regime, must of necessity result in a biliary secretion de- 
ficient in watery constituents, and proportionately rich in 
solid ingredients, /'. e., cholesterin and bile salts. 

The only other elements wanted for precipitation of the 
solid elements is a period of rest, i. e. stagnation. 

It is the accepted theory that the gall bladder is a recep- 
ticle for storing the bile, in the intervals between periods of 
digestion. Have we not here, then, a simple and reasonable 
theory of gall stone formation, viz., viscid bile from insuf- 
ficient ingestion of water, and precipitation of its solid ingre- 
dients during the period of storage or impounding in the 
gall bladder. This, however, you will say does not quite 
account for the moulding of the precipitate into calculi. 
Cry.stalization does the rest. 

Here is an example which shows as beautifully as any- 
thing can, the exquisite crystalline deposit of cholesterin. 
This, then, in brief is my view of the formation of gall stones. 
V^'iscidity of the bile, stagnation in the gall bladder, precipita- 
tion of cholesterin and bile salts, crystalization. 

How does this theory accord with the pathological and 
clinical facts } 

Man, the male, is proverbially the drinking member of the 
family, whether it be water, beer, wine or strong drink. 
This may be because of his laborious occupation, free per- 
spiration and greater thirst, but true it is that he is habitu- 
ated far more than women to swallow large draughts of 
liquid. This much in favor of a limpid secretion of bile. 

Women as a rule drink little. Their sedentary occupation 



190 1 Gall Stones. 1 71 

does not engender thirst. They do not crave water. Many 
shun it, and boast of how little they imbibe. This much in 
favor of a viscid biliary secretion, which needs only the 
periods of stagnation in the gall bladder for precipitation and 
crystalization. 

But why still greater frequency of gall stones in women 
who have borne children ? The supply of water available 
for functional purposes is still further diminished during 
pregnancy. In the early months of gestation, frequently for 
a number of weeks, nearly all material both solid and fluid 
is rejected by the stomach. During the whole period of 
pregnancy there is a new and imperative call for water to 
supply the wants of the growing foetus, and the amnionic 
fluid, new blood, and during lactation the milk supply. 

In recent years, much literature has appeared tending io 
show a relation between bacterial invasion of the gall bladder 
and cholelithiasis. Bacteria of various kinds do invade the 
gall bladder and are always found accompanying gall stones. 
It is not surprising that they reach the gall cyst, for the 
duodenum is the natural abode of many kinds, and a most 
inviting path is open to them via the common and cystic 
ducts. In former times the bile was supposed to be a germi- 
cide, but it is now known to be quite inocuous to bacterial 
life. Under normal conditions it is reasonable to suppose 
that bacteria do not reach the gall bladder in great numbers 
nor make it their habitat ; for the periodical out flow, pre- 
sumably with considerable force at beginning of digestion, 
constitutes a counter current in opposition to their advance. 
Let, however, a calculus form, and there is a fixture to which 
they adhere, and thus become constant inhabitants. The 
colon bacillus, all forms of pyogenic bacteria, the typhoid 
bacillus, and others, have been found in the gall bladder 
with gall stones. 

CLINICAL VIEW. 

The following cases are selected because they present 
typical examples of gall stone cases as seen clinically and 



1 72 The New England Medical Gazette. Apr., 

well illustrate the relation between the subjective symptoms 
and the mechanical conditions which cause them. 

First Condition. — One or more large stones wholly within 
the cavity of the gall bladder, too voluminous to pass into, or 
through the cystic or common duct, but may act at intervals 
as a ball. valve at the funnel shaped beginning of the cystic 
duct. 

Case. — Mrs. D., age 65, of active habit and robust consti- 
tution, has enjoyed excellent health up to the time of present 
illness, which is of about eight days' duration. The attack 
came on with feeling of discomfort and tensive pressure in 
the right hypochondrium, which has gradually increased, 
until for the past three days she has suffered acute pain, has 
had nausea and vomiting, and in the last twenty-four hours 
the temperature has been subnormal and a faint icteric dis- 
coloration is observable in the sclerotica. 

Physical examination discloses an elongated tumor occupy- 
ing the right hypochondrium and extending downward from 
about the eighth costal cartilage nearly to the crest of the 
ilium. 

Incision through the right linea semilunaris showed the 
tumor to be an enormously distended gall bladder, contain- 
ing bile stained pus and mucus, and an enormous oval gall 
stone resting in the funnel shaped beginning of the cystic 
duct, like a ball valve. 

Second Condition. — Many small calculi, varying in size, 
possibly also large ones, usually with well defined angles and 
facets. One occasionally enters the cystic duct, passes on 
into the common duct and is finally discharged into the 
duodenum. Finally a stone of a diameter equal to or slightly 
exceeding that of the cystic duct gets wedged into it and 
remains there indefinitely. 

Case. — Mrs. P., age 52, has suffered repeated attacks of 
pain of acute cutting character in the right hypochondrium, 



190 1 Gall Stones. 173 

extending to the epigastrium for several years. Each illness 
was accompanied with jaundice, varying slightly in intensity 
and appearing during the last hours of the attack. Nausea 
and vomiting were of frequent occurrence in the beginning 
of and during the progress of the illness. With the cessa- 
tion of pain, the jaundice quickly cleared up and establish- 
ment of usual health rapidly supervened, and continued 
until another attack. 

Physical examination through incision of the abdominal 
wall, just below the eighth costal cartilage, disclosed a gall 
bladder with greatly thickened walls through which many 
gall stones could be felt by palpation. Incision of the fun- 
dus of the gall cyst, resulted in the removal of forty-nine 
calculi, varying slightly in size, bearing sharp angles and 
smooth facets and dark brown in color. Palpation along the 
cystic duct disclosed a fiftieth stone so firmly lodged therein, 
that it could not be removed by way of the cavity of the 
gall bladder. The wall of the duct was therefore cut open 
longitudinally over the stone and the latter was thus removed. 

Third Condition. — In this, all the physical conditions are 
present which are above outlined in No. 2, /. e, many small 
calculi and perhaps large ones, angled and facetted or may 
be rounded. One enters the cystic duct, passes on into the 
common duct and there, for some reason, may be a con- 
genital or acquired narrowing, becomes impacted and acts as 
a partial or complete obstruction to the exit of bile. The 
bile is thus impounded behind this obstruction, all the he- 
patic ducts and the gall bladder become distended, the bile 
is absorbed, enters the blood current and is carried to all the 
tissues of the body, resulting in the violent and unmistakable 
pigmentation known as jaundice. No bile reaches the in- 
testinal tract, hence the feces become white or "clay 
colored." The excretory organs quickly seize upon the bile 
pigment which has become distributed through the tissues 
and it appears promptly in the urine. 

Case. — Mrs. R., age 35, was prostrated with pain high in 



1 74 The New England Medical Gazette. Apr., 

the right shoulder and under the right scapula, finally focus- 
sing in the right hypochondrium and radiating to the epigas- 
trium. After a few days she became intensely jaundiced 
and remained so up to the date of operation, a period of 
about six weeks. 

Physical Examination. — A tumor was easily detected in 
the right hypochondrium, projecting from beneath the costal 
cartilages, which was tender on pressure. An incision over 
the tumor disclosed the fundus of a greatly distended gall 
bladder. With an aspirator needle several ounces of yellow 
fluid were withdrawn. The gall cyst was then opened and 
five calculi varying greatly in size removed. Palpation along 
the hepatic ducts disclosed the presence of a sixth stone im- 
pacted in the common duct. The. wall of the latter was cut 
open longitudinally and the stone removed. 

DIAGNOSIS. 

A study of the above illustrative cases leads to the conclu- 
sion that gall stones may produce a wide diversity of symp- 
toms, the most pronounced of which are — 

First. — Pain in the right hypochondrium, or in the epigas- 
trium, or in the back under the scapula, or a combination of 
these. 

Second. — Gastric disturbances. Anorexia, nausea, vomit- 
ing, gastrodynia. 

Third. — Icterus present but fleeting in some portion of 
each attack in recurrent cases. Present with all intensity in 
all cases of permanent plugging of the common duct. Ab- 
sent in cases of obstruction to the cystic duct alone, or at 
most but slight. 

Fourth. — Clay Colored Feces. Present in all cases of 
severe icterus. Absent if icterus be absent. 

Fifth. — Bile in Gall Bladder. Present always if there be 
icterus and clay colored feces. 

Sixth. — Pigmented Unine. Absent if there be no icterus. 

Seventh. — Tumor in right hypochondrium. Present in 



I go I Gall Stones. 175 

all cases of temporary or permanent obstruction of the cystic 
duct. Absent or at least inappreciable in all other condi- 
tions. 

Other symptoms and conditions of importance to think of 
and to look for are — 

Calculi in the feces. 

Pus in the gall bladder. 

Cancer of the gall bladder. 

The discovery of gall stones in the feces in some obscure 
cases of gall stone disease, has been the final step which has 
made a diagnosis conclusive and decided upon the advis- 
ability of operation. 

Pus in the gall bladder is a frequent accompaniment of 
biliary calculi. An hepatic abscess may be the first hint of 
the presence of gall stone disease. A tender, painful tumor 
in the right hypochondrium projecting from beneath the 
costal cartilage, continuous in dullness with the liver, should 
always awaken the suspicion of biliary calculi, even in the 
absence of all other symptoms. 

Cancer of the gall bladder is not uncommon, and it is an 
accepted theory that the long continued irritation of gall 
stones may be the determining cause. A history of long 
invalidism with symptoms of gall stone disease, with finally a 
hard nodular tumor in the right hypochondrium without 
elevation of temperature, should lead to a suspicion of 
malignancy. 

Analysis of Symptoms. — A careful history of the case 
and analysis of symptoms is of greatest importance in reach- 
ing a diagnosis. The following scheme has been of great 
service to the writer : 

Pain. — Location, right hypochondrium, epigastrium or 
shoulder, constant or recurrent. 

Digestion. — Anorexia, nausea, vomiting. 

Icterus. — Recurrent or constant. 

Stool. — Clay color or normal. 

Urine. — Normal or pigmented. 



1 76 The New England Medical Gazette, Apr., 

Inspection of Feces. — Daily solution of feces and passing 
through sieve to discover calculi. 

Palpation and Percussion of Right Hypochondrium. — Pres- 
ence or absence of tumor. 

X ray examination of doubtful utility. 

With all care in analysis of symptoms, a diagnosis will 
often be impossible. The only single symptom which en- 
ables a positive diagnosis to be made is the discovery of gall 
stones in the feces. 

Pain in the right hypochondrium and epigastrium, jaundice, 
and a tumor presenting under the right costal cartilages, 
constitute a group of symptoms which carry great weight in 
forming a diagnosis. 

P^in in the right hypochondrium and jaundice are sug- 
gestive, but less convincing. 

Pain in the right hypochondrium and gastric disorders are 
also suggestive but far from convincing. 

Lastly, gall stones exist for years in many people without 
any symptoms whatever. 

CIo be continued.) 



MODERN SURGICAL TECHNIQUE 

WITH ANALYSIS AND STATISTICAL TABLE OF THREE HUN- 
DRED AND FORTY-FOUR OPERATIONS PERFORMED IN FIF- 
TEEN MONTHS, PRIOR OF JAN. I, I9CXD, AND SINCE USING 
RUBBER GLOVES. 

BY J. EMMONS BRIGGS, M. D., BOSTON, MASS. 

(Read at Washington, D. C, June, 1900, at Surgical and Gynaecological Association of the 
Anierican Institute of Homoeopathy.] 

With Sir Joseph Lister's great discovery, surgery emerged 
from chaos and uncertainly and took its place within the 
realms of science. Today it stands in the dignified position 
of being both a science and an art ; a science inasmuch as it 



igoi Modern Surgical Technique, ijy 

is a department of systematized knowledge, and an art, 
because it requires the systematic application of knowledge 
and skill in effecting a desired result. 

Lister occupies a position in surgery much like that held 
by Hahnemann in medicine. Not that either of these illus- 
trious personages represent all there is in modern surgery or 
medicine today, but they formulated great principles which 
marked a new era. The anti-septic spray of Lister has 
vanished, Hahnemann's psora theory of the fundamental 
cause of most chronic diseases has been swept away by more 
recent investigation, nevertheless the good seed sown will 
continue to bear fruit for countless generations. 

Knowing that all surgeons are interested and anxious to 
obtain the best results along the line of aseptic operating, 
the writer of this paper has been prompted to give to you his 
observations for a period extending over fifteen months, prior 
to Jan. I, 1900. It would seem that we have arrived at ab- 
solute perfection in methods employed for the sterilization of 
instruments, dressings, gauze mops, operating garments and 
most suture and ligature materials. It is, therefore, desir- 
able to consider other channels through which wound con- 
tamination may occur. In doing so, all substances which 
come in contact with the wound should be carefully scrutin- 
ized. The air of the operating room presented to the mind 
of Lister, far more serious forebodings than to the modern 
surgeon. As a source of possible infection it must always 
be considered, but practically it offers little cause for appre- 
hension. 

The dangers of wound infection from causes within the 
system, as the localization of septic bacteria from the blood 
stream at a point of injury, although possible is comparatively 
rare. 

There are two remaining sources of infection far more 
prolific of danger than those mentioned, viz. : the skin of 
the patient, and the hands of the operator. 

By means of thorough bathing, and special preparation of 



1 78 The New England Medical Gazette. Apr., 

the area of operation with soap and water, shaving the parts 
and rinsing with distilled or boiled water and ether or alcohol, 
the application of a soap or corrosive sublimate compress on 
the evening previous to the operation, followed on the day 
of the operation, and after the patient is anaesthetized, 
by another and more vigorous scrubbing of the area with 
soap and water with the quilted-hair brush, and rinsing with 
distilled water and also a one percent, formaline solution, the 
field of operation, may, in the writer's opinion, be rendered 
practically sterile. 

The staphyloccocus epidermidis albus of Welch, described 
in 1 89 1, cannot thus easily be destroyed. It is very often 
present in layers of the epidermis along the hair shafts, 
deeper than can be reached by any known means of cuta- 
neous disinfection. After careful sterilization of the surface 
of the skin so the scrapings are sterile when inoculated into 
culture media, the presence of this white coccus can still be 
demonstrated by making cultures from sutures passed 
through the skin, or from excised pieces of the skin.* For- 
tunately this coccus possesses a feeble pyogenic power, or 
aseptic wound healing would be rare. By the employment 
of the sub-cutaneous running suture (blind stitch) in areas of 
the body covered by down rather than hair, /. ^., all locations 
except the scalp, axilla, pubes, and face of the male, we can 
practically avoid these hair follicles and at the same time 
obtain very accurate approximation. The writer has, during 
the past two years, used this method of skin suturing in 
every case where practicable. 

By thorough preparation of the skin in the method out- 
lined, the sub-cutaneous method of skin suturing and the 
burying of all deep sutures, so that no stay-suture penetrates 
the skin, we reduce to the minimum the possibilities of infec- 
tion of the wound from the patient's own skin, and prevent 
the stitch-hole abscess. 

♦General Bacteriology of Surgical Infections. Dennis System of Surgery. 
Vol. I, p. 251. 



I go I Modern Surgical Technique. 179 

The surgeon is called upon daily to perform operations 
upon septic cases, to examine digitally the mouth, vagina or 
rectum, and his hands are thus constantly in contact with 
septic bacteria. The serious and all important question is, 
can the surgeon, with hands laden with septic bacteria, 
render them in every case, positively sterile in the short 
space of time which he has at his disposal in preparing for 
operation ? and again, can he rely with equal certainty upon 
all of his assistants, who must also be sterile ? In order to 
answer this question, let us consult the bacteriologists who 
have worked in conjunction with the surgeon and supplied 
the bacteriological knowledge necessary to confirm the va- 
rious methods employed. Before considering the bacterio- 
logical reports made from cultures taken from the hands of 
the surgeon after preparation is complete, it may be said 
that the best results have been obtained after the use of 
chlorinated lime and washing soda. This method we have 
employed for over two years, and is as follows : 

1. Wash the hands thoroughly with several changes of 
soap and water, using nail cleaners, wood and metal, quilted- 
hair brush and nail brush. 

2. Rinse in several changes of faucet water. 

3. Rub well into the hands, under the nails and up on 
the wrists, a paste made by adding a small amount of water 
to a tablespoonful of chlorinated lime and a slightly less 
quantity of washing soda. 

4. Wash off the paste in distilled or boiled water. 

5. Rinse in amoniated distilled water. 

Fully twenty minutes should be spent in the process 
above -named. The hands are then ready to receive the 
rubber gloves. 

Bacteriological experiments show the following : 
By using the Weir method for hand sterilization, chlorin- 
ated lime and soda, the best results obtained have been by 
Dr. Weir himself. It is natural that this should be so as the 
man who institutes a method is always most jealous to see it 



i8o The New England Medical Gazette. Apr., 

succeed. Dr. Weir reports in 42 tests 40 sterile results, 95 
per cent. The same observer obtained sterility in 70 per 
cent, with permanganate of potash ^d oxalic acid. Kelly in 
50 experiments with permanganate of potash and oxalic acid, 
got germ free results in 44, or 88 per cent. It is exceed- 
ingly probable that 75 per cent, would be too high a figure 
to represent an average of sterile results. 

A state of affairs far more satisfactory, nothing short of 
sterility of 100 per cent, is obtainable by the use of boiled 
rubber gloves. They were introduced by Halstead, of Balti- 
more, in 1 889, and are now very extensively employed. The 
profession was a little slow about their adoption, because 
every one felt that their use would interfere with that deli- 
cate tactile sense so necessary in the art of surgery. One is 
strengthened in this opinion on the first trial of gloves, espe- 
cially if they be moderately heavy or ill fitting. One is 
probably not favorably impressed with the ease, comfort and 
luxury of his first set of false teeth as soon as they are intro- 
duced, but as he becomes accustomod to them, their advan- 
tages are apparent. So with rubber gloves, at first decidedly 
clumsy, then tolerated, and finally in view of their advan- 
tages, they become almost indispensable. The user of the 
gloves soon acquires a sense of personal security against the 
dangers of infecting himself in severe septic cases, as in 
septic peritonitis following appendicitis. In operating upon 
clean cases he feels a like sense of security for the patient, 
for he knows that nothing but a boiled surface will come in 
contact with the clean wound, or peritoneal cavity. 

We often hear the argument that gloves, though ideally 
perfect, are subject to injury, being pricked or torn, and 
therefore, useless or even worse. There are operators who 
are constantly injuring their hands, scratching, pricking and 
cutting the fingers with instruments or the tying of ligatures. 
The latter cannot be avoided by the writer in operating 
without gloves in making a vaginal hysterectomy. Surgeons 
accustomed to injure their hands will, of course, cause rents 



IQOI Modern Surgical Technique, i8i 

in the delicate glove fingers. Should this occur in the midst 
of an operation a rubber finger cot should be drawn over the 
point of injury. There is no especial cause for apprehension 
regarding septic infection should puncture occur, for the 
hands are sterilized by the best known methods before put- 
ting on the gloves. 

The writer has heard it argued that the use of rubber 
gloves engenders carelessness on the part of the surgeon, 
that the tendency is to spend less time in the preparation of 
the hands, and to place too much dependence on the gloves. 
In reply to this argument, it is only fair to assume that the 
conscientious surgeon will follow out all the technique of 
hand sterilization according to the best of his ability, and 
because he adds one more safeguard than was formerly 
employed, demonstrates that he is wide awake to the possi- 
bility of infection and is taking all known means to prevent 
it. We have no right to infer that with the addition of this 
means he will reject the more important step of thorough 
hand disinfection. Gloves are prepared by thoroughly wash- 
ing them in ammonia water, using soap. They are then 
washed again in fresh ammonia water, placed in a towel and 
boiled from five to fifteen minutes. They are then removed 
from the receptacle in which they were boiled by means of 
the towel in which they are enveloped, and gloves and towel 
immersed in a basin of distilled or boiled water. They are 
removed from the towel by the person using them after he 
has been through the process of sterilization by chlorinated 
lime and soda, and applied wet. The water remaining in the 
gloves is expressed as nearly as possible, and the fingers of 
the gloves worked on with the assistance of a sterile towel. 
Handling the glove's with the bare hands should be avoided. 
The surgeon, his assistant and instrumenteur should wear 
rubber gloves. As a matter of economy nurses whose duty 
it is to pass gauze for sponging, never touching any sub- 
stance except dry gauze, gauze mops and sterile towels, may 



1 82 The New England Medical Gazette, Apr., 

wear cotton gloves sterilized with steam under pressure of 
fifteen pounds. 

It does not seem necessary to produce arguments in favor 
of the rubber glove. The boiled hand is the only infallibly 
sterile hand. One objection to the use of the gloves is ex- 
pense, which is very trivial. The most weighty argument is, 
that they interfere too much with the sense of touch. This 
argument, as far as the writer has observed, has always come 
from those who have either never tried gloves, or have had 
very limited experience with them, and who were, perhaps, 
unfortunate in their selection of gloves for their first experi- 
ence. They are a hindrance in making a vaginal hysterec- 
tomy, and their use is not advocated in this operation, except 
in easy cases where there are no adhesions. 

After what has been said it will be seen that the writer is 
an ardent believer in the efficacy of the rubber glove as the 
most efficient . means of obtaining absolute sterility of the 
hands. Yet he would not say but that, exceptionally, as 
good results have been obtained in the hands of operators 
who never use them, as by their most enthusiastic supporters. 
This much, however, can be truthfully claimed, that person- 
ally a marked improvement in the behavior of wounds was 
noticeable from the time of their adoption, and an ideal 
wound closure without suppuration has occurred in 276 out 
of 280 clean cases. 

It is not claimed that the rubber gloves are alone responsi- 
ble for the improvement which has been obtained in wound 
closure during the fifteen months to which reference has 
been made. Far from it. Greater pains have been taken 
in every particular which would have a tendency to promote 
healing by first intention, notably along the line of careful 
hocmostasis and accurate suturing. Nothing new has been 
developed which will add anything to our knowledge of 
haemostasis, yet greatest care has been used to stop all bleed- 
ing before closure of the wound with as few ligatures as 



igoi Mental Diseases, 183 

possible. Catgut is practically the only ligature which has 
been used, and a small size is selticted, and the knots made 
small and cut close. 

(To be continued.) 



SOME PREVENTABLE CAUSES OF MENTAL DISEASES. 

BY ELLEN L. KKITH, M. D., FRAMINCIIAM, MASS. 

There seems to be no one question more often asked by 
the friends of a patient than the one as to the pro'bable cause 
of the disease. Perhaps this is more especially true of 
mental cases, or it may only be that as my line of work has 
been chiefly among these patients, I have noticed it more. 
It is a question I have seldom tried to answer, feeling that 
the causes have been varied and complex and often such as 
might not appeal to the friends as the real ones. Of late, 
however, I have been led to think whether there were not 
many causes that might be classed as preventable, at least to 
some extent, and therefore of general interest. 

I must certainly include among the most important ones, 
pre-natal influences, and these every child has a right to 
demand shall be as favorable as possible. Yet, in reality, 
how miserable they often are ! If the young life is not 
wholly destroyed it is often weakened and the brain injured 
beyond the power of recovery. Many parents have spent 
time and money trying to undo in after years, the wrong 
done their unborn child before parental love had supplanted 
the selfish love of ease and indulgence. To be well born 
means much, and it is probably more in the power of parents, 
during these early months, to effectually control the -future 
of their children than is usually recognized. 

Granting that a child has come into the world with a 
normal amount of physical and mental health, where and 
when shall we look for danger signals, and what shall we 



1 84 The New England Medical Gazette, Apr., 

seek to avoid for the child still dependent on us for every- 
thing ? 

It is not my intention to go into the detail of the general 
care of children, only to touch on certain points that seem to 
affect more particularly the nervous system. Among the 
early ones is the bad management of children at night in 
permitting them to become frightened, or, if frightened, 
seeking to conquer them by force. Perhaps I should include 
the day as well as the night, for at no time can a severe 
fright fail to have its effects on the nervous system of the 
young or the old. 

There are two elements so powerful in affecting the nerv- 
ous breakdown of many people that they cannot be consid- 
ered too early in life. These are lack of moderation and 
lack of self-control, and the earlier a child begins to live 
moderately in all ways the better. The lesson will not be 
an easy one, but is worth some hard study and will need 
many years for its perfection. 

Much has been written on the school life of children, and 
the subject seems inexhaustible. An extremly readable arti- 
cle appeared some months ago in the Ladies Home Journal^ 
by Edward l^k, in which some rather radical ideas were 
presented. For example, we are told that at fifteen a boy 
or girl should be expected to have been in school only long 
enough to have acquired an accurate knowledge of how "to 
read aloud pleasantly and intelligently, to write legibly, to 
spell correctly, to express himself clearly in a letter, to count 
accurately, to use his mind himself and to use his fingers so 
that his hands will be a help to him in earning his living." 

At first this impresses the average reader as being too 
radical altogether, and as giving the ordinary boy or girl 
quite too much time for play and for development. Still, 
nearly every one can think of some boy or girl, who for one 
reason or another, was not sent to school at all until ten, 
twelve or even fifteen years of age, and yet who graduated 
from college as young as the average. The Jesuit Fathers 



I go I Mental Diseases. 185 

say, that in their observation, " the more a child knows at 
seven the less he knows at fourteen." Possibly the theory 
that early life is intended for growth and not for very much 
brain work, may prove to be the correct one. 

However, as a complete revision and a possible reforma- 
tion of the whole school system is not one of the present 
probabilities, must children necessarily be made nervously 
ill by it } A very large majority of children will go through 
the course with credit to themselves and with health as good 
as when they began. That others will not, is no reason why 
the system should be wholly condemned. That it has many 
grave faults all claim. Perhaps its greatest is that it de- 
mands nearly the whole time of a school boy or girl, and the 
fault of the parent is that this is not acknowledged, and 
therefore innumerable other things are crowded into the 
hours that the school has already appropriated. 

Home duties, real work. of many kinds are demanded of 
quite young children during the hours at home. Many a 
little girl does the work that would take a servant some hours 
to do each day, and many a boy is called upon to some 
extent, but, as a rule, unless it be in the country on a farm, 
there are more things thought suitable for girls to do about 
the home than for boys, and so the boys are left more free to 
find health and strength in play and exercise in the open air. 

Another competitor for the time already claimed by the 
school work is society ; and here, too, the girls suffer more, 
partly because of the open rebellion of the boys, who thereby 
escape its clutches, and partly by the tyrant. Custom, which 
demands more of girls in this direction. 

The study of music is also often made to take much time 
daily from a girl's play hours while her brother is free for his 
own pleasure. These three elements, together with the un- 
hygienic dress provided for most girls, seem to me to be the 
greatest factors in causing more girls than boys to break 
down during the average school course. 

But, allowing that most children can pursue the ordinary 



I S6 The New England Medical Gazette. Apr., 

school course without serious injury, what can be done for 
those who early show signs that indicate that they cannot ? 

The first point to be decided and definitely is, which shall 
have precedence, the school education or health ? It would 
seem to be an easy question to settle, but when one is un- 
certain just how much strain can be borne, one is in doubt 
how much may be venturdd with safety. 

By the time this question has to be settled, we no longer 
have to deal with the very young child, and we have to en- 
counter the youth's own will and wishes as well as our own 
desires and ambitions, thus making the problem doubly hard. 
Still it should be wisely met, and it is not thus met when 
young people are allowed to have continuous headaches, to 
lose their appetite and to study without proper food, to sit up 
at night for school work, giving up all recreation time, and 
who show nervous irritability by being what is wrongly 
called cross and ugly. These symptoms should be recog- 
nized early and treated promptly, not half so often by medi- 
cine as by lessening of the mental strain. How this can 
best be accomplished must be decided individually for each 
case. Sometimes it can be done by dividing one year's work 
into two, sometimes by stopping all work entirely for a year. 

It is not school children alone who suffer from preventable 
causes. If we look into the lives of every age and class, we 
find some who are living below par, yet for whom the value 
of life might be increased by a little careful management on 
their part or on the part of their friends. 

It is not always possible or wise to take away all work 
from over tired people, but a lessening here and there is fre- 
quently possible, by simplifying the wants or by the helping 
hand of another if the wants have already been brought 
down to a basis of necessities. 

Some principles apply to young and old alike, and if 
heeded would prevent many mental disasters. One is home 
nagging. I can think of no better term foi* what I mean. 
The origin of the word is from the Danish, meaning to gnaw, 



190 1 Mental Diseases. 187 

and that peculiar characteristic very common in some homes 
of always commenting, criticizing, complaining, or on the 
other hand of showing such tender solicitude that one is 
never allowed any freedom of thought or action, is not unlike 
the attention a dog bestows on a precious bone. All this 
excessive care has foundation in a desire to be of assistance 
to one's friends, but its effect is sometimes nearly or quite to 
drive the friend or relative from the home. To be allowed 
to live and develop along individual lines is one of the' 
greatest blessings. It need not make a person eccentric, 
though its tendency may be in that direction, but the whole- 
some friction that comes from rubbing against other individ- 
uals usually corrects the tendency. 

I am not referring here to normal home training or home 
discipline, but to the excessive manifestation of both, fre- 
quently indulged in by one or more members of a household. 
Sometimes the only salvation of the younger memlpers of a 
family consists in sending an older brother or sister away to 
school, or in encouraging the nagging one to find a home 
outside the family circle. It is an advantage to both and no 
detriment to the banished one, for it is chiefly because of 
over solicitude about home trifles that the habit arises, and 
absence from these relieves the anxiety and corrects the 
habit. 

I have seen cases that threatened to become really men- 
tally diseased, recover entirely by a change from home life 
and by relief from this undue pressure. 

Undue pressure with over-much friction seems to be the 
key note to the causes of mental break-down far oftener 
than mere overwork. The old saying that " it is worry not 
work that kills " usually holds true, but in this age of rush 
some of us are liable to drop from simple overwork. 

Habits of thought must have some influence in developing 
certain mental diseases. This is particularly true of those 
forms characterized chiefly by delusions, and may begin early 
in life. 



1 88 The New England Medical Gazette, Apr., 

The child who is allowed, perhaps encouraged, to think 
that his playmates do not care for him, or are trying to take 
advantage of him in some way, is very liable to become 
morose and reserved, and later to develop delusions of sus- 
picion and of persecution. There can be no better prophy- 
lactic for paranoia than a determination to believe that men 
are honest and intend to do well until proven to the contrary. 
It is also quite as well to let some one else do the proving ! 

On the other hand, for a child who has a bad inherttance 
to be unduly petted, pampered and flattered, the tendency 
will be to develop a self-exaltation and pride so characteristic 
of some cases of delusional insanity that it is manifested ex- 
ternally by carrying the head so high that it is really thrown 
backward. 

When we consider that a bad mental heredity includes not 
only fully developed insanity, but the neuroses, consumption, 
syphilis, and any disease that destroys the purity of the 
blood, we feel that it is not so very strange after all that so 
many young people become insane and are sent to hospitals 
before they have reached maturity. Adolescent insanity, 
occurring between 21 and 25 years of age, furnishes more 
cases than any other like period of five years, and it is the 
most hereditary of all forms of insanity. 

Hence the necessity of carefully individualizing the man- 
agement of the lives of so many young people. For many of 
them the safest course would be largely an out-of-door life, 
free from excitement and artificial stimulus. Proper food is 
a most essential feature in the preventive treatment of such 
cases. As children, milk is the best diet, and should be 
used largely, even if not fancied by the child. Some claim 
that it would be best to force its use. This with farinaceous 
foods, some eggs, fish and vegetables, should be used to 
almost the entire exclusion of meat until a child is eight or 
ten years of age, and should preponderate for a lon^ time. 

An abundance of plain, nourishing food is vefy necessary. 



igoi Mental Diseases, 189 

Fat is the great prophylactic in these cases and should be cul- 
tivated by all possible means. 

Though the youth claims our first attention as being in the 
most danger, we cannot stop when maturity is reached, for 
there is no period of life when those predisposed to mental 
disturbances may not yield to some undue strain. 

The teacher, who under this same questionable school 
system is severely overworked, is in constant danger. Bad 
habits of food, sleep and exercise are contracted by many 
during their school days and are continued when they 
become teachers. 

The more faithful the worker the less common sense is 
often used in regard to health. The mother, with her multi- 
ple cares and much work, often has to leave them all and find 
the rest she needs in an insane hospital. I remember being 
told some years ago by a young mother, possibly thirty years 
old, that her enforced stay in the hospital was the first rest 
of any kind that she had had since she was fourteen years 
old. There never seems to come the right time for rest, 
when work presses and children's needs are so numerous, 
but it is needed, and if not taken will perhaps be forced. It 
is often due to thoughtlessness on the part of the husband 
that more efforts are not made to lighten the cares and 
relieve the monotony of the wife and mother. 

What I said earlier in regard to a child's being taught 
moderation, applies with equal force to the adult. If the 
lesson has not been learned in childhood it should be later. 
One of the most essential factors in acquiring a peaceful and 
healthy mind is learning one's limitations. To aspire beyond 
our reach, to live beyond our means either as regards purse 
or strength, to strive after the unattainable is what brings 
unrest to the soul and disease to the mind. 

The choice of a suitable occupation is important when a 
young man or woman is obliged to consider how best to con- 
serve mental strength. Those occupations requiring close 
application and involving risks or much excitement should be 



I go The New England Medical Gazette, Apr., 

avoided. Regular work and fixed salaries, freedom from 
close confinement and continued brain work, and out-of-door 
life, if possible, are most liable to prevent wrecks. 

I have been asked to make some suggestions as to when 
other than home care should be advised. It is a question 
especially applicable to incipient cases, and hard to answer. 
I have not yet been able to answer it myself in regard to a 
young man about whom I was consulted some time ago. I 
should like to give very briefly a few points in the case. He 
is bright, handsome, boyish looking for 20 years, quick at 
mental work and fond of it, in fact determined to pursue it ; 
was sent home from college in his first year as mentally 
affected, has since entered a technical school, left for a time 
and became a reporter for a daily paper, but has now re- 
turned to school. Though very affectionate in his home is 
impatient of any control ; does not eat properly and is evi- 
dently going to break down entirely. His heredity is bad. 
Means are limited. I believe he should give up study, but 
what to substitute and how to control a young man who has 
much of the energy, excitability and stubbornness of acute 
mania, though yet under a fair degree of self control, is not 
an easy question to answer. He certainly is not a subject 
for a State hospital now, though he may be later, and life in 
a sanitarium would be irksome to him. Probably some out- 
of-door occupation, under proper guidance, would be the 
safest course, but to induce him to adopt it or to find the 
place for him will not be easy. This case illustrates the 
necessity of beginning prophylactic treatment very early. 

There are a few general principles that apply to most 
cases in regard to home versus hospital treatment. It is by 
no means always best to send a nervous or an incipient 
mental case away from home, yet I believe that, as a rule, 
there is less danger of erring by sending early rather than . 
keeping at home too long. 

There is always this to be considered, that if one member 
of a family is nervously weak other members are liable to be. 



I go I Association of Crime and Insanity, 191 

and may be affected by having the care or even the presence 
of a nervous invalid in the home. Again, the break down 
has come amid the home surroundings and may have been 
caused by them. Removal from them is often the essential 
step towards relief. 

The character of the home must usually decide the ques- 
tion. There are homes where it is impossible for any one 
within the four walls to have rest of mind or body. Busi- 
ness, pleasure, society, charity, and numerous other things, 
keep the whole atmosphere full of energy. From such a 
home, however happy and luxurious, the nervous patient 
should be taken as early as possible. 



REPORT OF CASES ILLUSTRATIVE OF THE ASSOCIA- 
TION OF CRinE AND INSANITY. 

INTRODUCTION. 

The subject of this evening with the Medico-legal section 
of the Boston Homoeopathic Medical Society has been forced 
upon the mind of the Chairman of this- bureau by recent 
association with four cases which seemed worthy of special 
consideration. As presented to me, and while under obser\'- 
ation, they seemed especially interesting and of peculiar 
significance in illustrating our duty, as physicians, to these 
patients, and the relatives and friends of those suffering from 
mental disorders or diseases, whose ill fortune it is to be 
arraigned before a court of justice, while the defect in their 
mental sphere is yet unrecognized. A remarkable fact to 
note, and one too often occurring in the association of the 
legal with the medical practitioner, is the mismanagement of 
this class of cases. They have apparently, sometimes in 
reality, been suffering from the most violent form of mental 
derangement, but during a state of lucidity convicted of 
crimes that were committed during a state or stage of exas- 
cerbation, sometimes with or without medical expert testi- 



192 The New England Medical Gazette, Apr., 

mony. Now while it may not be denied that our laws are 
very exact, and that the justice of our courts is beyond dis- 
pute, yet the fact not infrequently faces us, when put to the 
crucial test, that the prisoner is misplaced. There seems to 
open an opportunity still in a jury trial for those to decide, 
who are least capable of deciding vital questions, as was re- 
cently illustrated in a New York court, I think, where the 
opinions of the most astute medical experts, after most care- 
ful and repeated examination and observations, were over- 
ruled by the jury, it being a question of fact as to whether 
the man was or was not insane. We are not much in doubt 
of the opinion of the court who listened to that of the 
experts. It is often apparent in witnessing a trial that the 
prosecuting attorney, or attorney for the defence, is much 
more interested in the success of winning his case than in 
the facts of the mental status of the client. This we know 
is their duty to a degree, and it does sometimes seem, in the 
weakness of human criticism, that the doctors are not alto- 
gether guiltless. They want to win. One of our ex- 
governors, and I think one who now occupies a national 
position, once said, " Nothing succeeds like success." This 
seems to be the motto in court as elsewhere, and we will not 
deny that it is worthy of commendation, but be sure the 
premises are right. My point is, that the paramount issue 
with the professional man should be to get at the truth, and 
to this end they should labor together unhampered and 
unbiased — that the lawyers and the doctors should work for 
the common weal — ^ybu can trust the judge. 

The purpose of bringing this subject to the minds of the 
members at this time for discussion is to enlist your interest 
in a vital matter, that we may become more deeply con- 
cerned. For that is in every way for our greatest good 
always, which more fully subserves to the largest measure of 
benefit to our patients. The object of inviting in with us a 
legal representative is, that we may learn of him our truer 
relations to the law. And there should be a conjoint obliga- 
tion between the attorneys and the medical witnesses — a 



IQOI Association of Crime and Insanity. 193 

feeling understood if not expressed — to act to the end of 
placing these cases withio the proper institutions for re- 
straint. Confession of my own inability to cope with this 
question is needless, much less to suggest a possible solution 
of it, but if we have even excited combat, stirred you as it 
may be to a discussion, set you to thinking, then something 
has been accomplished. 

SUMMARY. 

Case I. — Man arrested for attempted murder of his wife 
and step-daughter, and suicide by shooting. Was not this 
mania } All were shot, none proved fatal. He was arraigned 
before the courts, tried, convicted and sentenced to penal 
servitude. 

The defence was insanity at time of act. Sane at the time 
of trial (many months afterwards). Was an alcoholic. The 
prosecution denied insanity at any time or at time of the 
tragedy, by testimony of medical expert. Sentence not 
severe. Both sides were satisfied with the disposition of the 
case, as the defence feared recurrence, and believed the 
family still in danger. • 

Case II. — Arrested for robbery on the "highway." Al- 
lowed bail. Was submitted to medical expert examination ; 
adjudged insane, suffering from *' dementia,'' Opinions sub- 
mitted to the court. Accepted. Case was committed to 
asylum. 

Case III. — Arrested on charge of attempted rape, and for 
improper conduct with young children. Was tried and con- 
victed without medical expert examination. After trial gen- 
eral belief in the idiocy and imbecility of the prisoner. Was 
subjected to medical expert examination. Opinion prevailed 
that he was *' feeble-minded," — age of a man and mind of a 
child." Result entertained as a fact by the court and ac- 
knowledged by the prosecuting attorney, but too late to 
reverse the decree. Was sentenced to reformatory. 

Case IV. — Man arrested on a charge of " Indecent Ex- 
posure." History of his case revealed the fact of recurrent 



194 The New England Medical Gazette, Apr., 

attacks of conditions suggestive of epilepsy or recurrent 
insanity. He was committed for trial, but result of examina- 
tion was submitted to the court. 

He was committed to asylum, adjudged insane, and at j 

time of act irresponsible for his conduct. ! 

Case I. — It was about seven years ago that I first met \ 

Mr. S. He was then a hale and hearty, jolly, cockney Eng- i 

lishman, of the peasantry type, approaching middle life ; thick 
set and stout of stature, average height, round face and 
rounder head, heavy set jaws, a strawberry blonde, with blue 
eyes and a freckled face. He had not a strong voice, but it 
was not difficult to hear it, however, when backed up by his 
severe manner of expression, characteristic of his disposition. 
He was, however, not so disagreeable in his manner when 
partially influenced by alcoholic beverages, in which he freely 
indulged, and which was his condition much of the time. 
This disposition was worse when he hadn't been drinking. 
He was, however, an earnest, hard-working and successful 
vender ; out early, often and late, and acquired a comfortable 
subsistence, and a small additional accumulation resulting in 
an unpretentious home. He had a wife — one of those de- 
voted, simple-mannered, lovable peasant women, conscien" 
tious and self-sacrificing, willing to bear the burdens of life 
as they come, severe as they may be, in the trueness of her 
vow to love, honor and protect one to whom she had 
espoused. My first call on this family was to prescribe for 
this wife — her heart — one of those hearts so frequently 
found in women whose cares, whose fears, whose anxieties 
and griefs of mind have carried beyond physical power to 
resist, and it seems as if the heart strings stranded, and when 
no longer the great reservoir for supplying the vital fluid is 
patent, then its possessor sinks quietly but surely into a state 
of enfeeblement from which she never rises. A few years 
later came cerebral apoplexia, paralysis and death. 

He had daughters and sons, all of whom were healthy. 

Following the death of his wife he plunged more deeply 
fnto his indulgencies to drown his sorrow. But realizing the 



igoi Association of Crime and Insanity. 195 

possible results of such debauchery, and becoming interested 
rather seriously in a second union, he undertook a reform. 
For a time he abstained from the fire water, but indulged all 
the more fiercely in the " weed." Tobacco and alcohol hav- 
ing for a long time been his boon companions. 

His newly accepted family of wife and step-children, to 
the exclusion of his own by kin of blood, proved anything 
but felicitous, and he was soon deeper than ever in self- 
indulgence. In a little while, however, his sight began to 
fail him, and he was unable longer to attend to business. He 
found himself staggering about — moping and feeling his 
way. Liquor had rarely ever intoxicated him to the degree 
of unbalancing his gait, but now he was ever apparently 
intoxicated whether he had been drinking or not. He 
became alarmed, and sought medical advice. Being of 
strong will and stability of character, when obliged to assert 
it — and this he did only when it affected self — he acted 
upon advice, and desisted from his strong habits. He was 
thought to be suffering from alcoholic amaurosis. Now 
began his acts of marked strangeness. He became dejected, 
despondent, feared loss of sight, and possibly of his life, 
hypochondriacal melancholic, and pictured to himself, as he 
related, all the dangers that were to befall him. His chil- 
dren, fearful of his mental state, applied to me, seeking his 
commitment to special care in an institution. He would 
consent to no examination but for his eyes. This at the 
infirmary, where he was treated for a few times, then refused 
admittance because of his wild and untractable disposition. 
He concluded to' return to his native land ; made- a most 
extravagant business deal and cleared out for England. After 
a few months, he returns in poverty and degradation. Seeks 
his children, makes exorbitant demands. Threatens the life 
of his son unless he concedes to his (the father's) wishes. 
His last demand was for money, which not receiving he 
avowes to his son that he will seek his wife, the step-mother, 
and if she refuses he will shoot her and then himself, and 
end all. The distance was less than a mile. No sooner 



196 The New England Medical Gazette . Apr., 

started than the son gets notice to the police station. The 
police arrive at the house just after the tragedy. The man 
hurried to the home of his wife, made his demand for money 
to buy a drink, refused, he draws his revolver, shoots her. 
The alarm arouses the household and brings the step- 
daughter to view, who in turn receives the contents of 
another chamber of the death dealing weapon, and then he 
mouths the muzzle and sends a bullet through the palatal 
arch that lodges behind the left orbit. Fortunately, or un- 
fortunately for him, none of the injuries proved fatal. He, 
with the others were cared for at the hospital ; he under 
police surveillance, until able to be removed to jail, and in 
due process of time was brought before the bar for trial. 
This was, indeed, a new bar for him. It is here we associate 
him with cases representative of "crime" and "insanity." 
The shock of his suicidal attempt, with the bullet yet in its 
lodgment as a constant reminder of his act ; his protracted 
and enforced abstinence from alcoholic liquors ; the regular 
habits ; the improved dietary, and unyielding restraint of 
hospital and prison life had improved his physical condition, 
and controlled his mental desires, but it needed only a little 
opposition on the part of his visiting friends to convert him 
into a madman, except as influenced by the fear of his 
attendants and of future incarceration with his trial still 
pending. He was morose, obstinate, indolent and ugly — 
ugly in its American usage. 

At his trial he did not present as insane. I was requested 
by the family to appear for his defence, with the hope of 
committing him to an asylum for the insane. They feared 
his release from confinement would result in a repetition of 
similar acts of violence. The lawyer for the defence decided 
that if this client could not be adjudged insane in the pres- 
ent, that he had best be incarcerated, hence would try only 
to reduce the sentence by asking the leniency of the court. 
In direct examination I was asked if I considered the man 
insane at present. My reply was negative. Did I believe 
him sane and responsible at the time he committed the 



I go I Association of Crime and Insanity, 197 

crime ? Reply was negative. The State attorney asked me, 
" Did the criminal know * right from wrong ' when he did the 
shooting?" I was, as a matter of course, not allowed to 
answer conditionally, or to make any explanation, but must 
give an opinion by saying only either Yes or No. There 
being given no measure, no basis or standard for comparison 
to judge right from wrong, I could easily believe that this 
man, with what I knew of his past life, and the condition of 
frenzy, fury, mania or madness at the time of the act, did not 
know "right from wrong" as you and I know it now, nor as 
he has known it since. My reply was " No ! " emphatically 
"No!" 

Here is where the lawyer has the advantage of the. doctor 
surely ; and he usually takes it. He formulates the question 
and suggests what language you may use in replying, allow- 
ing you only the alternative of answering in the negative or 
affirmative. Undoubtedly of wise origin, but not always used 
to the welfare of the truth or the prisoner, though sometimes 
may be relieved by the judge. 

He was examined by an expert medical witness for the 
prosecution, and was not found wanting in mental capacity. 
Nor did his testimony admit of any interpretation as of 
mental unsoundness in the prisoner at any time or place in 
the history of his life, past or present. From any facts 
gathered by the doctor in his examination of the prisoner — 
rather than X\\t fatient — there was nothing on which to base 
an opinion that the culprit was irresponsible for his acts. 
This from the prosecuting attorney's standpoint was based 
upon the offender's absolute ability to know "right from 
wrong." From whose standard I never heard stated. 

'Tis often quoted "All's well that ends well." 'Tis human 
to think so when the result is agreeable to our wishes. This 
man's fate was not too bad for the restraint of himself for his 
own good and for the safety of others. He was sentenced to 
imprisonment and labor for a period not incommensurate to 
his crime. 

I will not attempt a diagnosis, neither do I argue to prove 



198 The New England Medical Gazette, Apr., 

an opinion. But may I suggest to you before whom I speak, 
some of you professionals whose opinions are expert, being 
based on a special knowledge acquired by experience and 
practice ; or may I ask the question, is there not something 
in the life and custom and liabits of this case which might 
have contributed in great measure to a condition at least 
bordering upon the danger line, which is sometimes, at least, 
with difficulty drawn to divide the sound from the unsound 
mind } Why might not the man have been suffering from 
alcoholic mania, "mechanically conscious," but "filled with 
wild fury," as one author expresses it } In the Medico-legal 
consideration, as applied in criminal jurisprudence, we find 
these cases variously dealt with. Many find refuge in the 
Home for Inebriates. And while the question is open as to 
the degree of responsibility of the inebriate, why should not 
the lawyers, and the doctors, and the officers of the law, 
labor mutually for the best mterest and most proper disposi- 
tion of the unfortunate offender, rather than for the winning 
of their case. From personal observations I have the highest 
tribute reserved for the court — and I mean the judge solely 
— for he often exhibits more humanity than either the prose- 
cution or defence. 

Case II. — Mr. F. My acquaintance with this man cov- 
ered a period of thirteen years. His mother had several 
times consulted me in his behalf, with the general complaint 
that she believed him not in his right mind, that his peculiar- 
ities were noticeable and hi$ acts were not those of one of a 
sound mind. He is somewhat peculiar in his habits and 
general appearance. One would be attracted to scrutinize 
him in passing, as he wears his hair long and has a fanciful 
way of dressing it, and has other mannerisms. Some would 
incline to call him a "freak" or a "crank." He has been a 
source of care and anxiety for several years. 

The circumstances which led to his arrest, for which 
reason I was consulted in .the case as related, were as fol- 
lows : This young man h^d been under parental restraint 
for some time, and had been given his daily allowance of 



I go I Association of Crime and Insanity, 199 

money, received orders with promised rewards or threathened 
punishments according to his deserving. In the present 
instance his parents were away for a summer vacation, and 
he was left under the care of his sister, who meted out to 
him his usual requirements, as had been the custom of his 
mother. 

On a certain evening he did not return at the appointed 
time. Search and investigation revealed on the following 
morning that he had spent most of the night in a public 
park ; had associated himself with a negro with whom he 
was apprehended and arrested by an officer, and accused of 
having committed hi^^hway robbery. The policemen who 
made the arrest claimed that the prisoner had robbed a man 
who had fallen and was sleeping by the wayside ; that while 
detaining the prisoner at the call box the prisoner ruffled 
something in his hand and threw it into the gutter. This 
proved to be two bank notes which the officers believed to 
be the money stolen from the sleeper. 

The patient said that he saw the man lying across the 
sidewalk asleep, that he also saw two policemen standing a 
short distance away on the opposite side of the street. He 
suggested to his companion that they lift the man to his feet 
and set l\im on his way or else the "cop" would "pull him 
in," and "that would be too bad." He denied the charge of 
robbing the man, but averred that he was acting the part of 
the "good Samaritan," while the officers, "priests and 
Levites, passed by on the other side." 

The victim of the assault asserted that he was aroused 
from nis sleep, that the negro held him while the white man 
rifled his pockets. 

Knowing the patient's past, and believing his present con- 
dition of mind unsound, I undertook to show that he was 
irresponsible. He was released on bail, and taken to a medi- 
cal expert for examination, with the following result : — 



200 The New England Medical Gazette. Apr., 



McLean Hospital, Waverly, Mass., July 25, 1900. 

RKPORT OF A MEDICAL KXAMINATION (OF MR. F.) BV DR. 
EDWARD COWLES AND DR. FRANK L. NEWTON. 

We, the undersigned have together examined at Waverly, on the 23d 
instant, Mr. F., his father, and his brother-in-law, with reference to his, the 
said Mr. F*s, mental and physical condition, spending three hours in the 
inquiry. On the 24th instant his mother and his sister were examined for 
two hours for the same purpose, by Dr. Cowles, and all the persons above 
named have been known personally to Dr. Newton for a number of years. 
The examinations included a review of the history of the said Mr. F*s life- 
time; of its main incidents from infancy to manhood with reference to his 
physical and mental development, his education, his character and conduct, 
his attempts to engage in business, and his illnesses and manifestations of 
peculiarities indicating the state of his mental health. 

lie is now 34 years of age; he was born an apparently healthy infant, but 
from the age of about 3 to 8 years he suffered severely and almost fatally 
from asthma; at lo years of age he began going to school, and grew up a 
bright, promising boy, mentally the equal of other boys of his age ; he 
became especially interested in the study ot electricity and chemistry. Not 
being strong physically, and considered as limited in his endurance of mental 
work, he undertook only a special course in Harvard University, entering at 
about the age of (8 years. During two years of study there, he showed in- 
creasing tendency to headache and nervousness, and attention was attracted 
to his propensity for expansive and unpractical schemes for business and 
money making beyond his means and ability. 

At the middle of the second college year, when 20 years old, began the 
event which proved to be the loss of his mental health. He broke down 
under the stress of examinations early in 1887, and was brought home by a 
friend, who found him in his room in a dazed and confused state of mind; 
and of what then happened he had had no recollection afterwards. The 
college authorities advised his giving up his studies because he was mentally 
incapable, his writings being rambling and incoherent, according to his 
mother's memory of the statement. He returned later, however, but grew 
worse again, and was taken home by his parents, terminating his college 
studies. This was followed by months of seclusion at home. His strange- 
ness of conduct continued. He sat in the house inactive, silent and 
apathetic. He appeared confused, and to have lost memory and intelligence; 
he would leave unopened his letters received by mail. About this time he 
was taken to a specialist in Boston, who said he had "grave brain disease," 
and advised his bein^ taken to an asylum. He was, however, taken to the 
country for a time. The medical opinion then expressed was that the boy's 
case was hopeless. 

The foregoing statements, corroborated by the several persons examined, 
together with the subsequent history, clearly establish a diagnosis of primary 



190 1 Association of Crime and Insanity, 201 

dementia, a mental disease sometimes called adolesceut insanity^ to which 
young persons are peculiarly •prone. This was the onset of a progressive 
mental decline from which he has never recovered. The recurrences, in the 
subsequent 12 or 13 years, of periods characterized by confhsion and apathy 
or by depression with suicidal impulses, or by exhilaration and expansive 
ideas, with intervals of comparative lucidity, though with continuance of the 
fundamental dementia, constitute a consistent history of the progressive 
course of the mental disease. Within the last six years applications were 
twice made by his mother for his admission to the McLean Hospital, and 
upon the symptoms then described he would have been received, but for his 
parents having yielded to the patient's unwillingrness to come. 

The recognition of the patient's mental disease, and its character, serves to 
explain the remarkable association of grave mental defect with a superficial 
appearance of smartness and ability that is misleading. The mental damage 
is chiefly to his judgment, which at his best is only that of a child ; he lacks 
appreciation of the fitness of things, and the sense of proportion in the 
commonest affairs. Although his chemical education is defective, his natu- 
ral ingenuity has enabled him at times to make some small inventions. He 
is visionary and most unpractical in his expansive schemes. With facility 
of expression of his ideas, he is not hampered by any limitations of facts 
and circumstances ; he can make plausible and entirely untruthful statements 
with such evident sincerity as to gain sympathy for his schemes from those 
who abandon them later. His constant exaggerations are regarded as false- 
hoods by none who know him well. His natural gentleness of character and 
disposition not to injure anyone, have led to his being considered as harm- 
less to others, while at home for years he has had to be treated as incapable 
of taking care of himself, and at the same time he has had to be allowed to 
go much at large without suitable restriction because his insanity was not 
properly recognized. His need of restriction has been latterly more manifest. 

Mr. F's case has presented an especially serious aspect within the last year 
or more. A growing fondness for children, especially little girls (which act 
in more trusted persons might appear quite innocent) has been so manifested 
as to lead a number of persons, independently, to be distrustful of him. 
There seems to be some ground for taking precautions in this regard. Other 
considerations in his case are that he has been led into improper associations 
and to indulge in drinking habits through the influence of companionships 
against which it is becoming more difficult to guard him during the past 
year. 

Our findings in the case of this man, as stated in the foregoing summary, 
are sustained by many particulars that cannot be enumerated here. In our 
opinion he is insane, in a condition of chronic progressive dementia. In our 
opinion he is incapable of taking care of himself or his business affairs, and 
is irresponsible for his acts ; and further we believe that he should be placed 
under restraint and treatment in a hospital, both for his own benefit and 

protection, and for the protection of others. 

Edward Cowles, M. D. 
Frank L. Newton, M. D. 



202 The New England Medical Gazette. Apr., 

Case III. — Mr. A. This young man about thirty years of 
age, of idiotic or imbecilic appearance, was arrested on the 
charge of attempted rape committed against a girl of ten 
years, in a store of which he was the acting proprietor. 

His father, from under whose care **the boy," as he called 
him, had never been allowed to pass, believed it an act of 
blackmail instituted by the parents at the instigation of the 
officers of that locality, who were his avowed personal 
enemies: There was much to cause belief in such a theory, 
but as this was not the case before the court, it could not 
very well be brought out. 

The doctors, of whom I was one of the three on the defence 
called into the case by the father, were not for the examina. 
tion of "the boy " for mental soundness or unsoundness, but 
to inspect the child for a possible injury of six months' pre- 
vious commission. I can assure you, without further specu- 
lation, my hearers, that we didn't find any injury, nor did 
there need to be any inflicted to prove the legality of the 
claim by the prosecution, for proof of an attempt was quite 
sufficient. But the parent was obstinately opposed to any 
other procedure than to prove the innocence of his ** boy.'* 
" He was as gentle as a lamb, and as pure as a dove, and 
innocent of any crime," and all the time he kept declaring 
that " he was a mere boy," notwithstanding his age of man- 
hood, and "never did a wrong thing in his life." 

The prosecution needed but the testimony of the mothers 
of a few other children in the neighborhood, who told tales 
of similar experiences to corroborate the testimony of the 
complainant. The medical testimony of facts was purely 
negative, or really neutral, practically valueless. The case 
was an easy one. The judge could find nothing amiss in the 
law, and the jury found sufficient evidence in facts. The 
prisoner was found guilty, and sentenced to a reformatory, 
notwithstanding it was the general sentiment of the court, 
inclusive, that the "boy" was mentally incapacitated. 

The judge and jury, the prosecuting attorney, and all the 
physicians, I can almost authentically state, if it were proper 



190 1 Association of Crime and Insanity. 203 

to, were of the opinion reservedly expressed, that we were 
dealing with a feeble-minded victim of circumstances. When 
sentence came to be passed then the indignation of the 
family was aroused, and the father awoke to the possibility 
in the case, and bestirred himself to get release by establish- 
ing a case of irresponsibility. Examinations were made, 
strong letters of opinion were given, direct testimony and 
opinion of a medical expert was presented before the court ; 
the belief of mental enfeeblement was indulged by the judge, 
and acknowledged by the district attorney, who prosecuted 
the case, but the decree of the court could not be withdrawn. 
It had all come "too late." The parent was not willing in 
the beginning to accept medical advice to clear the case on 
such grounds. Here we are confronted by the apparent 
authority of parents, friends or relatives. Ought not there 
to have been an intervention on the part of the court or 
some authority, and a demand made for proper medical 
expert examination of this man, and if proved an " irresponsi- 
ble," even if found guilty of a crime, to have committed him 
to a suitable place for treatment and protection } Do not 
these cases demand our attention } Our mutual interest is for 
their proper assignment and everlasting benefit. 



Value of Examining School Children's Ears. — The 
value of these examinations is that they call attention to the 
existence of defects and thus prevent neglect. A frequent 
cause of ear trouble in children is lesions in the nose and 
throat. The practice of scrubbing the ears and nasal douches 
are harmful rather than useful. In children under six years 
of age the eustachian tube is so wide that liquid can get into 
the middle ear when swallowed. Over 50 per cent, of all cases 
of ear disease occur in children under ten years of age. The 
nose and throat of school children must be examined, and 
the conditions found must be treated in order to prevent ear 
complications. — Exchange^ 



204 The New England MedicaC Gazette. Apr., 



EDITORIAL. 

Contributions of original articles, correspondence, etc., should be sent to the publishers, Otis 
Clapp & Son, Boston, Mass. Articles accepted with the understanding that they appear only in 
the GazetU. They should be typewritten if possible. To obtain insertion the following month, 
reports of societies and personal items must be rgceived-by the i^th of the month preceding. 



BAZAAR FOR THE BENEFIT OF MEDICAL SCHOOL. 

We are in receipt of the appended circular, issued by the 
N. E: Hahnemann Association, which explains itself. It is 
evident that the practical work for the good of the college 
has begun, and we have no doubt that it will meet with the 
success which the cause merits. Let every physician do 
what he can to help this good work along. It is very en- 
couraging for us to be able to state that the school has 
recently received a fund of $2,000 for the benefit of the 
library, a bequest of $t,ooo to be added to the Alumni 
Scholarship Fund, and a recent tea party held by the Ladies' 
Aid Association at the residence of Dr. A. J. Baker-Flint, 
netted the sum of $355, which was given to the school for 
library purposes. 

To THE Friends of Homceopathv. 

The friends of New England homceopathy in general, and espe- 
cially those who are banded together in the membership of the 
New England Hahnemannian Association, are making a strenuous 
effort, in this first year of the new century, to place Boston Uni- 
versity School of Medicine on the permanent and independent 
financial basis, on which we may feel that most of the other dis- 
tinctively homceopathic institutions of New England now happily 
rest. The School and its practical achievements in the cause of 
homceopathy need no recalling to the minds of homoeopathists any- 
where. To its making and its maintenance have gone the unselfish, 
unrewarded efforts, freely given, of men who have stood with the 
highest, not only in the history of the homoeopathy of New England, 
but of the homoeopathy of the world. Some of those men have 



IQOI Editorial. 205 

passed to their reward. Others are passing rapidly in to the late 
afternoon of their working lives. It has long been among the 
dearest desires of them all, to see the School to which they have 
given so many of the best years of their lives, established on a 
sound and permanent financial basis. The School has always been 
a self-respecting, self-supporting institution. It does not ask finan- 
cial aid and upbuilding today, because it cannot, in its present com- 
paratively restricted sphere of work, still meet its needs. It asks 
large financial aid, that it may immediately and indefinitely enlarge 
its sphere of work, to the direct and practical good of the com- 
munity in which it labors, and to which it has for so many years 
been most practically useful. It has led the way, in the raising of 
the standards of medical education : daring, when older and far 
richer schools have hesitated to dare. It has sent out hundreds of 
men and women well equipped by sound medical training, and by 
the implanting of high ethical ideals, to do the medical work of the 
community. The wide success and usefulness of the School's 
alumni is the best guarantee of the quality of the work done by the 
School. We ask that this work be henceforth unhampered by the 
burden of the mortgage that for so many years the School has 
carried. We ask that we may have adequate provision for scholar- 
ships; so that hereafter not one of the many bright and earnest 
young men and women who annually come to the School, asking 
the modest financial aid which shall enable them to enter on a 
course of medical study, they pledging themselves to make good 
this aid to their Alma Mater within a certain space after graduation, 
may be denied such aid. To many of such the School finds itself 
today obliged to return a discouraging answer. Adequate scholar- 
ship endowments alone can make a different answer possible. For 
such endowments, and for the raising of the mortgage now hamper- 
ing the School, the friends of the School are now putting forth an 
especial effort. Will you join your effort to theirs ? 

On Friday, the nineteenth of April, there is to be held, at Copley 
Hall, Boston, an " ^^sculapian Festival," the proceeds of which are 
to be devoted to the purposes above mentioned. You are earnestly 
requested to aid in the success of this Festival, in any or all of the 
the following ways : 

By disposing of a number of tickets at (full admission) one dollar 



2o6 The New England Medical Gazette, Apr., 

each; (day admission) thirty- five cents each; or (evening admis- 
sion) fifty cents each. 

By securing sums of money, large or small, to be applied to the 
purposes of the Festival. 

By soliciting any of the below mentioned articles, for purposes of 
sale at the Bazaar of the Festival. 

FOR TABLE OF ** PHYSICIANS' WEAR.'* 

(Hoves. Neckties. Stocks, Hose. Garters. Belts. Mufflers. 
Chest-protectors (for wear with evening dress). Slippers. House- 
jackets. Surgeons* Frocks. Surgeons' Cuffs. Caps. Dressing- 
gowns. In a word, any article adapted for men's and women's 
wear, excepting, of course, heavy garments. 

FOR TABLE OF "PHYSICIANS' SUNDRIES." 

Note- books. Clinical Thermometers. Covers for Magazines. 
Sofa-cushions, worked with medical designs. Pin-cushions. Linen 
Cases for Stethoscope, etc. All sorts of desk furniture, Inkstands, 
Pens, Pen-wipers, Mucilage-bottles, Stationery, Blotting-pads, etc. 
Bags for soiled towels. Soap-saucers. In a word, anything suited 
to the furnishing of a doctor's office or waiting-room. 

FOR TABLE OF "DOMESTIC MEDICINE." 

Nurses' Aprons. Nurses Caps. Clinical Thermometers. Sand- 
bags and Salt-bags of all sizes, for quick heating. Alcohol Lamps. 
Medicine-glasses. Lint. Bandages. Oiled Silk. Rubber sheets. 
Emergency-boxes. Court -plaster. Hot- water Bottles. Flannel 
Cases for Hot-water Bottles. Japanese Heaters. Absorbent Cotton. 
Oil. Medicine- spoons. Medicine- droppers. Wrappers for In- 
valids. In a word, anything suitable for the plenishing of the home 
sick- room. 

FLOWER TABLE. 

Cut Flowers suitable for boutonnibres. Plants, Flowers for 
decoration. Ferns, Palms, etc., for decoration. 

ART TABLE. 

Engravings or Water- colors, suitable for the physician's office or 
waiting-room. Old Prints of medical subjects. Photographs of 
physicians. Calendars. Statuettes on medical subjects, like Rogers* 
" Playing Doctor." 



1 90 1 EditoriaL 207 

FOOD TABLE. 

Home-made Candies of wholesome sort. Bread-sticks. Oat- 
meal Cakes. Whole- wheat Bread. Simple, dainty Cookies. Straw- 
berries. Chocolate. Cream. Fruit Syrups. Jellies. Seltzer Water. 
Crackers of all kinds. 

BOOK TABLE. 

Any books written by physicians, such as the works of Oliver 
Wendell Holmes, Weir Mitchell, John Brown (Edinburgh), William 
Tod Helmuth, or any other medical author. Books about doctors, 
as Miss Phelps' " Doctor Zay," Mr. Howells' " Dr. Breen's Prac- 
tice,'* " Dr. North and his Friends." Medical works of all kinds. 

ARTICLES FOR THE *' DOCTORS* ORAB-BAG." 

Any sort of little article having whimsical relation to medicine, 
such as tiny Skeletons, Skulls for tobacco jars, packs of cards 
painted in medical designs, little Warming-pans, Flasks, etc. 

If you prefer to contribute to the Food or Flower tables, please 
send your contributions to Copley Hall not later than nine o'clock 
on the morning of April nineteenth. 

Contributions of money, in sums however modest, will be espe 
cially welcomed by ALL the tables. 

Your help in some one direction, at least, is earnestly hoped for 
and expected. 



LEGISLATION. 

In our last number we mentioned several legislative matters 
that were of importance to the profession. We are glad to 
state that two of the matters have been satisfactorily settled, 
both being killed in committee. The bill to give permission 
to the College of Physiological Optics to grant the degree of 
Doctor of Physiological Optics was "referred to the next 
General Court." The so-called Pfeiffer bill was given "leave 
to withdraw,'* the reports of both committees being accepted 
by the House without debate. This result shows what can 
be done by united, harmonious and persistent work on the 
part of the profession. 



208 The New England Medical Gazette, Apr., 

OBITUARY. 

Henry M. Smith, M. D. 

It is with great regret that we are obliged to chronicle the 
death at Escondido, Cal., on the i6th inst, of Dr. Henry M. 
Smith, of New York City. There are few men in the pro- 
fession whose loss we could so ill-afford. He has always 
been a most indefatigable worker for the cause of homoeo- 
pathy. He served as one of the editors of the "Pharmaco- 
peia of the American Institute," and his labor was of much 
value in perfecting this great work, but probably his most 
untiring, persistent, and finally successful endeavor, was in 
connection with the Hahnemann Monument. He served as 
secretary and treasurer of the committee from the time of its 
appointment, and his work in raising the necessary funds to 
complete the monument was prodigious. WRen we consider 
that it involved an expenditure of about $50,000, which was 
raised largely through the homoeopathic profession, we can 
form some idea of the task. While many connected with the 
Institute believed that the work never would be completed, 
Dr. Smith never doubted the issue and never relaxed his 
efforts to accomplish it. 

The following biographical sketch has been very kindly 
furnished us by his son. 

Henry M. Smith, M. D., son of John T. S. and Amelia 
Franklin Smith, was born in New York City, April 24, 1835, 
and always lived there. He was graduated at the New York 
Medical College in i860, and joined the American Institute 
of Homoeopathy the same year, and was elected provisional 
secretary. He also joined the Homoeopathic Medical Society 
of the county of New York, of which he was secretary for 
eleven years from 1861, and the Hahnemann Academy of 
Medicine. He was elected a permanent member of the 
New York State Homoeopathic Medical Society in 1865. 
He was professor of physiology in the New York Medical 
College for Women in 1865-66, and held the same chair in 
the New York Homoeopathic Medical College in 1866, '67, 



I go I Editorial, 209 

'68. In 1859 he married his first wife who died in 1865. In 
1867 be married again. For forty-five years he was actively 
engaged in the business of homoeopathic pharmacy, but dur- 
ing that time found time to edit, in connection with Drs. P. P. 
Wells and Carroll Dunham, and publish the American Homce- 
opathic Review J and to compile a great mass of statistics con- 
cerning homoeopathy, homoeopathic physicians and medicine. 
The last four years he had not taken active part in business, 
but had devoted his time largely to his work as necrologist 
of the American Institute, which his painstaking attention to 
detail made very considerable. The " Pharmacopeia of the 
American Institute," of which he was one of the editors, and 
the raising of the Hahnemann Monument at Washington, for 
which he was secretary and treasurer of the fund, had occu- 
pied a great deal of his time and attention. He died of 
pneumonia on March 16, at the home of his daughter in 
Escondido, Cal., after an illness of about a week. 



March 12, 1901. 

Dear Sir, — At the regular meeting of this Society, held 
in Buffalo on the 2 2d of February, 1901, the following reso- 
lution was unanimously adopted, and the secretary instructed 
to send copies of the same to the principal journals with a 
request for publication : 

" Resolved : That the Western New York Homoeopathic 
Medical Society does most emphatically and unanimously 
protest against the unwarranted, illegal and entirely unneces- 
sary interference by the Executive Committee of the Ameri- 
can Institute of Homoeopathy, with the action of the Institute 
in fixing the place of meeting at Niagara Falls. We regard 
this action as an impertinent assumption that the Institute 
did not know its own business when it voted, by a large 
majority, and after a fair and very full discussion, to prefer 



2IO New England Medical Case tie. Apr., 

Niagara Falls to all other places named, as the best place for 
holding the Institute meeting in June, 1901. 

" We have positive information that the facts as they exist 
at Niagara Falls have been entirely misrepresented by the 
circular letter sent by the Executive Committee. We can 
assure every member of the Institute that ample accommo- 
dations will be afforded all at Niagara at reasonable rates.'* 

George R. Ckitchlow, M. D., Secretary^ 

505 Norwood Avenue., 

Buffalo, N. Y. 



NOTES ON PATHOLOGY. 

CONDUCTED BY S. C. FULLER, M. D., PATHOLOGIST TO THK 
WESTBORO INSANE HOSPITAL. 



On the Relation of Chronic interstitial Pancreatitis to the 
Islands of Langerhans and to Diabetes flellitus. 

Opie {your, Exp, Med. Vol. 5, No. 4) as a result of his 
studies on the various forms of interstitial pancreatitis, seems 
to have demonstrated that the interstitial invasion of the 
Islands of Langerhans in the interstitial form'* of pancreatitis 
bears a direct causative relation to diabetes mellitus. 

He calls attention to the marked interstitial changes which 
take place in other forms of adult pancreatitis, and in the 
pancreatitis of congenital syphilis. In these conditions, how- 
ever, the interstitial changes are either of an interlobular or 
interacinars type alone, leaving the Islands of Langerhans 
entirely unaffected, while in diabetes mellitus, not only may 
the lobules and interacinar structure be implicated, but the 
interstitial proliferation also takes place within the intra 
lobular islets. Islands of Langerhans. 

In one of his eleven cases of inter lobular pancreatitis 
there was a ** diabetes of mild intensity," but the sclerosis in 



I go I Notes on Pathology, 211 

this case, supervening upon obstruction of the ducts, was far 
advanced and the Islands of Langerhans were also involved. 

These studies of Opie demonstrate, perhaps, more clearly 
than any other the double secretion of the pancreas, one of 
which is poured into the intestinal canal, and the other liber- 
ated into the circulation. 

The function of the Islands of Langerhans has offered 
much for speculation to investigators, and until lately very 
little has been known of their nature. Laguesse, Schafer 
and Diamare suggested that they elaborated a secretion 
which influenced carbohydrate metabolism. *Ssobolen, in 
recently conducted experiments, found that after feeding 
animals on carbohydrates the cells of the islands became 
more granular, and that after ligation of the duct of Wirsung 
in dogs the islands were not implicated in the sclerotic 
process. 

The Bacteriology of Cystitis, Pyelitis and Pyelonephritis 

in Women. 

Brown (Johns Hopkins Hospital Bulletin No. 118) reports 
the bacteriological examinations made on women with cysti- 
tis and pyelonephritis. One hundred cases were studied : 
acute cystitis 26, chronic cystitis 31, seven of which were 
associated with pyelitis ; tuberculous cystitis 6, two of which 
were associated with renal tuberculosis ; 1 7 cases with no 
infection, nine of which were due to urinary hyperacidity, 
and eight to other causes ; 2 cases of acute pyelitis and 
pyelo-nephritis ; 12 cases of chronic pyelitis and pyelo- 
nephritis, eight of which were associated with cystitis; 6 
cases of tuberculous pyelitis and pyelo-nephritis, four of 
which were associated with cystitis. 

He calls attention to the low sp. gr. usually found in pye- 
lonephritis, and of the importance of determining the amount 
of albumen ; for if the grade of pyemia is more marked than 
the grade of albuminuria, cystitis is probably present alone ; 

* Cited by Opie. 



212 The New England Medical Gazette, Apr., 

while, if the reverse is true, it indicates renal infection, alone 
or complicated with cystitis. 

The mode of infection of the bladder was in most cases 
through catheterization. Still there were instances of infec- 
tion from the rectum, kidney, or some other focus of infec- 
tion either by means of the blood or lymph. 

The bacteria most frequently found were B. coli comunis, 
B. proteus vulgaris, St. pyogenes aureus and the albus, and 
a stapholococcus which slowly, or not all, liquefied gelatin. 
In the tuberculous forms the tubercle bacillus was also found. 

A New Blood Stain for the Plasmodium flalarice. 

Qoldliorn (of the Carnegie Laboratory) has recently de- 
vised a polychrome methylene blue solution for rapidly dem- 
onstrating the Plasmodium of malaria. The smear which 
must be fresh is immersed in pure methyl alcohol for 15 
seconds, then washed in running water and stained from 7 
to 30 seconds in o.i per cent, aqueous solution of eosin. It 
is then washed as before and stained in the polychrome solu- 
tion for 30 to 60 seconds ; washed again and dried by agita- 
tion in the air ; no filter paper or heat should be used. 

If the dye should become too alkaline add a few drops of 4 
or 5 per cent, acetic acid. If too acid add a few drops of a 
saturated aqueous sol. lith. carb. 

The stain improves on keeping. 

By this method the chromatin body is stained red, the 
body of the parasite blue and achromatin zone remains 
unstained. 

The red corpuscles containing parasites may sometimes be 
seen containing blue granules. These granules are also 
demonstrated in macrocytes and negaloblasts in cases of 
pernicious anaemia. Blood platelets and the various leuko- 
cytes are also stained.. 

The method is rapid and reliable. 



igoi Societies, 213 

SOCIETY REPORTS. 



BOSTON HOnCEOPATHIC MEDICAL SOCIETY. 

BUSINESS MEETING. 

The regular meeting of the Society was held at the Boston 
University School of Medicine, Thursday evening, March 7, 
1 901, at eight o'clock, the President, T. Morris Strong, M.D., 
in the chair. 

The records of the last meeting were read and approved. 

PROGRAMME. 

1. "The Maternity Department of the Massachusetts 
Homoeopathic Hospital," with report of the service of Walter 
VVesselhoeft, M. D., obstetrician. 

2. " Fibroids." 

{a.) ** Clinical Notes." Alonzo Boothby, M. D. 

{b.) " Recent Literature." Harry O. Spalding, M. D. 

Discussion opened by N. W. Emerson, M. D. 

3. Protargol in the Treatment of Gonorrhoea in Women. 
Carl Crisand, M. D. * 

Discussion opened by Geo. R. Southwick, M. D. 

Dr. J. Emmons Briggs read an account of the Maternity 
Department of the Massachusetts Homoeopathic Hospital on 
West Newton Street, describing the accommodations for 
patients, and stating that only three deaths had occurred out 
of 161 cases treated from date of opening to Jan. i, 1901. 

Dr. Walter Wesselhoeft was not present to discuss the 
paper. 

Dr. Spalding stated that he did not claim originality for 
his paper, it being made up of extracts from " Recent Liter- 
ature," and were given simply to furnish a starting point for 
discussion. 

Dr. Crisand's paper on " Partargol in the Treatment of 
Gonorrhoea in Women " was not read. 



214 The New England Medical Gazette. Apr., 

Dr. George R. Southwick, in opening the discussion, 
stated that unfortunately he had not seen the paper, but that 
it dealt with a drug familiar to all. There is, perhaps, very 
little to say of the method of application. It is not so pain- 
ful as many seem to think, and is more effective than nitrate 
of silver; can be used in varying strength, as nitrate of 
silver, and about the same result ; acts promptly and less 
pain following application. One point in connection with 
protargol is the fact that these germs get into the crevices, 
or sulci, and there seem to acquire a habitat, and after a 
patient seems to be cured, an attack occurs for which there 
seems to be no reason. I would emphasize the, great impor- 
tance of local treatment in cases of gonorrhoea. I think it 
cannot be commenced too soon when the disease is dis- 
covered, the effects of which are familiar to all. I think it 
is a practical point, when we seen inflammation, make exam- 
ination and find a bit of pus which contains gonorrhoea, 
whether there is a method of treatment to prevent salpin- 
gitis, and how far it would be practical. If we find the 
germs present under these circumstances, how far shall we 
carry the treatment ? I have seen a case where a small 
amount of pus was present in the external os, which twenty- 
four hours before was free from infection. Is there anything 
we can do to prevent the extension of the disease } I think 
it means the thorough cleaning out of the urethra, vulva and 
vagina, the cervix and cervical canal. A patient was sent to 
me about two weeks ago with a history of gonorrhoeal infec- 
tion some three or four years before, there was also frequent 
micturition, and every symptom of cystitis. Cystoscopy was 
used. The patient had had doses of urotropin, and as good 
allopathic treatment as a misled physician could give. On 
carefully looking over the case I doubted the diagnosis. The 
patient was subject to recurrent sharp attacks of gonorrhoea, 
and I was satisfied that cystitis was not present. I speak of 
it, because gonorrhoea may resemble cystitis. I think it was 



IQOI Personal and News Items. 2 1 5 

wholly due to the condition of the vagina and recurrent 
attacks of gonorrhoea. 

Adjourned at 10.10. K. E. Allen, 

Secretary. 



REVIEWS AND NOTICES OF BOOKS. 



A Text- Book of HiST()rx)GY, Including Microscopic Technic. By 
A. A, Bohn, M. D., and M. von Davidoff, M. D. Edited by 
G. Carl Huber, M. D. Authorized translation from the Second 
Revised German Edition. By Herbert Gushing, M. D, W. B. 
Saunders & Co., Philadelphia and London. 1900. 
Of the many recent works published on histology this book may 
be easily classed among the best. The arrangement of the technic 
best adapted for the study of a tissue at the end of the histologic 
description of each subject, is a most convenient feature of the text. 
The subject matter is clear and concise, and, for the most part, 
free from discussion of matters still unsettled. The book is well 
illustrated with drawings accurately made, and instructive diagrams. 
The work is divided into three parts : I. Introduction to Micro- 
scopic Technic. II. General Histology, and III. Special His- 
tology, all of which, as intimated above, are very well treated- 
The book may well be recommended as a manual for students. 
The typograpical work is good. 

A Text- Book of the Diseases of Women. By Henry J. Gar- 
rigues, A. M., M. D., Gynecologist to St. Mark's Hospital in New 
York City. Illus. Third edition. Philadelphia : W. B. Saunders 
& Co. 1900. pp. 756. Price, cloth, $4 ?iet. Sheep, or half- 
morocco, I5 net. 

The author states that the above is a text-book for beginners, 
and a manual for general practitioners, but we think that even spe- 
cialists may glean some very good points and helpful information, 
especially along the line of treatment. 

As the whole range of gynecological work has been covered, or at 
least touched upon by Dr. Garrigues, it is unnecessary to reproduce 



2i6 The Neiv England Medical Gazette, Apr., 

the table of contents. One of the best sections of the book, how- 
ever, is that upon the anatomy aud physiology of the genital organs 
of women. These subjects are gone into with commendable thor- 
oughness, for it is certainly of the greatest importance that students 
should be carefully familiarized with the normal structure and 
functions of these parts. 

The surgical treatment of the diseases of women is hardly suf- 
ficiently elaborated to serve as a guide to the practitioner who is 
without opportunities for observiug the methods and technique of 
the skilled operator, but as an assistant in preparing for such ob- 
servation, and as a means to intelligently following gynecological 
surgery this book will prove satisfactorily helpful. 

Electro-therapeutics is a subject which receives due attention, 
while medicinal treatment is given in full and in detail. The latter 
is a most important point, too often not sufficiently dwelt upon. In 
the matter of local applications, especially, we commend the full 
and minute directions which accompany their mention. 

We hope that works on gynecology in the near future, may more 
frequently reduce the subject of differential diagnosis to the tubular 
form wherever possible. Although this is not done in the present 
work, considerable space is given to the topic, and none of the 
approved modern methods for determining the true nature of each 
case have been passed over. 

The illustrations are very numerous, the new ones being for the 
most part excellent, while many of the old ones are of no special 
value. 



Atlas and Epitome of Diskases Caused by Accidents. By 
Dr. Ed. Golebiewski, of Lerlin. Translated from the German, 
with editorial notes and additions by Pearce Bailey, M. D. Illus. 
Philadelphia: W. B. Saunders & Co. 1900. pp.549. Price, 
^4 net. 

Too many readers associate the word atlas with a cumbersome 
and unwieldly volume. The series to which the above-mentioned 
work belongs is far removed from the folio atlases of old. Each 
book is of a uniform and acceptable size, compact, handy, usable. 

The volume in question covers ground which has heretofore been 
somewhat neglected, or too cursorily considered. Physicians, medi- 



1 90 1 Reviews and Notices of Rooks. 2 1 7 

cal examiners for accident insurance, and even the laity connected 
with insurance companies need to be posted upon the sequellae of 
of injuries the result of accidents. 

This book is divided into two parts, one treating of injuries in 
genera], and the other of injuries affecting special structures and 
regions of the body. Numerous descriptive cases, in connection 
with colored plates, illustrate the teachings of the text. These 
plates are copied from original water- colors, mostly from life. 
Many pen-and-ink drawings, skiagraphs from photographs, etc., 
supplement them. 

Among the most prominent ways in which this book will prove of 
service is as an aid to diagnosis, for every physician knows that the 
relationship between traumatisms and disorders that are not imme- 
diately surgical, is often very obscure and difficult of demonstration. 

Any efficient help is welcome and greatly appreciated. The 
medico- legal relations of diseases caused by accidents also forms an 
important department of Dr. Golebiewski*s work. 

In general it may be said that he has briefly and succinctly pre- 
sented, within a reasonable compass, the results of his experience, 
and the testimony of the latest and most reliable literature bearing 
on this branch of medical practice. 

J NiT^oDUcn lox TO THE Studv OF Medicine. By Ci. H. Roger, 
Professor Extraordmary in the Faculty of Medicine in Paris, etc. 
Authorized translation by M. S. Gabriel, M. D. New York : 
D. Appleton & Co. 1901. pp. 545. Price, clolh, $5 ; sheep, <56. 
As a resum^ of recent medical advancement we may expect this 
volume to occupy a unique place. It is something of a novelty to 
turn the pages of a medical work which will be most valuable to the 
profession as a whole, not to the specialist or individual student 
alone. It is, however, well suited to use as a text- book, and will 
put students in touch with medicine as an all-embracing science. 
But to those of the profession, and they are many, who lack oppor- 
tunity to thoroughly acquaint themselves with the rapid strides 
which are being made in knowledge of the causation of disease, 
lesions and reactions of the organism which are discussed under 
pathological anatomy, and semeiology, the work will serve as a sub- 
stitute for lectures and laboratory experience. 



2 1 8 The New England Medical Gazette, Apr. 

Some of the principal chapters deal with the mechanical, physi- 
cal, chemical and animate agencies of disease, the general etiology 
and pathogenisis of the infections diseases, nt-rvous reactions, dis- 
turbances of nutrition, heredity, inflammation, septicemia and 
pyemia, tumors, cellular degenerations, examination of the sick- 
clinical application of scientific procedures, diagnosis and prognosis, 
therapeutics, etc. 

An immense amount of work is evidenced by the text, and much 
careful and scholarly research. A book of this kind is needed, 
and will be particularly appreciated by those who, without under- 
valuing the importance of laboratory investigations, still think clini- 
cal methods and the simpler means of reaching a diagnosis and 
prognosis should not be forgotten or slighted. 



PERSONAL AND NEWS ITEMS. 



Editor New England Medical Gazette: 

My Dear Doctor, — An especial effort is being made 
this year to extend the work of our national organization by 
increasing its roll of membership. Special committees have 
been appointed in every State, and the work is being sys- 
tematized so as to extend a personal invitation to every 
homoeopathic physician in the country. 

It is a lamentable fact that less than one-fifth of the physi- 
cians practicing homa^opathy are members of the representa- 
tive organization of the school. What homoeopathy is to- 
day is due to this Society, and what homoeopathy shall be in 
the future depends upon this Society. It has, through its 
existence and work, secured privileges and protected the 
rights of every homoeopathic physician in the land. It has 
made a recognition and standing for every one of its practi- 
tioners. 

The battle to protect the rights and to secure additional 
privileges for homoeopathic physicians is not and never will 



I go I Personal and News Items. 2 1 9 

be ended. It is, therefore, of vital importance, in order to 
secure the greatest good to all, that this organization be 
strengthened in every way possible. It is furthermore a 
duty that every member of our school owes to himself and to 
the cause of homoeopathy to support in every way possible 
The American Institute. 

Every physician of our school can and sHould aid in this 
work by supporting and endorsing, l)y membership at least, 
the efforts of this Society. 

Every physician is urged to become a member of this 
association now. Application blanks will be furnished by 
the Secretary or by any of the following members who are 
acting as Chairman of the Special Committee in their State 
to secure new members. 

Dr. W. E. (Jreen, Little Rock, Ark. 

Dr. Florence N. Ward, 606 Sutter St., San Francisco, Cal. 

Dr. Hugh M. Patton, 125 Mansfield St., Montreal, Canada. 

Dr. D. A. Strickler. 705 14th St., Denver, Col. 

Dr. Edward Beecher Hooker, Hartford, Conn. 

Dr. L. B. Swormstedt, 1455 14th St., N. W. Washington, D. C. 

Dr. Henry M. Paine, Atlanta, Ga. 

Dr. Joseph P. Cobb, 254 East 47th St., Chicago, 111. 

Dr. M. K. Krieder, (ioshen, Ind. 

Dr. George Royal, Des Moines, lo. 

Dr. M. Dills, Carlisle, Ky. 

Dr. James S. Barnard, 21 12 No. Charles St., Baltimore, Md. 

Dr. John P. Rand, Monson, Mass. 

Dr. Roy S. Copeland, Ann Arbor, Mich. 

Dr. W. S. Briggs, St. Paul, Minn. 

YiT. D. A. Foote, Omaha, Neb. 

Dr. G. Herbert Richards, Orange, N. J. ' 

Dr. John B. Garrison, iii East 70th St., New York City. 

Dr. H. E. Beebe. Sidney, Ohio. 

Dr. T. H. Carmichael, 7127 Germantown Ave., Philadelphia, Pa. 

Dr. Geo. B. t^eck. Providence, R. I. 

Dr. M. J. Bliem, San Antonia, Tex. 

Dr. C. E. Grove, Spokane, Wash. 

Dr. J. M. Fawcett, Wheeling, W. V. 

The above members of the Institute have accepted the 
Chairmanship, and have selected their associates, all of whom 



220 The Niw England Medical Gazette, Apr., 

are taking active interest in this great work for the good of 
the cause. 

Every member should, through love of the Institute, give 
enough of his time to extend 2i personal invitation to at least 
one or two of his friends. 

Many physicians we find are not only willing but pleased 
to join the Institute when personally invited to do so, and 
when told that the necessary three endorsers will be found 
for them. They have delayed in many cases by not knowing 
whom to ask to endorse their application. 

The cost of membership, which should accompany the 
application, is ^^7, which covers the certificate of member- 
ship and the first year's dues. 

A. B. Norton, M. D. 

President, 
Eugene H. Porter, M. A., M. D., 

181 W. 73d St., New York, N. Y., 

General Secretary. 

Alumni of the New York Homceopathic Medical 
College. — Please note that the date of the Annual Banquet 
is May 9, this year. The place of meeting is Delmonico's, 
and Dr. G. W. Roberts will act as toastmaster. 

All graduates are requested to join. Send application to 
Dr. E. S. Munson, Corresponding Secretary, 16 W. 4Sth St., 
New York. 

We are informed that there is a good opening for a homoe- 
opathic physician in Dighton, Mass., and one is wanted at 
that place. Mr. E. F. Andrews (Dighton), is responsible for 
this notice, and would be pleased to give further information 
in regard to the place. 

Dr. Horace Packard will sail on the 28th inst. for Europe. 
He will be away about five months. 

Dr. B. A. Sawtelle, class of '75, B U. S. of M., vyrill 
remove early in April from Norfolk, Conn., to Southington, 
in the same State. 

Dr. Amelia Burroughs announces her removal on March 
I from 480 Boylston Street to 31 Massachusetts Avenue, 
Boston, Office hours 9 to 11 a. m. and 2 to 4 p. m. 



THE NEW ENGLAND 

MEDICAL GAZETTE 

No. 5. MAY, 190X. . Vol. XXXVL 



TERATOHA OF THE PAROTID GLAND. 

BY T. M. STRONG, A. M., M. D, BOSTON. 
[Read before Boston Horn. Med. Society, Dec, 1900.] 

L. P., age 44 years, came to my clinic at the dispensary 
during the winter of 1899 and 1900, complaining of difficulty 
in swallowing. Examination showed a tumor in right faucial 
region, beneath and largely adherent to the palatal arch, 
which was made prominent by the growth. It extended 
downward to a level with the upper edge of the epiglottis. 
At first glance the tumor had the appearance of a hypertro- 
phied tonsil, but closer examination showed only a small 
tonsillar development and this rested upon the top of the 
growth, as though pushed forward by the latter. The growth 
was not movable. The mucous membrane was slightly in- 
jected and congested. The tumor was elastic with more or 
less resistance to pressure, but not painful to manipulation. 
The whole mass had an apparent circumference of about six 
inches, or that of a small Tangarine orange. There was no 
infiltration of surrounding tissues nor glandular involvement. 
There was no pain on swallowing, only a sense of discomfort 
and an increased muscular effort to pass the bolus of food, 
and this only since the tumor had reached the present size. 
There was an uncertain, indefinite history of two years, a 
reasonable history of one year, with beginning sensations of 
discomfort, ill-defined, and a positive history of six months 



222 The New England Medical Gazette. May, 

in which the tumor had been noticed, and within three 
months had apparently doubled in size. On the date of 
operation, March 8, of this year, it had notably increased 
since first seen. 

The operation was performed at the Massachusetts Homoe- 
opathic Hospital, where he had been courteously admitted to 
the free ward, in the services of Drs. Emerson and Rice, at- 
tending surgeon and laryngologist, respectively, the latter 
kindly aiding in the examination and operation. Anaestheti- 
zation was slow, but when once established was steadily 
maintained with the nasal tube, under the direction of Dr. 
Batchelder. The head was suspended over the end of the 
table, and the blood removed by sponging and a dentist's 
suction tube. Although apprehensive that the hemorrhage 
might be excessive it was never at any time free enough to 
cause any uneasiness. The soft palate was incised through 
its centre, and the tumor torn loose from its attachments to 
the former and the posterior pharyngeal wall. It did not 
separate clean and smooth, but with a rough, friable surface, 
although it seemed for a time that the tumor might be de- 
tached en masse. When a little more than half separated 
the walls suddenly gave way, and there was a discharge of 
broken down debris, simulating cancerous degeneration. 
After this it was simply clean away as much of the adherent 
friable tissue as was possible. The attachments involved the 
homular process, the superior pharyngeal muscle and wall, 
and down to and partly including the middle pharyngeal 
areas. The wound left presented a mass of torn, ragged 
tissue and muscle fibres, the anatomical areas presenting few 
recognizable traits. The cut edges of the palate could not 
be united on account of the friability of the tissue, and the 
pharyngeal muscle was represented by a torn mass of fibres. 
He was removed from the table pale and weakened, but not 
at all in a bad condition. The healing was uneventful, ex- 
cept that for several days there was an enormous patch of 
slough involving the operative area. The final healing left 



igoi Teratoma of the Parotid Gland. 223 

the palatal arch sufficiently in line and connection for all 
practical purposes, while the direct area of infliltration healed 
with comparatively few traces of any operative work. Since 
then he has had complaints of fugitive pains and distress on 
the opposite side, headache, et cetera, but no signs of any 
return. 

The diagnosis was not determined before the operation. 
The absence of pain, ulceration or glandular infiltration, 
seemed to negative cancerous involvement, nor did it appear 
to embrace the tonsillar tissues as already stated. A portion 
of the removed mass was submitted to my brother. Dr. F. F. 
Strong, for examination, and his report is as follows : 

" As submitted, the specimen consists of half of a mass of 
rounded form, containing various forms of tissue. The outer 
layers appear rather soft'and spongy, while the central portioh 
is denser, with small areas of an apparently cartilaginous 
nature. 

" Technique. — The mass was divided laterally and several 
pieces, about one centimeter square, were taken from various 
parts of the tumor. These were hardened in alcohol, em- 
bedded and sectioned in celloidin and stained with eosin and 
hematoxylin. 

" Histological Details. — The specimen consists of a great 
variety of structures, merged together without apparent order 
or arrangement, consisting mainly of mesoblastic tissues, 
with some areas of a glandular or epithelial nature. Through- 
out a diversified stroma of fibrous connective tissue, occur 
more or less rounded mas.ses of hyaline cartilage, while be- 
tween several of the latter masses appear areas of other 
tissues, the following varieties being identified: (i.) White 
fibrous tissue, which occurs in well-defined masses of elon- 
gated form, consisting of rather short, spindle-shaped fibres 
with prominent nuclei. In one place there appears to be a 
tendency for this fibrous tissue to return to the embryonic 
type, and we have tissue typical of the fibro-sarcoma, and 
the spindle-celled sarcoma, respectively. (2.) Myxomatous 



224 The New England Medical Gazette. May, 

tissue. Outside of one of the cartilaginous masses occurs a 
definite area of typical 'mucous' tissue, containing some 
areas of proliferating small, round cells, giving the appear- 
ance of a myxo-sarcoma. (3.) A few small areas of ductless 
glandular tissue, in some of the lumens of which there is an 
apparent tendency to atypical epithelial proliferation, as in 
carcinoma. (4.) Perhaps the most interesting part of the 
growth, from a standpoint of embryology, is a dense cellular . 
area, which at first sight resembles the picture seen in rectal 
or mammary adeno-carcinoma. Careful examination, how- 
ever, reveals the presence of delicate ramifying strands con- 
sisting of lymphatic endothelium, interlacing and forming an 
apparent stroma for the support of masses consisting of large 
pulpy cells, arranged in circular or cylindrical clusters. In 
some part of the mass these clusters are seen in early stages 
of formation, and it then becomes evident that they are the 
results of the proliferation of the capillary endothelium lining 
the lumens of a structure similar to that seen in a capillary 
angioma. The final structure in the present case would, 
were it unaccompanied by other forms of tissue, be classed 
as an endothelial sarcoma or 'capillary cylindroma.' In ad- 
dition to the tissues mentioned, there are a few small areas 
which apparently consist of unstriped muscle cells, while in 
one spot, a small mass of stratified cells was found resem- 
bling epiblastic epithelia, and embedded in a dense mass of 
white fibrous tissue, rich in infiltrated, or proliferated, small, 
round cells of undoubted mesoblastic origin. 

" Probable diagnosis. — The diversity of structure and atypi- 
cal arrangement of the specimen classifies it at once with the 
teratoid tumors, and the nature of some of the areas in the 
present tumor growth warrant the supposition that it had its 
origin during embryonic life, as a Teratoma of the Parotid 
Gland." 

The text-books do not refer to teratomata, with the excep- 
tion of Brown, who says, that teratomata of the throat are 
frequent ; and Kyle, who describes these growths as "tumors 



190 1 Teratoma of the Parotid Gland. 225 

containing hypoblastic, epiblastic and mesoblastic structures. 
A congenital tumor. The common site of cystic growths is 
at the point in the embryo where fissures exist, permitting 
the possibility of the inclusion of a portion of the epiblastic 
layer of the blastoderm. This would be especially true 
about the head and face where such fissures occur." 

Ziegler describes them as " possessing complicated struc- 
tures made up of different kinds of tissue, and characterized 
by the presence of tissues which do not normally occur at 
the sight of the growth. Tumors containing cartilage fre- 
quently occur in the parotid gland, which normally contains 
no cartilage. Cysts which are found in the neck also con- 
tain not infrequently cartilaginous foci in their walls and 
sometimes also adenomatous tissue." 

Delafield and Prudden refer to them as " congenital tumors 
which frequently contain a great number of different forms 
of tissues, such as the various forms of fibrillar and connec- 
tive tissues, cartilage, bone, teeth, hair, skin, muscles and 
glands. They are infrequently found about the head and 
neck." 

In a paper on a " Parotid Tumor Successfully Removed," 
which appears in the Lancet, \ 897, part 2, p. 20, the writer 
quotes from Paget's " Lectures on Surgical Pathology of 
Tumors" (3d. edit., p. 521), as follows: "Their structure 
(tumors of the parotid gland), has claimed for them the 
cachophonous title of chondro-myxo-fibro-adenoma, for they 
frequently contain all of these tissues. The malignancy 
which they sometimes possess is apparently dependent on 
the presence of sarcomatous elements amongst the fibrous 
tissue." 

Dr. Mixter, in a paper on " Tumors of the Parotid Gland 
Appearing in the Faucial Region " (Boston Medical and 
Surgical Journal y 1897, p. 134), quotes two cases having 
some similarity to the one here related. He points to the 
fact " that one of the deep processes of the gland is situated 
in front of the styloid process and passes back into the 



226 The New England Medical Gazette. May, 

glenoid fossa behind the articulation of the jaw. A tumor 
starting here would meet with less resistance going into the 
mouth, than outwards into the face." 

In spite of the diversity of structure in the tumors above 
described, they all resemble each other in that they are 
heterologous growths, that is, they consist of, or contain, 
tissues which are not normally present in the part from 
which they originate. In other words, they are all undoubt- 
edly the result of the development of embryonic inclusions, 
and fall properly under the head of growths known as tera- 
tomata. These inclusions are prevented from developing in 
early life by the pressure of surrounding structures; but 
when, later in life,»for some reason or other, this pressure is 
lessened, or some unknown irritation arises, the potential 
power of the inclusion may be converted into a condition of 
active proliferation, and a teratoid tumor results. 



TREATMENT OF EPITHELIOHA OTHER THAN BY THE 

KNIFE. 

BY JOHN L. COFFIN, M. D., BOSTON, MASS. 
[Read before the Mass. Surgical and Gynecological Society, Dec., 1900.] 

The treatment of epithelial growths of the skin by caustic 
rather than by the knife has claimed the attention of the 
profession, more and more for the past few years, and has 
constantly gained in favor rather than lost. It was my priv- 
ilege, fifteen years ago, to hear the method of cauterization in 
selected cases advocated by Dr. A. R. Robinson, of New 
York, and in a most able and interesting article, published in 
the New York Medical Record for March, 1900, after twenty 
years' experience, he is more firm than ever in his conviction 
that cauterization is in many cases the best, safest and most 
effectual treatment for cutaneous cancer. 

Just what is the condition which confronts us in an epithe- 



190 1 Treatment of Epithelioma. 227 

lioma of the skin ? We have an abnormal proliferation of 
the epithelial cells, pushing down into the subcutaneous 
tissue which, as the disease progresses, becomes itself in- 
vaded. The lymph-channels take up the wandering epithe- 
lial cells, carrying them to the nearest lymph glands where, 
becoming localized, they act as new foci for the development 
of the disease, and we have what is known as regional infec- 
tion. For the reason that the new epithelia constituting the 
growth never reach maturity, they are short lived and soon 
undergo degeneration of one kind or another, and we have 
the well known and characteristic ulceration as soon as 
marked extension of the original focus begins. From this it 
follows that in any case, where ulceration to the slightest 
degree has taken place, there must exist a surrounding zone 
already invaded by the epithelial hyperplasia, a zone the 
extent of which it is impossible to estimate from the macro- 
scopic appearances. 

It is not within the province of this paper to discuss 
whether it is a blood or microbic disease, suffice it to say 
that Nicholas Senn, in the recent second edition of his 
admirable work on tumors, quotes De Morgan in these words : 
" I can see no analogy between new growth, whether as 
innocent as lipoma or as malignant as cancer, and the prod- 
ucts of true general or blood diseases. From the first, a 
tumor is a living, self-dependent formation, capable of con- 
tinued growth, by virtue of its own power of using nutritive 
material supplied to it. Nothing like this is seen in any of 
the blood diseases," to which Senn adds, " Until additional 
and more positive light is shed upon the microbic origin of a 
cancer, we must adhere to the theory that carcinoma is an 
atypical proliferation of cells from a matrix of embryonic 
epithelial cells of congenital or post-natal origin." 

From the careful study of the pathology of a carcinomatous 
growth it is evident that up to a certain point, probably 
when the lymphatics begin to take up the hyperplastic cells, 
and subsequent regional affection takes place, cancer is 



228 The New England Medical Gazette, May, 

practically a benign growth and is susceptible of absolute 
cure, provided sufficient tissue is removed and no diseased 
cells left behind to serve as foci for new development. This 
result is undoubtedly accomplished by excision provided 
sufficient surrounding, apparently healthy tissue is sacrificed, 
but to determine just how much is necessary, is difficult to 
tell from appearances. In some cases excision sufficient to 
produce the desired result is productive of great mutilation, 
necessitating secondary plastic operations for cosmetic effects. 

It is in this latter class of cases especially that destruction 
by cauterization is applicable and gives most excellent re- 
sults. Its advantages are that owing to the lessened resist- 
ance the cancer cells are destroyed much more quickly than 
the normal tissue, so that comparatively little normal is sac- 
rificed, and the resulting disfigurement is reduced to a mini- 
mum. Again owing to what some believe to be a selective 
affinity on the part of certain drugs, especially arsenic, the 
cauterization extends sufficiently into surrounding tissue to 
destroy the diseased cells, thereby rendering return as little 
likely as if the whole surrounding zone was excised, or again, 
what is more likely, by the surrounding inflammatory action 
set up. On this point Robinson says, ** The destruction of 
these outlying cells depends, in my opinion, first, upon the 
existence of the acute inflammatory process destroying the 
pathological tissue quicker than it does normal tissue, accord- 
ing to a general law in pathology, and especially so in this 
instance, as the pathological epithelia lie in the lymph spaces 
and can, therefore, be vigorously acted upon by the inflam- 
matory lymph, thus changing quickly and very greatly the 
previous condition under which they live ; second, that arse- 
nic has a special selective antagonistic action on the epithelia 
in this disease, and third, that the toxins and toxalbumens 
from the necrosed tissue act distinctly upon the epithelia, or 
if the disease is a parasitic one, upon the organisms present." 

Of the various substances used in this destructive cauteri- 
zation, I much prefer arsenic and have, of late years, seldom 



igoi Throat Symptoms of Lachesis. 229 

used anything else. Success, however, depends much on 
attention to detail. For small, scaly patches, with which 
many cases begin, the repeated painting with Fowler* s Solu- 
tion, three or four times a day, until considerable inflamma- 
tory reaction is set up is sufficient. For the ulcerated cases 
the Marsden's Paste is by far preferable. Should there be 
much elevation above the surface it is best to curette the 
surface first, and it is imperative that any sound skin over 
the border of the ulcer and surrounding infiltration should 
either be entirely removed or thoroughly scraped or scarified. 
The length of time that the paste should be applied is much 
a matter of judgment and experience, some tissues reacting 
very quickly and others very slowly, so that its action must 
be more or less closely watched in any case. An average 
time is from twelve to sixteen hours. It should be applied 
until the whole visible portion is thoroughly necrosed. The 
subsequent dressing consists in simple application of some 
aseptic dressing, such as carbolized cosmoline, borated ung. 
aq. rosae or, as Robinson suggests, subiodide of bismuth, 
twenty grains to the ounce. After the separation of the 
slough, if healing is slow, I apply a ten per cent, aristol oint- 
ment. The pain suffered by this plan is often severe for the 
last few hours, sometimes necessitating a small dose of mor- 
phine. In the last four cases I have operated upon, however, 
I have incorporated ten per cent, of eucaine with, so far as I 
could see, no injurious results and with complete absence of 
pain or even discomfort. But the number of cases is, as yet, 
too small to draw conclusions concerning all cases. 



SOME THROAT SYMPTOMS OF LACHESIS. 

MAURICE \V. TURNER, M. D. 

The throat symptoms of Lachesis may be divided into two 
groups. 

The first includes the characteristic symptoms, /. e.y those 
which differentiate this remedy from others ; and also some 



230 The New England Medical Gazette, May, 

general symptoms applicable to the part. It consists of nine 
more or less complete symptoms, which are as follows : — 

I. — Throat and neck sensitive to slightest touch or exter- 
nal pressure ; it may cause nausea. 

Everything about the throat distresses, even the weight of 
the bed clothes. 

If in the evening on lying down anything touches the 
throat or larynx, it seems as though he would suffocate and 
the pain is much increased. 

2. — Difficulty of swallowing of saliva, not food ; of liquids 
more than solids, they escape through the nose. 

With spasmodic stricture, on swallowing solids there is a 
struggling and the food "goes the wrong way," gagging 
follows. 

3. — Feeling of a lump in the throat; sometimes painful; 
suffocative sensation ; must swallow often ; on swallowing 
the lump descends but returns at once. It feels as if it 
could be brought up, but it will not come. May wake from 
sleep distressed and unhappy with this sensation of choking ; 
must have the whole neck bare. 

4. — Tendency to affect the left side either alone or to 
begin on the left and extend to the right. 

This is the common feature, but the reverse may be true, 
/. e.y the right side first involved with extension to the left, 
where it remains fixed. 

This does not contra-indicate Lachesis. 

5. — Recumbent posture often impossible. 

6. — Aggravation after sleep; or the aggravation wakes 
him from sleep ; /. ^., sleeps into the aggravation. 

This is spoken of as the morning aggravation of Lachesis 
when it comes on waking in the morning, more properly it is 
the aggravation after sleep. 

Often, especially in the severer cases, the patient feels 
the aggravation immediately on going to sleep and it arouses 
him. 

7. — Aggravation from hot drinks. 

8. — Pain in the throat, extending to the ears ; desire to 



igoi Throat Symptoms of Lachesis, 231 

swallow ; aggravation on deglutition ; pharynx swollen, dark 
red. Swallowing increases the pain in the ears or sends the 
pain into the ears. 

9.— Throat and larynx painful on bending the head back- 
ward. 

The second group is made up of the concomitants. In it 
are to be placed the various sensations which are non-char- 
acteristic ; they simply round out the case. They are impor- 
tant but less so than those in the first group, which they 
often' elaborate. 

These symptoms should be taken into account and covered 
by the remedy ; but as they vary within rather wide limits, it 
is evident that for the purpose^ of selecting the remedy or 
discriminating between it and others they are useless. 

A few examples will illustrate : — 

Constant tickling in throat. 

Fullness and soreness in throat. 

Spasmodic contraction of cesophagus. 

Sensation of dryness in throat with inclination to swallow. 

Pain in small spot in throat at one side of larynx, some- 
what posteriorly. 

Burning sensation of swelling ; dryness in throat. 

To return to the first group. This combination of symp- 
toms is unique. The separate symptoms are found under 
various medicines, often two or three, and occasionally four 
occur together, never the whole nine. 

From this group of nine symptoms twenty-three or more 
remedies, my list is not complete, which cover a wide range 
of disease, must be differentiated. 

They are, agar., amyl-n., apis, asaf , bell., bry., cact., chel., 
cocc, crot-t., elaps, ign., kali-bi., kali-c, lye, mosch., naja, 
nat-m., nux-v., phyt., sep., stram., sul, 

I will speak only of eight ; of some of them very briefly, 
and take them partly alphabetically and partly in groups. 

With apis and belladonna there is more soreness or tender- 
ness of the throat which makes touch or pressure intolerable ; 
not the nervous uneasiness from pressure about the neck so 
characteristic of Lachesis. 



232 The New England Medical Gazette, May, 

Both are predominately worse from swallowing liquids; 
Lachesis also worse when swallowing saliva. 

We may take as a group the serpent poisons, of which 
perhaps crotalus horridus is the most intense (except possibly 
cenchris cartortrix). 

They as a class have certain peculiarities, which are well 
illustrated under Lachesis, and crotalus comes nearer to 
Lachesis than any one of the group or any other medicine ; 
so much so that it is no wonder that those who question the 
reliability of the Lachesis preparations prefer to substitute it 
for Lachesis. Still, in the provings we have, its symptoms 
are not identical with those of Lachesis. 

It has the sensitiveness •to touch and pressure of the 
clothes ; the dysphagia ; lump, sensation (globus hystericus) ; 
left sided tendency and the aggravation after sleep, all like 
Lachesis, 

It does not have the aggravation at the beginning of 
sleep, which is often marked with Lachesis, neither has it 
developed the other symptoms of the first group, — the ag- 
gravation lying down, from hot drinks, bending head back 
(in diphtheria it rather has a desire to throw the head up 
and back), and pain extending to the ears This ought to 
be sufficient to enable us to decide between them. 

We know that crotalus is useful in severer conditions than 
Lachesis, if that be possible, but we cannot say that it is 
only serviceable then. IVTilder states and nervous diseases 
may be helped by it, and then the decision between crotalus 
and Lachesis is likely to be difficult. 

Elaps corallinus has some of the throat symptoms of 
Lachesis ; especially the aggravation from touch, great sensi- 
tiveness, and from swallowing liquids and solids, not saliva. 
Besides this, it has the left sided tendency with the pain 
extending to the ears on deglutition. 

Naja tripudians shows even less similarity, though it has 
an affinity for the left side of the throat. 

Diphtheria with symptoms in many ways like Lachesis; 
with extension to the larynx and impending heart paralysis ; 
or threatened paralysis of the heart after diphtheria. 



igoi Throat Symptoms of Lachesis, 233 

The laryngeal and cardiac involvement being the essential 
things. 

The throat symptoms of lycopodium do not run so close to 
those of Lachesis as we are usually led to think. 

The sensitiveness to touch and pressure is very slight, 
though the throat may be extremely sore inside. The sensi- 
tiveness to pressure of the clothes under lycopodium is over 
the epigastrium and abdomen, not about the neck. 

Next the difficulty of swallowing is especially marked for 
liquids, though there is the constricted sensation present and 
food and drink may regurgitate through the nose. (Liquids 
only — Lachesis.) 

There is the sensation of a lump rising up in the throat 
from below, not particularly affected by swallowing. 

The right side of the throat is likely to be first affected 
with or without extension to the left side, or the membrane 
in diphtheria, descends from the nose to the pharynx or from 
the upper part of the pharynx down the throat. 

On waking the patient is cross, terrified or unrefreshed, 
not suffocated or choking. 

The aggravation comes in the late afternoon and early 
evening, 4 to 8 p. m. 

Warm drinks usually relieve, but occasionally there is the 
opposite state of amelioration by holding cold water in the 
mouth. 

The other symptoms are not present. 

With mix vomica many of the symptoms are absent. 

External sensitiveness not marked. 

Swallowing difficult of saliva, more so of food and still 
more aggravation after swallowing food. 

The sensation of a lump or plug in the throat is present, 
and the patient is aroused at night with a sense of impending 
suffocation, exactly as with Lachesis. 

Perhaps the right side of the throat is more likely to be 
affected with extension over both tonsils (diphtheria). 

There is often aggravation lying down and after sleep — 4 
A. M. and 4 p. M. 



234 ^-^^ -AVzt' England Medical Gazette. May, 

Stitches into the ear when swallowing occur, with fetid 
ulcers in the throat in "nervous cases.'* 

Phytolacca decandra is the last remedy of which I wish to 
speak. 

There is some resemblance to Lachesis, but with addi- 
tional symptoms, which are peculiar to Phytolacca, the dis- 
tinction is not difficult. 

Deglutition : painful, difficult ; and with every attempt 
excruciating pains through the ears ; regurgitation through 
the nostrils ; unable to swallow even water ; almost impossi- 
ble, i. e.y deglutition, because the throat feels so dry and 
rough. 

Sensation of a lump in the throat, causing a continuous 
desire to swallow ; like a plug ; worse on the left side, when 
swallowing saliva, or turning the head to the left. 

Swallowing saliva especially aggravates ; also worse from 
swallowing warm drinks. 

The great pain at the root of the tongue when swallowing ; 
the intense burning in the fauces as from a coal of fire ; the 
dryness, with absence of other symptoms are sufficient to 
differentiate from Lachesis. 

As the proof of the pudding is in the eating, so the evi- 
dence that a remedy has been properly selected lies in the 
relief or cure which follows its exhibition. 

I have a number of cases which are apropos to this study 
of Lachesis, but have selected two which illustrate its use in 
nervous affections of the throat. 

Case I, is that of Mrs. , who is now 39 years old, short, 

dark complexioned, in good flesh. She has had three chil- 
dren. About eight years ago, during her last pregnancy, 
albuminuria developed. Labor was uneventful, but she was 
much prostrated and gradually drifted into neurasthenia. 
From this she slowly improved, but has. never completely 
recovered. 

She came under my care in April, 1899, complaining of 
certain nervous trouble of which the most annoying was 
cesophagral spasm. The spasm was worse from swallowing 



igoi Throat Symptoms of Lachesis, 235 

solids or anything warm, and it was seldom that she went 
through a meal without it. 

Solids went the" wrong way," and she ^[agged. The con- 
dition was always worse during menstruation. She often 
waked with the choking, and when the attacks were bad 
could not lie down. There was pain from the throat to the 
left ear with the spasm. 

She received then Lachesis I2x, four doses in water, one 
night and morning for two days, and placebo. 

She gradually improved for ten days, was then worse, and 
then the remedy was repeated in the same way. Ameliora- 
tion this time for two weeks and with another repetition still 
larger, till finally she would go four, five or six weeks between 
accessions, and at last no return unless she becomes over 
tired, either physically or nervously, which has not occurred 
for some time. 

Case 2, one which ought to yield to Lachesis, is as follows : 
Mrs, G., 30 years old, tall, quite fleshy, very light complex- 
ion, with light hair. Married twelve years, one child, no 
miscarriage. 

She has had more than her share of severe sickness. Scar- 
let fever when very young, diphtheria when six years old, and 
since her marriage malarial fever, then cerebrospinal men- 
ingitis, followed by various paralyses and, later, nervous pros- 
tration. She has numerous discomforts, the worst being the 
way her throat has troubled her for six years. 

When first lying down at night a smothering sensation is 
likely to come on in the throat, and she feels as if she must 
sit up, but is often able to remain lying in bed. There is no 
heart complication. At other times the aggravation comes 
at 4 A. M. — after sleep — with hoarseness and a feeling as if 
her breath were cut off, and a hot burning sensation in the 
throat. 

At these times she can breathe through the nose but not 
through the mouth. This is all likely to continue till about 
ten o'clock in the forenoon. 

Her neck is very sensitive to the slightest pressure of a 
ribbon or the clothes generally. 



336 The New England Medical Gazette. May, 

Sometimes there is a little pain, stinging in character, in 
the ears from swallowing. 

She has been to me only twice, and the report comes that 
she is somewhat better. 

The remedy, if carefully exhibited, ought in time to com- 
pletely remove the trouble together with many, and perhaps 
all, of the other discomforts of which she complains. 



THE DIAGNOSIS AND TREATMENT OF GALL STONE 

CASES. 

BY HORACE PACKARD, M. D., BOSTON, MASS. 
[Read before Mass. Horn. Med. Society.] 

f Continued from April Number.) 

TREATMENT. 

HO\f(EOPATHTC. 

Cal. carb. 30X every 1 5 minutes to relieve the pain of a 
gall stone attack, /. e, gall stone colic. — Hughes. 

Berberis, (tinct.) — every 1 5 minutes. — Hughes. 

China 6x every 8 hours for four weeks to prevent their 
formation, then at increasing intervals. — Ruddock. 

Chelidonium, (tinct.) — expels and prevents formation, has 
cured numerous cases. — Hughes, Hale, Ruddock. 

Aconite 3x with large hot compresses over the seat of pain. 
— Ruddock. 

Podophyllin 3x to aid expulsion. — Ruddock. 

OLD SCHOOL. 

Sweet Oil. In the attack, large portions of hot sweet oil, 
half a pint a day. Do not be deceived by the appearance 
afterwards in the feces of round green boluses the size of 
marrowfat peas — balls of soap. 

Morphine gr. ^^ in the attack to temporarily relieve pain. 

Chloroform internally in four-drop doses as a prophylactic. 



I go I Gall Stones. 237 

Salicylate of sodium or phosphate of sodium in 3j to 3ij 
doses before each meal for several months. 

Gelsemium, 5 drops of tincture every 1 5 minutes. — Ringer. 

Walk the patient about during colic. 

An abundance of pure water. 

Alkaline waters, hot or effervescent. 

Poultice, or hot compress over right hypochondrium. 

Hot baths. 

Exercise daily. 

Massage of right hypochondrium and epigastrium. 

SURGICAL TREATMENT. 

Aspiration of gall bladder. 

Incision through abdominal wall just below 8th costal 
cartilage. Exposure of fundus of gall bladder, incision and 
removal of stones. 

If a stone be lodged in cystic duct, open and remove. 

Suture incision in duct. 

If stone is in common duct, make long incision through 
abdominal wall parallel with costal cartilages to give access 
to deep parts. Incise lesser omentum, which covers the 
common duct and hepatic vessels, exppse the site of the 
incarcerated stone, open the wall of the common duct and 
remove calculus. Sew up the wounded duct. Drain with 
rubber tube and gauze wicks. 

Review of the accompanying table corroborates previous 
statements regarding the predominence of gall stones in the 
female sex. Of the 39 cases here recorded, 33 were women. 
It appears that gaU stone disease is an exclusive occurrence 
of adult life. The youngest case was 26 years of age. 
From that they ranged to 8b. But 8 out of the 40 cases 
were under 40 years of age. 

The number of stones found vary from i to, in one case, 
295. In another a vast number of minute ones were found, 
scarcely possible to count, but approximated 200. 

Many and devious pathological conditions were met. In 



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240 The New England Medical Gazette, May, 

many cases there was a distinct empyema of the gall bladder 
with great distention and menace to the patient's life. 

This frequency of formation of pus is corrobojative of the 
theory of accession to the gall bladder of pyogenic bacteria 
from the duodenum by way of the common and cystic ducts. 

I have come to suspect the contents of any gall bladder 
septic when stones are present, and use every means to pre- 
vent fluid from being spilled upon the surrounding viscera 
and wound. Aspiration of th^ gall bladder is always a desir- 
able step to take before it is incised. Packing of the sur- 
roundings with mops of gauze, to catch any drops which 
might escape, is also a wise precaution. After the gall 
bladder is open a careful scrubbing with a X pc"* cent, 
formaline solution is conducive to sterilization of the lining 
membrane. 

In one instance I found a singular pathological condition 
accompanying gall stones. There were, apparently, separate 
chambers entirely cut off from the cavity containing the 
stones, and filled with a glary fluid of the consistency of 
white of egg. There was nothing to suggest cancer at the 
time, but several months later malignant disease developed 
and ended the patient's life. 

Another extraordinary case, number 31 in the list, had no 
symptoms whatever of gall stone disease. Her pain was all 
in the left epigastrium. Exploratory incision through the left 
semilunaris disclosed nothing abnormal in that region. Palpa- 
tion and inspection of all the abdominal viscera finally divulged 
gall stones. The original wound was closed and another 
made over the gall bladder. Through this four large brown 
gall stones were removed. There was no pus or mucus 
present. Fresh bile appeared in the wound, which warranted 
immediate closure of the gall bladder and also of the abdom- 
inal wound. The patient made uncomplicated recovery and 
has had no further trouble. 

Still another case of more than ordinary interest, number 
10, was a woman of 36 years, who has been operated upon 



190 1 Gall Stones, 241 

for a supposed dilocated kidney, from which she obtained no 
relief, but still had a bunch which she herself could easily 
feel. On examination of the case I found a vertical scar in 
the lumbar region and a circumscribed bunch in the right 
hypochondrium. She had never suffered gall stone colic, 
had never been jaundiced, and was troubled only by a con- 
sciousness of the bunch and ill defined bad feelings through 
the region of the tumor. I first explored the region of the 
operation and found a surprising state of matters. The 
cicatrix was easily traced down through the tissues. An 
exceedingly broad adhesion had been established, as a result 
of the previous operation between the abdominal wall and 
the border of the right lobe of the liver. This was severed. 
Exploration through this wound resulted in palpation of the 
tumor which could easily be distinguished as the gall bladder 
distended with many calculi. The exploratory wound in the 
lumbar region was closed, and a fresh incision made over the 
gall bladder through which 116 gall stones were removed. 

The facility for operation varies most markedly in different 
cases. A gall bladder distended so that its fundus projects 
well below the costal cartilages, and thin abdominal walls 
render the operation of cholecystotomy for removal of gall 
stones one of the easiest of operations. 

On the other hand, a gall bladder tightly contracted over 
a small number of calculi, with possibly one lodged in the 
cystic duct, constitutes a complication extremely difficult for 
even the most expert operators to cope with. If to this be 
added thick adipose abdominal walls, inadequate assistance 
and poor light, the operator is confronted by difficulties which 
would appall a beginner. 

In nearly all of the cases the operation performed was 
incision of the gall bladder, removal of the stones and suture 
of the fundus to the abdominal wound, thus establishing per- 
manent drainage. In a few cases the wound in the gall 
bladder has been closed immediately with Lembert sutures 
of fine silk. This has been done only when the cystic and 



242 The New England Medical Gazette. May, 

common ducts have been wide open and there was no pus in 
the gall bladder. In two cases the common duct has been 
opened and the incarcerated calculus removed. In both 
cases deep drainage consisting of a rubber tube, with wicks 
of gauze packed about it, hsis been instituted, and allowed to 
remain for thirty-six hours. 

It has not been an tmcommon thing to find a stone wedged 
in the beginning of the cystic duct, and I have nearly always 
succeeded in removing it through the gall bladder. In two 
or three instances the duct has been slit open frQm the out- 
side, and after removal of the stones, it was sutured with fine 
silk. 

The behavior of an abdominal wound is a matter of in- 
terest. It frequently happens that the case which indicates 
complete obstruction of the cystic duct at the time of the 
operation, opens up, and normal bile begins to appear in the 
wound within a day or two. Under such circumstances all 
drainage is removed, and the wound encouraged to close by 
strapping it with adhesive plaster. Where no bile appears 
either at the operation or thereafter an external opening is 
maintained until the deep cavity is obliterated. This in- 
volves the perpetuation of the fistulous opening, sometimes, 
for months. 

In adjustment of the parts after the operation, the follow- 
ing expedient is sometimes adopted which is of great value : 
The lips of the wound in the gall bladder are inverted by 
adjusting a Lembert suture at either extremity; through 
such wound drainage can be maintained as long as desired 
by simply keeping a drainage tube in. On its removal, the 
valve like opening closes spontaneously and rapidly. 

The danger of gall stone operations is relative. If per- 
formed when the general health of the patient is good, and 
before an abscess is formed, there should be no mortality. 
On the contrary, cases which have become debilitated from 
recurring gall stone attacks, when septic absorption has 



19^1 Modern Surgical Technique, 243 

occurred, and the contents of the gall bladder infects the 
abdominal wall, a mortality is inevitable. 

Of the 40 cases recorded in this report there are nine 
deaths, every one of which is traceable to collapse from 
neglect, exhaustion or sepsis. 



nODERN 5UR0ICAL TECHNIQUE. 

WITH ANALYSIS AND STATISTICAL TABLE OF THREE HUN- 
DRED AND FORTV-FOUR OPERATIONS PERFORMED IN FIF- 
TEEN MONTHS, PRIOR TO JAN. I, I9OO, AND SINCE USING 
RUBBER GLOVES. 



BY J. EMMONS BRIGGS, M. D., BOSTON, MASS. 

[Read at Washington, D. C, June» 1900, at Surgical and Gynaecological Association of the 
American Institute of Homoeopathy.] 

(Continued from April Number.) 

In the method of wound closure a decided improvement 
has been inaugurated in my work by following suggestions 
given by Dr. Horace Packard, of Boston, with whom it has 
been my good fortune to be associated for the past ten years. 
His method of wound closure which has been used when prac- 
ticable, for over a year, is based upon the principle of using 
only such sutures for the deep structures as can be readily 
absorbed, and catgut has been the suture material selected. 

Dr. Packard has put much time and energy into a series 
of experiments calculated to develop a reliable catgut of 
moderate size, which will preserve its strength in the tissues 
for about ten days, and then become absorbed. With this 
end in view, he has finally succeeded in hardening catgut for 
a specified length of time in a solution of chrome alum of a 
standard strength, and then chromisized it so that it has an 
enduring strength of ten days and is all absorbed in two 
weeks. This preparation of catgut is of a delicate green 
color, exceedingly strong, and ties very securely. 



244 ^^^ New England Medical Gazette. May, 

The abdominal wound is closed first by uniting the sev- 
ered edges of the peritoneum with an ordinary continuous 
catgut suture of small size, which probably absorbs in three 
or four days.^ Next the sheaths of the muscles are brought 
together with a No. 4 chrome alum catgut suture (with en- 
during strength of ten days to two weeks), and then the skin 
by a subcutaneous, fine silk suture. No silk worm, noF 
other stay sutures are employed. It will be seen that no 
sutures penetrate the skin, and there are none to be removed 
save the subcutaneous silk, which is left with a long end, so 
it can be easily grasped, and readily removed by the end of 
the second week. For some time a fine catgut ligature was 
used for the subcutaneous suture, but when a suture suf- 
ficiently fine to afford accurate proximation was employed, it 
was prone to give way before the skin was firmly healed, and 
the skin wound would gape. Kangaroo tendon, in my expe- 
rience, has signally failed to fill the requirements. It has 
been followed in years past by suppuration in a few cases, 
and several times it has failed to absorb at a sufficiently early 
date, acting as an irritant in the tissues. It has been ex- 
foliated as a foreign body. That obtained by me, commer- 
cially prepared, has not proven aseptic, and re-prepared it 
loses strength and is inferior to catgut. It has, therefore, 
been discarded. 

For drainage, gauze has been preferred, as it removes 
fluid by capillary attraction and prevents its accumulation. 
The principal disadvantage in its use in the peritoneal cavity 
is that it adheres to the edges of the abdominal wound and 
also to the intestines and omentum. ^ Its removal is accom- 
panied by much pain and discomfort to the patient. This 
can be overcome by administering nitrous oxide, and its use 
is a great boon in the desperate cases of septic peritonitis, 
where a number of ramifying wicks of gauze are left in the 
peritoneal cavity. Where only a single wick of gauze is 
used, as in a localized appendicular abscess, I have used the 
thin rubber cylinders manufactured by the Miller Rubber 



igoi Modern Surgical Technique, 245 

Co., of Akron, Ohio, or the ordinary rubber finger cot, cut- 
ting off the closed end, and running a wick of gauze through 
it, allowing the gauze to protrude slightly at each end. The 
great advantage of the rubber externally is that it can be 
removed painlessly. The capillary attraction is augmented 
by the rubber encasement of the wick of gauze, and con- 
tinues to drain as long as there is fresh gauze in contact with 
the protruding end of the wick. 

The following summary comprises all the cases operated 
upon during the fifteen months, is made up, solely, as will be 
seen, with reference to the wound healing. The total num- 
ber of operations is 344, 65 of them, however, were septic at 
the time of operation. We have; therefore, 280 clean cases 
with four failures to secure union by first intention, or what 
is more accurate, four cases where pus formed, either in the 
wound or in stitch holes. 

Of these suppurative cases a few words of explanation 
may not be out of place. 

Nos. I and 2. Cases of Hernia. 

No. 3. Case of Tubo-ovariotomy. 

No. 4. Case of Keloid of abdominal wall. 

Case I. — Mr. L., age ^6y was operated upon Oct. 26, 1899, 
for relief from a large, irreducible, scrotal hernia, which had, 
on several occasions, become incarcerated. It caused him 
constant pain, and frequent attacks of vomiting. He was 
very feeble and debilitated, and his mind considerably unbal- 
anced. He had a cystitis and, frequently, incontinence of 
urine. Knowing this, great care was taken in the dressing 
after operation, oiled silk being as carefully arranged as pos- 
sible. But, in spite of every precaution, the patient on the 
second night, during an attack of mental abberation, pulled 
off the oiled silk, disarranged the dressings generally, and 
completely soaked them with urine. In view of the septic 
character of the urine, a violent suppuration was expected. 
The wound showed no indications of infection until twelve 
days after the operation, when it reddened slightly, and per- 



Cases. 



Abscesses 

Ankylosis, Elbow Joint 

Appendicitis 

Incised Wounds 

Coccyx 

Imperforate Anus 

Empyema 

Gall-Stones 

Hernia 

Ingrowing Toe-nail 

Necrosis of Bone 

Osteomyelitis 

Puerperal Eclanpaia 

Pleurisy with Effusion 

Phimosis 

Prostrate, Hypertrophy of 

Rectal Surgery 

Recto- Vaginal Fistula 

Tubal Disease 



Tubal Pregnancy 

Tuberculosis — Ax. Glands 

Cervical Adenitis 

Inguinal Glands 

Ribs and Sternum 

Tumors — Carcinoma, Arm 

Carcimona, Clitous 

Intestine 

" Mammary 

** Uterus 

" Uterus 

Uterus 

Cysts, Ovarian 

Epithelioma 

Keloid, Abdominal wall 

Neck 

Myoma, Uterine 

Sarcoma, Breast 

" Infr. Clav'r Reg'n 

" Paiotid Gland 

Testicle 

Tumors without Ab.Sec. 

Septic Arm 

Finger 

Urethral operations 

Vaginal Tract — 

Cervix, Laceration 
« <t 

Crystecele 
Dysmenorrhoea 
Endometritis 
Miscarriage 
Perineum, Ruptured 
Polypus (Cervix) 

Prolapsus Uteri \ 

Rectocele 

Retroflexion < 

Vesicle Calculus 

fouls" 



Operations. 



No. of 
Opr'ns 



Drained 

Excision, Elbow Joint 

Appendectomy 

Sutured 

Excision 

Colostomy 

Resection Rib 

Cholecystotomy 

Herniotomy 

Section 

Amputation of Toe 

Osteotomy 

Caesarian Section 

Aspiration 

Circumcision 

Castration 

Laparatomy Suture, Intes, 
Tubo-Ovanotomy 
Abdominal Hysterectomy 
Vaginal Hysterectomy 
Tubo-O variotomy 
Extirpation 



Resection 

Extirpation 

Extirpation & Plastic oper. 

Aspirated Abodmen 

Extirpation 

Curetting 

Abdominal Hysterectomy 

Vaginal Hysterectomy 

Ovariotomy 

Extirpation 

Exploratory Laparotomy i 

Excision, Skin Grafting 

Abdominal Hysterectomy 

Extirpation 

Extirp. & Leg. Sub. Cla.V. 

Extirpation 

Castration 

Extirpation j 

Amputation 

Dilatation, etc. 

Amputation Cervix 
Trachelorrhaphy 
Anterior Colporrhaphy 
Dilatation Cervix 
Curetting 

Perineorrhaphy 
Excision 

Vaginal Hysterectomy 
Ventral Suspension 
Posterior Colporrhaphy 
Alexander's Operation 
Ventral Suspension 
Litholopaxy 



23 

I 

17 
3 
3 

I 

I 

I 

10 

2 
I 
2 
I 
I 

3 

2 
22 

I 

2 

4 
3 

I 
I 

I 
I 
I 

I 
I 
I 
6 

5 

I 
2 
2 

4 
I 

I 

4 

2 
I 
I 
I 

23 

I 

I 

12 

8 

3t 
II 

9 
32 

5 
43 

8 

2 

I 

7 

5 

I 

I 



TlmeofOp'n 



Septic Clean 



23 



344 



64 



o 

I 
6 
3 
3 

I 

I 
10 

2 



I 
I 

3 

2 

13 
I 
I 



SubeeQ. course 



Septic Clean 



21 



23 



8 

31 
II 

9 
32 

5 

'I 

2 
I 
7 

5 

I 
I 



280 



3 

2 

'5 

I 
I 

3 

2 

I 
I 



I 

2 

I I 

I 4 

I I 
4 

j 2 

I X 

I I 
I 12 

I 8 

I 3^ 
II 

! 9 

I 2 

I I 

7 

5 

I 
I 



55 



J89 



Total number of operations 344 

Septic at time of operation '64 

Clean at time of operation 280 

Aseptic healing after operation 289 

Septic development after operation in cases previously clean ... 4 
Septic at time of operation but rendered aseptic by the use of formalin 13 



IQOI Modern Surgical Technique. 247 

haps a teaspoonful of pus escaped. The discharge continued 
for four or five days and tfcen subsided. 

• In this case it is clear to my mind that infection -did not 
occur at the time of operation, but later as a result from 
septic urine. 

Case 2. — Mrs. S., age 42, was operated upon Dec. 9, 
1 898, for inguinal hernia. Kangaroo tendon was employed 
in closing the wound. On the tenth day the wound began 
to redden and in two or three days thereafter began to dis- 
charge bloody serum, and later pus. The knots of Kanga- 
roo tendon were expelled one by one, and then the wound 
closed. I have always attributed the infection in this case 
to Kangaroo tendon. 

Case 3. — It is difficult for me to know how this case 
should be classified. There is little doubt in my mind but 
that the case was septic when operated upon, as it was not 
recognized as such, being treated as a clean case, it seems 
only fair to classify it among clean cases which developed a 
septic condition following operation. 

Mrs. B, age 30, was operated upon Nov. 29, 1899, for a 
cyst of the left ovary. After removing it with the tube, the 
exploration of the right side was undertaken. Here strong 
adhesions were encountered, which were broken up with dif- 
ficulty. The right tube was found much distended and as 
large as my thumb, the fimbriated extremity of the Fallopian 
tube being completely sealed. This ovary was apparently 
healthy. Gauze mops were adjusted preparatory to remov- 
ing it, when it ruptured and a clear, transparent fluid es- 
caped. The condition was thought to be hydro-salpinx, and 
a suitable case for conservative treatment. The sealed end 
of the tube was excised, and the mucous membane of the 
interior of the tube stitched to the serous membrane, and the 
abdominal wound closed. 

On the second day symptoms of septic peritonitis began 
to appear, and the patient died on the sixth day. A post 
mortem examination revealed a general, purulent septic peri- 



248 The New England Medical Gazette, May, 

tonitis, which apparently originated in the right tube which 
was found gangrenous, and almost completely destroyed. It 
resembled a slough of the appendix veriformis. 

It is the operator's opinion that the tube contained a septic 
accumulation which was liberated by the conservative treat- 
ment adopted, and had this right tube and ovary been re- 
moved a better result might have been obtained. 

Case 4. — Mrs. J. (colored), age 41, was operated upon 
Oct. 18, 1899, for a tumor in the abdominal wall. The 
operation was simply an incision into the tumor, for the pur- 
pose of exploration, and to obtain tissue for microscopical 
examination. The knife entered tissue very hard and glis- 
tening, like a fibroid of the womb. No bleeding occurred 
from the cut surface. A piece of tissue was removed and 
the wound closed. The pathologist reported "keloid." The 
suppuration following the operation was very slight, but 
persisted for about a week. 



Matriculate at a Leading College Only. — To no other 
class of professional men does the stability and permanence 
of his alma mater mean so much as to the physician. The 
clergyman having entered his profession, cannot be debarred 
from preaching so long as he can obtain an audience, no mat- 
ter what becomes of the college from which he received his 
diploma ; the lawyer cannot be debarred from practice so 
long as he finds a client, and observes the amenities of his 
guild, no matter where he may locate, or what changes take 
place in the college in which he received his instruction ; but 
the physician whose diploma is from a new college, a defunct 
college, or a college whose assets give no guarantee of pro- 
longed life, is always an object of suspicion ; he is liable to be 
bliged to prove the character of the institution from which 
e graduated, and may actually be debarred from practice if 
is alma mater fails to be included, as time passes, among the 
eputable colleges of the land ; or if, at the the time of its de- 
ease, it had not met the requirements of some state board. 



190 1 Editorial. 249 



EDITORIAL. 

Contributions of original articles, correspondence, etc., should be sent to the publishers, Otis 
Clapp & Son, Boston, Mass. Articles accepted with the understanding that they appear only in 
the Gnsttt*. They should be typewritten if possible. To obuin insertion the following month, 
reports of societies and personal items must bt rteahtdby tk$ istk »/ihg m^nth prtctding. 



THE REPROVING OF THE MATERIA MEDICA. 

After some years of agitation it is good to know that the 
reproving of one drug, as a test, along lines more in accord- 
ance with scientific methods than ever before is beginning. 

In his annual address before the American Homoeopathic 
O. O. and L. Society, the President, Dr. H. P. Bellows, of 
Boston, presented a perfected plan for this work, a plan 
more comprehensive in detail than any yet suggested. The 
plan, as briefly summarized in the conclusion of his address, 
is as follows : — 

'* To summarize, in closing, I should say, therefore, that, 
from the standpoint of a specialist, the reproving of the 
Homoeopathic Materia Medica requires that such work be 
done either in our large cities or in close connection with our 
medical colleges ; that it be conducted by organized clubs or 
boards of physicians which shall be presided over by a 
master or director of provings ; that this director shall him- 
self be a general practitioner of the largest possible experi- 
ence and the broadest knowledge and grasp of materia 
medica, or that he be a specialist who has previously had 
such general experience in medicine ; that he shall have 
associated with him two or three other general practitioners 
for the division of labor and a body of specialists for the 
examination of special conditions and testing of special 
organs, and that these shall cover the mind and nervous sys- 
tem, the eye, the ear, the nose and throat, the chest, the 
genito-urinary system and the skin ; that arrangements shall 



250 The New England Medical Gazette. May, 

be made for the assistance at all times of laboratory experts 
for chemical, microscopical, bacteriological and physiological 
tests ; that the provers shall receive some adequate compen- 
sation for their time and services, the means to come from 
private sources, from funds administered by our medical 
colleges, or from the treasuries of our State societies ; that 
the provers shall be subjected to careful preliminary organic 
and functional tests ; that they shall receive the drug to be 
proven at the hands of the director of the proving so guarded 
by blanks and counter-tests that they shall not know the 
nature of the drug taken or when the actual administration 
begins ; that the examiners themselves shall not know what 
drug is being proven or when it is being administered, but 
may receive special hints or practical suggestions from the 
director at his discretion ; that the prover shall keep a daily 
record of his own condition and symptoms in a book provided 
for this purpose and shall submit this written record every 
day to the director of the proving ; that after careful ques- 
tioning the director shall each day send the prover to such 
specialists as may seem desirable for the further testing and 
verification of special symptoms or conditions which may 
arise, the visit to be made during the specialist's office hours 
or at such other convenient seasons as may be specified in 
advance or arranged at the time by telephone ; and that, 
finally, the results of the proving as a whole shall be sum- 
marized and arranged for publication in scientific form by 
the director with such aid from any or all of his associates 
as he may desire." 

The suggestions were accepted by the Society, Dr. Bellows 
invited to take the position of general director, and com- 
mittees have already been appointed in New York, Brooklyn, 
Chicago, Philadelphia, St. Louis, Boston, Baltimore, Cincin- 
nati, Buffalo, Cleveland, Detroit, Washington and San Fran- 
cisco. 

In Brooklyn the committee has organized, money has been 
raised and the work practically begun. 



I go I Editorial. 2 5 1 

In Boston the committee has been organized with Dr. E. P. 
Colby as director of provings, and a better selection could 
not have been made. 

This work initiates the most important movement in the 
homoeopathic school for many years, and it should receive 
the most enthusiastic and cordial support of every member 
of the profession. 

Everybody can help in some way, but the best and only 
way that will give results will be to respond to the calls of 
the committee. 

Necessarily work of this scope and character must be done 
in the large cities where laboratory facilities are at command, 
but some money must be raised, and this can be contributed 
by everybody, so everybody must help with what he can, be 
it ever so little. The committee has not yet cajled for funds 
but when they do, let everybody respond, respond gladly and 
generously. 

American Medicine. 

The above is the title of the new journal edited by Dr. 
George M. Gould* and a large staff of collaborators. It is 
"founded, owned and controlled by the medical profession 
of America," and its aim is to publish a journal which shall 
be absolutely free from "commercialism," as understood in 
its application to professional matters. Anybody who has 
ever had anything to do with medical journalism knows how 
very difficult it is to do this and attempt to financially sup- 
port the journal, and realize what a difficult task Dr. Gould 
and his assistants have undertaken, but it is in the right ; 
the only way a journal should be conducted, and we are sure 
it will receive the endorsement and cordial support of those 
who place profession above pocket-book. We cordially wish 
American Medicine a long and useful existence. 



2 52 The New England Medical Gazette, May, 



OBITUARY. 

Dr. W. D. Anderson. 

Dr. Wm. Dexter Anderson, of New Haven, Conn., died in 
March, 1901, at Grace Hospital, after operation for intesti- 
nal obstruction. 

Dr. Anderson was born in Londonderry, N. H., in 1841. 
When he was very young his parents removed to Boston. 
Here his father became a prosperous merchant. In 1858, 
Mr. Anderson, then in his 17th year, entered Yale College 
as a student in the academic department. He was very suc- 
cessful at his studies and an unusually popular man, receiv- 
ing an election to Scroll and Keys in May of his junior year. 
He graduated in 1862, then spent three years in the medical 
school, from which he graduated with a high standing in 
1865. 

For a time after graduating he practiced with Dr. Paul C. 
Skiff, but after the death of Dr. Arthur Foote, which oc- 
curred about the year 1869, Dr. Anderson purchased his 
home and practice. 

Dr. Anderson joined the Connecticut Homoeopathic Medi- 
cal Society in 1869, and was its president in 1879 and 1880. 

Dr. L. Louise Brigham. 

Dr. L. Louise Brigham, of Hartford, Ct., died April 2, 1901. 
She was a graduate of the Boston. University School of Medi- 
cine in 1843; practised in Hartford for seventeen years, 
building up a large business. She was quite an active mem- 
ber of the State society, and also belonged to the Dunham 
Medical Club of this city. 



I go I Editorial, 253 

New York, April 3, 1901. 

Meeting of the Hahnemann Monument Committee of 
THE American Institute of Hom(Eopathv. 

Held at the residence of Dr. \Vm. Tod Helmuth, 504 
Fifth Avenue. 

Dr. J. H. McClelland in the chair. 

Drs. J. H. McClelland,. J. B. Gregg Custis and \Vm. Tod 
Helmuth, the latter appointed Secretary /r^ tern. 

The President stated that the meeting had been called to 
consider the death of Dr. Henry H. Smith, the Secretary 
and Treasurer, and to take the necesary legal steps to fill the 
vacancy occasioned thereby. 

On motion of Dr. Helmuth, Dr. J. B. Gregg Custis, of 
Washington, D. C, was nominated for Secretary and Treas- 
urer of the Committee ; carried. 

On motion the following preamble and resolutions were 
unanimously adopted. 

Whereas, through the death of Dr. Henry H. Smith, this 
Committee has lost one of its most active and efficient mem- 
bers, and 

Whereas, through the untiring energy and perseverence 
of Dr. Smith much of the successful workings of this Com- 
mittee can be attributed, therefore 

Resolved, that the Hahnemann Monument Committee of 
the American Institute of Homoeopathy has sustained an 
irreparable loss in the demise of Dr. Smith, and offers this 
resolution as a tribute to his perseverence and self-sacrifice 
in assisting to secure a lasting monument to the founder of 
Homoeopathy in the United States of America. 

Resolved, also, that copy of this preamble and resolu- 
tions be presented to the American Institute of Homoeopathy 
at its next meeting in June and to the family of Dr. Smith. 

Wm. Tod Helmuth, 
Secretary Pro tern. 



254 T^^^^ iWze; England Medical Gazette. May, 



SOCIETY REPORTS. 



MASSACHUSETTS HOMCEOPATHIC MEDICAL SOCIETY. 

The sixty-first annual meeting of the Society was held at 
Pilgrim Hall, Boston, Tuesday evening, April 9, and Wednes- 
day, April 10, 1 90 1. 

EVENING SESSION. 

The meeting was called to order by the President, John L. 
Coffin, M. D., and placed in charge of Dr. Fred B. Percy, 
Chairman of the Committee on Diseases of Children, who 
presented the following program : — 

1. "Antitoxin in the Treatment of Diphtheria." W. C. 
Goodno, M. D., Philadelphia, Penn. Discussion opened by 
Geo. B. Rice, M. D. 

2. "A Method of Infant Feeding." Wm. F. Wesselhoeft, 
M. D. 

3. "Some Interesting Cases of Tuberculosis in Children." 
D. P. Butler, Jr., M. D. 

4. " Experiences with Marasmus at the Sea Side Hospital.'' 
Carroll C. Burpee, M. D. 

5. "A Leaf from the Children's Ward at the Massachu- 
setts Homoeopathic Hospital." A. S. Boomhower. M. D. 

6. "A Contribution to the Study of the Treatment of 
Pertussis." F. L. Babcock, M. D. 

Dr. Goodno's paper brought out a great deal of discussion, 
but it was almost universally conceded that we should use 
antitoxin in every case of diptheria. A vote of thanks was 
extended to Dr. Goodno for his exceedingly interesting and 
up-to-date discourse. 

Wednesday, April 10, 1901. 

The meeting was called to order by the President, John L. 
Coffin, M. D., and the records of the semi-annual meeting, 
also the records of the Executive Committee's quarterly meet- 



190 1 Societies. 255 

ings were read and approved. The reports of the Treasurer 
and Auditor were received and accepted. The report of the 
Necrologist, F. A. Warner, M. D., was read and referred to 
the Committee on Publication. Following is the list of 
deceased members during the past year : — 

Luther M. Lee, M. D., Benjamin H. West, M. D., Sarah E. 
Sherman, M. D., Charles L. Farwell, M. D., Henry F. Batch- 
elder, M. D. 

The report of the Committee on Amendments of By- 
Laws was received and voted upon. Dr. Moore offered an 
amendment to the By-Laws, which was referred to the same 
committee. 

The following candidates were elected to membership : — 

Solon Abbot, M. D., 10 Dean Ave., Franklin ; Jeanie O. 
Arnold, M.D., loi Brown St., Providence, R. I. ; Thomas E. 
Chandler, M. D., 670 Massachusetts Ave,, Boston; Marion 
Coon, M. D., Hotel Ilkley, Boston ; Charles T. Cutting, M.D., 
66 Highland Ave., Newtonville ; Charles J. Douglas, M. D., 
524 Warren St., Roxbury ; Mary R. Farnum, M. D., 45 Water 
St., Penacook, N. H.; H. E. Fernald, M. D., Elm St , Cohas- 
set ; Walter J. Graves, M. D., Peabody Sq., New Dorchester; 
Fred'k De F. Lambert, M. D., 33 Summer Street, Salem; 
Edwin R. Leib, M. D., 45 Pleasant St., Worcester; Francis 
H. MacCarthy, M. D., 39 Hancock St., Boston; Edward R. 
Miller, M. D., 63 Merriam Ave , Leominster ; Lillian B. 
Neale, M. D., 138 Marlboro St., Boston; Elizabeth B. New- 
man, MrD., Belmont; Helen F. Pierce, M.D., 13 Pleasant 
St., Plymouth ; Julia M. Plummer, M. D., 160 Huntington 
Ave., Boston ; William H. Watters, M. D„ 26 So. Common 
St., Lynn ; Henry A. Whitmarsh, M. D., 64 Jackson St., 
Providence, R. I. ; Ralph C. Wiggin, M.D., 26 Puritan Ave., 
Dorchester. 

Dr. F. P. Batchelder, Chairman of the Committee on Reg- 
istration and Statistics, made a very interesting report which 
was referred to the Committee on Publication. 



256 The New England Medical Gazette, May, 

Report of Committee on Obstetrics. 

Gborgb H. Earl, M. D., Chairman. 

General Subject : Temperature after Delivery. 

1. **A Brief Study of Temperature in Certain Serious 
Puerperal Complications, with Cases." Sarah S. Windsor, 
M. D. 

2. "Dispensary Cases and Statistics." Lena H. Diemar, 
M.D. 

3. "Two Cases." Nelson M. Wood, M. D. 

4. "The Common Cause, with Cases." George H. Earl, 

M.D. 

After luncheon the meeting was called to order by the 
President, John L. Coffin, M. D., and the report of the 
Election Committee was received as follows : — 

President, George S. Adams, M. D. 

Vice-Presidents, Winfield Smith, M. D., George E. Percy, 
M.D. 

Recording Secretary, Frederick L. Emerson, M. D. 

Corresponding Secretary, Frederick P. Batchelder, M. D. 

Treasurer, Winslow B. French, M. D. 

Librarian, J. Wilkinson Clapp, M, D. 

Censors, John L. Coffin, M. D., Edward P. Colby, M. D., 
Fred B. Percy, M. D., Nathaniel W. P2merson, M. D., Frank 
C. Richardson, M, D. 



Report of Committee on Clinical Medicine. 

Elmer H. Copeland. M. D., Chairman. 

1. "The Modern Idea of the Use of Drugs as Medicines," 
Conrad Wesselhoeft, M. D. 

2. ** Diseases of the Chest in iSooand 1900." Herbert C. 
Clapp, M. D. 

3. "Serum Therapy and the Animal Extracts." J P. 
Sutherland, M. D. 

4. " Modern Aids to Accurate Diagnosis." John P. Rand, 
M.D. 



IQOI Societies. 257 

Report of Committee on Insanity and Nervous Diseases, 

Eli.bn L. KxiTH, M. t)., Chairman. 

1. "The Influence of Manual Education upon the De- 
velopment of the Speech Centres." Illustrative Case. 
Frank C. Richardson, M.D. 

2. "The General Practitioner and the Insane." Clara 
Barrus, M. D., Physician at the Middletown State Hospital, 
New York. 

3. "Suicidal Tendencies of the Insane." Edward H. 
Wiswall, M. D. 

4. "The Report of Four Cases of Pernicious Anaemia in 
Insanie Subjects with a Consideration of the Nervous Sequelae 
of the Disease." Solomon C. Fuller, M.D. 

The meeting adjourned at 5.15 p.m. to meet at Young's 
Hotel, where dinner was served to one hundred and sixty-five 
members, and at eight o'clock the annual address of the 
President was delivered and very much enjoyed by all 
present. 

The papers and discussions will be found in full in the 

transactions. 

Frederick L. Emerson, M. D., 

Secretary, 



Teaching Hygiene in Somerville, Mass. — The Som- 
erville, Mass., School Board, according to an item appearing 
in the public press March 26, passed the following order : 

" That in the primary and grammar schools instruction in 
physiology and hygiene be entirely oral, and that hereafter a 
single desk book be furnished for the use of teachers only ; 
and it is hereby also ordered that instruction be regarding 
the proper care of the body, rather than the structural 
formation." 

The order that should be passed by every school board is 
that such teaching should be given by, and at the discretion 
of, a properly qualified and appointed physician. Not less, 
but more teaching of the right kind is needed. 



258 The New England Medical Gazette. May, 

AMERICAN INSTITUTE ANNOUNCEMENT. 

The Executive Committee beg to announce to the mem- 
bers of the Institute, and the profession generally, the follow- 
ing important notice as to the railroad arrangements and the 
program of entertainment offered to the Institute and its 
guests by the citizens of Richfield Springs. 

The usual fare and one-third rate for the round trip, on 
the certificate plan, has been granted by all the roads. 

Arrangements have also been made whereby all members 
coming from the Western Country via Buffalo can stop over 
at the Pan-American Exposition for ten days on any kind or 
character of ticket, providing said ticket is deposited with 
joint agent. No. 50 Exchange Street, Buffalo, and the pay- 
ment of $1 made. 

For those who come from the Eastern Country, The New 
York Central, West Shore and Lackawanna will make amic- 
able arrangement that will grant our members a suflRcient 
stop over at Binghamton or Utica, at which points they can 
procure regular excursion tickets to Buffalo and return. 
This will allow members from the East to attend the exposi- 
tion at a very slight additional expense. 

Through parlor cars will be run direct to Richfield Springs 
from both the East and the West. The Delaware and 
Lackawanna Road will put on its summer schedule of trains 
for the session of the Institute, which provides close connec- 
tions at both Utica and Binghamton. 

The Entertainment Committee and the citizens of Rich- 
field Springs offer the following unusually fine social pro- 
gram which has been so arranged as not to interfere with the 
work of the Institute. 

Saturday, June 15. — Open Air Concert, Richfield Springs 
Military Band, 3.30 p. m. 

Sunday, June 16. — Sacred Vocal and Instrumental Con- 
cert in the EarHngton Hotel parlors, 8.30 p. m. 



190 1 Societies. 259 

Monday, June 17. — Open Air Concert, Richfield Springs 
Military Band, 3.30 p. m. 

Tuesday, June 18. — Open Air Concert, Richfield Springs 
Military Band, 3.30 p.m. Grand Ball, Hotel Earlington, 
tendered to the Institute and its guests by Messrs. E. M. 
Earle & Son, 10 p.m. Supper, 12 m. 

Wednesday, June 19. — Drive over magnificent mountain 
roads to Lake Otsego, the famous ** Glimmerglass," of Ytm- 
more Cooper, sail over the lake to Cooperstown, his home ; 
Luncheon in Cooperstown, drive home to Richfield along the 
shores of Lake Otsego, reaching Hotel Earlington about 5 
p.m. 

N. B. — Each day the ladies of the Institute are invited by 
the Citizens of Richfield Springs to take this delightful ex- 
cursion to Cooperstown and return. 

Music in the parlors Hotel Earlington, 11 a. m. Open Air 
Concert in Earlington Park, 4 p. m. Reception at the 
Waiontha Golf Club, 4 to 6 p. m., by the president, Mr. T. R. 
Proctor. Progressive P^uchre Party, tendered by Messrs. 
Earle & Son in the Earlington parlors. 

Thursday, June 20. — Drive to Cooperstown and return 
(same as Wednesday), 10 a. m., 5 p. m. Music in the parlors 
Earlington, 1 1 a. m. Open Air Concert, 4 p. m. Musicale 
in the parlors of Hotel Earlington, 9.30 p. m. 

Friday, June 21. — Drive to Cooperstown and return (same 
as Wednesday), 10 a.m., 5 p.m. Music in parlors Earling- 
ton, II A. M. Open Air Concert, 4 p. m. Grand Compli- 
mentary Vaudeville PLntertainment, tendered to the Institute 
and their guests, by the Entertainment Committee and Citi- 
zens of Richfield Springs. (It will be the endeavor of the 
Committee in charge of this entertainment to procure in 
New York City for this performance only the very best 
available talent, and no expense will be spared to make this 
vaudeville performance one of the highest class. 

Saturday, June 22. — Music in Hotel Earlington parlors. 



36o New England Medical Gazette. May, 

1 1 A. M. At 2 p. M. at the Lake House, on Canadargo Lake, 
a Clambake tendered by the Entertainment Committee and 
the Citizens of Richfield Springs. Music by the Richfield 
Springs Military Band. 

The Citizens of Richfield Springs announce it as their 
purpose to make every member of the Institute pleased with 
their visit. They do this as an advertisement of their health 
resort, and the Committee feel assured that the session of 
1 90 1, will be the most pleasant one in the history of the 
Institute. 

A. B. Norton, M. D., President, 
E. H. Porter, M. A., M. D., Secretary. 



Infection through Modelling Clay. — Mr. M. O. 
Leighton, health inspector of Montclair, N. J., in a paper 
read before the American Society of Bacteriologists at its 
recent meeting in Baltimore, made the following statements : 

" In the ordinary schools such clay, after having been 
used by one student, is returned to the stockbox and subse- 
quently used again. Study of clay thus obtained from 
schools showed bacteria to be tolerably abundant in the clay. 
The species of bacteria identified were those which ordinarily 
occur in pus formations, thus showing that clay may be capa- 
ble of distributing these organisms. An attempt to sterilize 
clay showed that the only efllcient means of accomplishing 
this purpose is by the use of superheated steam under the 
pressure of 1 5-20 pounds for forty-five minutes. 

" Next, an attempt was made to determine how long cer- 
tain pathogenic bacteria could remain alive in the clay. 
Sterilized clay was inoculated, under proper precautions, 
with the bacilli of typhoid, diphtheria and tuberculosis. The 
clay was then kept moist and warm, and studied periodically 
for the presence of these organisms. The results were, 
briefly, as follows : B. typhi abdominalis grew vigorously 
after having been enclosed in the clay for thirty-two days. 
After that no colonics were found. B. diphtheria grew after 
having been enclosed in the clay for eighteen days. B. 
tuberculosis was alive after eighteen days." 



190 1 Reviews and Notices of Books, 261 

REVIEWS AND NOTICES OF BOOKS. 



Obstetric and Gynecologic Nursing. By Edward P. Davis, A. M., 
M. D., Professor of Obstetrics m the Jefferson Medical College, 
Philadelphia, and in the Philadelphia Polyclinic, etc. Philadel- 
phia and London: W. B. Saunders & Co. 1901. pp. 402* 
Price, $1.75 net. 

The above is one of the most valuable of the recent contribuions 
to medicar literature for nurses. It is exceptionally thorough and 
comprehensive, and in a plain, straightforward, practical way gives 
all the teaching required by a nurse engaged in obstetrical and 
gynecological work. 

In Part I., Obstetric Nursing, an outline of the anatomy and 
physiology of pregnancy is followed by instruction in nursing in 
complicated and uncomplicated cases. Chapters are devoted to 
preparations for confinement, nurse's duties during and after labor, 
care of the child, obstetric surgery, complications during and follow- 
ing labor, feeding and weaning, disorders of infancy, etc. 

Under Part II., the examination and management of patients, 
local treatment, douches, preparation for and assistance during 
operations, post-operative nursing, and care in special cases are 
treated at length, and many additional directions are given in 
regard to the preparation of surgical supplies, selection of foods 
and aseptic precautions to be observed. 

There are many good full page illustrations, and carefully a pre- 
pared index. 

Transactions of thp: Ho.vkeopathic Medical Society of the State 
OF New York for the Year 1900. Vol. XXXV. Edited by 
the Secretary, De Witt G, Wilcox, M. D., Buffalo, N. Y, pp. 410. 
The present volume is a record of the forty-eighth annual meet- 
ing of this society, held at Albany, N. Y., Feb. 13 and 14, 1900, and 
of the thirty-fourth semi-annual meeting held at Brooklyn, N. Y., 
Oct. 3 and 4, 1900. 

It contains a large number of short suggestive papers, which are 
well supplemented by the discussions they evoked. Transactions 
like these are interesting reading, and form excellent books of 



262 The New England Medical Gazette, May, • 

reference, inexpensive to society mcinbers, and serviceable to all 
who would keep in touch with what is being thought and done 
along medical lines. 

We are pleased to note that Drs. N. W. Emerson and Horace 
Packard, of Boston, have been elected honorary members of this 
society. 

A Text-Book on Practical Obstetrics. By Egbert H. Grandin, 
M. D., with the collaboration of George W. Jarman, M. D. Third 
edition, revised and enlarged- Illus. Philadelphia : F. A. Davis 
Co. 1900. pp. 511. Price, cloth, {4 net; sheep, J5 net. 

As a standard work on obstetrics Grandin and Jarman's occupies 
a decidedly leading position. If it is less voluminous than certain 
contemporary treatises which might be mentioned, it is not the less 
instructive and reliable on the subject of essentials. The schema 
of the work, which for the most part relegates instruction in 
anatomy, physiology, embryology and pathology to other and earlier 
chairs, admits of a considerable omission and condensation of 
matter ordinarily included. We think this a reasonable and advan- 
tageous plan to pursue, and that little is gained by diffuseness and 
repetition if the student comes to obstetrical work well grounded in 
preliminary branches. 

We also commend the omission of many of those antiquated wood 
cuts, whose introduction to the pages of books on midwifery ante- 
dates the memory of the oldest practitioner. There are still 21 few, 
notably those illustrating the structure of the genital organs, which 
we hope to see superceded by far better ones in a subsequent edi- 
tion. There are numerous excellent plates, photogravures from 
nature, in the present volume. 

We have always liked this book, and continue to think it well 
and conscientiously written. It is clear and practical, not over 
burdened with theory, statistics or literary references which do not 
help a man out appreciably in a difficult case, and which often 
confuse a student. 

Students and practitioners need more than one text book on 
obstetrics, and the one under discussion may well be among the 
nuTiber selected. 

We quote one or two of the many sensible sayings concerning 



j 1 90 1 Reviews and Notices of Books. 263 

I precautions, to prevent infecting the lying- woman : * • These precau- 

tions take but little time, and the man who is not willing to give 

I this time to safeguard a human life had better decline obstetrical 

\ work altogether.'* 

I Again, "The vaseline-pot should, once and for all, be banished 

from the lying-in chamber.'* 

Concerning the time for instrumental delivery, " It is a question 
of conditions, and not minutes or hours." 

i 

I Nursing Ethics for Hospital and Private Use. By Isabel 

I Hampton Robb, Graduate of the New York Training School for 

' Nurses, Bellevue Hospital, etc. Cleveland: J. B. Savage. 1901. 

Price, $1.50. 

The qualifications of a young woman who wishes to become a 
professional nurse are summed up by the author as being good 
physical health, education and culture. To these must be added a 
sense of personal responsibility which shall ensure the conscientious 
discharge of her obligations. 

The author very carefully presents the ethical side of a nurse's 
service as probationer, junior, senior and head nurse while in the 
hospital, and the relations she should bear to patient, doctor and 
family when practicing her profession outside. 

It is unfortunate so much important and well expressed advice 
and instruction should be dissociated from a text- book on nursing, 
as joined with the technical teaching, a larger circle of readers 
might be reached. 

The Medical Adviser; or How to Treat the Sick and the 
Injured. By O. Edward Janney, M. D., Professor of the Practice 
of Medicine in the Southern Homoeopathic Medical College. 
Baltimore: Maryland Homoeopathic Pharmacy Co. 1901. 
pp. 72. 

Designed primarily for the use of patients temporarily out of 
reach of a physician, this monograph is also recommended by the 
author to readers at large. The best things it contains are the sug- 
gestions on diet in common diseases, but the text throughout is too 
sketchy to be otherwise than frequently misleading to the laity. 
This is especially noticeable in the section on Remedies and Reme- 



264 Th^ New England Medical Gazette, May, 

dial Measures. The subject of dysentery, for instance, is dismissed 
as follows : " Mercurius corr. 3X one tablet every hour or two." 

There are several good receipts for the preparation of food for 
the sick. 



Infant- Feeding in Its Relation to Health and Disease. By 
Louis Fischer, M. D., Attending Physician to the Children's 
Service of the New York German Poliklinik, etc. Illus. Phila- 
delphia : F. A. Davis Co. 1901. pp. 368. Price, cloth, $1.50 
net. 

We have no hesitation in predicting that Fischer's Infant- Feed- 
ing, will at once command the appreciative attention of the profes- 
sion. It is the work of an educated man and a clinician who has 
thoroughly mastered his subject. 

The plan of the book embraces a description of the digestive 
organs of the infant, verified actual capacity of the stomach at dif- 
ferent ages, properties and action of the digestive juices, intestinal 
bacteria, constituents of breast and cow's milk and their value, 
feeding of milk, diet of mother, wet-nursing, care of nipples, impor- 
tance of record of infant's weight, properties of human and cow's 
milk, modification of milk, how good milk may be secured, sterili- 
zation, pasteurization, modification,* mixtures, infant foods with 
analyses ! and deductions, condensed milk, Gsertner's '* mother- 
milk," chemical and clinical reports on same, infant stools, appro- 
priate feeding of infants in various diseases, rectal feeding and 
feeding in intubation cases, dietary. 

When breast milk is not available. Dr. Fischer favors the feeding 
to healthy infants of raw milk obtained under conditions of perfect 
cleanliness. He points out its superiority over sterilized or pasteur- 
ized milk, and gives rules for its modification at home. The use of 
modified or laboratory milk is not recommended. He notes that it 
causes constipation, retards development, and may occasion or 
predispose to intestinal disorders and scurvy. 

It is impossible to call attention to all the good points of this 
book which will not only supplement, but supercede much of the 
present teaching of infant-feeding. 



igoi 



Personal and News Items. 



265 



PERSONAL AND NEWS ITEMS. 



Emergency Hospital at Pan-American Exposition. 




The above cut represents the Emergency Hospital which 
has been erected on the Pan-American Hxposition Grounds 
at Buffalo. It is equipped with all the approved medical and 
surgical appliances necessary for emergency work. A 
unique feature consists of two electrical ambulances, and also 
another automobile ambulance to run either by gasoline or 
steam. The hospital has accomodations for from twenty-five 
to thirty patients at one time. Physicians visiting the expo- 
sition will doubtless find much to interest them in the ar- 
rangements and appliances of the hospital, all of which are 
of the most modern style. 

At the next meeting of the American Homoeopathic Oph- 
thalmological, Otological and Laryngological Society, which 
will open its session in the parlors of the Hotel Earlington, 
Richfield Springs, New York, on Saturday, June 15, at 2.30 
p. M., and have sessions on Monday and Tuesday, June 17, 
and 18, it has been arranged to have Mr. M. R. Hutchison, 



266 The New England Medical Gazette, May, 

E. E., exhibit and explain his recently perfected akouphone 
and akoulalion, mycro- telephonic instruments so constructed 
as to reproduce and intensify sounds and still preserve their 
quailty. 



AMERICAN INSTITUTE OF HOMCEOPATHY. 
president's office. 

New York, March 29, 1901. 
To THE Members of the Amer. Inst, of Homceopathy : 
Having appointed Dr. A. C. Cowperthwaite to the office 
of Necrologist, in place of Dr. H. M. Smith, deceased, I 
would respectfully urge upon the members of the Institute 
that they forward to him at once all the data within their 
possession as to the death of any member of the Institute 
during the past year. 

Fraternally yours, 

A. B. Norton, 

President, 



Dr. Given's Sanitarium at Stamford, Conn., is pleasantly 
situated on a hill overlooking the city of Stamford and Long 
Island Sound, and is easy of access from New York and all 
New England States. 

It is a well known fact that certain climatic conditions are 
beneficial in certain nervous and mental disorders, and the 
invigorating (coast) air of this locality, charged with ozone, is 
a sedative in itself. 

During the past year another cottage has been added, and 
the recreation hall has been enlarged, thus improving upon 
the already excellent accommodations offered for patients 
desiring special treatment. 

All modern means are employed for the treatment of 
nervous and mental disorders. A separate department is 
devoted to the treatment of drug habits. 



190 1 Personal and News Items, 267 

Dr. Kraft, editor of the American Homosopathisty 57 
Bell Ave., Cleveland, Ohio, is collecting a small but select 
party of ladies and gentlemen for a fifty days' summer tour 
in Ireland, Fnence, Italy, Switzerland, Austria, Germany, 
Holland and Belgium. Terms moderate. Apply early. 

For Sale. — A $2,000 country practice in Massachusetts. 
Terms very reasonable. Collections over 90 per cent. Ad- 
dress "Y," Care Otis Clapp & Son, 10 Park Sq., Boston, 
Mass. 

The town of Norfolk, Connecticut, is in need of a homoeo- 
pathic physician, and it is said to be a good opening for one. 
For information regarding the place, address Dr. B. A. Saw- 
telle, Southington, Conn. 

Dr. Thos. H. McClintock, class of '98, B. U. S. of M., 
has removed from Hillsboro Bridge, New Hampshire, to No. 
56 Buckingham St., Hartford, Conn. 



268 Ihe New E?igland Medical Gazette. May. 

Death Rate of Six Large Cities.— It may be of inter- 
est to glance at the death rates of six of the large cities dur- 
ing the past five years : 

189s 1896 1897 1898 1899 



London . . . 


19.8 


18.6 


18.2 


1 8.7 


19.8 


Paris . . . . 


21.3 


19.0 


18.6 


19.7 


20.2 


Berlin . . . . 


19.4 


17.9 


17.7 


17-3 


18.7 


Vienna . . . 


23- 1 


22.3 


20.9 


20.1 


20.6 


St. Petefsburgh 


28.8 


30.9 


29.0 


25.8 


25.2 


New York . . 


23.2 


21.8 


20.0 


20.5 


19.8 



The death rates for New York given here are for the bor- 
oughs of Manhattan and the Bronx, and are calculated from 
the results of the United States census of 1900, It is seen 
by this table that there has been a tendency to a lower death 
rate during the past few years. This may be accounted for 
by a lessening of the virulence of influenza, by better paving 
of streets, and by a more careful oversight of water and milk 
supply. Much can still be done by physicians and sanitarians 
and municipal governments in these relations. — New York 
Medical Journal. 

A Useful Dragon Fly. — The United States Government 
has been experimenting with the savage looking but harmless 
dragon fly. Experimenters saw one fly eat up 800 mosquitos 
in an hour, and it is now proposed to breed the " darning 
needle " on a large scale to see if they cannot be made suffi- 
ciently numerous to kill the mosquitoes that infest some parts 
of the country. ... A recent report of a commission of 
surgeons of the United States Army, prepared by Dr. Walter 
Reed, is of interest in this connection. The conclusion 
reached by this commission is that the mosquito serves as the 
intermediate host for the parasite of yellow fever and it is 
highly probable that the disease is propagated through the 
bite of this insect. — Exchange. 



THE NEW ENGLAND 

MEDICAL GAZETTE 

No. 6. JUNE, XQOx. Vol. XXXVI. 



COMMUNICATIONS. 



PRESIDENTIAL ADDRESS. 

BY JOHN L. COFFIN, M.D. 
[Delivered before Mass. Horn. Med. Society, April lo, 1901.] 

Ladies and Gentlemen^ Members of the Society: 

Since last we met, the last year of a century has closed, 
and with its demise the nineteenth century has passed into 
history. Not the history that is written but the history that 
is. The history that is written at best gives only the salient 
points, the remarkable things that have been done, the nota- 
ble or notorious people that have lived, and from the perusal 
and comtemplation of these recorded facts we endeavor to 
construct an idea of the genius of the ages past. Not so 
with the remarkable century just gone. We are not yet so 
remote that it is necessary to summon our imagination to 
help in forming our estimate. 

The blood is hardly yet cold in our veins that fought at 
Lexington or froze at Valley Forge. Our ears still tingle 
and our hearts throb at the voice of Patrick Henry, and 
Jefferson, and We'bster, and Calhoun, and Clay. The story 
is still told in the flesh of Bull Run, of Fredericksburg, of 
the Wilderness, of Gettesburg, and Antietam. The trying 
days of the reconstruction period are yet a reality to many of 



270 The New England Medical Gazette, June 

us and the solution of the race problem is still with us today 
in all its complexity. We no longer drag our weary way 
over the hot and dusty road in the stage-coach, but travel on 
the wings of the wind surrounded by all the luxuries of an 
up-to-date hotel. We talk almost, if not quite, all around the 
globe. Distance and space are annihilated. These are facts 
well known to us and these are the things that will be 
known to the future, emblazoned as they will be on the 
pages of the written book. 

But of more importance far than all this is the fact that 
we still know and feel all those tremendous, subtle, silent 
forces of humanity which have made these achievements pos- 
sible. We know the denial and self-sacrifice of the parents 
that the children might be educated, and the earnest struggle 
and endeavor of the children that they might be worthy of 
the sacrifice. We remember that early and wholesome dis- 
cipline at home and in school, resulting in that intelligent 
obedience which enables the American citizen-soldier to 
walk unflinchingly into the hell of battle and to stay there 
till he wins. We feel the honest struggle of the New Eng- 
land conscience with dogma and tradition, that everlasting 
reaching out after truth which resulted in a religious eman- 
cipation, and rendered possible an Emerson, a Channing, a 
Theodore Parker and a Phillips Brooks. We are yet an 
integral part of that living, breathing, resistless, onward-striv- 
ing humanity, which under Divine guidance has made the 
nineteenth century the best the world has yet seen. Never, 
I believe, has the intelligence of the great mass of people 
been so well developed as today, never has the laborer been 
so well-housed and well-fed both physically and mentally, 
never to so great a degree has the possession of great wealth 
been so much regarded as a sacred trust to be used for the 
benefit of mankind, and therefore it is that at the dawn of a 
new century we stand fully conscious of the debt we owe the 
past, fully appreciative of the responsibilities thereby entailed 
upon us, but at the same time proud of our forebears and 



190 1 Presidential Address, 271 

their work, strong in our ability to do the duty of today, and 
filled with courage and determination for the future. 

So has it been with our chosen profession. As we look 
over the past hundred years we are dazed at the names and 
deeds that stand out in bold relief. The names of Jenner, 
Claude Bernard, Rasori, Brussais, Couvelhier, Andral, Ma- 
gandie, Rokitansky, Vichow, Lister, Cooper, Lagenbeck, 
Hutchinson, Paget, Spencer Wells, McDowell, Sims, War- 
ren, Dunglison, Austin Flint, Mott, Hamilton, Gross, Bige- 
low, Meigs, Agnew, and many others. And in our own 
special school the names of Hahnemann, Stapf, Gresselich, 
Fleishman, Quin, Jahr, Gram, Pope, Hughes, Drysdale, 
Lippe, Dunham and Talbot. 

When we recall the discovery of the homoeopathic law, of 
anaesthetics, of the principles of asepsis and antisepsis, when 
we contemplate the advance made in surgery and the perfec- 
tion of the various instruments to assist us in diagnosis, we 
stand almost aghast. But of far greater moment to human- 
ity is the fact that, guided by the brilliant and indefatigable 
labors of these noble men, the whole body of medical men 
and women have steadily and persistently added their mite 
to the work until the ordinary, every-day, average practi- 
tioner today, has more knowledge of the human body in 
health and disease that is accurate and true, than ever before 
since the world began. This is a condition of affairs, of which, 
we, each and every one of us is a living part, a condition of 
which we may justly be proud and which should constantly 
stimulate us to add what we may, be it ever so little, to the 
sum total of medical knowledge. 

Fascinating as is the temptation to dwell in the glorious 
past, we must live in the prosaic present. It was wisely or 
otherwisely, ordained by our founders, that the society should 
twice each year be benefitted, or bored, by an oration and 
presidential address. 

As we opine that the object of the oration was to give 
such members as might be selected, full license to choose 



272 The New England Medical Gazette, June 

their pet subject and display their elocutionary and oratorical 
powers through all gradations from a Booth to a Barn- 
stormer, so we conceive that the object of the presidential 
address was to consider more especially those things of vital 
interest to the society itself, a sort of annual stock-taking. 
We are the representative society of our chosen faith in the 
State and as such our interests are two-fold ; first as regards 
those matters of general interest to the whole profession, and 
second those pertaining more especially to homoeopathy. 

Not for some years have there been before the legislature 
matters of such importance to our profession. The first 
matter to come up was a bill to give the College of Physio- 
logical Optics permission to grant the degree of Doctor of 
Physiological Optics. The general character of the scheme 
may be judged from the fact that of sixteen students enrolled, 
the names of four appeared in the application for a charter- 
and the names of eight of the sixteen appear as trustees of 
the institution. Through the efforts of the leading oculists 
of the city, backed by the profession generally, we are happy 
to say the bill was practically killed in committee. The com- 
mittee reporting '* reference to next general court ". Of far 
greater import and danger to the welfare of both the public 
and the profession, was a petition of one Dr. Emanuel Pfeif- 
fer, praying for some modification of the existing laws gov- 
erning the Board of Registration whereby the fees for 
examination should be reduced and graduates of legally char- 
tered medical schools should be granted licenses without an 
examination. This was a very crafty and plausible attempt 
to cripple absolutely the Board of Registration by cutting of 
its resources and its principal power. The petitioner as well 
as remonstrants were represented by able legal counsel. 
There were present at the hearings among the remonstrants 
the president of the Massachusetts Medical Society, the 
president and vice-president of the Massachusetts Homoeo- 
pathic Society, the president and legislative committee of 
the Boston Homoeopathic Society, and many others. Com- 



1 90 1 Presidential A ddress, 273 

munications were read by the deans of Harvard, Boston 
University and Tufts Medical School. As a result of their 
work the committee unanimously reported "leave to with- 
draw," which was accepted by the House a few days after 
without debate. 

The third legislative matter of interest was a petition 
afterwards incorporated with the report of the Board of 
Registration, including under the rules and laws of the 
Board, osteopaths, mental healers, clairvoyants and Chris- 
tian scientists, who heretofore have been exempt. This 
matter is still under consideration, and the influence of this 
as well as of other societies is being used to further the 
recommendation. The point I wish to emphasize is that the 
above pernicious legislation has been defeated, largely be- 
cause there has been harmonious and concerted action by 
the medical fraternity, brought about very largely by the 
interest and activity of the committees on legislation of the 
various societies, more especially by that of the Boston 
Homoeopathic Society, headed by its able president, Dr. 
Strong, whose labors were unceasing and invaluable. 

All these matters but tend to show that there is no reason 
why, under proper management and well-organized co-opera- 
tion, we cannot have here in Massachusetts as satisfactory 
laws regulating the practice of medicine as in any State in 
the union. 

I have not touched upon the question of vivi-and anti-vivi- 
section because that is perennial. We can examine that at 
any time. So far as I know, no injurious legislation has 
been enacted and the cat-loving old maids of both sexes 
have had the pleasure of doing what they consider their duty. 

Next to these matters of general interest to us as medical 
men and women, comes those of special interest to us as 
homoeopaths. Our Massachusetts homoeopathic institutions 
should always be the especial interest of this society, for 
either directly or indirectly we are held accountable and are 
accountable for their success. Our State hospital has 



274 The New England Medical Gazette, June 

throughout the year fully maintained its well established 
reputation for good work. The staff has been materially 
enlarged by the appointment of second assistant physicians 
and surgeons. What to my mind is more a cause of con- 
gratulation is the fact that never before has the medical side 
of the hospital been so continually occupied. This certainly 
shows that the appreciation of our methods of practice is 
constantly growing with the public. Our Hampden County 
members are to be cordially congratulated on the opening of 
the new Hampden County Hospital, and treading close upon 
the heels of this fact comes the good news that undoubtedly 
the name of Essex County Homoeopathic Hospital of Salem, 
will before long be added to our list. Of one thing this 
society may be sure, and that is, that if Essex County has 
started to have a homoeopathic hospital she will have it, for 
since the foundation of the world, the New World, I mean, 
Essex County has generally accomplished what she set out 
to do, whether it be to catch fish or burn witches. 

Of the State Insane Hospital at Westboro, I can say that 
we still cure a larger per cent, of cases admitted that are 
classed as curable than any other State hospital ; our accom- 
modations have been over-crowded during the entire year, 
and the legislature will undoubtedly appropriate means for 
additional buildings during the present session. What is 
true of our hospitals is equally applicable to our dispensaries. 
At the college dispensary on Harrison Avenue the clinics are 
constantly increasing in size, and more room or the opening 
of the building for afternoon hours is imperative. 

Under the auspices of a committee appointed by the so- 
ciety in 1873, there was established a medical school. What 
has the society as a society done for it since ? Search the 
records as I may I fail to find a single mention. Appar- 
ently it gave birth and then deserted its off -spring. But the 
child fell into good hands, was well tended and well nour- 
ished, and today has arrived at healthy maturity. 

The attitude of the society toward the college has for the 



1 90 1 Presidential A ddress. 275 

most part been one of indifference. This is not as it should 
be. The college should always have the cordial support of 
the society, and the faculty should always feel that in their 
labors they have back of them the friendly support and the 
influence of this representative body. The society in no 
small degree is dependent upop the college, for the last 
census shows that out of our published list of members, num- 
bering 329, 224 are graduates. If, then, the society desires 
that the new additions to its membership shall be well- 
equipped men and women, capable of becoming useful, 
active workers and ornaments to the profession, it certainly 
is for its interest to encourage and support by all means in 
its power the college from the graduates of which the society 
largely recruits its members. There are many ways in 
which this body might be helpful to the college. At the 
present time the trend all along the line is toward a marked 
advance in the requirements for admission to the study of 
medicine. Some advance has already been made, but much 
more is necessary and so far the faculty has hesitated to 
take so radical a step. One advance to the standard already 
set by the leading institutions is, in my judgment, much less 
pernicious than a series of slight advances, and were the 
faculty assured by united action that such a move was 
desired and endorsed by this society, I am sure the faculty 
would feel encouraged and sustained in such action. The 
immediate result of such a change is loss of students ; the 
ultimate result will be an increase in members and quality. 
Loss of students means loss of income, a most serious matter 
for any institution dependent almost entirely upori fees for 
its maintenance. For a time then during the transition 
period, there is grave danger of the institution becoming finan- 
cially embarrassed. Here, again, this society can be of great 
practical assistance, not by the direct contribution of mpney, 
but by their influence with those who have means and are 
seeking worthy channels in which to dispose of it It was this 
influence that built our hospital and endowed it so hand- 



276 The New England Medical Gazette. June, 

somely. It will do it for the medical school if the society 
will only use its individual and united efforts in that direc- 
tion. I would earnestly recommend, therefore, that this 
society appoint a standing committee, no member of which | 

shall be a member of the faculty, to confer with that body as 
to ways and means in which and by which the society may 
be of practical assistance to the medical school. 

Finally I wish to speak somewhat of the relation of the 
members to society and the work of the society as a whole. 

The attitude of each and every member should be one of 
loyal and enthusiastic support, with a cheerful willingness to 
work. It has been my experience in the past on more than 
one occasion to have heard a member say, " O, yes, I belong j 

to the State Society, but I don't get much out of it. I pay I 

my fee every year and get a dinner and hear a few papers | 

read, but I can't say I get much out of it." Such a spirit is 
unworthy of the age in which we live. Not what do I get 
out of it, but what can I put into it for the benefit and help 
of my fellow members, should be the motto of every man I 

and woman worthy to meet in this body. A more recent 
criticism, and one not entirely without reason, is that too 
many of the papers are presented by the specialists, and so 
are not of a character to be most helpful to the general body 
of general practitioners. The best answer to this criticism 
is, that the critics themselves should do more work. 

The specialists more frequently prepare papers because 
they are undoubtedly more frequently urged by the commit- 
tees of the various bureaus, they are more frequently invited 
no doubt, because giving as they do all their time and study 
to the perfection of a single department, they are the more 
conversant with the most recent advance along their partic- 
ular line, because they have more time for literary work and 
because they are oftentimes more accustomed to express the 
results of their investigations and experiences on the written 
page. Nevertheless there is always the danger strive against 
it as one may, of the specialist studying the case too much 



igoi Presidential Address, 277 

from his particular point of view, and therefore it is, that 
there is no paper more valuable and more acceptable than 
that carefully prepared from the rich store of clinical experi- 
ence, which is the possession of every conscientious general 
practitioner. The more they write, the less will the specialists 
be called upon. 

To one who has watched the general character of the 
work of the society for the past fifteen or twenty years, the 
improvement is marked and gratifying. The papers cover 
a wider range of subjects, show evidence of more study, 
and extended research and conclusions are more frequently 
drawn from the consideration of a collection of recorded clin- 
ical cases than from the single case as formerly. But in one 
respect the society has not made satisfactory advance, that is 
along the line of the study and development of our materia 
medica, a department vital to our existence as a distinctive 
school. I do not know that the society should be blamed, 
indeed I do not feel that the society should be criticised for 
this. There are many good and sufficient reasons for it, but 
I do believe the time is ripe for work on this most important 
subject. It is very gratifying to know that in some direction 
this work has been begun along satisfactory lines. 

At the last meeting of the O. O. & L. Society, the Presi- 
dent, Dr. Bellows, of Boston, presented a definite plan for 
the revision of the materia medica. The provers should be 
hired, they should be examined by a general practitioner, and 
by the various specialists, to note their normal condition. 
During the proving, under the care of a director of provings, 
the prover from day to day is to undergo physical examina- 
tion and any deviation from normal noted. Such in brief 
are the gross outlines of the plan. The committee on presi- 
dential address reported that the suggestion contained therein 
should be put to the practical test and committees should be 
appointed in the various cities to prove a single drug. The 
committee consists of a director, two general practitioners, 
and one practitioner in each branch of special work. 



278 The New England Medical Gazette, June, 

In Brooklyn, New York, the necessary money has been 
raised, the committee appointed, and the work begun. Here 
in our own city the committee has been appointed with 
Dr. E. P. Colby as director. Dr. Bellows is general director 
over all committees. This is the right and scientific way in 
which to prove a drug, where the narrative of the prover 
is supported by the physical, chemical and pathological 
examination. 

I sincerely trust that this society will see its way to do 
something to encourage persistent, steadfast work in materia 
medica, and with this end in view would recommend that the 
society offer annually or biennially a prize for the best paper 
on materia medica, and that the contest be open to the 
members of the senior class of the Boston University Medical 
School. 

The danger in the present attitude of the old school to- 
ward us, which may be summed up as one of tolerant indif- 
ference, the apparent tendency of some few of the newer 
members of our faith to long after the flesh-pots of allopathy, 
the possibility of the official recognition of our school in the 
army and navy, are all themes worthy of our consideration at 
this time, but I fear I have already taxed your patience far 
beyond the bounds of courtesy. 

Tonight upon the threshold of a new century, gaze as far 
as we may, there is to be seen only encouragement. We 
have an established medical faith. It has been accepted by 
many and that many increasing every day. It has been 
established by one hundred years of indomitable perserver- 
ing work by noble men and women who had that greatest of 
all courage, the courage of their convictions. It is for us 
who know that their convictions were true and right to see 
to it that their labors have not been in vain. True, are we 
yet a minority in the medical world, but in all great reforms 
that ever have been or ever will be, it is necessarily the 
minority that is right. Whenever I meditate on minorities, 
I am always reminded of a story of the late Dr. Bartol. The 



I go I IV/mt is Peritonitis f 279 

reverend doctor had invited a young friend to assist him in a 
service in the old church at the west end. The two rever- 
end gentlemen sat in the pulpit while the congregation as- 
sembled. There were not many, and as the time approached 
for the service to begin, the young man remarked upon the 
few people present. The elder divine peeked around the 
desk, surveyed the congregation, and then quietly remarked, 
" Yes, yes, there are but few sjich people." 



WHAT IS PERITONITIS? 

BY HORACE PACKARD, M.I). 
[Read before Boston Horn. Med. Society.] 

The subject, which I have selected tonight, is perhaps 
couched in somewhat peculiar terms. Modern bacteriolog- 
ical research has materially changed former theories regard- 
iug inflammation, and has established beyond any question 
what is peritonitis. All who have giyen heed to facts, which 
have been evolved of the relation which microbic life bears 
to the human body, can be but profoundly impressed with 
the importance of the subject. Much light has been thrown 
upon many hitherto obscure pathological problems. 

Inflammations of the peritoneum have been, and are now, 
among the most perplexing affections which menace human 
life. Without premonitory symptoms, pain arises in the 
abdomen, quickly followed by local or general tenderness, 
reflex nausea and vomiting, gradually increasing distension, 
loose movements, collapse and death may be, within four or 
five days from the beginning of the attack, and without any 
inkling whatever on the part of the family or physician of 
what the cause has been of such a calamitous illness. 

Since it has become known that the appendix vermiformis 
figures so largely in inflammatory abdominal affections, it is 
natural that in cases of persistent pain and tenderness, sus- 



28o The New England Medical Gazette, June, 

picion should be aroused of its complicity. Excluding these, 
however, as well as cases of peritonitis, which are a sequela 
to tubal disease in the female, there are still a not inconsid- 
erable number which are obscure in their origin, fatal in 
their effects, and exhibit on exploratory incision, or autopsy, 
no physical explanation of their cause. 

What I have to say to you is based largely upon matters 
which have come to my notice in the course of examination 
of cases of abdominal infection. The cases quoted are some 
out of the ordinary run which have come to my knowledge. 

Case I. — Mrs. C, age 62, was seen in consultation with 
her family physician late in the evening of Dec. 10, 1898. 
She had for two years or more been troubled with intestinal 
indigestion. The day prior to my visit she had vomited at 
noon, which was accompanied by pain in the abdomen of 
indefinite character. Saturday, the day of my visit, the pain 
had become very severe, with recurrence of vomiting and 
loose stools. Her temperature was 101.8®, pulse 112. Pal- 
pation disclosed great tenderness in right hypochondrium, 
occupying the whole space between the costal cartilage and 
crest of ileum. N6 tumor demonstrable. My notes, written 
at the time, read " Obscure case, may be appendicitis, possi- 
bly gall stones. Exploratory incision advised." 

The patient was immediately taken to the hospital and the 
abdomen opened. The appendix was sought first and found 
normal. The gall bladder was next explored and found also 
normal. The pelvic organs were also without pathological 
change. The intestines were then inspected, and, after 
going carefully over their whole length, the upper part of the 
ileum, at about its junction with the duodenum, was found, 
for a distance of about fifteen inches, dark livid red, infected, 
but not nodular, thick and inflexible as compared with nor- 
mal intestine. There was no plastic deposit on the perito- 
neum, no pus, no feculent fluid, no perforation. The wound 
was closed without drainage, and ice bags applied to the 
abdomen. But little pain was suffered thereafter. The 



igoi WAat is Peritonitis f 281 

patient gradually improved and finally recovered from the 
operation and lived about ten months. No tumor ever de- 
veloped in the abdomen, and she had no recurrence of the 
acute symptoms. The appearance of the part of the gut 
affected was of acute inflammatory infiltration. 

Was this a case of localized enteritis, caused by invasion 
of the intestinal walls with bacteria from the interior of the 
intestine ? 

Case 2. — Miss W., age 25, was prostrated Oct. 15, 1899, 
with obscure abdominal pain. In spite of treatment, it con- 
tinued increasing in severity with elevation of temperature 
and pulse. 

I saw her in consultation with Dr. Wm. G. Hanson, the 
evening of October 18. At that time the abdomen was 
exceedingly tender, without localization ; pain was contin- 
uous and diffuse; temperature 102 2-5°, pulse 118. I could 
neither confirm or refute a diagnosis of appendicitis, but in 
view of the obscurity and menace, advised an exploratory 
incision. She was hurriedly .removed to the hospital, and an 
incision made over the appendix, which, on exposure, was 
found unperforated and apparently was not the source of the 
trouble. On inspection of neighboring loops of intestines, 
they were found covered with patches of exudate, were dark 
red and distended. Another incision was made in the me- 
dian line to facilitate wider exposure. The same yellowish 
exudate was found over nearly all the intestinal peritoneum 
and the pelvic organs. Intense inflammatory redness was 
apparent everywhere. All parts were carefully cleaned by 
gently rubbing with mops of soft gauze under a stream of 
sterile water. Lastly the abdomen was irrigated with saline 
solution and the wounds closed without drainage. Ice bags 
were packed over the abdomen. The patient gradually 
improved and recovered. 

In this case there was no visible gate-way open for infec- 
tion of the peritoneal cavity. The appendix was not at fault. 
The appendages were normal. There was no perforation of 



282 The New England Medical Gazette. June, 

the intestine. What was the cause and source of the peri- 
tonitis ? 

Case 3. — Mrs. C, age 38. Two children. General health 
good up to present illness. Friday, Feb. 23, 1900, suffered 
pain in the abdomen during night, accompanied by loose 
movement of bowels. Had been taking anti-fat pills for a 
few weeks, which produced some diarrhoea. Was seen by 
her physician. Dr. Hodgdon, Saturday afternoon. Tempera- 
ture then 103®, pulse 130 ; pain diffuse over the whole abdo- 
men, much distension. I saw the case March i, and found 
distension still present and diffuse tenderness ; temperature 
1022-5°, pulse 120. No further movements had occurred. 
The patient had vomited the preceding Monday. Here was 
another obscure case. I could make out no localization of 
pain or tenderness, no tumor. Again, in view of the ob- 
scurity and menace, exploration was advised. Incision in 
the median line showed the intestine covered with a plastic 
exudate, foul fluid in the pelvis, but appendix and append- 
ages normal. Further exploration along the small intestine 
disclosed a segment, about a foot long, greatly thickened, in- 
tensely red, with small areas of gray necrotic patches scat- 
tered over it. It was much like Case i only a more intense 
degree of involvement. The same treatment was adopted 
as in the preceding case, except that gauze drainage was 
adjusted. The patient succumbed in a few hours. 

Was this again a case of penetration of the intestinal wall 
by the bacteria which inhabit the intestinal canal, and if* so, 
what condition made such a dire disaster possible .-^ 

Case 4. — Mrs. M., age 6^^ of Irish birth and strong con* 
stitution. Was prostrated Saturday, December 29, with 
feeling of sickness all over. Sunday morning vomited and 
had pain in the bowel, which became sore and tender all 
over. She felt hot and feverish. Took castor oil, and had 
four or five free movements. Her physician was summoned 
Monday. Temperature was then loi 4-5®, pulse 104. 
Tenderness seemed localized toward the right side. Tues- 



igoi W/tat is Peritonitis f 283 

day was more comfortable, temperature 99 2-5®, less tender- 
ness. I saw her Wednesday, and was summoned because 
the bowels were more tender, painful and sore, and had 
become distended and .vomiting had supervened. In this 
case appendicitis was suspected, but final diagnosis was held 
in abeyance, because of obscurity of symptoms. Exploratory 
incision was advised and accepted. The appendix was found 
normal, but the whole peritoneum was inflamed, covered 
with yellowish white deposit, and there was much foul puru- 
lent fluid in the pelvis and lumbar fossae. No focus of in- 
flammation nor defective area could be found. The abdo- 
men was thoroughly flushed, mopped and irrigated and gauze 
drainage established. The patient lived about eighteen 
hours. A culture was made of the fluid found in the abdo- 
men and an infection of pneumococci found. This latter, 
while it gives no hint of value for guidance in future cases, 
demonstrates that a fatal peritonitis may be established with- 
out physical lesion of the abdominal viscera, and from other 
source than the intestinal contents. 

GENERALIZATION. 

Cases I and 3 demonstrate fairly satisfactorily that peri- 
tonitis may be produced by direct penetration, through the 
intestinal wall, of pathogenic bacteria, which at all times 
inhabit the intestinal canal. 

Cases 2 and 4 demonstrate that peritonitis may exist with- 
out evidence of such penetration and irrespective of the 
intestinal contents, 1. ^., it probably occasionally becomes in- 
fected directly through the blood current. In the last case, 
there was a recent history of some kind of a pneumonia or 
bronchial attack of mild character from which the patient 
was convalescent when the abdominal trouble came on. 
This was probably the source of the pneumococci. 

We come back to the question, what is peritonitis } 
Modern pathological research has changed the views of all 
who have given the matter careful consideration. The time 



284 The New England Medical Gazette, June, 

has been when any disease which was characterized hy pain 
and tenderness in the peritoneal cavity was called peritonitis. 
It was a very common thing to speak of fibroid tumors as 
causing peritonitis. As bacteriological science has come to 
be more widely known, the question arises whether it is 
proper to call any inflammatory development, or anything 
that suggests inflammation, peritonitis, unless there are bac- 
teria in the abdomen, or some bacteriological process is 
going on. ' There are many microbic organisms, which are 
capable, if they reach the peritoneal cavity, of producing a 
train of symptoms that we call peritonitis. Experiments have 
been made of injecting into the animal, bacteria which have 
been sterilized. They act as poisons, producing diarrhoea, 
but the animal will get well. But let pathological living 
bacteria be injected in the same quantity, and in the resist- 
ance of the animal there will be more or less fatal sequelae. 

It is interesting to look at the peritoneum as an anatomical 
structure. I would call your attention to the peritoneal 
tissue. It is something over one-third of the area of the 
anatomical covering of the body. It is provided on the 
upper portion, about the region of the middle tendon of the 
diaphragm, with little openings varying from 3-16 to 5-16 of 
an inch in diameter, and these connect with the lymphatics. 
To one dealing with the abdominal organs, and operating on 
them, flushing them, according to the modem method of 
using saline transfusion, it is of interest to note how quickly 
the peritoneum will absorb. It seems but a few minutes 
after the injection is given, when it is absorbed and taken 
over the system, for the pulse, which has been weak, will 
improve in a very short time. 

It is said that the peritoneum is very inactive in resistance 
of bacterial organisms. There is usually a strong effort 
early on the pait of nature to ward off all infection by throw- 
ing out plastic exudate over the intestine, and cutting it off 
from the other portions of the cavity. This is nature's safe- 
guard, and if she cannot do it, here comes the great menace 



i 



IQOI Service at Mass, Homoeopathic Hospital, 285 

to the system. This will indicate to you my views of peri- 
tonitis, that it is a derangement of the peritoneum itself and 
a subsequent invasion of toxines. It is evident from clinical 
evidence that a great many cases of local peritonitis take 
care of themselves. The peritoneum is relieved by nature 
and absorption occurs and repair takes place. We can reach 
but one conclusion, that the earlier the abdomen is opened 
and the material washed out and drainage established, the 
better the patient is prepared to withstand the attack. The 
use of copious solutions of poisonous substances has been 
given up and clear water is not used. Instead copious injec- 
tions of saline solution are given to facilitate the washing 
away, through the drainage that has been established, and 
the drawing out of millions of bacteria, and rendering their 
toxines inert. 

This is the history of cases of peritonitis that have come 
to my notice. They usually die, the mortality, in spite of all 
modem methods, is not very encouraging. Cases that come 
to the surgeon are almost always far advanced, after the in- 
flammation is general, the abdomen is distended, and the 
patient septic through and through. Under these circum- 
stances death is pretty likely to occur. 



REPORT OF THE SURGICAL SERVICE OF THE MASSA- 
CHUSETTS HOnCEOPATHIC HOSPITAL FOR JULY. 
AUGUST AND SEPTEHBER, 1900. 

BY WINFIELD SMITH, M. D. 

It is a great temptation in reporting a service at the 
Homoeopathic Hospital to make a complete list of all the 
cases which have come under the supervision of the attend- 
ing surgeon, and to add such a list to the general report, but 
as this unduly complicates the description of the more impor- 
tant cases occurring in the service, I shall refrain from such 



286 The New England Medical Gazette, June, 

an indulgence and separate the cases into groups which, 
though somewhat unusual, are sufficiently descriptive to over- 
come the bad features of such classification. It is perhaps 
unnecessary to add that a surgical service, such as we have 
at our hospital, is characterized by many so-called "general ** 
cases, and that the multiplicity of the phenomena and the 
growth of the service from one year to another, only adds to 
the general interest and makes the specific cases more num- 
erous. The number of surgical cases coming under our 
observation last summer was 235, and of these, 212 were 
subjected to operation of greater or less severity according 
to the case. The difference between the 212 and 235 is 
represented by the cases of actual operation on the one 
h^nd, and those of anaesthetization on the other; but 23 
cases of simple anaesthesia comprise some which were ether- 
ized for the purpose of examination and were found inopera- 
ble or inexpedient, together with -several which were sub- 
jected to removal of a piece of tissue from a cervix for 
instance, or in one case from the clavicle, for the purpose of 
microscopic examination and determination of the character 
of the disease. It may be said, however, that all the 235 
mentioned were subjected to ether or chloroform, and hence 
come in legitimately to such a report as we are endeavoring 
to make. In ^6 cases the abdomen was opened, and there- 
fore they have been placed under the head of "abdominal." 
39 cases, comprising all classes of operations done through 
the vagina, with the exception of vaginal hysterectomy, are 
put in the class called "vaginal." 10 cases, exclusive of 
those of carcinoma or sarcoma requiring abdominal opera- 
tion, are cited under the head of "malignant," and consist of 
such cases, for example, as carcinoma of the breast and of 
the penis, and of the superior maxilla, with epithelioma of 
the lip and tongue, and sarcoma of the clavicle. 1 2 cases, 
including haemorrhoids, fistula in ano, and fissura ani, come 
under the head of "rectal." While 16 cases, such as strict- 
ure of the urethra, hydrocele, tubercular testicle, varicocele. 



igoi Service at Mass. Homceopathic Hospital, • 287 

hypospadias, phimosis, paraphimosis and cyst of the scrotum, 
come under the head of " genito-urinary." " Fractures " in- 
clude Potts, fracture of the bones of the foot and of the fore- 
arm, intracapsular, 'fracture of the hip, several fractures of 
the clavicle, and one each of the patella, femur at its middle, 
shaft of the humerus, of the external condyle of the humerus, 
and a depression of the skull calling for trephining. Under 
"dislocations and diseases of the osseous structures'* are 
included dislocation of the elbow joint, which is somewhat 
rare, floating cartilage of the knee, chronic osteitis of the 
tibia, necrosis of a rib and tuberculosis of the knee. 19 
cases are grouped under the head of "abscesses," subnamed 
ischio-rectal, labial, post-auricular, inguinal, etc. Under 
"foreign bodies," cases of needle in the foot and in the 
finger are included. While under "miscellaneous," are 
placed empyema, streptococcus infection of the legs and 
arm, cyst of the gluteal region and of the forehead, sinuses 
of the cheek, keloid, lipomata, haematoma of the thigh, trau- 
matism of the nose and contraction of the fingers following 
burn. 

A general examination of the list may be interesting. 

As appendicitis is now exciting the interest and the inge- 
nuity of surgeons the world over, it may be well to speak of 
28 cases which occurred in this term, several of which 
seemed of a hopeless character. They all recovered. Two 
cases paid the price for their lives in sustaining a faecal fistula, 
which, however, in each case was repaired with success in a 
subsequent service. Of one of these cases I shall speak 
more fully later on. 

In many cases of abdominal section for other causes than 
appendicitis, the appendix was removed on account of un- 
doubted signs of previous inflammation, and in fact it may 
be said at this time that I invariably inspect the vermiform 
appendix and, when feasible, the gall bladder when the 
abdomen is opened for any purpose whatsoever. In the 
cases in which the appendix was removed in addition to 



288 The New England Medical Gazette, June, 

some other operation in the abdomen, I cannot see that it 
complicated the recovery in any way, and it certainly left the 
patient with a very considerable menace for the future 
removed. 

The interesting cases in such a list are, of course, num- 
erous, and it is impossible in a paper of this kind to even 
enumerate them, so I shall content myself with giving atten- 
tion to the failures only, thinking that in that line most may 
be learned for the future. Six of the patients of this list 
died. One case of appendicitis, operated on several days 
before, came from the previous term in a semi-moribund 
condition on the first day of the service and the wound was 
further opened to permit better drainage. This patient 
scarcely survived the operation. 

The six cases dying from operations performed during the 
service were, one of double pyosalpingitis, an abscess of the 
left tube having ruptured into the abdominal cavity several 
days before the patient was brought into the hospital ; one 
of carcinoma of the ovaries, a rare disease, in which the 
operation was done to add to the comfort of the patient 
whose abdomen was filled with a serous effusion from the 
peritoneum ; one of recurrent carcinoma of the breast ; one 
of deep cervical abscess, tubercular in character, situated 
over the middle of the right clavicle and undoubtedly con- 
nected with a large abscess cavity in the upper lobe of the 
right lung ; and lastly, one of streptococcus infection in both 
legs, which I will describe a little later in the report. 

Taking the cases in detail : that of double pyosalpingitis 
was one from which the patient had suffered for a long time 
from inflammation of the uterine appendages, and if I re- 
member rightly had been previously advised to have an 
operation for relief of the symptoms. Neglecting this oppor- 
tunity, pus formed in considerable amount on the left side 
particularly, and finally ruptured into the abdominal cavity. 
General peritonitis supervened, and while the patient made 
a strong fight for life she suddenly sank a few days after the 
operation and died. 



IQOI Service at Mass, Homceopathic Hospital, 289 

The second case, carcinoma of the ovaries, presented con- 
ditions which I have never met before or since in these 
organs. The abdomen was filled with a dark colored serum 
to such a degree as to interfere by pressure with respiration, 
and the ovaries presented a curious deposit of carcinoma 
which caused enlargement of each organ to, on the right 
side, a mass three inches in diameter, and on the left, a very 
hard adherent body at least five inches through its narrowest 
part. The disease was diagnosed as a probable malignant 
case. The abdomen was opened more for the purpose of 
relieving the discomfort from which the patient suffered 
than from hope of doing any lasting good. When the 
ovaries were inspected, however, it seemed that there might 
be a possibility of achieving a better result than at first 
thought. There was no unusual complication in the removal 
of these carcinomatous organs, although the adhesions men 
tioned above were many and strong, but the disease had 
already evidently sapped the patient's strength as she died 
the following day. 

The case of recurrent carcinoma of the breast was one 
' which I never had the opportunity of seeing, as the patient 
was in the last stages of cancer and was sent to the hospital 
by her family as a last resort. Her condition was so septic 
and foul that one of the assistants took exclusive charge of 
the case until her death, as it did not seem right to subject 
other patients to even the possibility of infection from one 
for whom we could do nothing. 

The next case was one of prostatic disease in which it had 
not been diflScult to introduce a catheter and keep the 
bladder clean and comparatively asceptic. The kidneys 
were undoubtedly incompetent as he suddenly sank into a 
comatose condition from no local reason which we could 
discover, and died of uremia in a few hours. 

The case of tubercular abscess of the neck died on the 
medical side to which he had been removed for general treat- 
ment sometime after the operation had been performed. 



290 The New England Medical Gazette, June, 

From the symptoms it was evident that another abscess had 
formed in the lung which had ruptured into the trachea and 
caused death from suffocation. 

The last case of streptococcus infection of the legs also 
died on the medical side, but comes in our list on account of 
the operation which we made in order to evacuate the pus 
which formed in large quantities. This case was unique. 
The woman came into the hospital supposedly suffering from 
rheumatism confined to the knees and to the parts below 
them. There was sweUing in each leg below the knee and 
this continued to increase for several days, until through the 
courtesy of Dr. Walter Wesselhoeft, who was on service on 
the medical side, I was invited to examine the case with a 
view to operation, as Dr. Wesselhoeft had found evidence of 
pus on each side. The patient rapidly grew worse, and 
operation was called for at once. An incision was made in 
each leg from a point just below the outer part of the knee 
opposite the lower portion of the head of the fibula down the 
outer side of the leg and well along the dorsum of the foot. 
This disclosed an enormous pus cavity due to streptococci, 
according to microscopic examination, and showed a condi- 
tion of the muscles and intermuscular tissue such as I have 
never seen. The muscles were dissected out by pus and 
sloughing masses of cellular tissue as well as one could do it 
with a scalpel and forceps, and the foul character and exces- 
sive secretion of the discharge continued until some time 
after the operation when the patient succumbed undoubtedly 
to general infection. On investigation it was found that the 
probable entrance of the streptococcus was through the 
uterus, as the patient gave a history of uterine and adnexal 
disease which had existed for a considerable time. Why the 
deposit should be confined to both legs and should affect no 
other part of the body during the first stages of the disease, 
is a question which we have not as yet been able to answer. 
If it had occurred on one side of the body only, it might be 
supposed that infection was deposited in that one place, but 



190 1 Service at Mass, Homoeopathic Hospital. 291 

having it in similar places on both sides at the same time 
complicates the case to such a degree that it has been impos- 
sible up to this time to arrive at a satisfactory solution of the 
problem. 

There are, of course, many cases in a service list such as 
this which might be of interest, but it is impossible to even 
outline them in the space and time at our command. There 
are two, however, which are of such unusual character, that 
I have thought it well to go into them somewhat fully for 
reasons which will appear, I think, in the recital of their 
histories. 

The first case was one of double inguinal hernia with 
chronic appendicitis in a Swedish girl of apparently robust 
constitution. The herniae were repaired and the appendix 
was removed in the typical manner, a Dawbarn suture being 
applied to the stump of the appendix which was turned 
toward the bowel in the usual way. The morning following 
the operation I was informed by telephone that the patient 
was doing badly, in fact that she was almost in a condition of 
collapse. Advising at once an intravenous injection of saline 
solution, I went immediately to the hospital and found the 
patient suffering from symptoms of internal hemorrhage. 
Opening the abdominal wound as soon as possible, the peri- 
toneal cavity appeared clean and showed no evidence of 
hemorrhage, or anything to account for the very serious con- 
dition of the patient. Being convinced, however, that hem- 
orrhage from the stump was the cause of the collapse, and 
noticing that the caecum was partially filled with a soft mass 
which might be blood, I immediately removed the sutures 
and turning out the stump for inspection, found a tiny vessel 
ejecting, synchronously with the heart beat, a small stream 
of arterial blood which was evidently the source of all the 
hemorrhage and the cause of the serious symptoms present, 
and this was definitely determined by the fact that sewing 
over the vessel with a small catgut suture, controlled the 
hemorrhage. Another Dawbarn suture was applied, the 



292 The New England Medical Gazette, June, 

stump turned again toward the bowel and the ordinary Lem- 
bert suture placed over the site of the appendix. The abdo- 
men was closed as previously, and barring the natural weak- 
ness incident to the loss of considerable blood, the patient 
thereafter made an uneventful recovery. In talking with 
my colleagues about this case later, it seemed impossible 
that after the application of a Dawbarn suture hemorrhage 
from the stump can result, but this is the second one with 
which I have come in contact within a year, the first one 
being at the Leonard Morse Hospital at Natick, the patient 
being a young robust boy of eighteen years. There was no 
complication from the hemorrhage which was comparatively 
slight, only showing in the stools the morning after the ap- 
pendix was removed. In this first patient the hemorrhage 
was evidently spontaneously controlled, but it was a hint 
which was undoubtedly of use in the second case. Since 
the Natick experience it has been my habit to put the sepa- 
rate stitches of the Dawbarn suture close together and in- 
clude a great deal of tissue under each stitch. For this 
reason it cannot be said that the hemorrhage was caused by 
insufficiently deep sutures, and while I think the patient was 
inclined to be a " bleeder," there was not sufficient evidence 
to establish that idea as a fact. In one way, at least, this 
case has been of practical benefit, as each appendix stump is 
now subjected to very careful scrutiny, and small bleeding 
points are ligatured or sutured to prevent such accidents as 
the ones cited. 

The next case which I wish to report is one which has 
been and is somewhat of a mystery. The patient fifty years 
of age, long past the climacteric, entered the hospital suffer- 
ing from prolapsus uteri of such a degree that the womb 
protruded from the vaginal orifice. Slight pressure only was 
necessary to keep it in position, and ventral suspension was 
decided upon as a remedy. The operation was complicated 
in no way, nor was there anything to cause apprehension for 
several days after, but on the fifth day the temperature rose, 



IQOI Service at Mass, Homceopathic Hospital, 293 

the pulse became rapid, there was soreness through the 
wound, but not sufficient evidence of pus to warrant one 
thinking that the symptoms were due to sepsis. On the 
sixth day after the operation the condition became alarming. 
The abdomen was reopened through the old wound to deter- 
mine, if possible, the cause of the difficulty. When the 
bowels were exposed, a portion of the small intestines about 
sixteen centimetres long was found to be congested and 
thickened to such a degree as to interfere with the move- 
ments of the contents of the bowel. About the middle of 
the outer surface of this inflamed area, a scratch or slight 
fissure was noticed, and this was folded in and a Lembert 
suture of catgut applied over it. The site of the uterine 
suspension was perfectly clean and showed no evidence of 
any inflammation. The wound was partially closed and 
drainage was inserted to guard against infection. The 
patient continued to have a slight temperature and pulse for 
two or three days, but the symptoms gradually subsided and 
recovery occurred. No satisfactory explanation has as yet 
been offered for this case except the possibility of having 
pricked the intestine during the first operation, but one 
would think that the symptoms would have appeared before 
they did, and that the second operation would have been 
called for long before it was necessary. Intra intestinal 
complications would hardly have been relieved by the sec- 
ondary operation, and as convalescence began directly after 
the abdomen was opened the second time, the covering in of 
the slight fissure of the intestine was undoubtedly curative 
in its effects. 

A few general remarks in closing may not be out of place. 
Regarding suppuration it may be said that this was practi- 
cally a " clean " service. The appearance of pus in a case 
which was aseptic at the time of operation was practically, 
although not quite, unknown. It must be remembered that 
the presence of a fraction of a drop of pus in or about a 
wound stamps the case as " suppurative," although the con- 



294 '^he New England Medical Gazette. June, 

valescence of the patient may be in no way retarded and the 
wound may thereafter heal, as though no complication what- 
ever had appeared. It is worth something to be able to say 
that in no "clean" case was there any menace to the 
patient's recovery from infection by pus, and that nothing 
"septic" was introduced into the wounds from the hands, 
the instruments, the atmosphere or the dressings which en- 
dangered the life or even the well-being of the patients who 
came under our treatment during this service. On examin- 
ing the list it will be seen that no " surgical " death occurred 
and that patients died despite, rather than because of, 
surgical interference. 

Regarding rubber gloves I have only to say that my 
opinion has in no way been influenced in their favor by any 
experience which I have .had during the past year. They 
are still to me more of a complication than an assistance, and 
should be worn only when one is operating on septic cases 
in order to avoid bringing the hands in contact with material 
which may make it impossible to get them clean for subse- 
quent operations. To the surgeon personally they are un- 
doubtedly of some use as a protective against infection, 
although not as universally useful in this way as the rubber 
glove enthusiast would have us believe. Needle pricks are 
still a menace, and while gloves may cover a contused or an 
incised wound and thus avoid personal infection, a surgeon 
having his hands in such a condition should avoid operating 
until the menacing spots are healed, unless they are found 
on the fingers, when a sterilized finger-cot may be used to set 
aside the necessity of covering the entire hands and fingers 
with a material which undoubtedly interferes, in some degree 
at least, with fine manipulations. 

There is no better time than this to mention the excel- 
lence of the Massachusetts Ilomceopathic Hospital as a place^ 
to do surgical work, and it is only fitting to say that no public 
institution of which I have knowledge, which is subject to 
the same conditions, has a lower death rate than this hospi- 



I go I Energy in the Practice of Medicine, 295 

tal in which we are all so much interested. That this is 
due, in some measure, to the methods employed goes with- 
out saying, but a large share of the credit must be given to 
the assistants and nurses of the hospital who are indefatiga- 
ble in their efforts and painstaking and conscientious in their 
work from the time the patients enter the hospital until there 
is nothing more to be done for their comfort* or recovery. I 
wish thus publicly to thank them for the assistance given me, 
not only during the term of service, but also on any occasion 
when their services have been required. 



Energy in the Practice of Medicine. — We know of no 
profession or occupation which requires more vim and energy 
than the practice of medicine. We know many brainy, well- 
qualified men who have failed to possess the necessary "push" 
to carry the load. It has always seemed to us that even if a 
man lack natural energy, he might arouse sufficient artificial 
voltage to carry him through. 

The young man who begins in indolence will end in failure 
in the practice of medicine. The older man who acquires the 
habit will fall in the same ditch. Be thorough ; be energetic ; 
be prompt ; nothing else will do. — Charlotte Medical JoumaL 



Bubonic Plague. — The rat has generally been described 
as a potential means of distributing the disease, but according 
to Dr. Cantlie's investigations, it is the insect parasites that 
infest its coat. When the rat has been killed, these parasites 
forsake the animal and seek refuge upon any persons in the 
vicinity. Immunity from attack by these pestiferous para- 
sites can only be assured by careful personal cleanliness, 
since it has been conclusively proved in the hospitals that the 
disease cannot thrive where strict hygiene is maintained. 
— Modem Medical Science, 



296 The New England Medical Gazette. June, 



EDITORIAL. 

Contributions of original articles, correspondence, etc., should be sent to the publtsbers, Otis 
Clapp & Son, Boston, Mass. Articles accepted with the understanding that they appear only in 
the GatetU. They should be typewritten if possible. To obtain insertion the following month, 
reports of societies and personal items mutt bt rtceived by tht ijth 0/tke m»nth prtctding. 



This is the month when many anxious students will be 
made happy in receiving the diploma which will enable them 
to begin their chosen work in life. Now is the time when 
the temptation is great to give advice on various matters per- 
taining to their professional life, but we shall resist the 
temptation, and in place thereof extend to them the right 
hand of fellowship, and cheerfully and gladly welcome them 
to the active ranks of the noblest profession on earth. 
Whatever may be their success professionally, they may be 
sure of the good-will and support and co-operation of their 
fellow-practitioners as long as they display those qualities of 
mind and heart which make up the conscientious, honest and 
upright man and woman. 



OBITUARY. 

Dr. Jane K. Culver. 
Dr. Jane.Kendrick Culver, one of the most successful of 
the women physicians of this city, died at her home No. 2 
Commonwealth Avenue. Dr. Culver came of distinguished 
ancestry. Her maternal grandfather was one of the Alexan- 
der Hamilton family, and her mother was a Felton, a name 
intimately associated with educational matters for many 
years, one branch of the family having been a president of 
Harvard College, while three others occupied the head posi- 
tion in as many other educational institutions. Dr. Culver's 



I go I Editorial. 297 

father was Jacil Kendrick, of Enfield, Mass., near which 
town the deceased was bom. She received her medical edu- 
cation in the Boston Univ. Med. College, where she was 
graduated in the class of '78, and for the past twenty-three 
years has been an active practitioner in this city. Her hus- 
band was William C. Culver, of Boston, who died ten years 
ago. He will be recalled by many as superintending the 
first borings made for the Hoosac Tunnel, as well as for his 
prominence in local politics. For many years he held a high 
position in the internal revenue department in this city.- His 
uncle was Hon. David Culver, at one time lieutenant gov- 
ernor of New Hampshire and for whom one of the Dart- 
mouth College buildings is named through a bequest which 
he made to that institution. 

Dr. Culver was a member of many local organizations, 
most of them closely allied to medicine. She was the oldest 
living member of the Ladies' Physiological Institute, and was 
at one time its vice-president ; also honorary vice-president 
of the American Institute of Medicine ; vice-president of 
the Massachusetts Gynecological Society ; a member of the 
American Art Society, the Boston Medical Society, the Bos- 
ton University Alumni, the Women's Educational and Indus- 
trial Union, and many others. She also took a strong per- 
sonal interest in the Society for the Prevention of Cruelty to 
Children, as well as the other which takes the dumb animals 
as the centre of its interests. She was at one time a candi- 
date for the Boston School Board. Dr. Culver's death was 
due to a complication of heart troubles, and she had been 
seriously ill since the early part of March. She was a 
woman of singularly strong personality which made for her 
many friends, both in and out of her chosen profession ; and 
as a proof of the kindly interest manifested during her ill- 
ness, it is interesting to note that nearly eleven hundred 
persons called at her home during the first eight weeks of 
her illness to offer their personal sympathy. She leaves one 
daughter, who reside in New York. — Boston Transcript, 



298 The New England Medical Gazette. June, 

Dr. Anna Furber Smith. 

Dr. Anna Furber Smith, who died at Covington, Ky., 
March 31, 1901, was a daughter of the late John N. Furber, 
who was for many years a prominent attorney of Covington. 
She was graduated from the Boston University School of 
Medicine in 1885, and for a number of years practised her 
profession in Covington and Cincinnati. She afterward mar- 
ried Dr. William H. Smith, an earnest worker in church and 
benevolent work. She leaves two infant children. 



EDITORIAL NOTES AND COMMENTS. 



REPROVINQ DRUQ5. 

The following letter from Dr. W. P. Roberts, of Janesville, 
Wis., shows that the plan for reproving the materia medica 
has already aroused attention and a desire for co-operation : 

To THE Editor : 

Recently, while waiting to have an order filled in Clapp's 
Pharmacy in Park Square, Boston, I chanced to pick up the 
May number of The New England Medical Gazette, 
and on page 249 read the article " Reproving of the Materia 
Medica." From reading that article I feel like exclaiming, 
** What a grand undertaking ! '* If suggestions will be con- 
sidered and recognized by the general directors of that move- 
ment I will be glad indeed to cast in my mite to aid in the 
glorious work. 

Some twenty years since, while filling the position of 
house physician in Hahnemann Hospital, Chicago, I con- 
ceived a similar idea and was able to interest a few of the 
graduating class of that year (1879) to set such a scheme on 
foot by holding a meeting, and in an informal way organized 
what we called the Scientific Chair of Hahnemann College, 



IQOI Editorial Notes and Comments, 299 

of Chicago, III. The design was for reproving homoeopathic 
remedies by the aid of all modern scientific appliances. The 
Chair was to get its funds from the graduates and friends of 
that institution. After we held our meeting we consulted 
with the faculty of the college who seemed to take a deep 
interest in such a movement, and the leading members of 
the faculty made fair promises to attend to it and see that 
the graduates and profession at large be notified in their 
next annual announcement of the college, also that they be 
invited to take a part in the work. Thus we left the matter 
in the hands of the faculty. The invitation did not appear, 
and nothing ever came of the undertaking. Our plan, 
briefly outlined, was through the annual announcement to 
invite all the alumnus and interested profession to join in 
helping to support such a scientific chair in that college, we 
were to pledge ourselves to contribute not less than five 
dollars each annually for five years toward the support of the 
professor of that department, and the trustees of the college 
were to give free tuition to a few worthy provers to induce 
them to volunteer in the work. We expected if the chair 
was established that future graduates would perpetuate the 
work until the materia medica should become as reliable as 
science could make it. We also hoped that our success 
would induce other medical colleges to take up the work and 
that every medical college in the land would establish such a 
scientific chair, and that soon some agreement would be 
entered into so that each college would take a certain num- 
ber of drugs (no two colleges to prove the same drugs the 
same year) and prove them, so that each year a score or 
more drugs would be proven. As to method of proving, we 
planned that our professor have full charge of provers for a 
week prior to exhibiting the drug, and that careful examina- 
tion be made of the prover while living on a wholesome diet, 
and a strict account or record of condition be kept during 
that time by examination of all excrements by aid of micro- 
scopic, thermometer, chemical tests, etc. With this record 



300 The New England Medical Gazette, June, 

preceding the proving, and by keeping a careful daily record 
of temperature, and chemical, and microscopical examina- 
tions of urine fceces, etc., daily, while proving, any imagina- 
tion of the prover would be obviated. 

It has seemed to me strange that such a grand scientific 
work has been so long delayed, and it now seems almost too 
good to credit. I sincerely hope that every person whether 
of this, that, or the other school of healing the sick, will be 
interested enough to contribute in this new movement. I 
feel sure that had the homoeopaths adopted such a scientific 
proceedure twenty-five years ago, that there would not have 
been so many charlatan methods come into existence, nor 
would there now be such a desire on the part of half-breed 
homoeopaths to uilite with the alopaths in declaring that 
there is no difference in the two schools. 

Huxley tells us that science is trained and organized com- 
mon sense. Common sense should teach us that since 
Hahnemann established the law of similars in curing disease 
that the clinical thermometer, microscope and chemical ex- 
aminations have come into the science of dealing with mor- 
bid conditions of mankind. So now there is no excuse for 
any person possessing common sense — whether he be of 
one or the other pathy — in turning in to help science (com- 
mon sense) to prove the effects of drugs on healthy human 
beings. In my humble opinion, if the idea advanced in that 
article can be promoted we will within ten years advance the 
science, of drugs (medicine) more than it has been since the 
founder of homoeopathy passed out of this life. " So mote 
it be." 

W. P. Roberts, M. D., 

Devereux Mansion, Marblehead, Mass. 
May 17, 1901. 



IQOI Societies, 301 



SOCIETY REPORTS. 



BOSTON HOiVKEOPATHIC HEDICAL SOCIETY. 

BUSINESS SESSION. 

The regular meeting of the society was held at the Boston 
University School of Medicine, Thursday evening, April 4, 
1901, at eight o'clock, the President, T, Morris Strong, M. D,, 
in the chair. 

The records of the last meeting were read and approved. 

The following physicians were proposed for membership . 
Robert M. Southgate, W. H. Waters and Alice H. Bassett, 
all of Boston. 

The committee appointed to draw up resolutions on the 
death of Dr. Chas. L. Farwell, made the following report : 

Whereas, the short life mission of our late colleague has 
been prematurely ended, and. 

Whereas, he was a man of good scholarly attainments, 
genial disposition and open, generous character, therefore be 
it 

Resolved, that by his death the medical profession has 
been deprived of a member who was, and gave promise to be, 
a most valuable associate for many years. 

Resolved, that these resolutions be spread upon our 
records and a copy, properly engrossed, be sent to the widow 
of the deceased. 

- N. M. Wood, 
a. f. boothby, 
Percy G. Browne, 

Committee. 

On motion of Dr. Frank E. Allard it was voted that the 
society, through the secretary, extend to Dn Jane K. Culver, 
sympathy and hope for her recovery. 

Dr. Strong made a brief report for the standing committee 
on legislation, stating that the bill to give the New England 



302 The New England Medical Gazette, June, 

Optical Institute the right to grant degrees had gone into 
the general court for the third reading, when it was. laid on 
the table. By mutual agreement the bill went back to the 
committee. 

Advocates of the Pfeiffer bill were given leave to with- 
draw. 

The State Board of Registration in Medicine will be given 
another hearing tomorrow (Friday) with the probability that 
the committee will sustain the recommendations of the board, 
i. e, it is the hope and supposition that they will do this. 
This about ends the legislative matters for this session. 

The vivisection bill was discussed pro and con^ and the 
committee has as yet made no report. 

SCIENTIFIC SESSION. 

Dr. Boothby exhibited a specimen of a double uterus. The 
case was diagnosed as a tumor of the abdomen. The patient 
had a good many symptoms of sepsis, and she was thought 
to be in a rather precarious condition when brought to him. 
Pregnancy was thought to be present, though the uterus was 
felt. The abdomen was opened and a double uterus found, 
in one side of which was a foetus. The other side, as well as 
the tube, was septic. The foetus was removed first and then 
the uterus and appendages. Dr. Boothby had never seen a 
double uterus in his practice before. Shortly after a case 
was sent him from Hartford, where there was a double 
vagina, with cervix distinct in each vagina, but the two 
canals opened into one. Had had one child, but came very 
near dying. 

Dr. W. F. Wesselhoeft exhibited the largest appendix he 
had ever seen, one he had recently removed at the hospital. 

Report of the Section of Surgery. 

Wm. F. Wksselhohft, M. D., Chairman. 
Alice L. Pattkrson, M. D., Secretary. W. B. Frrnch, M. D., Treasurer. 

The President appointed the following committee to nomi- 
nate sectional officers for the ensuing year, Drs. F. W. Col- 
burn, M. R. Lakeman and Alice C. Patterson. The commit- 



IQOI Societies. 303 

tee reported as follows : Chairman, A. H. Powers, M. P ; 
Secretary, Chas. T. Howard, M. D. ; Treasurer, Augustus C. 
Haub, M. D., who were duly elected. 

PROC^RAM. 

1. "Report of Surgical Service of the Massachusetts 
Homoeopathic Hospital from Jan. i to April i, 1901." N. W. 
Emerson, M. D. Discussion opened by Winfield Smith, M.D, 

2. "What is Peritonitis .? " Horace Packard, M.D. Dis- 
cussion opened by J. Emmons Briggs, M. D. 

3. "The Modern Technique of Surgery." George H. 
Earl, M. D. Discussion opened by Alonzo Boothby, M. D. 

4. "A Factor in Wound Disturbance." William F. Wes- 
selhoeft, M D. Discussion opened by J. B. Bell, M. D. 

Dr. N. W, Emerson's " Report of Surgical Service of the 
Massachusetts Homoeopathic Hospital from Jan, i to April 
I, 1901," was omitted. 

Dr. Horace Packard, not being present at this time. Dr. 
Earl's paper on "The Modern Technique of Surgery" was 
the first paper read. 

He contrasted the means adopted by modern surgery to 
prevent sepsis, with the lack of precaution fifteen or twenty 
years ago, dexterity arid celerity being the aim of the sur- 
geon. Cleanliness, he said, is the one thing we are all trying 
for — great care in cleansing the hands, scrubbing them with 
soap and water, also thoroughly cleansing the field of opera- 
tion, and the least possible handling of delicate or bruised 
tissues. When practicable using dry dressings, and then 
letting everything severely alone, avoiding as far as possible 
all poisonous antiseptics, justifies us in claiming that the 
mild power is greater. 

Dr. Boothby: It seems to be, perhaps, a worn out sub- 
ject, and yet one which may be always interesting. One 
point which may be considered as a part of this surgical 
technique, an important point has been solved in a very 
simple and direct way by our good chairman, Dr. Wessel- 
hoeft, and I take great pleasure in saying that his method of 
disinfecting the catgut is a thorough and absolutely perfect 



304 The New England Medical Gazette, June, 

one. The only objection has been that it was almost impos- 
sible to get it aseptic. Now, with his apparatus, I believe it 
is possible to completely disinfect the catgut. We have sent 
specimens to the Massachusetts Institute of Technology to 
be tested, and they have been returned as aseptic. 

As to the surgeon wearing gloves, I believe in it just as 
little as ever I did. I have my assistants wear gloves. I am 
positive that no patient has had serious trouble from my 
hands, though I admit they are not absolutely aseptic. I 
cleanse the hands very thoroughly, the nails especially, scrub- 
bing with a sterilized brush. I believe the assistant can 
wear gloves, because he does not have the delicate work to 
do that the surgeon has. I have very difficult work to do, 
which I could not do with gloves. The point is, whether 
the hands, sterilized as completely as possible, are dangerous 
to the patient. I advocate bare hands for the operator, but 
the assistants should wear gloves, and the surgeon should do 
so in an infectious case, if he can. There has been a great 
change, as Dr. Earl has said. Twenty-five or thirty years 
ago, I used to go to the Massachusetts General Hospital to 
see Dr. Bigelow operate, who was quite as skilful as any sur- 
geon we have now, and he would put on a coat stiff with 
blood, and physicians would come into the operating room 
just as they had been visiting their patients, and if there 
was anything of peculiar interest in the case, would put their 
fingers into the wound. 

Dr. Briggs : I would like to say just a word in regard to 
peritonitis. We have the different kinds of inflammation, 
which are the cause of the disease. We are familiar with 
the different forms, and they are due to a form of bacteria 
which caused the infection, that by the streptococci being 
the most severe. The germ enters the system through the 
blood serum of the interior wall, and the history of a case of 
peritonitis is a rapidly progressive and fatal one, and the 
only way to avoid death is by early and rapid operation. We 
have a sort of clew to the germ which has caused the mis- 
chief. If due to the streptococcus, the progress of the 



igoi Societies. 305 

disease is very rapid ; that due to the staphylococcus and 
pneumococcus are a little less so. We also have peritoneal 
infection due to gonorrhea attributable to previous disease of 
the uterus and tubes, and spreading from contact 

I recently had a case which illustrates the connection be- 
tween some symptoms of the abdominal cavity, peritoneum 
and lungs. A woman, 35 years of age, never had an attack 
of peritonitis or appendicitis, was taken with severe pain in 
the right side nearly over the appendix ; temperature 102^, 
pulse 1 20. Made careful examination, the slightest pressure 
on the appendix caused intense pain. It seemed to me there 
was too high a temperature and too rapid a pulse for a case 
of short standing, eighteen hours. It is rare in my experi- 
ence to find such a high pulse in a short time. The patient 
went to the hospital, and I was summoned to operate. The 
temperature still high, but the patient was coughing, exam- 
ined the lungs and found very marked case of pneumonia, 
lower lobe of right lung involved. An illustration of pneu- 
mococci infection. It may have developed in the lung, and 
also at the same time in the peritoneum. I would like to 
quote a case very briefly. It was a complicated type of the 
peritoneal symptoms of peritonitis. A case of very severe 
infection of the throat, so severe that I made a culture. The 
Board of Health reported no diphtheria, but an abscess of 
the throat developed. After a week or ten days some pain 
developed in the abdomen. It was questioned whether to 
operate. After four or five days the symptoms referrable to 
the peritoneal cavity subsided and the patient is improving. 

At one time I had an experience with a patient of Dr. 
Wood, of Charlestown. The patient came to the hospital 
with great pain in the abdomen, operated and found the 
peritoneum of the intestines inflamed, but it was not peri- 
tonitis. The patient developed typhoid fever, and made good 
recovery. 

There is one thing that has particularly interested me, 
why are we having so many cases of peritonitis and located 
over the appendix and upon operating find the appendix 
normal } I have had three or four such cases. 



3o6 The New England Medical Gazette, June, 

Dr. Boothby : A patient of mine had a child who de- 
veloped some abdominal symptoms. I could not quite make 
out that it was appendicitis. Dr. Sutherland saw the case 
also, but we could not decide that it was appendicitis. The 
abdomen was very much distended and there was a diffuse 
peritonitis. The father desired an exploratory incision, and 
in this case the appendix was inflamed, as were other parts 
of the abdomen. There were dark spots over the intestine, 
which looked like infected blood serum between the coats of 
the bowel. It seemed as thiough those patches were the 
cause of the trouble. Patient died from the disease. I ques- 
tion if it could not have been saved by an early incision 
and cleansing. In some cases of typhoid fever the condition 
has infected the peritoneal cavity, and it is a good plan to 
operate under such circumstances. 

Another patient I had with Dr. Spalding. The patient 
had been sick only a short time; violent inflammation; abdo- 
men opened and a long portion of the colon was inflamed, 
and for a long distance there were pin holes clear through 
the bowel, so many openings could not be sewed up and 
patient died. I had another case of violent peritonitis, and 
we considered it appendicitis. I opened the abdomen, and 
immediately there came out quite a little quantity (2 oz.) of 
reddish brown serous discharge. I found upon examination 
appendix somewat inflamed, right ovary and tube were very 
much involved. In this case the inflammation might have 
come up to the tube, but was not in the tube originally. I 
do not believe it was a gonorrheal infection. The patient 
seemed to be relieved for three days, when the symptoms 
returned as violent as ever, and the abdominal cavity was 
washed out ; in three or four days the symptoms returned, 
again the cavity was washed out with saline solution. Patient 
gradually improved a little, left the hospital, but died within 
a year. These cases were peritonitis, u e. there was an 
infection of the peritoneum. 

There are various kinds of peritonitis, a kind that produces 
adhesion and those which do not. I agree with Dr. Pack- 



1 90 1 Societies. 307 

ard that we have diseases of the peritoneum which are not 
from the appendix or the tubes, but come from the gall 
section. 

Dr. C. H. Thomas: I can recall one case, that of a 
patient who was sent to the maternity with all symptoms of 
eclampsia. She had persistent nausea, unable to take any 
nourishment ; urine scanty, only 2 oz. or 5 oz. It became 
necessary to produce labor. Saline solution was introduced 
into the abdominal cavity. In twenty-four hours the quantity 
of urine had increased to 33 oz., illustrating the power of 
absorption of the peritoneum. 

Dr. Wesselhoeft illustrated his method regarding "A 
Factor in Wound Disturbance " by three diagrams, showing 
different modes of suture ; the ordinary method of leaving a 
blind space where serum can collect, causing suppuration, 
and another method of providing for drainage of the wound. 
Dr. Bell : It takes two to make a quarrel and it takes two 
to make trouble in a wound — the seed and the soil. Some 
of us can remember the early history of the whole question 
of wound infection, that all stress was laid on the germ, 
given the germ disease must follow. Now the soil has 
become very important. It is not considered that all infected 
with tuberculosis will die. This matter has not received its 
due importance in surgical circles. 

It seems to me of the greatest importance in closing the 
wound that an exit should be provided for the serum ; other- 
wise, upon pressing the wound the serum will run out, which 
is prevented by the suture. Now in particular cases, where 
there is a great deal of difficulty in securing stoppage of 
hemorrhage, it is important to put in for 48 hours suitable 
drainage, and on opening, the dressing will be found satu- 
rated. In a case of cancer of the penis, there was difficulty 
in making the wound perfectly dry, thought it would be dry 
enough and closed without drainage. After a day or two 
serum collected and I thought pus was there, but there was 
no rise of temperature. I hoped that it would be absorbed, 
but it was not, so a probe was used, and out gushed normal 



3o8 The New England Medical Gazette. June, 

serum. The wound had gathered infection. It is quite im- 
portant to note Dr. Wesselhoeft's method of closing the 
wound after operating on the appendix where drainage is 
required. You close two-thirds with through and through 
sutures and drain lower part, the first half will close by first 
intention, because it has good drainage. 

Germ and soil are both factors of infection. 

Dr. Briggs: I have been very much interested in this 
paper and the method of obliterating the sac or cavity which 
may remain beneath. I want to say that Dr. Packard has 
used strips of gutta-percha tissue in this last term of service 
and one term previous, and it is astonishing how much serum 
will pour out, saturate the dressings and relieve almost the 
probability of infection. 

Dr. Packard : It leaves one inference, that about every 
wound we make suppurates. I believe that most wounds are 
left clean, serum leaks out, but will not turn to pus, unless it 
is infected. I have resorted to drainage of my wounds, not 
because I had suppuration, but because I observed that by 
leaving proper drainage there was a quantity of serum ab- 
sorbed by the dressings. I do not want to have it go out 
broadcast that the majority of our wounds are infected. 

Dr. Wesselhoeft: I do not think there is any wound 
made that has not possibility of infection. 

Dr. Packard : The inference is that a good many of them 
had suppurated, and you admit infection, so you had to resort 
to something. 

Dr. Earl : I do not know as it bears on this subject, but I 
would like to mention the relation of this treatment to a 
woman after labor. I think the plan which has been taught 
in this school bears out exactly the point of the paper to- 
night, the providing of drainage for the uterine cavity and 
vaginal vault. There you have a cavity which not only 
throws out serum but blood, the uterine cavity. The vagina, 
which is more or less distended, and the old way of keeping 
a patient on the back, provided the necessary reservoir. It 
is better to get the patient into a position to allow drainage 
after labor. 



• igoi Societies. 309 

Dr. Sutherland : The diagram explains something in my 
experience. Because of suppuration some of the perfect suc- 
cess in operation has been lacking. I remember the case of 
a young boy operated upon for appendicitis at the hospital. 
Four or five days after leaving the hospital a deep hole two 
or three inches in length was' found in the abdominal wall. 
A collection of serum had occurred in the wall between the 
peritoneum and the muscle. The abdominal cavity was not 
opened. Apparently the peritoneum had healed previously* 
but something was wrong with the tissues. The diagrams 
tonight throw a little light upon the case. 

Adjourned at 10.10. 

Edward E. Allen, 

Secretary. 



Concentrated Sunlight. — With concentrated sunlight 
I have removed facial blemishes, such as moles, warts and 
sebaceous tumors, with excellent results. I find though that 
it is liable to burn too deep if not carefully watched. In a 
stubborn case of acne pustulata, I tried the experiment of 
cauterizing a particularly stubborn pustule with sunlight, 
effectually destroying the pustule, but burning so deeply into 
the skin as to leave a scar after healing was accomplished. 

— Dr, H, 7! Webster in Southern Progressiva Med. Journal. 

Olive Oil as a Food. — The use of pure olive oil as a 
food, with the meals, should be used, by both the mentally 
depressed and the abnormally excitable. It helps nutrition 
and gives a gentle aid to elimination. If it cannot be taken 
with food preparation, a teaspoonful or two can be taken 
regularly at the close of each meal. — Medical Sentinel, 

Personal Influence. — The life of every man is freighted 
with good, which he leaves along the way he goes to bless 
and beautify, or with evil, which he unloads upon his fellows. 

— Exchange. 



3IO The New England Medical Case tie, June,- 



BOSTON HOMCEOPATHIC MEDICAL SOCIETY. 

A special meeting of the society was held at the Boston 
University" School of Medicine, April i8, 1901, at eight 
o'clock, the President, T. Morris Strong, M. D., in the chain 

The reading of the records of the last meeting was omitted. 

SCIENTIFIC SESSION. 

Dr. Horace Packard exhibited a fibroid tumor removed 
from a woman that morning. The patient had known of the 
tumor for some years. She was first seen by Dr. Packard 
three or four years ago, the tumor at that time being small 
and non-interference was advised. Growth was slow and she 
was advised to see him again, but put off doing so until 
Tuesday. The last three or four months the tumor had 
grown rapidly, causing much pain, and two menstrual periods 
had been passed The cervix was very soft, suggesting the 
possibility of pregnancy, as did also the absence of the men- 
strual periods. In view of these facts operation was per- 
formed, and a very large fibroid tumor removed, which, upon 
dissection, was found to contain a three month foetus. If 
the operation had not been performed, abortion would have 
occurred. 

Another pathological specimen exhibited by Dr. Packard 
was an ovarian tumor removed by him six months ago. 
Nothing different appeared exteriorly, but the cyst wall was 
exceedingly black. At first it seemed like a strangulated 
ovarian cyst, but on looking very closely he found it was not 
strangulated. Examination of the peritoneum showed that it 
was black too. Careful investigation showed the discolora- 
tion to be due to blood pigments, which probably resulted 
from sub-peritoneal hemorrhages. 

Dr. Jos. Chase, Jr., gave an account of a peculiar case 
which came to his notice last February. He received a call 
to come immediately to the electric light works, one of the 
workmen had broken his ribs. He found the man lying on 






190 1 Societies, * 311 

the floor, groaning and unable to move ; pulse very slow, 56, 
with cold perspiration. Pressure caused pain. Under the 
scapula there protruded about four inches of what seemed to 
be a piece of bone from a rib. After an anaesthetic had 
been given Dr. Chase cut through the side of the thorax but 
did not find any periostium, instead found a piece of wood. 
He immediately cut down a little further and pulled out a 
pointed piece of wood gi inches in length, from a revolving 
shafting pulley, which had struck the workman's jumper and 
passed through his clothing into his side. 

Report of the Section of Anatomy and Physiology., 

Wbslky T. Lrb, M. D., Chairman. 
D. W. Wblls, M. D., Secretary. Marion Coon, M. D., Treasurer. 

The President appointed the following committee to nomi- 
nate sectional officers for the ensuing year : Drs. Howard, 
Spalding and Lewis. The committee reported as follows : 
Chairman, David W. Wells, M. D. ; Secretary, Edward E. 
Allen, M. D. ; Treasurer, Helen S. Childs, M. D., who were 
duly elected. 

1. " Hypnosis a Physiological Condition." Demonstration 
on one or more subjects. F. E. Schubmehl, M. D. Discus- 
sion opened by F. C. Richardson, M. D. 

2. "Why We Grow Old." John P. Sutherland, M.D. Dis- 
cussion opened by A. H. Ppwers, M. D. 

3. "Studies in Respiration and Cardiac Activity." Demon- 
stration of the use of the Stethograph, Chest Pantograph 
Cardiograph. Physiological Department of Boston Univers- 
ity School of Medicine. Discussion opened by F. E. Allard, 
M. D., and H. C. Clapp, M. D. 

Dr. Schubmehl said that the cataleptic state is due usually 
to suggestion, and the subject remains in the attitude in 
which he is placed without any effort on his part. He also 
stated that Mr. Curtis, the subject to be hypnotized, was not 
feeble-minded, but in good health and interested in athletics. 
He was, apparently, perfectly under control, unable to move 
without permission, and his insensibility to the prick of a 



312 The New lEngland Medical Gazette, June 

needle, proved how connpletely he was under the influence of 
the anaesthetic. 

Dr. Richardson was not present to open the discussion. 

Dr. Suffa : I hoped to see some demonstration that wouKl 
convince me that the hypnotic state is a physiological condi- 
tion. I myself do not believe that to be a fact. I cannot 
conceive how a person in a hypnotic state, where the brain 
power is inhibited, also all intelligences of the brain senses 
are in abeyance, can be called a physiological condition. 
Also how it is of therapeutic value. We know it is possible 
to make them do anything they are told to do. It seems to 
me a very dangerous thing. It is claimed by some a patient 
must be susceptible, or hysterical, and it seems to me, if not, 
they are a class of patients w'ho are ill-balanced. If this 
treatment is carried out, and it is much easier to make a sort 
of cumulative and lasting effort, would it not produce an un- 
balanced mind t If not a medical, it has a legal aspect. 
Unless it can be shown that it is of therapeutic value, which 
it has not, it ought to be under control. 

Dr. Klein : In Germany, in 1886, it was shown how easily 
persons with deranged minds can be influenced. A young 
lady, a patient from an insane asylum, when hypnotized, could 
be placed in any position. It was shown that the greatest 
harm could come to such patients, if hypnotism was produced 
more than once it would leave them in a more dangerous 
condition to the community and the asylum. Magnetic 
power produces no influence upon patients under hypnotism. 
I consider it very dangerous to fool with hypnotism. I have 
used it in operations upon the eye, but I would not do it 
again. I found it left patients in a worse condition than if 
they had not been hypnotized. I prefer ether or chloroform. 
I think the medical profession ought to oppose such means, 
as great harm can be done. It has a great demoralizing 
effect, not only on the patient but on the whole community. 
The medical profession should not encourage it. 

Dr. Earl : I agree somewhat with Dr. Suffa and Dr. Klein. 
It may not be out of place to relate an instance which 



I go I Societies, 313 

occurred not many years ago. A woman was in the second 
stage of labor, hemorrhage from placenta praevia had nearly 
cost her life, and she -was in a pretty desperate condition. 
Dr. Schubmehl was present and two or three students.. It 
seemed wise to deliver her with forceps, as we were without 
an anaesthetic and there was no time to get one. She was 
n)uch frightened and apprehensive. Dr. Schubmehl tried 
suggestion, she laid still, and was pretty soon delivered. I 
feel, if we had delayed to procure an anaesthetic, or to give 
it, the woman's life would have been endangered. 

Dr. Sutherland : The facts are very interesting and more 
convincing than theories. I had some experience in the hos- 
pital five or six years ago.* A case of aphonia. The patient 
could not speak, only whisper, could not utter a note. Ex- 
amined for laryngitis, but the larynx was in perfect condition. 
Electricity and medicine were tried without cure. Then it 
was decided to try suggestive therapeutics, which might pro- 
duce some effect. She was told that tomorrow is Christmas, 
and we want you to wake up and say to your nurse, " Merry 
Christmas." In the morning she awoke, and said, " Mrs. 
Wright, I wish you a merry Christmas." She returned home 
and after a year had had no return of the aphonia. She was 
in an abnormal state, and was restored to a normal one. 

Dr. Wells : The good or ill effects of hypnotijsm depend 
upon the nature of the suggestion made. There are plenty 
of records of the benefit of suggestion at the reformatory 
Dr. Quackenbush, of New York, states that many boys have 
been reformed by suggestion. 

The French authority referred to (Charcot) represents one 
school in the treatment of this subject, and his experiments 
have been made almost entirely upon hysterical subjects. 
Bernheim, however, has experimented on non- hysterical sub- 
jects, and he has developed entirely different phenomena. It 
is well to say to the subject, "You will not be subject to 
another suggestion against your will." Cures have undoubt- 
edly been performed by Christian scientists, layers on of 
hands, and during pilgrimages, to shrines, and we ought to 



314 The New England Medical Gazette. June, 

examine what the element of truth is in these different kinds 
of cures. What do these cures consist in ? Is it in the hyp- 
notic power ? We ought to inform ourselves of the elements 
of truth in these various fads. 

Dr, Powers : My knowledge of hypnotism is not exten- 
sive. I had a case where there was a needle lost in the hand 
and operation made for finding it, and the hand came under 
my care for treatment. It was sensitive, and the patient of a 
very nervous temperament. At that time I was interested 
in hypnotism, and I suggested that if she would let me try 
hypnotism, the pain would be lessened. I did so. and while 
the hand would be drawn away a little, I could dress the 
wound with comparatively little piiin. A dentist, doing a 
good business, who would not be called hysterical or feeble- 
minded, was a sufferer from headaches, which were relieved 
by hypnotism. I have seen patients entirely insensible after 
three or four long breaths of ether, and operation could be 
performed with less than a drachm of the anaesthetic. 

Dr. Haskell: I have known Mr. Curtis well all this 
winter, and I consider him far from being hysterical. I have 
found him a young man of original thought and he has made 
original suggestions. 

In regard to the ill effects. I would like to ask Dr. Schub- 
mehl if it has not got something to do with the last sugges- 
tion that the operator gives the patient. If he tells him he 
is going to feel better and will be all right, when he awakes, 
it will do away with all ill effects. 

Dr. Schubmehl : I told him he would be all right. I 
think all ill effects are due to neglect in making the sugges- 
tion at the last that the patient will be all right. All bad 
effects are due to the operator. 

Dr. Suffa : Do not French authorities say it is dangerous.^ 

Dr. Schubmehl : Arsenic is poisonous, yet we all use it. 

Dr. Packard : I have very little evidence that I can pre- 
sent to you upon this subject. I do use suggestion a great 
deal without thinking of using hypnotism, especially in 
convalescence. I do not think I have used hypnotism as an 



I go I Societies, 315 

anaesthetic, it is too uncertain. In the convalescence of 
patients, I often experience very gratifying results from sug- 
gestion. With patients that are apprehensive and hysterical, 
or anticipating an uncomfortable night, the suggestion that 
they will have a good night, or will go to sleep at nine 
o'clock, often produces most beneficial results. Sometimes 
after a simple powder given by the nurse, the patient will go 
to sleep and have a quiet night. 

Dr. Sutherland's scholarly paper, " Why We Grow Old," 
was heard with much interest. 

He emphasized the importance of an external stimulating 
power and nutrition from within for the life and preservation 
of protoplasms. 

Mr. Wyesse, of the physiological laboratory, with the as- 
sistance of members of his class, demonstrated the use of the 
stethograph, chest pantograph and cardiograph. 

Adjourned at 10 10 o'clock. 

Edward E. Allen, Secretary, 



RHODE ISLAND HOHCEOPATHIC SOCIETY. 

The regular monthly meeting of the Rhode Island Homoeo- 
pathic Society was held at Hotel Newman, Providence, R. I., 
on Friday, May 10. 

The President, Dr. John H. Bennett, of Pawtucket, pre- 
sided, and there was a large attendance of members. 

The society placed itself on record as in favor of a uni- 
versal State law, if possible, for the regulation of the practice 
of medicine. The new law, compelling an examination for 
every new practitioner, was also spoken of, and the constitu- 
tionality of the law has been proven in this State. One new 
name for membership was presented. 

THE BUREAU OF OBSTETRICS. 

Dr. H. M. Sanger, reported, i. "Treatment of Septic 
Wounds of the Uterus." W. Louis Chapman, M. D, This 



3i6 The New England Medical Gazette, June, 

was a very interesting and instructive paper and special stress 
was laid upon the value of antistreptococcic serum in the 
treatment of apparently hopeless cases. Dr. A. H. Wood 
opened the discussion of the paper, and also reported a rare 
case of deciduoma malign um. 

2. "A Case of Malpractice." C. J. Hashouck, M. D. 
This paper was the report of a case of apparent blackmail, 
which the doctor has successfully fought and obtained judg- 
ment in the Supreme Court. 

Owing to the lateness of the hour the paper by Dr. Jeannie 
O. Arnold was postponed to the next meeting, and the 
society adjourned to the dining-room where a lunch was 
seryed. 

List of Officers — President, John H. Bennett, M. D., of 
Pawtucket, R. I. (Boston University, 1891); Vice-president, 
H. M. Sanger, M. D., Providence, R. I. ; Secretary, Martin 
Budlong, M. D., Providence, R. I. ; Treasurer, H. Clinton 
Crocker, M. D., Providence, R. I. (Boston University, 1893). 

Board of Censors. — H. A. Whitmarsh, M, D., Providence, 
R. I. ; George F. Allison, M. D., East Providence, R. I. (Bos- 
ton University, 1891); Mary D. Moss, M. D., Providence, 
R. I. (Boston University). 



THE AHERICAN INSTITUTE OF HOHCEOPATHY. 

The Executive Committee desire to state as a final an- 
nouncement, that the program submitted by the chairmen 
of the various committees indicates an exceptionally valuable 
series of papers and discussions for the forthcoming meeting. 

The citizens of Richfield Springs have subscribed $2,cxx) 
to entertain the Institute. The social feature of this year's 
session will in consequence be of unusual attractiveness. 

The entertainments, which have all been arranged so as 
not to conflict with the work of the Institute, will make the 
week a particularly pleasant one, especially for the ladies. 



1 90 1 Societies, 3 1 7 

There will not be a dull moment for any one at Richfield 
Springs, for between riding, driving, wheeling, boating, fish- 
ing and golfing every one may find recreation in the intervals 
of work. 

We are also assured that at all hotels every effort is to be 
made to make each member of the Institute a friend of 
Richfield. They look upon a convention of physicians as an 
opportunity to advertise the merits of their health resort 
rather than, as we are usually looked upon, the legitimate 
prey of the landlord. 

The railroads have made the customary fare and one-third 
rate for the round trip, and in addition have made special 
arrangements so that every one desiring to attend the Pan- 
American Exposition at Buffalo, may do so without forfeit- 
ing the special reduced rate. Through cars to Richfield will 
be put on, and special connections made so that Richfield 
will prove easy to reach from all points. 

In all parts of the country unusual efforts are being made 
to secure a long list of new members for this session, and 
from reports already received there should be a greater acces- 
sion to our membership than ever before. As the cause of 
homoeopathy depends upon the strength of our national 
organization, we appeal to every member of the Institute to 
make this most important work for the welfare of the school 
a personal obligation. Let every loyal homoeopath secure 
one new member to the Institute this year. 

Lastly we call upon every homoeopathic physician, be he a 
member of the Institute or not, to be present at this meet- 
ing ; our visitors will be as warmly welcomed as our mem- 
bers, and we promise to one and all a most profitable and 
enjoyable meeting. 

A. B. Norton, M. D., Presideiit. 

E. H. Porter, M. A., M. D., Secretary. 



3 1 8 The Neiv^ England Medical Gazette, June, 



REVIEWS AND NOTICES OF BOOKS. 



Mental Diseases and Their Modern Treatment. By Selden 
Haines Talcott, A. M., M. D., Ph.D., Medical Superintendent of 
the Middletown State Homoeopathic Hospital in Middletown, 
N. Y., etc. New York: Boericke & Runyon Co. 1901. pp. 
352. Price, cloth, $2.50. 

For twenty- five years Dr. Talcott has been brought in close con- 
tact with the insane, and enjoyed exceptional advantages for 
observation and study. In a work from his pen, therefore, we 
should expect to find embodied the results of his great experience, 
in a form calculated to appreciably assist in elucidating many prob- 
lems connected with the causation, pathological changes, and symp- 
tomatology of insanity, and the treatment and care of the insane. 
It is with a certain sense of disappointment, therefore, that while 
conscious of many excellencies in this work, we find it more in- 
teresting and readable than original and scientific. 

It is true, the author disavows any thought of offering his book 
as an " exhaustive treatise " upon insanity, but we will venture to 
ask, why this omission to make it such in the interests, not only of 
his own reputation as an alienist, but also of the prestige of the 
homoeopathic school? We feel that from such a man we might 
rightfully expect a treatise which should compare favorably with the 
writings of those of similarly extended experience in the old school. 
Instead of this we have what more nearly approaches a series of 
coversational papers on mental hygiene, the views of the ancients 
interspersed with poetical quotations, and accepted definitions, 
symptoms and pathological findmgs of different forms of mental 
disorders. 

The section, however, on hospital construction and methods is 
helpful and instructive, and should certainly have been amplified. 
While the pages given up to materia medica present nothing not 
already familiar to the average student, they will prove a great con- 
venience, as they group all the old stand-bys generally used in the 
treatment of nervous disorders. 



1 90 1 Societies. 3 1 9 

A Text Book of Gynecology. Edited by Charles A. L. Reed, 

A. M., M. D., President of the American Medical Association 

(1900-1901), etc. Illus. New York : D. Appleton & Co. 1901. 

pp. 900. Price, cloth, $5 ; sheep, $6. 

Such a book as the above furnishes a certain embarrassment of 
riches both from the number of its authors, and thp multiplicity of 
the subjects included. While we doubt its supplanting any of the 
standard and simpler text- books on gynecology, we are sure it will 
prove a serviceable work of reference. 

Many noted writers have contributed to its pages, each writing 
upon the topic most familiar to him. Specialists, other than gyne- 
cologists alone, have assisted in the preparation of this volume. 
The pathologist, dermatologist and neurologist have each con- 
tributed valuable material. 

The work of contributors, instead of being bound together in the 
form of distinct monographs, has been in some instances used only 
as the basis of a chapter, all the subject matter being rendered con- 
secutive, systematic and homogeneous by the editor. Under the 
table of contents the different divisions of each chapter are men- 
tioned in connection with the writers responsible for the text. This 
arrangement, collaborative as well as individual, seems most satis- 
factory in its results. 

Some of the chapters attracting special attention are those on 
diagnosis, sepsis and anti-sepsis, the pelvic floor and its injuries, 
infections of the external genital organs, neoplasms of the uterus, 
infections and inflammations of the fallopian tubes, the female 
urinary apparatus and the rectum. 

A special word should be said for the numerous illustrations 
which are not only excellent, but also of uniform merit. The 
mechanical work is a credit to the publishers. 

A Manual of Practical Hygiene for Students, Physicians and 
Medical Officers. By Charles Harrington, M. D., Assistant 
Professor of Hygiene in the Medical School of Harvard University. 
Illus, Philadelphia: Lea Brothers & Co. 1901. pp. 729. 
Price, cloth, ^4.50. 

In the seventeen chapters which comprise this book a wide range 
of subjects is considered, viz. : foods, beverages, condiments, food 
preservation, contamination of foods by metals; air; the soil; 



320 The New England Medical Gazette, June, 

water ; habitations, schools, ventilation, heating, plumbing \ disposal 
of sewage, of garbage ; disinfectants and disinfection ; quarantine ; 
military, naval and marine hygiene; tropical hygiene; hygiene of 
occupation; vital statistics; personal hygiene; vaccination; dis- 
posal of the dead. 

Dr. Harrington has given us a most interesting and comprehen- 
sive work, deserving better treatment at the hands of the binder 
than it has met with, the margins being so narrow that the back 
margin is encroached upon unduly, and the appearance of the page 
is quite spoiled. 

The text is very well arranged. The section on foods is supplied 
with tables showing comparative composition and nutritive value. 
Poisoning by animal foods is explained and illustrated by selected 
cases. Adulterations, and their detection by suitable tests, occupy 
several pages. In the section on air, the part air plays as a carrier 
of infection is most instructive and important ; the same may be 
said of the text relating to the carrying properties of the soil and 
water. In connection with water the history of typhoid epidemics 
and Asiatic cholera is reviewed. The chemical and bacteriological 
examination of water is given at some length. 

The other chapters in this book are equally good, those on quar- 
antine and military hygiene being exceedingly interesting. Quaran- 
tine regulations, home and foreign, are stated in detail together with 
methods of inspection, disinfection, quarantine laws, etc. The 
section on military hygiene is brought up- to date, recent wars hav- 
ing furnished new and valuable data. 

We commend this work on hygiene, not only to the profession, 
but also to all thoughtful citizens. 

The Curahilht of Tumors by Mkdicines. By J. Compton Lur- 

nett, M. D. Second edition, revised. Philadelphia : Boericke 

& Tafel. 1901. pp.345. Price, cloth, $1.25 ;«^/. 

Those who find other of Dr. Burnett's books suggestive reading 

will doubtless wish to add the present one to their collection. He 

is certainly a prolific, if diffuse, writer. VV^e wish he used better 

English, and knew how to condense what he has to say, but his 

style, dcmbtless, does not offend buyers of his works. 

The present volume is designed to aid practitioners in overcom- 
ing that constitutional diathesis which predisposes certain persons 



igoi Societies, 321 

to develop benign or malignant tumors, and also to assist physicians 
in selecting such remedies as will inhibit the enlargement of growths, 
once they have appeared, or altogether dissipate and cure them. 

Dr. Burnett explains in detail his understanding of pure homoe- 
opathy applied to this class of cases, and cites numerous illustrations 
in support of his views from his own practice. The book is neatly 
gotten up with large, clear type, and a cheerful bright red binding. 

The American Year- Book of Medicine and Surgery for 1901. 
A Yearly Digest of Scientific Progress and Authoritative Opinion 
in all branches of Medicine and Surgery, drawn from journals, 
monographs and text-books of the leading American and foreign 
authors and investigators. Arranged with critical editorial com- 
ments by eminent American specialists. In two volumes — Vol, I, 
including General Afcdicine^ Ovtavo, 681 pages, illustrated; 
Vol. II, General Surgery y0ct2LV0f 610 pages, illustrated. Phila- 
delphia and London : W. B. Saunders & Co. 1901. Per vol. : 
Cloth, ^3 net; half morocco, ^3.75 net. 

A year ago this work for the first time was issued in two volumes, 
and the same plan has been followed in the Year- Book for 1901. 
One volume is really not enough, or else becomes too bulky, while 
two volumes can be and have been made both attractive and con- 
venient in size. It is an advantage, also, to have the sections on 
medicine and surgery distinct from each other ; they can be bought 
and used separately or together, each being complete in itself. 

Books of this class often fail to receive the recognition to which 
they are fairly entitled. They represent the condensed views of a 
large and representative number of leading writers, teachers and 
practitioners. They furnish an explanatory index, as it were, to 
countless journals of the day, new and authoritative text-books, 
special papers, and other important contribution to medical science 
that would otherwise be unavailable because so scattered. They 
offer in compact form a means of following from year to year the 
progress made in all the important departments of medicine and 
surgery, and in time constitute a library of considerable historical 
value. 

In the work under consideration the contents of the volume on 
Medicine are arranged under the following headings : General 
Medicine ; Pediatrics ; Pat^nology and Bacteriology ; Nervous and 



322 The New England Medical Gazette, June, 

Mental Diseases ; Diseases of the Skin and Syphilis; Materia Med- 
ica, Experimental Therapeutics and Pharmacology ; Physiology ; 
Legal Medicine ; Public Hygiene and Preventive Medicine ; Physi- 
ologic Chemistry. Contents of the volume on Surgery are grouped 
under General Surgery; Obstetrics; Gynecology; Orthopedic 
Surgery; Ophthalmology; Otology; Diseases of the Nose and 
Larynx; Anatomy. 

Among the leading contributors may be mentioned Da Costa, 
Keen, Hirst, Duhring, Starr and Stengel. Both volumes are ade- 
quately indexed, well bound, and printed on the high calendared 
paper which we hope will eventually be altogether discarded. 

The Pathology and Treatment of Sexual Impotence. By Victor 

G. Vicki, M. D. From second German edition. W. B. Saunders. 

189Q. Price, t2. 

As the author states, not much that is new has occurred in this 
line during the comparatively short time elapsing between the two 
editions. The subjective matter is arranged in ten chapters, com- 
prising Introductive Anatomy, Physiology of Sexual Act ; Etiology, 
Diagnosis, Prognosis, and Treatment of Impotence. 

The work is well written, thorough, and of value to any one 
interested in this special subject. 

We are inclined to feel, however, that one such book serves the 
purpose intended for a considerable time. 



REPRINTS AND MONOGRAPHS RECEIVED. 



Treatment of Prostatic Hypertrophy. By Parker Syms, M. D. 
Reprinted from ikit Journal of the American Medical Association ^ 
Jan. 12, 1901. 

Some Remarks on the Present Status of the Physician in the 
United States. By Emil Amberg, M. D. Reprinted from the Vir- 
ginia Medical Semi' Monthly^ Feb. 8, 1901. 

A Scientific Basis for Medicine. — Life and its Association with 
Matter-Matter Not Vital but Absolutely Chemical. Two papers by 
E. C, Hebbard, M. D. Reprinted from the Medical Times, Feb- 
ruary and March, 1901, 



1 90 1 Personal and News Items, 323 

The Failure of the Consensus Judgment with Reference to 
Tuberculosis. By Charles Denison, A. M., M. D. Reprinted from 
the Medical News, Dec. 29, 1900. 

Some Notes on the Treatment of Rheumatism. By Alfred 
Stengel, M. D. Reprinted from the Medical News, Dec. 22, 1900. 

Aneurism of the Arch of the Aorta, with Rupture into the Supe- 
rior Vena Cava. By Alfred Stengel, M. D. Reprinted from the 
American Journal 0^ the Medical Sciences, November, 1900. 

A Review of the History of Cardiac Pathology. By Alfred 
Stengel, M. D. Reprinted from the University Medical Magazine^ 
October apd November, 1 900. 

Progressive Pernicious Anemia. By Alfred Stengel, M. D. Re- 
printed from the Medical A^ews, Oct. 20, 1900. 

Vaccination in the Light of the Royal British Commission. Ed- 
ited by Montague R. Leverson, M. D. Reprinted from the Homcco- 
pat hie Physician, 1900. 

Fatty Degeneration of the Heart. By Thomas E. Satterthwaite, 
M. D. Reprinted from the Medical Nexvs, Feb. 2, 1901. 

Eye Strain Notwithstanding Acute Vision. By David Wells, M. D. 
Reprinted from the New England Medical Gazette, February, 
1901. 



PERSONAL AND NEWS ITEMS. 



Dr. James Krauss, of Maiden, expects to sail for Europe 
on June 5, to return and resume his practice in November, 

Wanted. — An assistant physician at Westboro Insane 
Hospital. Address, Dr. G. S. Adams, Westboro, Mass. 

For Sale. — A thriving practice. Present owner going 
abroad. Rare opportunity. Address " W. G. B.," care Otis 
Clapp & Son, 10 Park Square, Boston. 

A graduate of B. U. S. of M., class of '99, located within 
a few miles of Boston, would be glad to assist one or more 
physicians by taking their practice a few hours every day or 
by relieving them during vacations. Address "J. E. M.," 
care Otis Clapp & Son, 10 Park Square, Boston. 



324 The New England Medical Gazette. June, 

The Third Annual Meeting of the American Proctolngic 
Society will be held at Hotel Aberdeen, St. Paul, Minn., 
June 4, and 5, 1901. 

Order of Business. — Executive Meeting. Reports of Com- 
mittees. Reading of Papers and discussion of same. Dem- 
onstrations by Clinics and presentation of specimens. 

Dr. Martin will present: (i) A Case of Naevus in the 
Second Rectal Chamber. (2) Presentation of a Specimen 
of Congenital Hyperplasia and Coarctation of the Rectal 
Valve. Report of Committee on Progress of Proctologic 
Literature during the past year. ^ 

President, Dr. James P. Tuttle, New York ; Vice-pfesident, 
Dr. Thomas Charles Martin, Cleveland ; Secretary -Treasurer, 
Dr. William M. Beach, Pittsburg. Executive Council, Dr. 
Samuel T. Earle, Jr., Baltimore; Dr. A. Bennett Cooke, 
Nashville ; Dr. J. Rawson Pennington, Chicago. 

First Day 1.30 p. m. — Meeting of the Council. 2.00 p. m.. 
Executive Meeting ; Reading of Minutes ; Treasurer's Re- 
port ; Report of Council; Reports of Committees on other 
than Scientific Subjects offered ; Unfinished Business ; New 
Business. 3.00 p. m.. President's Address, Dr. James P. Tut- 
tle, New York. 3.30 p. m., Reading of Papers. Primary 
Tuberculosis of the Rectum and Anus with Report of Cases, 
Dr. Leon Straus, St. Louis. Disease of the Sigmoid, Dr. 
George B. Evans, Dayton, O. Report of Two Cases of 
Valvotomy, Dr. Samuel T. Earle, Baltimore. Treatment of 
Prolapse of the Rectum, Dr. J. Rawson Pennington, Chicago. 
Foreign Bodies in the Rectum, with Report of a Case, Dr. 
Lewis H. Adler, Jr., Philadelphia. 

Second Day 1.30 p. m. — Reading of Papers. A Study of 
Simple Ulceration of the Rectum from a Clinical Standpoint, 
Dr. A. Bennett Cooke, Nashville. A New Method for the 
Painless Removal of Hemorrhoids, Dr. Thomas Charles 
Martin, Cleveland. Anal Pockets, Dr. Louis J. Krouse, Cin- 
cinnati. The Treatment of Recto-Colitis, Dr. William M, 
Beach, Pittsburg. Paper, Dr. George J. Cook, Indianapolis. 
4.30 p. M., Executive Meeting, Reading of Minutes, Election 
of Members and Officers, Miscellaneous Business, Adjourn- 
ment. 



THE NEW ENGLAND 

MEDICAL GAZETTE 

i 
No. 7. JULY, 1901. Vol. XXXVI. 

COMMUNICATIONS. 



THE nODERN IDEA OF THE USE OF DRUGS AS 
HEDICINES. 

BY C. WESSELHOEFT, M. D. 
[Read before Mass. Horn. Med. Society.] 

This is the question upon which I have been requested to 
write something. The time at my disposal will not permit 
more than a brief allusion to some of the main points of the 
problem which I have treated of more fully in a paper read 
before the Medical Society County of New York, Feb. 9, 
1888) see N. A. Jour, of Homoe., March and April, 1888). 
To this I must refer to some extent. There I endeavored to 
point out that what is called the history of medicine is only 
very remotely and indirectly connected with medicine, being 
mostly an exposition of philosophical dogmas concerning life 
itself, while we search in vain for any direct knowledge or 
principle governing the action of medicine proper. The 
search for such a principle or such knoAvledge leads to many 
interesting reflections, for everywhere there can be traced a 
belief in the action of drugs to cure disease. "Simple ob- 
servation of the bent of the popular mind to-day will show 
us the root of the origin of the universal faith in drugs and 



326 The New England Medical Gazette. July, 

will assist us in understanding the nature of tradition. Look 
about you where you please and you will be overwhelmed al- 
most with this atmosphere of faith in medicine to accomplish 
the miraculous. Every wall, every rock, is inscribed with it. 
The landscape is disfigured and made uncanny. It pervades 
society quite as much. It is proclaimed by cunfiing labels 
of nostrums and by flaring announcements in the highways 
and in whole sheets of the newspapers. This faith is shared 
by the humblest squatter in the far West, as well as by the 
highest dignitaries of the land." The present craze for medi- 
cine is now even more widespread than in the so-called dark 
ages, and "patent medicines " to-day show us just how materia 
medica was collected and grew ages ago. Read only the 
shrewdly worded labels on the bottles and packages, and com- 
pare them with the pages of our old friend Pedanius Diosco- 
rides, and the manner of the tradition will become apparent. 
In Chap. II. of the book on ** poisonous animals and rabies 
of dogs,'* he instructs us to burn crawfish with twigs of clem- 
atis, and after having powdered the ashes, powder some gen- 
tian root, mix with the ashes of crawfish in wine, make a 
gruel of it and administer to the person bitten. It is better, 
says our ancient friend, that some should suffer the medicine 
in vain than to be led into danger for want of prompt action. 
In another chapter selected at random (Cob. XXXII, Vol. II) 
Dioscorides says : " In order to cure the swelling of the 
breast, wash some dictam herb (Origanum dictamus) in the 
cold, and bathe the breast with the water. If you doubt the 
efficacy of this medicine and decide to test its power, anoint 
with it the horns of a young goat, and they will cease to 
grow." 

Such was materia medica away back in the middle ages. 
Pathological and physiological theories constituted the science 
of medicine. At the time of Claudius Galenus the relation 
between soul and body was that which interested physicians, 
who thought then, as they do now, that deep insight into 
anatomy and physiology would lead the way to the cure of 



190 1 Modern Idea of the Use of Drugs as Medicines, 327 

disease, while no effort was made to study the effects of 
drugs and other therapeutic agencies. ** What we are search- 
ing for is proof of positive curative power of drugs, — proof 
based upon direct induction, not on conclusions drawn from 
tradition." One question arises : Had the ancient traditions 
and beliefs which they begot suddenly ceased to exist in the 
beginning of this century ? No, they were present every- 
where, and physicians shared them. The faith and belief 
that medicines may and do cure, was an accepted axiom ; all 
held fast to it, and none more so than Hahnemann himself. 
Would Hahnemann have conceived of the principle (S. S. C.) 
which he formulated if he had not been possessed of the time- 
honored hereditary belief in medicine } His reformatory idea 
was born of this belief. What did he demonstrate if he did not 
seek the specific power inherent in medicines } Starting 
from his China experiment, and supplementing it by anala- 
gous data collected • from literature, he thereon founded his 
system ; in his process of reasoning he never doubted the 
faith that medicines cure, but only found a formula which 
brought the ancient belief of the curative power of drugs 
into rational relation with pathological conditions. 

Before trying to define " the modern idea of the use of 
drugs," let us consider for a moment what has been embraced 
under the term of medicine hitherto. " For centuries every- 
thing a physician had to learn has been included in that 
term ; but it is time that we should distinguish more carefully, 
especially now that the art of using drugs, and the art of 
studying their most extended effects is receiving very little 
attention in the great medical schools of the world. We 
read with interest the advancement of pathology, the brilliant 
classification and diagnostic distinction of disease, but when 
we endeavor to find what ' medicine ' has to do with them, 
we are greatly disappointed. . . . '* 

Therapeutics embrace many things besides hydro-therapy, 
antitoxines, electricity and even dietetics. 

In the middle ages, law, theology, and what was called **medi- 



328 The New England Medical Gazette, July, 

cine" were all or could \i2N^ been contained in one of those 
large pigskin covered volumes, • Now a large building could 
not hold our medical literature. This comprises anatomy. 
What that is you all know. There is nothing of medicine in 
it. Physiology, teaching of the functions of organs, says 
nothing about medicines or medicine. Chemistry deals with 
a great many substances used in medicine, but chemistry 
does not teach the art of using its productions as medicuies 
any more than botany teaches the medicinal use of the plants 
it describes. Neither is surgery medicine. It is now the 
most popular way of dealing with diseased organs, but not 
by the use of medicines, unless we can call the scalpel, the 
needle and the ligature "medicine." Where surgeons use 
medicines they do not claim to be practicing surgery ; when 
they are employing the knife, or the ligature, or the needle, 
they are not giving medicine. Not but that they have the 
whole of the materia medica to draw upon ; when they make 
use of it then only are they practicing medicine. 

Pathology, that vast field occupying so many busy minds, 
and leading us into the mysterious labyrinths of disease, is 
not medicine any more than anatomy, physiology or chemis- 
try. Indeed, it is often further from medicine than chemistry 
or botany ; and those who, under the leadership of Virchow, 
the greatest pathologist of the past century, hope that ad- 
vancing pathology will lead us to the knowledge of curing 
disease by medicine, hope in vain. It is only the knowledge 
of disease, combined with the most comprehensive knowledge 
of wTiat is curative in drugs and other agencies (see p. 3 of 
the Organon) that will lead to the cure of disease. 

Many other practices and methods of treating disease, such 
as hydro-therapeutics, massage, immunization, electiicity, 
while they are very indispensable branches of therapeutics, 
do not deal with medicine or medicines proper, and in future 
should not be considered under that name. 

It belongs to the future to develop the knowledge of drug 
power under a most comprehensive general law of cure, and 



igoi Modern Idea of the Use of Drugs as Medicines, 329 

this alone, from a somewhat exalted standpoint at present, 
deserves the name of medicine. This by no means precludes 
the other therapeutic branches which I have named. No 
physician of the present or future will dare to claim that 
medicine alone, or any other single branch of therapeutics, 
will suffice to cover the ground of his usefulness; and the 
time will surely come when physicians will make a distinction 
between therapeutic methods, and will have their diplomas 
define their position and knowledge accordingly, giving med- 
icine its proper place among the methods of treating disease. 

Before obtaining an idea of the modem use of medicines — 
now that we have determined what is meant by this term — it 
will be well to recall what that idea was one hundred years 
ago. What the use of medicine was at that time none has 
ever described better than Hahnemann in that inimitable 
" Review of Physic '* contained in the Organon, from which 
I condense : System had succeeded system. There were 
theories of disease to which theories concerning the action of 
drugs were applied. At one time the cry was, " Take care 
and remove the cause." But they could not find it because 
it has been and is yet undiscemible. An indigestible meal 
or a foreign body are seen easily enough, but the actual arid 
remote cause and essence of disease, no matter how carefully 
and minutely searched for by microscopical examination of 
histological elements, was then and is now still undiscovered. 

There is still much to be looked for back of the microbe. 
A hundred years ago a theoretically discovered cause of dis- 
ease was sought to be removed by emetics, purging, venesec- 
tion, for the removal of inflammation. This was obeying 
" causal indications," and was called rational. The idea was 
rational enough, but the method was based on fallaceous the- 
ories in accordance with which they used what were called 
repellants, as the exsiccation of ichorous ulcers was attempted 
by means of astringents, cauterization, etc. '* To harmonize 
with the theory of causal cures, physicians at that time pre- 
supposed the existence of morbid mattqr, which they sought 



330 The New England Medical Gazette, July, 

J 
to remove by acting upon the kidneys, the skin or the sali- I 

vary glands." Salivation and diuretics as well as sudorifics 

were invented ; classes of medicine were arranged for this 

purpose without regard to the other deleterious effects those 

sudorifics, salivates and diuretics puoduced. ' " On this afc- 

count," says H., "scarcely anything is found in all works on 

materia medica, from Dioscorides to those of the present 

time, regarding individual remedies and the special proper 

action of each." 

CuUen, pretty much as Pedanius Dioscorides, was about the 
only authority on materia medica as a specialty, anti-dating 
Pliny and Galen ; so was William Cullen, the author of the 
. principal text-book at the end of the eighteenth and the be- 
ginning of the nineteenth century. He was as far in advance 
of Dioscorides as Hahnemann was in advance of his contem- 
poraries with regard to accurate knowledge of drug-effects 
and the methods of obtaining them. 

In order to get a glimpse, at least, of the idea of the use 
of medicines a hundred years ago we find that, according to 
Cullen, their effects were due to sensibility, and irritability, 
of the nervous system exerting its influence on the contrac- 
tile, chiefly the muscular fibres, of the body; this again va- 
ried with the different temperaments; it was stronger in 
youth and weaker in advancing age. The temperaments be- 
ing dependent on five conditions, — on those of the simple 
solids ; the fluids ; on the relation of solids to fluids ; on the 
distribqtion of fluids ; and fifth, on the condition of nervous 
force. 

So far speculation was conservative and moved upon safe 
ground, but it leaves that ground when we come to the con- 
sideration of the uses of drugs. There we find they .^e di- 
vided into twenty-three classes, such as astringents, tonics, 
embracing all bitters ; emolients (water and poultices) ; sed- 
atives; anti-spasmodics ; antacids; anti-alkaline remedies; 
salivants ; emetics ; laxatives ; diuretics ; emmenagogues, etc. 

In order to see how these theories work when applied in 



igoi Modern Idea of the Use of Drugs as Medicines, 331 

certain cases of disease, we find them floating in the air ; 
thus CuUen is convinced that Peruvian bark cures intermit- 
tents alone by its tonic quality dependent upon its bitter and 
astringent effects upon the stomach, to which it imparts new 
tone by strengthening* its fibres and, thence, imparting tone 
to the rest of the system. ^ There is no use, says Cullen, in 
attributing a specific effect to bark, when its eflFect is easily 
explained by its tonicity. 

How this was disposed of by Hahnemann we all know by 
his historical footnote on p. 109, Vol. H of his translation of 
Cullen's Materia Medica. 

It is interesting to note how laxatives and purgatives were 
regarded in those days, and that their effects and mode of 
action were explained and made use of then precisely as they 
are to-day. Their action was local and remote. Unloading 
the intestines and acting as depletients, also as derivatives, 
by lessening the blood pressure in certain parts where it was 
supposed to be excessive. Some were considered more ac- 
tive or stronger than others, but anything like a peculiar or 
specific effect, or their effect upon other organs besides the 
intestines, was not taken account of. 

It is always interesting to seek for the explanation of tonics. 
It is asserted that astringency and tonicity are not identical, 
(Hahnemann's Trans., Vol. II, p. 64) and that there are tonic 
medicines which have no astringent effect, but whose effect 
is attributable to their bitterness alone ; but they unfortun- 
ately (rften possess other qualities, narcotic, irritant, laxative, 
or otherwise, which prevent their use as tonics unless we 
select the "pure bitters" free from other objectionable 
effects. They cure by " strengthening the tone of the mus- 
cular fibres of the stomach." What a convenient idea this 
was, applying with perfect elasticity to the cure of interrhit- 
tents as well as dyspeptics. This idea has been handed 
down to the present day, when not only in the popular mind 
but that of medical men also, the stomach is often named as 
the source of almost any complaint, and the popular cry is 



332 The New England Medical Gazette. , July, 

for "tonics/* with this difference that one hundred years ago 
they meant some " bitters/' now they mean whiskey. 

Straws show which way the wind blows. This sketch as- 
suredly transgresses the time allowed me, therefore it is pos- 
sible now only to sketch the most important points very 
briefly. What remains to be said is what the idea of medi- 
cine was fifty years ago, and what it is to-day. 

In 1846, John Forbes, M. D., F. R. C, published an article 
entitled, " Homoeopathy, Allopathy and Young Physic," 
which, (though a reply criticising William Henderson, M. D.^ 
of the University of Edinburg, who wrote "An Inquiry 
into the Practice of Homoeopathy") is, next to Hahne- 
mann's ** Review of Physic," the best essay on that subject 
ever written. While it touches upon some alleged weal^ 
points in homoeopathic practice, it also most candidly exposes 
those of allopathy, and furnishes some of the best material 
for the comprehension of the idea of the use of drugs at that 
time. I can only extract a few short passages to show the 
prevalent idea. This was " heroic bleeding and mercuriali- 
zation," compared with which the res.ults obtained by Dr. 
Fleischmann and Henderson may indeed astonish our heroic 
bleeders and mercurializers, or may even turn them, being 
so full of faith in drugs, to the pole opposite to heroism — 
homoeopathy itself. To the truth of Homoeopathy, Dr. 
Forbes opposes much specious reasoning, claiming for its 
cures the aid of the powers of nature only (940). In addition 
to this. Dr. Forbes tells us (949) that a large proportion of 
men of science " in the latter part of their career abandoned 
much of the energetic and perturbing " medication of their 
early practice and trusted greatly to the remedial powers of 
nature. "But while we are thus exalting the powers of 
nature at the expense of homoeopathy, are we not, at the 
same time, laying bare the nakedness of our own cherished 
allopathy .? . . . that the treatment of every disease on the 
ordinary plan must, at the very best, be useless, while it in- 
flicts on our patients some serious evils (that homoeopathy is 



1 



I go I Modern Idea of the Use of Drugs as Medicines, 333 

free from), such as swallowing of disagreeable and expensive 
drugs and the frequently painful and almost always unpleas- 
ant effects produced by them during their operation ? " This 
dilemma, by the way, Dr. Forbes manfully admits but does 
not seem to escape from it when he says that " in a large 
proportion of the cases treated by allopathic applications the 
disease is cured by nature and not by them. ... In a 
somewhat smaller proportion, the disease is cured in spite of 
them, . . . consequently in a considerable proportion of 
diseases it would fare as well or better ... if all remedies 
. . . especi^ly drugs were abandoned.*' 

The idea of the use of medicines fifty years ago is further 
illustrated by a few passages which are here condensed : '* To 
be satisfied on this point (the proportion of cures) we need 
only refer to the history of one or two of our principal dis- 
eases, as, for instance, fever, pneumonia, syphilis." " In 
these, the author tells us, that antimony and blood letting are 
being discredited (by Louis and others in Recherches sur les 
Effets de la saignee^ Paris, 1835); likewise mercury in syph- 
ilis. . . . Physicians of long experience adopting a mild 
and tentative or expectant mode of practice. . » . We doubt, 
therefore, if we should greatly, if at all, exceed the bounds of 
truth if we said that the progress of Therapeutics, during the 
centuries that have elapsed since the days of Hippocrates, 
has been less than that achieved in the elementury science 
of medicine during the last fifty years. The department of 
medicine must, indeed, be regarded as yet in its infancy. . . . 
that much of the practice of medicine," in as far as it exists in 
the administration of drugs, is a system of traditional routine 
and conventionalism, haphazard and guesswork." 

This is the idea concerning medicine of one eminent phy- 
sician and was soon voiced by another, dedicated to Dr. John 
Forbes* in 1853. 

In order to get the idea of another exponent of medicine 



* Brief expositions of Rational Medicine in Modern Inquiries. By Jacob 
Bigelow» M. D. Little, Brown & Co., 1867. 



334 The New England Medical Gazette, July, 

more than forty years ago, a few short passages must be cited 
here. 

"The artificial method of treatment is founded on the 
assumption that disease can be removed by artificial means. 
... It was only necessary to subdue the inflammation, to 
expel the morbific matter, to regulate the secretions, to im- 
prove nutrition and to restore strength, and the business was 
at once accomplished. . . . The destructive tendencies of 
disease, and the supposed pronenesS to deterioration of nature 
herself, was opposed by copious and exhausting depletion, 
followed by a shadowy array of alteratives, deobstruents and 
tonics. Confinement by disease which might have terminated 
in a few days was protracted to weeks and months. . . . 
When carried to its * heroic ' extent, artificial medicine un- 
dermined the strength, elicited new morbid manifestations, 
and left more disease than it took away. The question raised 
was not how much the patient had profited under his active 
treatment, but how much more of the same he could 
bear." 

"A considerable amount," continues Dr. Bigelow, "of vio- 
lent practice is still maintained (1858) by routine physicians. 
Edged tools are brought into use as if they could never be 
anything more than harmless playthings. It is thought 
allowable to harass the patient with daily and opposite pre- 
scriptions ; to try, to ab^don ; to re-enforce and to reverse ; 
to blow hot and cold on successive days, but never to let the 
patient alone nor to intrust his case to the quiet guidance of 
nature. Consulting physicians frequently and painfully wit- 
ness the gratuitous suffering, the continued nausea, the pros- 
tration of strength, the prevention of appetite, the stupefac- 
tion of the senses, the wearisome days and nights which would 
never have occurred had there been no such thing as officious 
medication. ..." 

Enough of this idea of medicine a hundred years ago, and 
forty years ago. The above words were strong and convinc- 
ing, and it seems as if Hahnemann himself had written them. 



I go I Modern Idea of the Use of Drugs as Medicines, 335 

so closely do they compare with passages from his famous 
" Review of Physic." Indeed, there is a strong probability 
that that Review was carefully read by both Drs. Forbes and 
Bigelow, who involuntarily fell into the spirit of it and 
straightway quoted the sense if not the precise words. Such 
is the contagiousness of vivid writing. 

Notwithstanding this sketchy and almost garbled attempt 
at a description of medicine in the past hundred years, it has 
already overstepped ' the bounds of time allotted to it, and 
still tKe idea of medicine of the present day remains to be 
touched upon, also its comparison with the past. Omitting 
for the present hydro and electro-therapeutics as well as im- 
munization by toxines, we will glance at medicines and the 
modem idea of medicines. We will at once draw for inspir- 
ation upon one of the latest text-books of practical therapeu- 
tics.* Here we read : "The definition of the word 'thera- 
peutics ' in Billings* dictionary is : ' that ^ branch of medical 
science which treats of the application of remedies to the cure 
or alleviation of disease,' and, practically, the term is almost 
universally used to signify the employment of drugs for such 
purposes. ..." Again, " In the language of one of the 
most progressive medical men of to-day in the United States, 
the man who does not believe in the proper use of drugs for 
the cure of disease must lack the very keystone of the arch 
upon which all medical knowledge rests." 

There we have it again — belief in the action of drugs, the 
ancient belief which was handed down to Dioscorides, Pliny, 
Galen, Paracelsus, Hahnemann. That part of it remains 
to-day as it was hundreds of years ago. But the point for 
the knower of things to decide is, how was it ever discovered 
that medicines cured } Was fever questioned much } But 
that attribute of drugs seems to have been taken for granted. 
Hahnemann never doubted that cinchona cured fevers ; he 
only maintained that it did so by virtue of its power to pro- 

•A Text-Book of Practical Therapeutics. By Robert Amory Hare, M. D. 
Lea Bros., 1894. • 



336 The New England Medical Gazette. July, 

duce similar fevers, and he gave the world-old axiom, rule or 
law according to which medicines could be used. This is 
also a modern idea of the use of drugs. It has stood the 
test for a century. But there are other ideas of the use of 
drugs and ideas regarding their mode of action. " Drugs," 
says our text-book, " act in two ways, which are sometimes 
called near and remote, or direct and indirect. The near or 
direct action of a drug is that influence which is felt by the 
exercise of its effects directly upon the tissues with which it 
comes in contact ; the indirect, or remote, influence is that 
result which comes as a sequence of its primary effect. As 
an illustration of this we may take the local use of cantha- 
rides. The local, near, or direct effect of this is a blister ; 
the remote or indirect effect is the absorption of exudations, 
or the influencing of inflammatory processes. If pilocarpine 
is used, its direct effect is the sweating which ensues, the 
indirect effect is the relief of dropsy (sic) through the removal 
of exudation by the increased action of the skin, salivary 
glands and kidneys." So say the books. 

Here we have Hahnemann's axiom of similia similibus 
curantur, and also that of the dominant school. This, as ex- 
pressed in Dr. Hare's book, is very disproportionate to the 
2,400 odd medicines enumerated. Many of these evidently 
cannot act according to the simple rule of direct and indirect 
action ; and Dr. Hare does no injustice to the knowledge of 
that school by seemingly making his explanation of the action 
of drug apply to the whole list. Opium certainly does not 
act in that way, neither does mercury, neither does digitalis, 
whose great and specific actions are well known to depend 
upon their primary and seconday tonic effects, which is a 
very different matter than direct or indirect or simply irritant 
effects, where usually the primary effect is the opposite of 
the secondary effect. 

We are able to derive a very correct idea of the present 
use of drug or medicines when we take down any modern 



I go I Modern J dea of the Use of Drugs as Medicines, 337 

text- book on materia medica.* Here we learn incidentally 
that, although' the principle of antagonism (allopathy) is de- 
nied, it forms, as will be shown directly, the basis of modern 
"regular" practice, and we also learn that this practice rests 
on a rude classification of drugs arranged so as to make the 
roughest toxic effects of a drug fit into a certain class, entire- 
ly regardless of its other qualities and effects. A cathartic 
is supposed to have no other effects ; a tonic simply strength- 
ens regardless of other toxic effects'; an alterative simply 
alters, etc. In nature there are no such classes. 

In our idea of modem medicine we adhere to the maxim, 
similia similibusy which, if not universal, certainly applies to 
a great many drugs. The "regular school," on the other 
hand, repudiates any law or principle, especially the term 
allopathy^ etymologically well constructed to mean that the 
Galenian principle of contraries still prevails, as can be plain- 
ly demonstrated. Thus they classify their medicine into 
about twenty-seven classes, most of which begin with "anti," 
and all the rest denote acceptance of antagonism, f or a con- 
trary condition to that for which they are given. As such we 
have " antacids," "anthelmintics," "antiseptics," "antiperi- 
odics," "antipyretics," "counter-irritants," etc., and still 
they claim that they have no such thing as an allopathic 
principle. 

They have numerous other classes, such as "alteratives" 
and " tonics," and these names drag themselves along through 
every text-book without a sign or an attempt to explain why 
certain drugs are classified as tonics and others as altera- 
tives ; why, for instance, colchicum and iodoform are altera- 
tives, and cinchona, copper, nitric acid, etc., are tonics. Al- 
though these names do not begin with "anti," these drugs 
are plainly directed, according to the rule of contraries, 
against the condition for which they are prescribed, and it 
must be borne in mind that those conditions are mostly con- 
ceived in the mind of the prescriber who h^s to invent a con- 



*J3arthalow. fLect. VI., p. 84, etc. 



338 The New England Medical Gazette. July, 

dition to which his theoretical antagonist can be directed. 

We diifer with them in this in that we aim to avoid all 
suppositious states and theoretical actions of drugs ; we en- 
deavor to elicit hard facts well and positively known signs 
(symptoms) as indications to which we oppose equally well 
known effects of drugs. It is also true that this opposition 
of drug-effect to disease-effect involves a certain principle of 
antagonism, although we select according to similars; the 
curative action must be antagonistic in some way. This is 
our idea of medicine. 

There is one more modem idea of the use of medicine to 
be considered just for a moment, although it requires more 
time and space. 

The usual text-books like the U. S. Dispensatory, often 
allude to the drug effects as physiological,* only rudely to be 
distinguished from their toxic effects, and these again from 
their therapeutic uses. All this rests upon the same illogical 
theory as their classification according to theoretical action. 

We hold it easily demonstrable that there are no medi- 
cines — as there are none in the U. S. Dispensatory — the 
healing effects of which are not attributable to their patho- 
genic, that is, to their sick-making power. (Lect. II, p. 24-6.) 
This difference of opinion is due to the question as to what 
is physiological and what is pathological or toxic. ... If 
belladonna paralyzes the inhibitory nerves of the heart, that 
is always toxic and pathological ; if Curare produces paralytic 
inertia, it is toxic and pathological. If digitalis produces 
slowness of the heart, or if alcohol increases its action and 
excites the brain ; if opium produces somnolence and insensi- 
bility to pain, these are never in any sense physiological 
actions. This would mean normal, healthy, functional action, 
while all those drug effects cause abnormal activity, differing 
essentially from healthy functional activity. 

To draw a true balance between physiological and toxic 
effect, is simply impossible ; to call the mote uniyersal effects 



*U. S. Dispensatory, p. 1272. Barthalow Mat. Med., p. 160, 179, 299. 



1 90 1 Serum- Therapy and the A nimal Extracts, 339 

after moderate doses physiological and the more dangerous 
effects toxic is merely an arbitrary distinction without a prin- 
ciple. 

But enough of this. Here we are at the beginning of a 
new century with the ideas of the uses of drugs but very par- 
tially developed, our doctors divided into sects on matters of 
opinion and belief, not on knowledge. 



SERUn-THERAPY, AND THE ANIMAL EXTRACTS. 

BY JOHN P. SUTHERLAND, M. D,, BOSTON, MASS. 
[Read before Mau. Horn. Med. Society.] 

If the title of my paper were to accurately index its con- 
tents, it would read, "What I do not know about Serum- 
Therapy." For of the knowledge born of actual experience 
I have little or nothing to offer you. Yet I accepted our 
chairman's flattering invitation to present a paper on " Serum- 
Therapy and the Animal Extracts," soothing my conscience 
with the reflection that I should acquire much valuable infor- 
mation in the effort to prepare the paper, and the Society 
would have a like privilege in listening to the discussion. 

The term " Serum-Therapy " signifies the use of a blood 
serum in the treatment of diseased conditions, although it 
has been extended to include the use of a serum for the pur- 
pose of rendering man or an animal immune to a certain dis 
ease, or cause of disease. The theory itself is one of the 
marked products of the last quarter of the last century. It is 
the direct outcome of the modern laboratory, the result of 
scientific experimentation, the lineal descendant of the "Germ 
Doctrine." Its scientific basis is expressed in the axiom, 
"Infectious diseases are caused by germs." Few now deny 
the claim that micro-organisms are the exciting factors in the 
production of many diseases, and it is useless, at this time, 
to discuss the relative potency of micro-organisms and their 
toxic products as exciting causes. 

Recognition of the pathogenic power of microbes has led 



340 The New England Medical Gazette, July, 

to the improved technique of modern surgery, whereby re- 
sults at once so brilliant and so beneficent have been made 
possible. It has been said that at least two things are essen- 
tial to the production of a crop, viz. : seed and soil. In the 
case of the infectious diseases pathogenic bacteria are the 
seed, the susceptible animal organism the soil. 

With this idea as a basis efforts were made to explain 
natural recovery from infectious diseases and the immunity 
thereby acquired. A person who recovers from an infectious 
disease is exempt from that disease for a certain time, which 
may be short, perhaps a year, as in diphtheria, or life-long as 
in the case of measles, scarlet fever, etc. Various theories 
have been propounded to account for this immunity. Pasteur 
supposed that during the multiplication of these pathogenic 
micro-organisms in the animal body, they exhausted some 
substance necessary for their maintenance and then ceased to 
grow and the person or animal recovered, being consequently 
immune, Chauveau, however, contended that in their growth 
micro-organisms threw out some substance which accumulated 
to such an extent in the animal as to further prevent their 
development, and the animal recovered and was immune. 
Metschnikoff supposed it was due to the action of the white 
blood corpuscles, — in this connection called phagocytes. 
But these and sundry other chemical and physiological theo- 
ries have been found to be erroneous- The accepted theory 
ijow is that there is produced in the recovered animal, by such 
recovery, "anti" bodies or substances which are opposed to 
the poisonous, or toxic, products thrown out by the growth 
of germs in the body, and these substances are termed anti- 
toxins. 

I shall not occupy your time by discussing the value of the 
chemical and physiological theories propounded in explana- 
tion of recovery and immunity, but will summarize the 
results of such discussions in the following statements : 

A child who recovers from diphtheria has the antitoxin of 
diphtheria in its blood as a result of such recovery ; and as 
long as the antitoxin remains, the child will not take the 



190 1 Serum-Tfierapy and the Animal Extracts, 341 

disease again but will be immune. An anaimal that recov- 
ers from the injection of the product of growth of a culture 
of diphtheria also has the antitoxin of diphtheria in its blood. 
A person or an animal recovered from tetanus has the anti- 
toxin in the blood, and the presence of this antitoxin protects 
against another attack. A person can have as many anti- 
toxins in his blood at the same time as the number of infec- 
tious diseases from which he has recovered. A person can 
be immune from small pox by recovery and yellow fever by 
recovery, and have at the same time antitoxins of both 
diseases in his blood in preventive or immunizing amounts. 

It was but a short step to assume that the blood of a per- 
son or animal thus immunized against a certain disease, if 
injected into the blood of a person or animal suffering from 
that disease would neutralize the virus and prevent its action. 
Bacteriological investigations were not slow in putting this 
idea to the test and many experiments were made resulting 
in what seems' to be proof that the blood-serum of animals 
artificially immunized against certain diseases, contains a 
something which is " germicidal " as to the micro-organisms 
producing such diseases, or which antidotes the poisonous 
product of these special micro-organisms. 

It is a well-established fact that all kinds of germs do not 
act in the same way, in producing disease. Some are strictly 
parasitic, having a habatat in certain tissues or organs of the 
body, and living at the expense of their host ; interfering 
with the performance of the function of the part infested, 
thus producing disease. Other kinds are pathogenic not by 
direct action, but by the production of a poisonous some, 
thing — (toxio.) — as the result of their life's activity. This 
poisonous something — (toxin,) — need not be produced in 
tlie living organism ; — it can be artificially made by cultivat- 
ing the germ in a suitable culture-medium. The toxin thus 
artificially produced is as virulent as the toxin produced in the 
living organism : and its injection into a living organism is, 
followed by the train of symptoms attributed to the germ it- 
self. Very few, however, of the pathogenic germs produce 



342 The New England Medical Gazette. July, 

soluble toxins. Among those that do, the diphtheria and te- 
tanus bacilli are peculiarly prominent from the fact that the 
blood-serum of animals artificially immunized against diph- 
theria and tetanus contains a true anti-toxin : and these anti- 
toxins have been used very widely as therapeutic agents. 

The diphtheria anti-toxin is the best known, from having 
been the most universally used of the entire group of serums. 
The specific bacillus of diphtheria was recognized by Klebs in 
'83; cultivated and described by Loffler in '84; in '91 Beh- 
ring commenced his experiments upon diphtheria immunity, 
and almost immediately thereafter anti-diphtheritic serum 
formed one of the most prominent subjects of discussion in 
lay as well as medical literature. Such has been the influence 
of newspaper and literary-magazine articles on the minds of 
the laity, that now m the majority of cases a physician is 
looked upon as culpable by the friends and relatives of the 
patient if he fail to use "anti-toxin** as soon as the diagno- 
sis "diphtheria** is made, and families readily submit to pro. 
phylactic injections of the anti«-toxin, if any member be strick- 
en with the disease. It did not require a decade to arouse 
adverse criticism of the treatment, but the probability is that 
such injury as has been traced to the use of the anti-toxin, 
has been" due to the preservative used, the pure and unmedi- 
cated anti-diphtheretic serum in common with other anti-toxic 
serums being innocuous. " The anti-toxin treatment of diph- 
theria** was the subject of a paper presented to the Society 
yesterday evening, by Dr. Goodno, and thus requires no 
further consideration at this time. 

"Anti-tetanic serum*' is a true anti-toxic serum, prepared 
in a similar way to the anti-diphtheritic serum. Tetanus^ 
however, is a comporatively rare disease, and experience in 
its treatment is not sufficiently wide to enable one to authof. 
itatively judge as to the efficacy of this serum. Theoretically 
it must be of value, and the claim is made (Therapeutic Notes 
for Feb., 190 1,) that anti-toxin therapy has reduced the mor. 
tality in this disease from 90 per cent, to 40 per cent. 

" Anti-streptococcic serum '* demands a moment's consider- 



igoi Serum-Therapy and the Animal Extracts. 343 

ation. Animals are immunized by the injection of living vir- 
ulent streptococci, instead of by the use of gradually increas- 
ing doses of attenuated virus, or toxin. It is called an anti- 
mycotic, or anti-mycetic instead of anti-toxic serum, because 
it arrests and prevents the growth of the germ rather than 
antidotes its toxin. It is recommended as useful in scarlatina 
erysipelas, chronic otitis media, puerperal septicaemia, pelvic 
inflammations, post-operative sepsis, septic cellutitis and mixed 
infections ; and several cases of cerebro-spinal meningitis, are 
recorded as having been cured by it. Unfortunately, there 
are several varieties of streptococci, and the serum of one' 
variety is not protective against another variety. The serum 
is therefore called " an experimental remedy, the exact value 
of which remains to be determined." As to scarlet fever and 
erysipelas the writer is justified by his experience in feeling 
that he has reliable remedies to make use .of, but he acknowl- 
edges the painful and lamentable fact that he has seen several 
cases of various forms of meningitis and septic infection with- 
in a few years which have proved fatal. And within three 
months he has seen two fatal cases of meningitis, (one follow- 
ing a pneumonia and the other following grippe) and a fatal 
case of streptococcic infection, with multiple abscess, in which 
he regrets not having used anti-streptococcic serum. 
• "Bubonic plague serum " is said to be "mildly protective, 
but not curative." " On this side of the water " it does not 
attract the attention it did six months or a year ago, and may 
be classed with antityphoid, anticancer, antirabic, antitubercle, 
antipneumococcus, yellow fever and cholera serums, all of 
which are under experimental investigation with more or less 
promise of ultimately developing a degree of usefulness as 
preventive or curative measures. 

" Antivenomous serum" or " snake antitoxin " is to be 
classed with the antitoxins of diphtheria and tetanus in point 
of preparation and efficacy, if reports from India are reliable. 
In New England snake-bite is not of as frequent occurence 
as it is in some parts of our broad country, but this may be 
due to the traditional potable and highly palatable prophylac- 



344 2^^^ New England Medical Gazette, July, 

tic which fishermen and sportsmen usually take with them in 
liberal quantities on their expeditions and without which no 
kit is complete. 

It seems but yesterday that the whole world was excited 
over the announcement that tuberculin or Koch's lymph 
would cure tuberculosis. Many high hopes were ruthlessly 
dashed to the ground by the failures which followed the trials 
to which the lymph was subjected. From a state of hopeful 
anticipation public and professional opinion swung to the 
limit of pessimism and scepticism, and bacteriological inves- 
tigators came near meeting a Waterloo, so that the later dis- 
coveries along the line of serum therapy worked hard to ob. 
tain a hearing. A point to bear in mind is that tuberculin 
is a toxin, not an antitoxic serum, and its use at the present 
time is chiefly for diagnostic, not therapeutic, purposes. 

From the historical point of view ** vaccination " is a prac- 
tice of too great importance to be overlooked in this connec- 
tion, but the production of vaccina by the use of the lymph 
of cow-pox vesicles is nothing more or less than prophylactic 
inoculation, the descendent of the time-honored oriental cus- 
tom of small-pox inoculations. And while the practice un- 
questionably had great influence in determining the trend of 
medical thought and laboratory investigations of the last 
century it cannot claim attention as an instance of serum 
therapy. 

You are all familiar with the method of treating inoperable 
malignant tumors by the hypodermatic use of ** Coley's Mix- 
ture,** — but you may not all be familiar with the story of the 
discovery and perfection of the method. Here we are dealing, 
not with an inocuous anti-toxic serum, but, as in the case of 
tuberculin, with a poisonous substance produced by germs — 
a "toxin." 

" A number of observers having noted improvements and 
occasional cures in malignant tumors from an intercurrent 
attack of erysipelas, Coley and others attempted to follow this 
indication by inoculating erysipelas on to the region of the 
tumor The method gave very promising results, but proved 



190 1 Serum-Therapy and the Animal Extracts, 345 

impracticable on account of the frequently fatal issue of the 
erysipelas. In 1894 Coley proposed to modify the method by 
using the toxins, the germs themselves having been removed." 

Later he made use of unfiltered cultures containing the 
dead germs, the germs having been destroyed by heating the 
cultures to a temperature sufficient to render them sterile 
(SS'' to 60** C). It was Coley who first tried a combination 
of erysipelas streptococcus and bacillus prodigiosus, it hav- 
ing been discovered that the bagillus prodigiosus, a non- 
pathogenic organism^ possessed the power of increasing the 
virulence of the erysipelas germ. After prolonged investiga- 
tion and experience Coley's own conclusions are as follows : 

"I. The mixed toxins of erysipelas and B. prodigiosus ex- 
ercise an antagonistic and specific influence upon malignant 
tumors, which influence, in a certain proportion of cases, may 
be curative. 

2. This influence is slight in most cases of carcinoma (in- 
cluding epithelioma) ; most marked in sarcoma, but varies with 
the different types, the spindle-celled form showing by far the 
greatest influence. 

3. The action of the toxins is not merely local in character 
but systemic. 

4. The toxins should be used only in clearly inoperable 
cases, or after primary operation to prevent recurrence. 

5. The results will vary greatly with the strength of the 
preparation, the most virulent cultures giving the best re- 

,sult." — Am. Journal of the Medical Sciences, Sept. '96, re- 
printed by Parke, Davis & Co. 

My experience with " Coley's mixture" has been limited to 
one case of multiple sarcoma of the "spindle-celled" variety. 

The use of "Animal Extracts" for one purpose or another 
is as old as the human race. The aboriginal American ate 
the hearts of brave men, when he could get them, to make 
himself brave (to cure cowardice). Domestic medicine prizes 
highly such remedies (simples) as snakes' skins, skunk's oil, 
goose oil, etc. Two-hundred an^ fifty years ago blood pre- 
pared in a certain manner was considered a remedy "of ex- 
cellent virtue, which, being taken inwardly and applied out- 



346 The New England Medical Gazette, Jiily» 

wardly, easeth pains, and cureth most diseases/* "Elixir uf 
Mummie" (man*s flesh hardened) was thought to be "a won- 
derful prevention against all infections.'* The "Essence of 
man's brains," made from the "brains of a young man, that 
hath died a violent death, together with its membranes, arte- 
ries, veins, nerves, and all the pith of the back-bone," was 
looked upon as "a most infallable medicine against the Fall- 
ing-sickness." A famous "Spirit of human sculls" was used 
as "a kind of General Panacea!' "Oyl of Snakes and Ad- 
ders" did "wonderful cures in recovering hearing in those 
that be quite deaf." "Bears* Balsam," made from bears* feet 
was looked upon as "an incomparable balsam to apply for 
Stiffness, the Gout and Palsie.** The "Quintessence of 
Snakes, Adders and Vipers,'* make from "the biggest and 
fattest Snakes, Adders and Vipers" to be obtained in June 
or July, was said to be " of extraordinary strength and virtue 
for the purifying of the blood, the flesh, and the skin ; and 
consequently cleanseth of all diseases therein. It cures also 
the Falling-sickness, . . . and strengthens the Brain, Hear- 
ing and Sight, and preserveth from gray-hairs ; reneweth the 
old to Youth, preserveth Women young, cureth the Gout and 
Consumption ; and it is good against Stings, Bites, and Pesti- 
lential infections." Do not smile too incredulously at these 
things. Have we not before our memories, as it were but 
yesterday, the wild, enthusiastic rush that was made for* 
Brown-S6quard's famous "Elixir.?" And have we not to-day^ 
in this our country of advanced civilization, an "American 
Animal Theraph Association } " In the Journal of this Asso- 
ciation we read much about a wonderful " Lymph Compound " 
which contains the following ingredients, taken from seven, 
months-old goats : "lymph, taken from the thoracic duct and 
lymph glands ; extracts from lymphatic glands, and of the 
gray matter of the cerebrum, medulla, cord and testicles. 
Ingredients from bulls : . . . Semen, taken chiefly from 
globus major and minor. The menstruum is composed of 
blood serum, diluted with carbon water, and the entire com- 
pound is preserved from coagulation by the addition of a very 



I 



I go I Serum-Therapy and the Animal Extracts, 347 

small amount of chloride of gold and sodium, from which the 
irritating properties have been taken." This is the powerful 
modern "tonic to cell-function, and reconstructor of cell-struc- 
ture." The list of diseases for which this newest lymph com- ' 
pound is confidently recommended, is far too long to quote. 
It is suggested, merely, by the index of any work on patho- 
logical conditions. Who says that the ancient alchemist died 
without heirs } ' 

Truly the medical experiences of our generation, bears wit- 
ness to the truth of the axiom that there is nothing new under 
the sun ! 

The term " animal extracts," as used to-day, refers chiefly 
to the thymus, thyroid and supra-renal glands, and the pre- 
parations made from them. , Extract of thymus gland is said 
to cure exophthalmic goitre. At all events it has been used 
in the treatment of both simple and exophthalmic goitre with 
some success. Suprarenal extract is said to be " the most 
powerful astringent and haemostatic known." Congestion of 
every organ to which it can be appjied, ** is relieved by the 
external use of the extract. ... It benefits all forms of in- 
flammation, in all parts of the body. . . . And it is the 
strongest known stimulant to the heart." These facts we 
learn from the Medica/ Age, April, 1900. The gland has 
been used in the treatment of Addison's Disease, diabetes 
mellitus, exophthalmic goitre, various forms of heart disease — 
mitral and aortic, — and the following are some of the condi- 
tions for the relief of which suprarenal extract has been suc- 
cessfully employed as a local application : Urethral stricture* 
intertrigo, hay fever, epistaxis, laryngitis, conjunctivitis, rhi- 
nitis, acute catarrhal otitis, middle-ear congestions and gran- 
ulations, and acute inflammation of the drum. 

Not the least important application of suprarenal extract 
has been for the blanching of the tissues prior to surgical op- 
erations, such for example as the removal of polypi or spurs, 
anterior turbinectomy, division of adhesions, buccal curettage, 
tonsillotomy, etc. It makes a bloodless field ; and, although 
some complaint has been made of secondary post-operative 



348 The New England Medical Gazette. July, 

hemorrhage, this can readily be avoided or controlled by re- 
peating the suprarenal spray. 

The most popular and extensively used animal extract is 
obtained from the thyroid gland, of which there are several 
preparations. It has a high reputation, in the cure of myx- 
cedena. According to Osier, in his article on the subject. 
" The results, as a rule, are most astounding : unparalleled by 
anything in the whole range of, curative measures. Within 
six weeks, a poor, feeble-minded, toad-like caricature of hu- 
manity, may be restored to mental and bodily health." In 
cretinism, it is claimed, the effect of thyroids is little less than 
marvelous. In the treatment of insanity, Clouston says, "No 
case should be allowed to become incurable, without trying a 
course of thyroids." Obesity is said to be cured or improved 
in a majority of cases, by the administration of thyroids. The 
gland, or its extract, appears to be efficacious in chronic rheu- 
matism, arterial schlerosis, schleroderma, prurigo, psoriasis, 
ichthyosis, and lupus : in haemophilia, in pelvic hyperaemia, 
fibroid tumor, disturbed lactation, and sundry gynecological 
conditions. Its use has also been recommended in tetany, 
paralysis agitans, acromegaly, acute suppurative tonsilitis, and 
retarded consolidation of fractures. 

" According to Serafine the treatment of simple goitre by 
Thyroid gland is best adapted for the form known as struma 
parenchymatosa. Definite cure is rarely observed, and only 
in young subjects. The results are satisfactory in sixty-three 
per cent, of cases, the goitre lessening in size. In thirty per 
cent, of the cases .the treatment is absolutely valueless. 
When goitre has undergone secondary degenerations, such as 
colloid or cyst formation, the treatment is useless." 

My own experience in cases of thyroid feeding has been in 
cases of long-standing bronchocele in exophthalmic goitre 
and in obesity; but I probably have made an unfortunate 
selection of cases, for I have to report my results as wholly 
negative. 

Cerebrine I know only by name, but as it seems to me to 
be nothing more nor less than a reincarnation of the "Essence 



1 90 1 Serum- Therapy and the A nimal Extracts, 3 49 

of Man's Brains " of three centuries ago, it may well be 
allowed to remain a relic of the therapeutic past. 

ProtonucUin is a preparation for which great claims are 
made. I have used it in myelo-splenic leukaemia, in pernicious 
anaemia, malignant growths, and in cases of marked nervous 
exhaustion ; but I am unable to be at all certain that it exert- 
ed any influence whatever, good or ill, on the progress of the 
cases. 

Camogen and Extract of Red Marrow are preparations 
which cannot be excluded in a list of Animal Extracts. To 
my mind they are to be classified simply as concentrated 
foods. My experience with them has been of comparatively 
moderate extent, but in some cases I have reason to think 
they were distinctly useful. I have used them in three or 
four cases of pernicious anaemia, one of which seems to have 
been cured. Credit may be due to the red marrow in this 
case, although other curative measures were also employed. 
In a recent case of climacteric metrorrhagia, and in a few 
cases of chlorosis, and marked debility with anaemia, I am in- 
clined to credit camogen and red marrow with being of de- 
monstrable service. In the category with the remedies just 
discussed we must include the beef extracts and special food 
preparations. Nor can we, without ingratitude, omit mention 
of two articles which surely are ''animal extracts" in the 
strictest sense of the term, and whose wide usefulness stands 
undisputed. I refer to milk and eggs. 

In concluding this brief and exceedingly inadequate review 
of a large and highly important subject I would say that the 
theory underlying the use of antitoxic serums appeals strongly 
to the thinking mind as at least a plausible theory ; one which 
promises much in alleviating suffering and in curing disease ; 
one which should not lightly be set aside without intelligent 
and exhaustive examination of its claims. My own experience 
in this connection has not been extensive enough, however, 
to tempt me to cast aside in favor of this or any other system 
of cure the methods that I have made chief use of thus far in 
my medical life. 



350 l^he New England Medical Gazette. July, 

If, as it has been claimed and partly demonstrated, the 
anti-toxic serums are non-medicinal and innocuous, there 
would seem no reason why they should not be extensively 
experimented with along clinical lines. The toxins, like 
tuberculin, and Coley's mixture, being poisonous substances, 
should be used with the extremest caution, and only after 
possessing the fullest attainable knowledge of their powers. 

Thyroid and supra-renal preparations possess pathogenetic 
properties of some power. One may feel justified in using 
them along "physiological" lines. Why should the symp- 
toms of "thyrodism," tachycardia, oppression, exophthalmos, 
glycosuric, albuminuria, irritability, emaciation, vertigo, not 
be made use of on the principle of similars } Has this ever 
been attempted } This seems to me to be an interesting and 
suggestive query. 



CHEST DISEASES IN 1800 AND IN 1900. 

BY HERBERT C. CLAPP, M. D., BOSTON. 
[Delivered before Mass. Horn. Med. Society, April lo, 1900.] 

The chairman of this bureau has asked me to write upon 
this subject, thinking it an appropriate one for the first year | 

of the new century. Since any essay approximating a com- 
plete exposition of it would fill a book, I will merely ask you I 
to take a few glances here and there, to look on this picture | 
and then on that, and for the most part to draw your own \ 
conclusions. 

In 1 8cxD a medical student coming up for examination on 
the subject of heart disease must have had a very easy time, 
after a "snap course." In fact, the works on practice, print- j 

ed about that time, which I have consulted, contained little I 

or nothing on the subject. 

They did dwell on dropsy, which, as everybody knows, may 
or may not be connected with some form of heart disease, but 
no distinctions were made. A few words were said on the 
pulse and circulation, but very little else that was practical. 



I901 Chest Diseases in l8oo and in igoo. 351 

Hippocrates and Celsus thought heart disease impossible, 
as the heart was the centre of life, and disease of the heart 
was incompatible with life itself. What we now consider 
symptoms of heart disease were by the ancients interpreted 
as symptoms of disease of the lungs, nerves, etc. 

The first great advance was made .by Vesalius, when in 
1543 he gave a clear description of the anatomy of the human 
heart. 

The next important step was taken by Harvey, who in 1628 
described the circulation of the blood, although, queerly 
enough, this great discovery had no effect upon the clinical 
study of heart disease for very many years. 

The real birth of the science of heart disease was possible 
only after the discovery of auscultation and percussion, which 
was made in the century which has just ended. 

Although Auenbrugger had in 1761 published his little 
book on percussion, this new invention at the time attracted 
no attention whatever; and it was not until 181 1 that Corvi- 
sart exhumed the book, translated it into French, and demon- 
strated the importance of the subject, although the full value 
of percussion was only appreciated by Piorri in 1840. 

The greatest discovery of all, however, so far as heart dis- 
eases are concerned, was that by the illustrious Laennec in 
18 16, of auscultation, of which he was the originator, and 
which he brought to a wonderful state of perfection. 

Then, and then only, can it be said that the real science of 
cardiac disease was born. And so, when asked what progress 
we have made in this branch during the last century, we have 
to Answer that there is no contrast at all. From nothing it 
has grown to everything, especially in pathology, aetiology 
and diagnosis. Although in the treatment of its advanced 
stages our progress has shown little to boast of, yet our in- 
creased knowledge now enables us to make the treatment in 
the earlier stages and the preventive treatment of great im- 
portance. 

As to the development of knowledge regarding the lungs, 
bronchi and plurae, the introduction of auscultation and per- 



\ 



352 The New England Medical Gazette, July, 

cussion in the early part of the nineteenth century was also 
of great (although less) value. 

Much was known about diseases of these structures before, 
even from the earliest times. But, on the other hand, much 
was a confused jumble of ideas waiting to be cleared up by a 
nicer differentiation based on more exact methods of diagno- 
sis. Pneumonia and pleurisy were often mistaken for each 
other, phthisis and bronchitis, phthisis and empyema, phthisis 
and asthma, to say nothing of the intermixture of outside 
diseases, as asthma and heart disease, for example. Koch's 
tubercle bacillus, announced in 1882, has afforded consider- 
able help in differentiation, and the Roentgen rays a little. 
Of more value than either has been the clinical thermometer. 
A better diagnosis has naturally paved the way for a better 
treatment. 

By far the most effective agent in the nineteenth century 
in improving the treatment of disease was homoeopathy, which 
in i8cxD was not known in America, but was beginning to 
make itself felt in Germany. Its value, as shown to the 
world, has been both negative and positive ; negative, as 
showing that patients could get well without the crude poly- 
pharmacy, the bleedings, blisters and gigantic doses of drugs 
given in 1800 ; and positive in showing that medicine given in 
this way had real and true curative powers. Its negative 
value, which alone was acknowledged to any extent by physi- 
cians who were not its advocates, enabled the expectant 
school to do far better work than the more zealous but 
regular routine practitioners. Pneumonia is the disease be- 
yond all others in which, undoubtedly, homoeopathy has proved 
its greatest worth, and the contrast between the two schools 
at the beginning of the nineteenth century was far greater 
than at its end, on account of the change of base in the allo- 
pathic school, induced to great extent by the revelation of the 
powers of nature in curing disease afforded by homoeopathy. 

Now let us take a few glances at the common treatment of 
some of the diseases of the chest, as practised one -hundred 
years ago, comparing them mentally with the present treat- 
ment, with which we are all familiar. 



IQOI Chest Diseases in l8oo and i^ igoo, 353 

In a monograph on consumption published in London in 
181 1 by Dr, Richard Reece, and dedicated to His Royal 
Highness George Prince of Wales, who gave his name and 
protection to a Phthisical Dispensary founded by Dr. Reece 
in 1805, with William Wilberforce as President, and many 
patrons among the nobility, the author advises, among other 
remedies, blood-letting, sweating and mercury either by mouth 
or by inunction. Purging he recommends, because " nothing 
so much aggrevates the diseases as costiveness. In the first 
stage of the malady a blister or a seton is a remedy indispen- 
sably necessary. . . When the scrofulous diathesis runs 
high and a sufficient discharge is not promoted from the 
blister, a seton affords a more enlarged means of answering 
the same intention. To most patients under the disease this 
appears a severe remedy. It is, however, one of the first con- 
sequence, if resorted to before the structure of the lungs has 
received much violation. In this early period it keeps down 
that fulness of vessels which favors the progress of suppura- 
tion. It does powerfully correct the scrofulous diathesis. . . 
When the system is quieted by the foregoing remedies, an 
emetic of ipecacuanha I have found very beneficial. . . The 
diet should be such as tends to allay irritation and to abate 
the ignition of the system. Spirituous and vinous liquors 
should be strictly prohibited, as well as animal food in solid 
form." 

Dr. William Buchan, in the twelfth edition of his work on 
medicine, published in London in 1791, in speaking of the 
treatment of consumption (which disease, he says, is seldom 
cured), strongly recommends asses' milk, which he thinks 
would produce extraordinary effects if taken early enough, 
and in sufficiently large quantities. "But," he adds, naively, 
" if it be delayed till an ulcer is f orm«d, which is generally 
the case, how can it be expected to succeed V* 

He next goes on to say : " Some extraordinary cures in 
consumptive cases have been performed by women's milk. 
Could this be obtained in sufficient quantity, we would recom- 
mend it in preference to any other. It is better if the patient 



354 ^'^^ Kew England Medical Gazette, ]^y^ 

can suck it from the breast, than to drink it afterwards. I 
knew a man who was reduced to such a degree of weakness 
in a consumption, as not to be able to turn himself in bed. 
His wife was at that time giving suck, and the child happened 
to die, he sucked her breasts, not with a view to reap any ad- 
vantage from the milk, but to make her easy. Finding him- 
self, however, greatly benefited by it, he continued to suck 
her till he became perfectly well, and is at present a strong 
and healthy man." At this day our comment on this story 
might be, — Haecfabula docet that a kind act may sometimes 
, prove a boomerang. The chapter ends thus: "Before we 
quit this subject, we would earnestly recommend it to all, as 
they wish to avoid consumptions, to take as much exercise 
without doors as they can, to avoid unwholesome air and to 
study sobriety. Consumptions owe their present increase 
not a little to the fashion of sitting up late, eating hot sup- 
pers and spending every evening over a bowl of hot punch or 
other strong liquors. These liquors, when too freely used, 
not only hurt the digestion and spoil the appetite, but heat 
and inflame the blood and set the whole constitution on fire." 

The disease empyema has been known for many years. 
Indeed, even Hippocrates seems to have had about as much 
knowledge of it as anybody down to the- time of the discovery 
of auscultation and percussion, less than a hundred years ago. 
The operation as performed to-day, if done at the right time, 
saves a very large percentage of its victims ; whereas, on ac- 
count of the difficulty of recognizing the disease in 1800, and 
the crudity and bungling of the operation for letting out the 
pus when discovered, empyema was a very fatal disease one 
hundred years ago. So much so that Dr. R. Brookes, in his 
Practice of Physic says that : " Sharp has no good opinion 
of the operation, for he says he has opened several persons, 
who have died of consumption of the lungs from an abscess 
which had consumed a great part of the lungs, and he does 
not remember to have found any pus lodged in the thorax. 

** Besides," continues he. "it is evident that many who die 
consumptive, die of the discharge they spit up from the 



IQOI Chest Diseases in 1800 and in igoo, 355 

lungs, and, therefore, we ought not to undertake any opera- 
tion which promises so little success. There may, I own, be 
abscesses formed between the lungs and the mediastinum 
which may fall into the cavity of the thorax ; but then if the 
pus is small in quantity, it may be absorbed by the lungs 
themselves, and, if there is much, the operation will be of 
little service. Besides, these cases are very rare, and the 
symptoms of pus being fallen upon the diaphragm are very 
equivocal, and, therefore, I think the operation should be 
omitted, though the empyema is supposed to actually exist." 

I have in my library, in the Latin language, Van Swieten's 
Commentaries on the Aphorisms of the great Boerheave, the 
learned Professor of Physics in the University of Leyden, 
published in Paris in five large and handsome octavo volumes, 
the last of which appeared in 1773, the publication of the 
whole extending over five years. This was one of the great 
classics and authoritative for the physicians of the year i8cxd. 

In his essay " Of the Empyema " he says in one place : 
'* But since it is necessary for the said mattfer in the breast to 
be discharged by the paracentesis or incision, if it procures 
not other passages for itself, therefore it is required of the 
physician to know in which side of the thorax the matter 
lies ; the fluctuation or rattling of which in the breast is some- 
times perceived by the patient in turning around in the bed, 
and even sometimes the collision of the matter is audible to 
those who attend the patient. 

"For determining this point, therefore, Hippocrates orders 
the patient to be set fast in a chair ; that while one holds his 
arms, the physician may shake him and, at the same time, 
hearken, with his ear near to the side, in order to perceive 
the collision or rattling of the matter collected in either 
cavity of the breast. But then he also intimates, at the same 
time, that the great thickness or excessive quantity of matter 
may sometimes hinder any rattling of the matter from being 
heard, when the breast is yet full of matter. . . When a 
great rattling or noise of the matter is perceivable upon shak- 
ing the shoulders of those who have an empyema of broken 



356 The New England Medical Gazette, July, 

suppuration in their breast, the quantity of said matter is less 
than in those in whom it makes but little noise or fluctuation, 
if, at the same time, they have also a more flushed color of 
their countenance. But in such as have no rattling of the 
matter, but only a violent difficulty of the breathing, with a 
livid color of their nails, these are quite filled with matter and 
in a deplorable condition." 

What a contrast to the modern methods of diagnosis, and 
how they did allow the golden opportunity for a successful 
operation to slip by ! 

A few years ago a man in Canada, having a worthless eye, 
was advised to have it enucleated ;^ but the operating oculist, 
when the patient was anaesthetised, carelessly removed the 
wrong eye. Our author, perhaps having a similar catostrophe 
in view, goes on to say how it may be avoided in empyema : 
" But since it is of such importance to the physician to know 
for certain in which side of the thorax the matter is contained, 
Hippocrates has, therefore, made it his business to collect to- 
gether all the signs, and has attempted the practice of diverse 
artifices by which a firm or sure diagnosis might be obtained. 
Accordingly, he observes that the side of the thorax which 
contains any considerable quantity of matter, so as often to 
yield no rattling noise from the fulness, does thence appear 
more enlarged or swelled than the other opposite side, which 
is a circumstance confirmed after him by the observations of 
modern surgeons." 

The most curious diagnostic proceedure is this : " But be- 
cause" the affected side grows hotter than the other, therefore 
he advises the whole thorax to be wrapped up in thin linen 
that has been dipped in liquid bole or red earth, dissolved and 
rendered very fine and thin by trituration, and then directs 
the incision or cauterization to be made in the place that ap- 
pears the soonest dry ; or else he likewise advises the whole 
naked chest to be anointed with the like red liquid, that the 
place may appear where it is soonest dried up. But then he 
prudently cautions that in this case several hands must be 
employed to anoint the breast all over at once or in an instant, 



I90I Sun Baths, 357 

otherwise a mistake might arise from the part which was first 
wetted appearing sooner dry than the rest." 

Later he says that where it is not quite evident just where 
the seat of the vomica is, some physicians are accustomed to 
cauterize several outward parts of the thorax, thinking that 
some one will hit the case, or to apply emollient poultices 
with or without first cutting the skin, hoping to entice the 
matter out at one of these spots after a while. 

Much more of interest might be quoted from these old 
books, but perhaps this will suffice. 



HoMCEOPArHS Successful. — Every applicant for a license 
to practice homoeopathy in the District of Columbia, during 
the past year, was accepted,— Afedica/ Arena. 

Nephrectomy for Floating Kidney. — In some in- 
stances of floating kidney nephrectomy is indicated. This 
is only where tubercular infection, marked degeneration from 
renal calculus, or the presence of malignant disease is dis- 
covered. Under no other circumstances, save with the pos- 
sible exception of cases in which the ureter has become 
obstructed and hydronephrosis has developed, is it warrant- 
able to remove the kidney. — 5/. Louts Medical and Surgical 
Review, 

Sun Baths for Tuberculous Joints. — Some French 
authors recommend local sun baths for tuberculous joints. 
De Millioz, of Lyons, has the patient recline on a couch in a 
sunny spot of a garden in suitable weather and under a sky- 
light or in a window where several hours' exposure to the 
sun's rays can be obtained. The diseased joint is freely 
exposed and afterwards covered with wool and firmly band- 
aged. He claims rather remarkable results in the early 
stages, and decide^ improvement in the suppura,ting cases. — 
Exchange, 



358 The New England Medical Gazette. July, 



EDITORIAL. 

Contributions of original articles, correspondence, etc., should be sent to the publishers, Otis 
Clapp & Son, Boston, Mass. Articles accepted with the understanding that they appear only in 
the Gaattt*. They should be typewritten if possible. To obtain insertion the following month, 
reports of societies and personal items mutt de rectivtd by tke isth 0ft1u month prtctding. 



Dr. Max Pettenkoper. 



To those among us who find themselves unable to accept 
without question all the claims of dogmatic bacteriologists, 
the life and labors of Prof. Pettenkoper, whose death occurred 
last month in Munich, cannot be other than a subject of 
deepest interest, and should not be allowed to pass without a 
word of appreciation. 

Although not a practicing physician few among his con- 
temporaries in the profession have influenced more profound- 
ly both the theory and practice of medicine. The first he 
influenced in a marked degree by his methods of investiga- 
tion; the second, by the results of these methods, for it is 
not too much to claim that they have laid the firm foundation 
for what we now know is modern sanitary science. How 
great and far-reaching his work in this field has been is shown 
by the fact that to-day this science is not only that of the 
prevention of disease by the removal of available causes, but 
also — and this is especially to be borne in mind — the science 
of enhancing that vital energy within the individual organism 
by means of which it is enabled both to resist the inroads of 
disease and to insure the most perfect activity in its struggle 
for exactness. As yet, it is true, the practical appreciation 
of the results of his labors is far from perfect and universal, 
but at the end of his long and laborious life Pettenkoper 
could look back on the accomplishment of all that it was pos- 
sible for a single individual to achieve in this direction. 



I90I Editorial, 359 

Bom in 181 8, he took his medical degree at the age of 
twenty-five in Munich, where he then devoted himself under 
Leberer, and, later, under Liebig, to the special study of 
physiological chemistry. After having occupied the position 
of assayer to the mint for a short time — a position he accept- 
ed in part to secure the means of subsistence and in part to 
perfect himself in the methods of exact chemical experimenta- 
tion — ^he was cabled by his university to assist the chair of 
dietetic chemistry, a subject which led him directly to the 
systematic study of hygiene. In 1853 he was promoted to a 
full professorship in this branch, which he at once strove to 
raise and expand to that of hygienic science. In this he 
finally succeeded in 1865 ; but it was not until 1875 that the 
first Hygienic Institute was founded under his initiation and 
direction. He remained at its head until 1 894, when he re- 
tired, full of years and honors, from active work. 

Throughout all his long and laborious career as investiga- 
tor and teacher he had set himself the task of studying in all 
directions and by the strictest methods all those physical and 
chemical factors of the conditions of life which constitute the 
environment of the human organism in its collection, as well 
as its individual aspects. Above all others, his attention was 
directed to the influence of dwellings and food on the growth, 
development and working capacity of the human body. In 
regard to the first it may be said that he and his followers 
have succeeded in establishing data of the utmost practical 
consequence. The questions of the Vitiation of air by respi- 
ration and by the various occupations carried on in enclosed 
spaces, of ventilation, heating, lighting, etc., have been 
studied and in no small measure answered by his methods of 
direct experimental inquiry. In the same way the allied 
questions of converting the humidity of walls, cellars, floors 
and air-spaces, porous ventilation, the penetratioli of gases of 
the soil into houses, the character and origin of these gases, 
and many other matters of like interest and importance, were 
brought to definite conclusions in regard their bearing on 



360 The New England Medical Gazette, July, 

health, and the possibility of remedying their injurious effects. 
The knowledge of all these subjects, which now place it 
easily within the reach of the practical builder to meet the 
requirements of scientific sanitary construction, was but 
vaguely held or wholly neglected until fully elaborated by 
him and his pupils. 

When we now look complacently on the Hygienic Institute 
everywhere flourishing and speak glibly of the modem de- 
mands of hospital, tenement, office and other buildings de- 
signed for the use of a great number of inmates, we are too 
apt to forget the endless labor, care and thought bestowed on 
these subjects by Max von Pettenkoper and those in all 
countries whom he inspired to follow in the paths he first 
pointed out. Walter Wesselhoeft. 



Acute Pericarditis. — Primary rheumatic affections of 
the pericardium were formerly thought to be idiopathic ; 
Foureur and Banti, however, have found streptococci and 
pneumococci in such cases. There is, however, no specific 
bacterium that can be regarded as the sole cause of peri- 
carditis. — Exchange. 

Treatment of Chronic Prostatitis. — Chronic prosta- 
titis and chronic seminal vesiculitis, unless of very long 
standing, will be much benefited by hot rectal irrigations. 
In addition they call for massage by means of the finger 
introduced into the rectum. The irrigations may be prac- 
ticed every day at first and later every three or four days 
according to indications. The digital massage, however, 
should not be repeated oftener than once in five to seven 
days and should be discontinued altogether for a time if it 
aggravate rather than relieve the condition. Such an aggra- 
vation would mean that the inflammatory process in the 
organs was too acute as yet to admit of massage. — Medical 
Times. 



1 90 1 Societies, 361 



SOCIETY REPORTS. 



BOSTON HOMOEOPATHIC MEDICAL SOCIETY. 

BUSINESS SESSION. 

The regular meeting of the Boston Homoeopathic Medical 
Society was held at the Boston University School of Medicine 
Thursday evening May 2, 190 1, at eight o'clock, the President, 
T. Morris Strong, M. D., in the chair. 

The records of meetings held in April were read and 
accepted. 

Charles W. Bush, M. D., 103 Court St., Newtonville, Mass., 
was proposed for membership. 

Robert W. Southgate, M. D., W. H. Watters, M. D., and 
Alice H. Bassett, M. D., all of Boston, were elected to mem- 
bership. 

Voted : To postpone the June meeting one week, because 
of Commencement. 

report of the 
Section of Pathology and Therapeutics. 

M. W. Tuknbk, M. D. Chairman. 
S. C. FuLLBR, M. D., Secretary. Anna B. Davis, M. D., Treasurer. 

The President appointed the following committee to nomi- 
nate sectional officers for the ensuing year: Drs. C. H. 
Thomas, F. W. Colburn and Ellen H. Gay. The committee 
reported as follows : Chairman, S, C. Fuller, M. D. ; Secre- 
tary, Thos. R. Griffith, M. D. ; Treasurer, W. B. French, M. D., 
who were duly elected. 

PROGRAMME. 

1. "Jamaica as a Health Resort." Anna B. Davis, M. D. 
Discussion opened by Dr. Frank Albert Davis. 

2. " Report of a Case of Small-Pox." Henry H. Amsden, 
M. D. Discussion opened by Dr. Conrad Wesselhoeft. 



362 The New England Medical Gazette. July, 

3. " Report of Medical Cases Treated at the Massachusetts 
Homceopathic Hospital from January i to April i, 1901." 
Services of J. P. Sutherland, M.D., Edward E. Allen, M.D. 
Discussion opened by F. B. Percy, M. D. 

4. "Some Experiences with the Plague." William H. 
Watters, M. D. Discussion opened by Dr. John P. Suther- 
land. 

I. Dr. Anna B. Davis gave an attractive description of 
the Island of Jamaica, and considers it an ideal resort for 
certain classes of invalids. Exercise should be taken early in 
the morning and after three o'clock in the afternoon. There 
is an abundance of fish, vegetables and fruits. The water is 
efficacious in gout, rheumatism and kidney diseases ; also dys- 
pepsia and liver troubles. Visitors should avoid the dew in 
the morning and sun at noon. One-sixth of the native popu- 
lation die of old age ; tuberculosis comes third, and diarrhoeal 
diseases are not common. Nervous patients derive the most 
benefit. The cure of insomnia is almost marvellous. Cases 
of malaria and tuberculosis should remain at home. 

Dr. Frank A. Davis : There is very little that I can say in 
discussing this paper that will add interest to it. I can sim- 
ply say that, from my knowledge in visiting Jamaica, I endorse 
every word in the paper. It can be well called the garden of 
the tropics, the land of perpetual summer and eternal beauty. 
It is 1,600 miles from Boston, and the passage takes about 
five days. Many people are very sick on the way ; and that 
is not peculiar, because, as has already been said, most of the 
passengers are those who seek Jamaica for their health. One 
of the Bahama Islands is passed on the way, and for half a 
day the steamer runs along the coast of Cuba. On landing, 
one sees groups of natives, who seem to have nothing to do 
but to laugh and be happy. The temperature is rarely above 
90*^, usually from 78^ to 81*^. The roads, which are kept in 
repair by the natives, are unsurpassed by any in the world. 
The hospitals consist of one story, with open doors and win- 
dows, and patients can be seen stretched on their cots, mostly 
old people and paupers. I went to Jamaica myself for my 



IQOI Societies, 363 

health. I broke down during my college course, and tried 
various expedients in Boston, growing worse. I was gone 
three or four weeks, and came back well. Twelve invalids 
were on the same boat. Jamaica is an excellent place for 
tired business men. Last year I sent a young lady there who 
had been very sick with insomnia and loss of appetite. She 
slept most of the time in Jamaica, and can)e back absolutely 
well. Another case went to Jamaica under my direction, a 
man occupying a very prominent position, who was overworked 
and had been rejected by several insurance companies because 
of sugar in the urine ; he was also troubled with insomnia. 
The first night out he slept and every night thereafter. In 
four weeks was entirely recovered. Upon his return one of 
the insurance companies, who had previously rejected him, 
gave him a policy for i! 10,000. 

In visiting Jamaica the things to be avoided are : alcohol, 
wet clothing and the mid-day sun. 

If any physician is tired out and wants to rest, there is no 
better place than Jamaica. If he has any patients with ner- 
vous troubles he should send them to Jamaica. 

Dr. J. T. Sherman : I quite agree with all that has been 
said about that beautiful place, Jamaica. I had, on one occa- 
sion of my visit, a long talk with an English naval captain, ' 
who had been all over the world, and he knew of no more 
beautiful place than this. 

One point I would call attention to. I would advise inva- 
lids visiting the Island not to go during the rainy season. 
Late in November or last of January is the best time. Dr. 
Davis spoke of abstaining from alcohol while there. I saw 
more cases of delirium tremens than ever before. All use of 
alcohol should be avoided. Some people seem to think they 
must take alcohol upon arrival, but it is a great mistake. 
Cases of alcoholism would lie in a comatose condition a day 
or more before the excited stage came on. One of the physi- 
cians there said it was very dangerous to take the vile stuff. 
I think the voyage has a great deal to do with the benefit 
derived. From July to October you are liable to strike a 



364 . The New England Medical Gazette, July, 

hurricane, but from the first of November to the first of July 
there is absolutely no danger, and the only thing encountered 
will be an occasional shower. I should certainly recommend 
it for neurasthenics. The climate far surpasses that of Flo- 
rida, which is so humid it is oppressive, and the air from the 
Everglades is malarial. On the north side of the Island you 
get the north-east trade winds in summer, and in December 
the sun. At Kingston, the last time I was there, the thermo- 
meter was 100^, and suffering more from heat than before, I 
returned to Port Antonio, where the nights are usually cool, 
and no particular change in the temperature at any time. 
The Island itself is beautiful ; flowers and maiden-hair ferns 
grow in profusion ; one mountain is covered with the fern. 
I think fruits should bd avoided. If a patient will be careful 
and keep out of the sun during the middle of the day and the 
dew in the morning, taking off clothing as soon as damp, no 
harm will result, 

2. Dr. H. H. Amsden's paper reporting a case of small- 
pox cured with tartar emetic, was listened to with marked 
attention ; and the discussion which followed was full of pro- 
fit, especially to the younger members present. 

Dr. Conrad Wesselhoeft : In discussing this paper it is not 
my object to criticize it, but, if possible, to add some experi- 
ences of my own, I have not read up much upon it for some 
time. I ought, perhaps, to have done so, but will give you 
some of my own limited experience A physician may go 
through several epidemical attacks of small-pox and see sev- 
eral cases without getting much real experience of the disease. 
This has been my case. I can remember four distinct epi- 
demics. My first experience was in the '50s, when I saw two 
or three cases, which I remember very distinctly. One case 
was in a family in Dorchester, a young lady. The eruption 
was slight, and certainly had not arrived at the point of pus- 
tulation when I left the case one day, and the next day the 
patient died. It was quite a shock, as there was every sign 
of early recovery. That is all I can say about that case. 
Very soon after that I saw another case, a child about four 



I90I Societies, 365 

years old, in an Irish tenement, who had the disease very 
marked. It had passed from the vesicular stage to that of 
pustulation ; but in none did I discover umbilication. I know 
that point was impressed upon my mind. The child recov- 
ered in a short time. The vesicles dried and the child was 
well. I do not remember how long the convalescence lasted, 
but it recovered very soon. During the Civil War, some 
time in the '60s, I saw several cases ; I do not know how 
many — not a great many. One was extremely severe. It 
was termed confluent small-pox where the vesicles canie out 
first very close together, and the pustules were as close to- 
gether as cells in honeycomb. Another case was that of a 
woman about fifty years old, who was fleshy, which made the 
case all the worse. I went two or three times a day to dress 
the case. Once the pustules broke, and the pus went all 
over everything, — over the bed, over my hands, and I expected 
in fourteen days to have the disease, but did not. The patient 
went out of my hands, and died about a week later. 

In '72-73, when we had quite a flurry of small-pox cases, I 
had several cases (ten or twelve) which were all mild and 
distinctly diarrhceal. Now about the distinction between the 
cases of varioloid. There may be cases of varioloid which 
are really small-pox, but much milder than cases of chicken 
pox. The child with the marked vesicles, without pustula- 
tion, was a violent case of chicken pox. 

Another case : that of a young lady. She had some fever. 
I advised her to stay at home, as she had a pimple on her fore- 
head, though I was not sure it was small-pox. She went to a 
dancing party,'and my first observation was the pimple; it 
had developed into an umbilicated vesicle. I took her aside 
and advised her to go home. The distinction is that in . 
varioloid very few of the vesicles reach the stage of umbilica- 
tion, while in the genuine, or more violent, the umbilicated 
vesicles are always in the majority This is the distinction 
between the two diseases as far as I am able to make it. The 
distinction between the different forms of this disease and 
scarlet fever is very easy, but not so with measles. When 



366 The New England Medical Gazette, July, 

they first break out, it is very difficult to say what they are 
going to be, when there is headache and fever. Infants have 
the measles lightly, but with older people the eruption 
appears slowly, and the disease is apt to be severe. If an 
isolated case, it is better to reserve judgment until it is known 
what shape the primary pimples are going to take. 

Now with regard to the treatment of these cases I have 
very little to say. The greatest caution should be used to 
keep patients quaranteed. Bathe with soap and water, adding, 
perhaps, a little soda, and the utensils should be very care- 
fully destroyed. In olden times this did not receive much 
attention. Sterilized gauze and cotton should be burned after 
using. Perhaps the use of a little vaseline, or any other 
greasy substance on the parts, will prevent the spread of dis- 
ease. Premonitory symptoms are sometimes the most violent 
of all, and you think the patient is going to have some violent 
disease, whether typhoid fever or small-pox it is often difficult 
to say. One case I had where the symptoms were most dis- 
tressingly violent. ' The patient was unconscions and deleri- 
ous ; at last little pimples appeared in very small number, not 
more than half a dozen, overall the body. They went through 
^he course very lightly, dried up and dropped off, without 
leaving any scars. You would have supposed the patient was 
going to have some fatal disease. Unfortunately, it is impos- 
sible always to say as to remedies. I shall mention only one 
or two. Aconite and veratrum viride are certainly very ex- 
cellent in premonitory stages of the disease. In the second- 
ary fever stage, especially at the time of pustulation, it seemed 
to me, if I can call it experience, rhus was the best indicated. 
The appearance of small-pox is allied to that of erysipelas. I 
cannot now remember whether I had any striking results. I 
have seen no death, except what I have mentioned. When 
the pustular stage is distinctly developed, I have used tartar 
emetic in the third trituration, with the result that the pus- 
tules would dry up before their time and would not run the 
course that they would in other cases. 

Dr. Sutherland: I would like to ask when patient's hus- 
band was vaccinated } 



igoi Societies, 367 

Dr. Arasden : He was vaccinated about the third djy of 
the disease. 

Dr. Clapp : That was the work we tried to do in the epi- 
demic of '72. It was done successfully. It was a race be- 
tween the germs of the disease and the germs of the virus, 
which should get there first. At that time nothing else was 
talked about, the papers were full of it, and it was the talk of 
the town. I saw a good many cases, I think there were at 
least fifty, not only my own cases, but those I saw with older 
physicians. I was enthusiastic and anxious to see as many 
as possible for the experience. My ardor ought to have been 
tempered by the recollection that the disease is, as a rule, an 
extremely nasty one ; that is the only expression that occurs 
'to my mind, especially as there were many severe cases at 
that time. Nevertheless, I had no personal fear, because I 
had supreme faith in vaccination. One thing was demon- 
strated : that vaccination protects, but not unless it saturates 
the system. 

Dr. Amsden : With what did you vaccinate } 

Dr. Clapp : From arm to arm, — from a healthy child. 

Dr. Chase : Did you not use ivory points } 

Dr. Clapp : Ivory points came in before. I never saw a 
case of transmission of disease from one child to another, and 
yet upon that Dr. Martin depended for the sale of his virus. 

Dr. Sherman : In the winter of '73 I had charge of the 
small-pox, hospital. There were four thousand vaccinations 
made under my directions, when I took patients out of houses 
if I could vaccinate the occupants within seventy-two hours. 
If not, it would not protect them. 

As to the question of what form of virus was used. I used 
Dr. Martin's virus. I also got some virus from abroad. It 
came in small tubes. I got very good results, though not 
always as rapidly as the other in taking. It would be five or 
six days before it would show. 

The question of the early diagnosis of small-pox is a serious 
one, and one we ought to meet. A case of small-pox, if not 
under vaccination, will run a much more rapid course than 



\ 



368 TAe New England Medical Gazette, July, 

any other eruptive disease. The only way to distinguish is 
to take a group of eruptions on the face, or chest, or back. 
Individual groups will have every stage of the eruption. If 
you have a doubtful case, I can give you good advice from my 
own experience. When I had charge of the small-pox hospi- 
tal I received the kindest treatment from the old school 
physicians. . When they had a doubtful case they sent for 
me, and left it to me to decide, because, they said, if they 
made a mistake every one would be down on them, but the 
town was back of me. I advise you to call the Health Officer 
and let him do the deciding. 

Dr. Piper : I would like to know what the experience with 
glycerine lymph has been. It has not been as satisfactory to 
me as that made here in Chelsea. I had a much larger per-' 
centage of failures with the glycerine lymph than I formerly 
had with the lymph from Chelsea. 

Dr. Chase : The only difference, I think, is the Chelsea 
lymph would have a larger percentage of takes. I have used 
the glycerine lymph, but I have had no serious trouble follow- 
ing its use. In the other form I have had quite a number of 
cases of lymphangitis following, so I think it the safest thing 
to use. 

Dr. Amsden : I had occasion to vaccinate with Mulford's 
lymph in the tube, but with excellent results. When using 
the point the virus is carried a little further into the system. 
I use a needle only to scarify with. 

Regarding remedy : I was guided by the bronchial symp- 
toms of tartar emetic. As I stated in my paper, I do not 
think it is wise to draw conclusions from a single case. The 
husband of my patient was attended by a physician two 
weeks before the wife came down. The physician also came 
down with varioloid. The husband, with a broken rib, was 
more susceptible to small-pox. In this case the period of in- 
cubation had elapsed. It was of some interest to me in my 
explanation of the case. 

3. Dr. Allen's paper covering report of cases treated at 
the hospital from Jan. ist to Apr. ist, 1901, brought out sev- 



1901 Societies. 369 

eral interesting points in the treatment of pneumonia and 
typhoid fever. 

Dr. Thomas: I do not think I can say anything in addi- 
tion to what Dr. Allen has said. It was very gratifying that 
the cases of typhoid fever responded to treatment so well. 
The case of the school teacher was the worst cases I ever 
saw. She raised clear blood, which was controlled by oxygen. 
In regard to the boy ill with acute nephritis I have seen him 
several times since his discharge, and he is entirely well. Dr. 
Allen has covered the cases very well, and the charts and 
pathological specimens will speak for themselves. 

Dr. Piper : I would like to ask if saline solution is given 
in the hospital in pneumonia } 

Dr. Allen : Not since I have been connected with the 
hospital. 

Dr. Sutherland : I have never used it m pneumonia, but 
have given it subcutaneously for hemorrhage in typhoid fever 
with most gratifying results. 

I want to say in regard to the service reported, that it was 
rendered chiefly by Drs. Thomas and Allen, which was 
omitted from the paper, but it seems a fair thing to mention 
it at this time. 

4. Dr. W. H. Watters read the next paper on "Some Ex- 
periences with the Plague," and it was a very interesting 
account of his work abroad during the summer of 1900, in the 
laboratories at Glasgow. 

Dr. Sutherland: I do not know just why I accepted an 
invitation to discuss the paper. I knew nothing about the 
plague forty-eight hours ago, except what I saw in the paper 
last summer, but I think my chief object was to look up the 
subject, so I should not remain ignorant. It is possible for 
the disease to progress in a very short time ; and it is the 
deadliest of all diseases. Upon looking into the matter I 
found only a very meagre account, and almost nothing re- 
garding the etiology. I obtained possession of a little pamph- 
let on the disease, and I was surprised to find the difficulty 
that attends the diagnosis. I was surprised that enlarged 



370 The New England Medical Gazette. July, 

glands are not all necessary. Sometimes it simulates typhoid 
fever or takes a diarrhoeal form. There are various types of 
the disease. A case of typhoid fever, where there is a pecu- 
liar septic condition and the patient has come from a distant 
country, requires unusual care. If tjiere are so many types, 
there can not be only one or two remedies. I think I am, 
perhaps, as much at sea here as before. If a case, from the 
symptoms, looks like typhoid fever, treat it as typhoid ; if 
cholera, as cholera. With our improved sanitary conditions 
the disease ought not to be as fatal as in the past. 

Dr. S, C. Fuller exhibited the following pathological speci- 
mens : 

1. Specimens showing secondary carcinoma of mesenteric 
lymph glands. 

2. A dilated heart, showing endocarditis and degeneration 
of the myocardium. 

3. A large splenic tumor. 

4. Chronic trichinosis of the intercostal and pectoral 
muscles, the structures being studded with hundreds of en- 
cysted parasites. 

Adjourned at 10:25. 

Edward E. Allen, 

Secretary, 



WORCESTER COUNTY MEDICAL SOCIETY. 

The regular quarterly meeting of the Worcester County 
Homoeopathic Medical Society was held at Worcester, 
Wednesday, May 8, 1901. The meeting was called to order 
at 10 A. M., with President Luscombe in the chair. 

The records of the preceding meeting were read and 
approved. Drs. J. L. Bacon, of Westboro, and Alice E. 
Rowe, of Springfield, were elected to membership. The 
name of Dr. Burleigh Parkhurst, of Clinton, was referred to 
the board of censors. 

Dr. John F. Worcester, of Dorchester, was appointed dele- 



igoi Societies, 371 

gate to meeting of the American Institute of Homoeopathy, 
with Dr. J, P. Rand, of Monson, substitute. 

Drs. Luscombe, Rockwell and Nichols were appointed a 
a committee to take charge of the library of the society, and 
to superintend its removal to a new location when necessary. 

The following motion, made by E. B. Miller, M. D., was 
carried by a unanimous vote : 

Moved, that at each meeting of the society, a brief re- 
sum6 of the literature of the proceeding year on the subject, 
or subjects under discussion at that meeting, be presented by 
one or more members of the bureau reporting. Such mem- 
bers to be appointed by the chairman of the different bureaus 
as early in the year as practical. 

The society was invited to hold its mid-summer meeting at 
Fitchburg, by the president of the society, Dr. Luscombe, 
which invitation was accepted and a vote of thanks extended 
to Dr. Luscombe. 

Following the business session, the bureau of Neurology, 
Dermatology and Diseases of the Nervous System, reported 
the following papers. Dr. F. P. Glazier, chairman, was un- 
avoidably detained, and Dr. Ellen L. Keith, of Framingham, 
was appointed to take charge of the meeting. 

1. *• Thyroid feeding in Insanity." Dr. George S. Adams. 

2. "What can we do for the Consumptive." Dr. A. M. 
Gushing. 

Dr. Adams' paper embodied his experience \yith the use of 
thyroid extract, in cases of myxodema with marked mental 
symptoms, at the Westboro Hospital. He had found it of 
great value in this condition, and cited several cases where 
he had used it with marked success. 

Dr, Cushing's paper dealt with the modern methods of the 
treatment of tuberculosis, and he spoke particularly of the 
use of different oils and balsams by absorption and inhalation. 

These papers were topics for general discussion. 

Dinner was served at the Newton at i p. m. 

F. R. Warren, M. D., Secretary . 



372 The New England Medical Gazette, July, 

PERSONAL AND NEWS ITEMS. 



Dr. John McE. Wetraore has removed from 41 East 29th 
Street to 43 West 54th Street, New York City. Telephone, 
48s3-38th Street 

Dr. Frederick W. Payne, of Steinert Hall Building, Boston, 
will spend the summer in Europe, returning the last of 
August. 

We have just received word of the death of Dr. Byron D. 
Spencer, of Bangor, formerly of Rockland, Me. 

Dr, G N. TowLE, class of '90, B. U. S. of M., formerly 
located at Bucksport, Maine, has taken the practice of the 
late Dr. S. Stuart Webb, of Houlton, Maine. 



REVIEW. 

"King's American Dispensatory." New edition. En- 
tirely rewritten and enlarged, by Harvey W. Felter, M.D., 
Adjunct Professor of Chemistry in the Eclectic Medical In- 
stitute, Cincinnati, O., and John Uri Lloyd, Ph.M., Professor 
of Chemistry and Pharmacy in the Eclectic Medical Institute, 
Cincinnati, O. Two volume Edition, royal octavo, contain- 
ing together 2,284 pages, including complete indices. Cloth, 
$4.50 per volume, post paid^ Sheep, $5.00 per volume, 
post paid. The Ohio Valley Company, Publishers, Cin- 
cinnati, O. 

The issue of volume II completes this excellent work, the 
first volume of which was issued in 1898. It combines 
many valuable features and is probably the most complete 
work of its kind in existence. Much of the subject matter 
has been entirely rewritten besides which, a vast amount of 
new material has been added. An acceptable feature to 
homoeopathic practitioners is to be found in the mention of 
many homoeopathic remedies and their recommendation in 
the form of triturations. The work contains a large number 
of very good illustrations, and the subject matter is treated 
in considerable detail. It is full of information and should 
constitute an acceptable work of reference to every physi- 
cian of whatever school. 



THE NEW ENGLAND 

MEDICAL GAZETTE 

No. a AUGUST, 1901. Vol. XXXVI. 

COMMUNICATIONS. 



THE 5URQICAL TREATMENT OF TUBERCULAR JOINT 

DI5EA5E. 

BY GRORGE W. ROBERTS, M.I)., NEW YORK. 
[Read before the Mast. Surgical and Gynecological Society, June, 1901.] 

Had the authpr something new and striking to offer, purely 
upon treatment, it might be excusable to delve at once into 
the subject with no word upon preliminaries ; but as it is, 
with no great advances to report, no new remedy or opera- 
tion to describe, we are obliged to deal with facts, and it 
would be a grave omission were we to fail in calling attention 
to the great importance of early diagnosis in its bearing upon 
the successful surgical treatment of tubercular joint disease. 
It would, of course, be futile to attempt in a short paper the 
discussion of particular lesions, except incidentally, and, 
therefore, it is the general subject which will command our 
attention. 

Strictly speaking, "joint tuberculosis " does not in the be- 
ginning have to do with the joint except in rare instances. 
In nearly all cases it begins as a tubercular osteitis in the 
epiphysis, and in an appreciable number of cases it ends 
without ever involving the joint structures themselves. 



374 The New England Medical Gazette, Aug., 

Tubercular synovitis, tubercular chondritis and tubercular 
osteitis beginning at the very end of the epiphysis are at least 
rare. The vast majority of tubercular joint lesions begin an 
appreciable distance from the joint itself, produce recogniz- 
able symptoms before they reach the joint, and are quite 
amenable to operative treatment before that time. When the 
process has involved the joint we do not believe it possible to 
avoid in more than a very small percentage of cases serious 
limitation of motion, and only too frequently there is com- 
plete destruction of the joint. It, therefore, needs no extend- 
ed argument to convince one that early diagnosis is essentially 
a part of surgical treatment. 

It is a fact, however, that by far the larger percentage of 
cases find their way to the physician and surgeon only after 
that precious prodromal stage has passed, and, therefore, we 
are to divide tubercular joints into two grand classes, /. e,, — 
(i) Those in which the disease is still — speaking strictly — 
extra articular, and (2) those in which the synovial mem- 
brane was affected from the beginning, or has become in- 
volved later in the progress of the disease. 

This classification differs somewhat from that usually fol- 
lowed by the text-books ; it is by no means complete, and is 
suggested merely in order to facilitate the discussion of sur- 
gical treatment. The distinction is not as important with 
some joints as with others, but in general it is clear, and often 
it is all-important. This applies particularly to the knee and 
shoulder, for here the distance from the starting point of the 
epiphyseal focus to the joint surface is often so great that 
extensive operative procedures can be executed without the 
least danger of seriously affecting the joint mechanism. 
The same statement applies to occasional cases of tuberculo- 
sis at the elbow — beginning in the lower end of the humerus. 
In this class of cases it is usual to find marked epiphyseal en- 
largement with muscular atrophy, spasm and flexion deform- 
ity, with absence of joint effusion and swelling of the synovial 
membrane. 



190 1 Treatment of Tubercular Joint Disease. 375 

In our judgment early extra-articular incision, followed or 
rather accompanied by the free use of the trephine, drill and 
Volkmann's spoon for removal of the osteitic focus by an extra 
articular route, is not only justifiable, but is an eminently 
conservative operation. It is to be chosen in preference to 
any form of medical or even mechanical treatment under the 
circumstances described. 

The older the patient the more forcibly does this apply, 
and in the adult one cannot doubt that a very large propor- 
tion of cases can be diagnosed early enough, and saved 
months of suffering and serious deformity by this means. In 
childhood, when most of the tubercular bone lesions occur, 
the progress of the so-called bone abscess toward the joint 
is far more rapid, since there is more cancellous structure 
present and correspondingly less of the resisting mineral 
matter. But even in children, especially in knee-joint tuber- 
culosis, it is not at all infrequent to see nature herself pursue 
this course, i, e. — the tubercular focus enlarging in all direc- 
tions finds an opening through the compact bony tissue at an 
extra-articular point, the periosteum gives way and finally the 
abscess presents at the surface, leaving the joint not at all, or 
only slightly, damaged. 

Whether mechanical treatment can have a very direct in- 
fluence upon these cases is to our mind a fairly debatable 
point, and we confess that the explanation of such influence 
is quite beyond us. 

However, protective apparatus can never be injurious to 
these patients, and, while our experience has never shown its 
advantage, we must admit that the inference would be a hard 
one to draw. 

The second class of cases, those in which the lesion invol- 
ves the joint itself, either having begun in the synovial mem- 
brane, or having extended from the epiphysis to the joint 
cavity, presents an entirely different clinical picture, in addi- 
tion to muscular spasm and atrophy, the cardinal symptoms 
of joint or epiphyseal tuberculosis — we find in case of the 



376 The New England Medical Gazette. Aug., 

superficial joints the diffuse, fusiform enlargement, which in 
addition to the other symptoms almost always portends 
chronicity and ultimate serious impairment of function. No 
class of surgical cases is as trying to the surgeon's time and 
patience, — you may spell the word both ways. If he is to 
be adequately paid for his services the patient's pocket-book 
must also suffer, but — Ah ! How frequently are these cases 
among the dispensary class, and how rarely among the opu- 
lent. And this circumstance has a direct bearing upon the 
prognosis, for hbwever altruistic the surgeon there soon comes 
a limit to his possible accomplishment, unless generous means 
are at his disposal. In the vast majority of such cases it is 
absolutely useless to start with any method of treatment 
without impressing upon the patient, parents or guardian the 
extremely chronic condition of this disease, the fact that in 
order to accomplish even a tolerably good result, months and 
years, rather than weeks, of care will be necessary. 

In the Laura Franklin Free Hospital for Children, where 
we always have a large sprinkling of these cases, we find that 
a generous proportion of them have been ** cured " at one 
time or another, according to the parents' story, and we must 
confess that parents, particularly of the poorer classes, can 
hardly be blamed for failing to see necessity of such prolonged 
treatment as is often necessary in order to save a joint which 
has become tubercular. 

The surgical treatment of these cases is both mechanical 
and operative. Considering the mechanical side first we are 
at once confronted by a score of opinions and theories which 
are more or less antagonistic in their details, but, at the same 
time, the general principles underlying all are annually becom- 
ing better defined, and perhaps we may be pardoned for confin- 
ing ourselves to the main features, rather than entering into 
details which would necessitate intolerable prolixity. 

We firmly believe that mobility of the limb, together with 
the constant increased intra-articular pressure engendered by 
muscular spasm, are the greatest auxilliary factors in de- 



IQOI Treatment of Tubercular Joint Disease. 377 

struction of the joint and in aggravation of the tubercular 
process. Both fixation and extension are therefore indicated 
if we would minimize the damage and place the limb in the 
best possible condition for recovery. The theory that fixation 
of a tuberculous joint tends to its ankylosis is quite exploded 
in our opinion. 

The question before the orthopoedist is not " whether to 
fix and extend/' but " how to fix and extend." Unfortunate- 
ly, perfect fixation and perfect extension are each quite im- 
possible, and we must therefore be content, even in the most 
favorably located joints, with as good approximation of these 
two conditions as circumstances will permit. In some joints, 
notably the ankle and those of the upper extremity, extension 
is quite out of the question, but here Nature has been kind 
to us, in that in each instance we are dealing with a joint in 
which the disease is never as serious as in the knee or hip, 
and the result of simple fixation and non-use is quite satisfac- 
tory. 

In tuberculosis of the hip we are in the habit of using the 
Phelps method, which consists, briefly, in first placing the 
child in bed, and having fixed the body and well leg in plas- 
ter of Paris, extending the leg with the weight and pulley, in 
the line of the existant deformity. 

As soon as complete relaxation of the muscular spasm has 
been attained (three to eight weeks), we apply the long 
Phelps' splint, which provides both traction and fixation. 
When the knee is affected, the Thomas knee brace is preced- 
ed by fixation with plaster of Paris, and, in the more aggra- 
vated cases by traction. 

One of the most important and, unfortunately, frequently 
neglected points in the use of traction is that, as its object is 
the diminution of intra-articular pressure, it must be executed 
in the line of deformity. 

Frequently physicians, carrying in mind the fact that 
their object is to straighten the limb, pull it toward the 
straight line. In the more pronounced angular deformities 



378 The New England Medical Gazette, Aug., 

this result is an increase instead of diminution of intra-artic- 
ular pressure, for the reason that the long bone to which the 
traction is applied, having inserted into it the rigidly spastic 
muscle acting as a fixed point, acts as a lever of the first-class 
in which the weight moves in a direction opposite to that in 
which the power is acting. 

Another grave error is the omission to fasten the child's 
body and the well limb when applying extension in hip dis- 
ease. If we fail to fix the pelvis there is no use in fixing the 
diseased limb, for motion of the pelvis has the same effect 
upon the joint that the femur has. 

In tuberculosis of the ankle, tarsus, shoulder, elbow, wrist 
and corpus, immobilization must suffice, since efficient exten- 
sion is quite impracticable. 

In all serious cases of tubercular joint disease there is op- 
portunity for difference of opinion as to when mechanical 
treatment must be supplemented by some of the more radical 
operative measures. It is exceedingly difficult to express an 
opinion which will apply to all classes of cases. A small so- 
called cold abscess, when in relation with the deeper joints 
like the hip and shoulder, is in our judgment best handled by 
simple aspiration. The injection of various solutions and 
emulsions of iodoform have given us poor satisfaction, indeed. 
The procedure is painful and not without danger, and does 
not in our experience present any advantage whatever over 
simple aspiration. If the fluid re-collects once or twice it is 
usually bound to come to the surface, and we take this or a 
large collection of fluid as an indication for operation. By 
operation we, of course, do not refer to mere incision. If 
these fluid collections — the result of caseation — are to be in- 
terfered with at all beyond simple aseptic aspiration, the 
operation must be as complete and radical as possible. In 
operating these cases it must be borne in mind that the fluid 
and the cavity are, so far as the ordinary pyogenic germs arc 
concerned, aseptic but capable of infection. 

The abscess cavity invariably connects directly or indirect- 



190 1 Treatment of Tubercular Joint Disease, 379 

ly with the joint cavity or with the epiphyseal focus, and if 
we would avoid a mixed infection, which is always serious and 
frequently fatal, the operation must be conducted upon the 
same lines of asepsis as we would employ in opening a healthy 
joint, or the abdominal cavity itself. The short incision 
is a delusion ; if we cut at all it is far better to incise 
the cavity from one extremity to the other. It is our custom 
to make — barring anatomical barriers — an incision which 
equals or exceeds the longest limits of the cavity, to retract 
widely, and, having evacuated the fluid, to expose every nook 
and comer, using the Volkmann's spoon to remove the tuber- 
cular membrane, with the most painstaking precision. From 
some portion of this cavity will be found the tortuous sinus 
leading to the joint and the original bone focus. This sinus 
may be small, but the spoon will easily make it large enough 
to admit the finger with which the joint is explored ; diseased 
bone is then freely scraped away, or the joint resected if nec- 
essary. 

A large rubber drain pipe, as large as the finger and with 
stiff walls, is then introduced, entering the joint by the most 
direct route from the surface. The rest of the wound is 
closed, and we, as a rule, get aseptic healing of all except the 
drainage tract. 

Arthrectomy and excisions must be looked upon as major 
operations, and the greatest discretion is necessary in their 
election ; the advisability, methods and results of a single 
class of excisions is an ample subject for a long article. We 
can, therefore, only consider one or two important points. In 
children any amount of temporizing which does not endanger 
the limb or life is justifiable rather than the performance of 
a resection, which removes epiphyseal lines before the bone 
has nearly or quite completed its growth. Resection of the 
knee under twelve years of age is followed by disastrous 
shortening of the limb. Each bone has its peculiarities in 
this respect, and he who disregards them brings upon the 
patient serious results and upon himself the patient's just 



380 Ihe New England Medical Gazette. Aug., 

condemnation. In conclusion it may be said that this sub- 
ject might better be handled in a volume than in a paper of 
respectable length, — that it tries the surgeon more sorely 
than does the delectable vermiform appendix and the serpi- 
ginous pus tube put together, — that our mistakes in these 
cases are far more hideous than the ill-adjusted fractures 
which haunt us in our dreams, and send us to the Fidelity 
and Casualty for a mal-practice policy, — and our triumphs are 
often more beautiful when described than when seen with 
the naked eye. 



nODERN AIDS TO ACCURATE DIAGNOSIS. 

KY J. I*. RAND, M. D., MONSON, MASS. 
(Read at the annual meeting of the Mass. Horn. Med. Society, April 10, 1901.) 

Ladies and Gentlemen: 

The subject assigned to me is too large for anybody to com- 
prehend within the limits of a single paper, since all that has 
proved valuable in the past we still retain to form with dis- 
coveries of later date the modern aids to accurate diagnosis. 
I will therefore make no attempt to cover the whole ground 
but state as concisely as possible some of the methods by 
which medicine has been taken out of the mysticism and de- 
veloped into an actual science. 

Disease was formerly supposed to be the result of some 
offence to Deity, and even yet the superstition is implied in 
our formal expressions of condolence. We still hold the Deity 
responsible for our personal bereavements when .we say, 
*Whereas it has seemed best to an all wise Providence to take 
our dear brother or sister, etc." 

But the golden thread of truth runs through all ages and 
superstitions alike Our deities change with the measure of 
our comprehension, and while the religion of the savage and 
scientist has but little in common, in this they both agree : 
Disease is still an offence to the Deity — the Deity of natural 
law by which our material bodies are governed. 



190 1 Modern Aids to Accurate Diagnosis. 381 

There are a few diseases mentioned in the New Testament 
in connection with the miracles of healing, viz.: leprosy, 
metorrhagia, epilepsy, congenital amaurosis, paralysis, fever 
and dropsy, though some of these we consider as symp- 
toms only. From this small beginning of nineteen hundred 
years ago diseases have been studied, classified, and divided 
until they are far more numerous than the hair upon some of 
our heads, in short, are practically without number. I do not 
mean by this that diseased conditions have materially in- 
creased, of course they have to some extent, but not greatly. 
The difference comes rather with our improved habits and 
means of observations which constitute the words of my sub- 
ject. Diseases themselves are not new. 

But what are some of the ''Modern Aids to Accurate Diag- 
nosis ?" First — The improved forms of surgical technique by 
which the "exploratory incision" is made a warrantable pro- 
cedure. Seeing puts an end to guess-work. Prof. Helmuth 
used to tell his classes, "It is a very easy thing to diagnose a 
tumor when you have it on the table". That was before the 
days of license in abdominal explorations. To-day the con- 
servative surgeon will very rarely venture a positive opinion 
in an obscure case. With the sweetest tones of assurance 
the patient is invited to come to the hospital for an "explora- 
tory incision" and so trivial has the procedure become to the 
mind of the operator that it is advised with less hesitation 
than a young physician would feel in asking a patient to dis- 
robe for a physical examination. 

The exploratory incision however is a great "eye opener," 
in short is an autopsy in the original and best sense of the 
word. It lets light into many an obscure corner and often 
prevents and takes the place of a post-mortem examination to 
establish a diagnosis. 

How many cases of ovarian disease have been mistaken for 
appendicitis — how many distended gall-bladders for malignant 
growths — how many normal pregnancies for uterine fibromo 
only thoise who have had experience can appreciate or under- 
stand. 



382 The New England Medical Gazette. Aug., 

Almost every surgical device contributes in some way or 
other to accuracy in diagnosis but the ones upon which we 
especially rely relate particularly to the organs of sight. Take 
so simple an apparatus as the conical speculum, the convex 
mirror and a condensed light and you have the open door to 
the diagnosis of almost every disease of the nose, ear, throat, 
vagina and rectum. 

The Opthalmoscope constructed upon a little different plan 
makes it possible to inspect the anterior chamber of the eye 
and to see highly magnified, the terminal branches of the op- 
tic nerves and blood-vessels as they appear upon the choroid 
and retina. Nowhere else are the nerves and blood-vessels ex- 
posed to such direct observation, and strange, but true, dis- 
eases of remote organs, especially the kidneys, can often be 
detected in this way. 

More wonderful still is the cystoscope with its incandescent 
electric light for examination of the distended bladder, and a 
like apparatus for exploring the stomach through an oesopha- 
geal tube. Prof. Doughty, of New York, told us at our meet- 
ing last October, you remember, his method for injecting the 
kidney itself through the ureter in order to determine its po- 
sition, distensibility and size. 

But there is a world beyond our feeble vision in which lies 
hidden the key that unwraps the mysterious origin of disease. 
Here are the secrets of life and death, here the wonders of bi- 
ology and pathology and the microscope is the "open sesame" 
to them all. 

The essential principle of the microscope is not new. In 
1671 a Jesuit priest named Kircher, with a crude magnifying 
glass discovered "minute living worms" in putrifying cheese 
and meat. Only four years later a Dutch linen merchant, 
Anthony Van Leewwenhoek, beheld in the saliva, intestinal 
contents, rain water, and decomposing fluids "minute living 
particles" which he called animalculce. 

In 1762 Plencig, of Vienna, after much careful observation, 
asserted his belief that the phenomena of disease and the de- 
composition of animal fluids were wholly caused by these mi- 



I go I Modern Aids to Accurate Diagnosis. 383 

nute living germs. And yet for over two centuries the theory 
of spontaneous generation held sway and had it not been for 
the indefatigable labors of Cohn, or Koch, and the peerless 
Pasteur, might still remain. 

The evolution of the microscope has been the evolution of 
pathology and the evolution of pathology means accuracy in 
diagnosis. 

Think of what the microscope has already done for the ad- 
vancement of science! Beginning with scabies which was 
once supposed to be a constitutional taint it brought the 
acarus into view and proved the parasitic origin of the dis- 
ease. Then came hydatids in recurring abscess of the liver 
and traechini in diseased pork, and then that line of abnormal 
tissue formations we designate as innocent and malignant 
growths. 

It is no secret that the master minds in the profession 
await the report of the microscope before venturing a diagno- 
sis. 

By the aid of chemistry, centrifugal sedimentation and the 
microscope, urinary analysis has been brought to a high state 
of perfection. There is no disease of the kidneys in which the 
urine does not afford reliable information and in some it is our 
only source. Here we find renal and bladder epithelium, 
crystals of many and various salts, corpuscles of blood and pus, 
masses of fibrin or albumenoid material thrown off as casts, 
numerous forms of minute vegetable growths known as bac- 
teria, and possibly the male element of reproduction. Com- 
pare the one crude test of boiling a suspected urine with the 
many delicate and distinct analyses that we now employ and 
you can gain some idea of the tremendous advances made in 
a single department of diagnosis. 

But the microscope cannot work alone. Diseases are for 
the most part associated with, if not produced by, minute liv- 
ing vegetable growths called germs. Just how these germs 
produce the phenomena known as disease is not fully under- 
stood, but the fact of their etiological relation is no longer 
doubted. The modern pathological laboratory is the oracle 



384 The New England Medical Gazette. Aug., 

of scientific investigation. Here are prepared those culture 
beds upon which are propagated and grown almost every form 
of bacteria which produce disease. The hanging gardens of 
ancient Babylon were surely not more wonderful. 

You are all familiar with the methods commonly employed 
for the detection of diphtheria by our municipal authorities. 
The germ of this disease was discovered by Klebs in 1883 
and a little later was studied by LoefHer who proved it to be 
the cause of diphtheria. Under favorable conditions this germ 
multiplies very rapidly, much more so .than the ordinary 
forms of bacteria, so that we are able to recognize it by the 
rapidity of its growth as well as by its microscopical appear- 
ance. 

It is only a few years since that the brightest clinicians 
were wrangling over the differential diagnosis of diphtheria and 
membranous croup. The one was supposed to be a constitu- 
tional disease highly contagious with a local manifestation in 
the throat. The other was regarded simply as a local dis- 
ease. But the microscope found in both the same pathogenic 
bacteria and settled the whole question at once. 

But diphtheria is not the only disease of obscure origin 
which the microscope has made plain. Already the test has 
assumed formidable proportions but the end is not yet. In 
1885 Pollender discovered the germ of that disease common 
among cattle but sometimes present in the human subject, 
anthrax. In 1879, Hansen, that of leprosy, in 1889, Eberth, 
that of typhoid fever, in 1882, Koch, that of tuberculosis 
following with that of Asiatic cholera two years later. In 
1884, Nicolaier, that of tetanus, in 1886, Frankel proved the 
diplococcus of pneumonia to be the cause of that most fatal 
disease. In 1894, Kitasato and Yersin discovered the germ 
of the bubonic plague, that "black death" which swept over 
Europe in the fourteenth century destroying twenty-five 
millions of people, and in 1894 Canon and Pfeiffer claimed to 
have discovered that smallest and most active of known mi- 
crobes, viz., the grippe germ with whose result we are all of 
us more or less familiar. 



IQOI Modern Aids to Accurate Diagnosis. 385 

But the causes of our most typical of all infectious diseases, 
small pox, measles and scarlet fever have thus far eluded 
detection. All are without question of bacterial origin. The 
very fact of a period of incubation is proof that the original 
infection was not sufficient at the start to produce immediate 
results. It requires time for it to multiply and grow before the 
characteristics of the disease appear. Newton had no clearer 
demonstration of the law of gravity in the falling apple than 
have we of a specific living germ in every diseasp that exhib- 
its a period of incubation. We may not find this germ, our 
glasses may be too weak, yet it is there. 

All pathogenic germs, however, are not of vegetable origin. 
One at least, plosmodium malariae, is an animal parasite 
which was discovered in the blood of afflicted patients, by 
Laveran in 1880. It had been long observed that malaria was 
most prevalent in low marshy districts and that infection was 
most likely to follow exposure to the night air in the summer 
or early autumn. It had also been observed that the disease 
was not directly communicated from one individual to another. 
People living in malarious districts had well held the mosquito 
as an object of detestation, with him they had fought and 
bled and died. Then came a pause in the denunciations of 
the poor insect ; scientists had found the germ of malaria in 
his insatiable maw and the cry arose, "the mosquito is God's 
good angel sent to eat up and destroy the malevolent bacteria 
that devastate the race. But the pause was only a brief one. 
Soon the apprehensions- came that the mosquito who could 
take up germs might scatter them as well, and his winged 
majesty became an object of suspicion. 

In 1896 Dr. Bignami published in the Lancet a very strong 
argument in support of the theory that the infection of mala- 
ria was usually due to the bites of mosquitoes, but it was left 
to the closing year of the nineteenth century to demonstrate 
the fact. Italian observers had repeatedly shown that mos- 
quitoes from a malarious district when allowed to bite perfectly 
healthy persons, who lived outside, would communicate to 
them the disease. 



386 The New England Medical Gazette, Aug., 

History has shown no grander display of enthusiam than 
that of Dr. Sambron and his companions who exposed their 
lives to the contagion of malignant malarial fever in the 
marshes of Campagna, Italy, only last summer: Dr. Sambron 
believed that a certain variety of mosquito called the 
anopheles was the agent by which the malarial germs were 
communicated and the experiment was tried to prove it. 
With one sole companion he camped out for three months in 
a most intensely malarial district taking no medicine or any 
precautions whatever against contagion, except to protect 
himself from the bites of mosquitoes, and neither he nor his 
companion took the disease. 

A very strong counter-test was also made a few months 
ago when mosquitoes that had bitten malarial patients in Italy 
were sent to London, where there is no acute malaria, and 
there allowed to bite the son of Dr. Manson, who, according 
to Dr. Osier, really suggested the mosquito theory of malaria. 
Dr. Manson's son was strong and perfectly healthy, but in a 
few days following the bites of the mosquitoes he developed 
a typical attack of malaria. 

Compare this nicety of observation with what was consid- 
ered good practice in the diagnosis of malaria only a few 
short years ago, viz., the administration of heroic doses of qui- 
nine. If the patient lived it was malaria, if he died it was 
not, though the dose taken might have been enough to kill 
him. 

We smile at the credulity of our English ancestors whose 
test for witchcraft in the seventeenth century was by wrap- 
ping the suspected individual in a sheet with his thumbs and 
great toes tied together and then dragging him through a 
mill pond. If he sank promptly, he was considered innocent, 
if he did not he was condemned to death. 

Some day the therapeutic method of diagnosing malaria by 
quinine and syphilis by merucry and iodide of potash will ai>- 
pear as crude to the scientific physician as the barbarous tests 
for witchcraft do to us. The Philadelphia Medical Journal of 
March 30, 1901, in speaking of suppurative conditions simu- 



I go I Modern Aids to Accurate Diagnosis, 387 

lating malaria, says, "The delay caused by the administration 
of quinine in order to exclude malaria is as a rule inexcusable 
for we have at our command that more reliable source, the 
microscopical examination. ... A single droplet of blood 
will not only determine the presence of the disease but will 
also indicate our therapeutic measures and the necessity of 
proper isolation to prevent its spread by means of mosquitoes." 

And right here let me call your attention to a very inter- 
esting report presented at the Pan-American Medical Con- 
gress in Havana only last February, by Dr. Reed and his as- 
sociates of the U. S. A. on the propagation and spread of 
yellow fever. 

I cannot go into the details of his experiments, but the gist 
of his conclusions were: that in no instance was yellow 
fever communicated by fomites or contaminated clothing, as 
we have hitherto supposed, but that in all eases the agent ol 
infection was a variety of mosquito known as the ciilex 
fasciatus, and this being true, the most effectual methods of 
preventing the spread of the disease must be the destruction 
of mosquitoes and the protection of both sick and healthy 
against their bites. 

I will also add that the specific germ of this disease, though 
claimed to have been discovered by Sanarelli in 1897, is not 
known. 

The question of malaria opens up the whole subject of 
blood examination and the possibilities that go with it. Of 
late much attention has been paid to this branch of pathology 
as a means of diagnosis. 

With suitable apparatus we may count the different varieties 
of blood cells and ascertain their relative numbers. Normally 
there is about one white corpuscle to three hunc'red red. A 
moderate increase of white corpuscles, say one white to one 
hundred red is called hyperleucocy-tosis. A still greater in- 
crease of the white corpuscles is leucaemia. If there is a 
marked diminuation of the haemaglobin or coloring matter of 
the blood without a corresponding decrease of the red corpus- 
cles the condition is called chlorosis. If we have the clinical 



388 The New England Medical Gazette, Aug., 

features of leucaemia, such as enlargements of the spleen 
and lymphatic glands without the characteristic changes in the 
proportion of blood cells, we have a pseudo leucaemia or 
Hodgkin*s disease. When the red corpuscles are very much 
diminished in number and deformed in outline, the amount of 
haemogoblin relatively increased and the number of cells nor- 
mal or diminished, we have all the conditions known as per- 
nicious anaemia whose prognosis is very grave. 

Here are at least five diseases once classified under the gen- 
eral terra, consumption of the blood, which the microscope 
has made possible to differentiate. And we must not forget 
the achievement which this society has already recognized, 
of that promising young pathologist, Dr. Solomon C. Fuller, 
who first observed and published to the scientific world, crys- 
tals of morphine in the blood of an opium eater. 
• There is one aid to accurate diagnosis too old to be called 
modern and too valuable to be set aside, and that is the steth- 
oscope which was introduced by Laennec in 1816. I will not 
attempt to describe its various forms and modifications. The 
principle of all is the same and the best instruments of to-day 
possess little advantage over the one oiginally devised By 
means of the stethoscope we are enabled to recognize and 
interpret the various sounds associated with the heart as well 
as the grosser forms of pulmonary disease, It is a very easy 
thing to diagnose a pleuritic effusion, a large cavity or ex- 
tended area of consolidation by percussion and auscultation. 
But I doubt if the man lives who can tell infallibly whether a 
given consolidation is tuberculous or not by the physical signs. 
He may think he can, and in the great majority of cases his 
judgment may be correct, but unless he has actually seen the 
germ of tuberculosis present he cannot be sure. 

And right here I crave your indulgence if I digress for a 
single moment to enter a protest against the sending of a sus- 
picious patient to a hospital for consumptives whose sputum 
is not known to contain bacilli. It is wholly possible that the 
patient may not be tuberculous at all, and, if he is not, you 
are exposing him to an unnecessary risk. 



igoi Modern Aids to Accurate Diagnosis, 389 

Be the hospital ever so cleanly there is still a certain dan- 
ger of contagion and the weakened and debilitated constitu- 
tion is just the one to suffer by it. 

Personally I believe the microscope to be the consummate 
diagnostic test in pulmonary tuberculosis. 

Three years ago I obtained the records of 273 patients 
whose sputa I had examined. Of this number 177 showed 
bacilli and 96 did not. Of the former 81 per cent, had already 
died of tuberculosis, of the latter only 3 per cent., and some 
of these may possibly have become infected subsequent to the 
examination. At any rate the presence of bacilli in the spu- 
ta of a suspicious patient diminished his chances for recovery 
forty-eight times. 

If the death rate was any evidence of a correct diagnosis 
the microscope surely made a creditable showing. 

I cannot forego the temptation to digress a little farther and 
tell you the glad news that consumption in this state at least 
is on the decline. According to the official returns of the 
Massachusetts Board of Health, in 1890, 130 out of every 1000 
deaths were due to consumption, while in 1899 there were 
only 99.5. An actual decrease of 3 1-2 per cent, as compared 
with the entire death rate and a comparative decrease of 
nearly 24 per cent, if consumption is considered alone. 

Remember this when the climate of Massachusetts is com- 
plained of. Instead of the old stereotyped statement that one 
seventh of our people die of consumption, we can now say, 
that in 1899, not one-tenth of our mortality was due to this 
disease. 

But I must not digress farther ; I wish I had the ability to 
crowd the wisdom of a thousand pages into a brief statement 
of fifteen minutes I would like to speak of cerebral locali- 
zation and of the advances made in diagnosis of diseases of 
the stomach, but there is not time. 

I cannot close however without at least a reference to that 
modern and most wonderful electric invention known as the 
X Ray. From a surgical standpoint it forms with anaesthesia 
and antisepsis a trinity of tremendous possibilities. 



390 The New England Medical Gazette. Aug., 

The importance of this discovery when all the world was 
bristling with bayonets can hardly be overestimated. The X 
Ray and the R/d Cross Nurse are the two lone stars in the 
dark horizen of a wounded soldier. 

I will not describe the apparatus or its use ; you are all fa- 
miliar with both. It is no longer impossible to see through 
the solid flesh, and when we think of Garfield, and the lives 
that might have been saved in years gone by by just such an 
instrument, the words addressed to the Master by the sisters 
of Lazarus appeal to us with peculiar significance; "If thou 
hadst been here our brother had not died". 

And lastly, let me emphasize my belief that the achieve- 
ments of the century just passed are but the earnest of better 
things to come. 

There are men in this society who have watched the evolu- 
tion of medical diagnosis from small beginnings until it is 
almost a science. It will be a science sometime, and some- 
time we shall be able to recognize and understand the various 
phenomena known as disease as easily as we can now com- 
prehend the cause and periodicity of a solar eclipse. 



Sympathy Between the Eyes and Teeth. — To cases of 
neuralgia of the eyeball and surroundings produced by dental 
irritation McQuillen added an important report, a case of se- 
vere attack of neuralgia of right side of face, extending to the 
temporal and frontal region and involving the right eye. Her 
physician being under the impression that the teeth were at 
fault, brought her to him. The pulp of the right canine was 
found exposed ; four of the other teeth were also badly de- 
cayed, and it was thought advisable to extract all of them and 
make a new plate in place of the defective set which the 
patient was wearing at the time. There was not the slightest 
recurrence of the neuralgic pains. McQuillen adds that if 
every physician recognized the importance of a prompt exam- 
ination of the teeth under similar circumstances, a great deal 
of unnecessary pain could be spared their patients.— y<?//r«a/ 
of Ophthalmology. 



190 1 Tuberculosis and the Great Soutlnuest. 391 

TUBERCULOSIS AND THE GREAT SOUTHWEST. 

By Dr. Merrill, Colorado, Texas. 

In submitting the following article, the writer begs to state 
that he is fully aware of the fact that there is already in exis- 
tence a sufficiently cumbrous list of places to which those 
afflicted with pulmonary tuberculosis may resort. This arti- 
cle is not intended to call attention to a location necessarily 
more favorable than any other to the phthisical patient, but is 
designed to describe as briefly as may be, a region which, 
while remote from New England, may perhaps be available to 
the use of some practioner. The locality referred to is situa- 
ted in the west central and western portions of the State of 
Texas, in general along the line of the Texas and Pacific rail- 
road. Pure and bracing air, suitable elevation, generally fa- 
vorable climate, and easy conditions of existence are some of 
the advantages which prove beneficial to a certain class of tu- 
bercular patients. The expression "certain class" is used ad- 
visedly, because the patients who derive most benefit from a 
stay in this part of Texas are those who have little or no tem- 
perature, slight consolidation, and who, in brief, present incip- 
ient cases. A noticeable peculiarity of the region consists in 
the fact that many tubercular patients gain strength and ac- 
tivity, become free from expectoration, and are enabled to live 
apparently in perfect health, so long as they remain here. A 
return to the North is frequently attended with recurrence of 
temperature, cough, sweating, emaciation, and other unfavor- 
able signs ; and several cases where permanent stay at the 
North was attempted terminated in death. Cases showing 
comparative advance in the disease seem to be arrested, but 
cough is not always permanently stopped. In one case com- 
ing to the writer's notice, the patient had had numerous hem- 
orrhages, very copious expectoration, and other signs of well- 
established phthisis. Life in the open air caused the cough 
and expectoration to disappear, but they recur when the pa- 
tient is overfatigued or otherwise physically depressed. Ad- 
vanced cases are not at all benefited by a life here, but gener- 
ally progress rapidly to a close. We have now spoken of the 



392 The New England Medical Gazette, Aug., 

effects of this region upon different stages of phthisis. For 
those contemplating a trial of the curative Texan plains it is 
well to understand the mode of living most conducive to im- 
provement and recovery. A life of activity in the open air 
should be the object to be attained. Cattle-raising is the chief 
industry here, and it is generally easy to make some sort of 
arrangement to become located on a ranch. Many ranchmen 
willingly receive those too ill to labor. A patient able to do a 
limited amount of work can nearly always find opportunity to 
do ranch work for his board. 

Regarding now the region itself. As before indicated, it 
lies in the west-central and western portions of Texas, and 
that part of it of which we have personal knowledge comprises 
an area lying about the town of Colorado. The soil, climate 
and other natural features of the territory lying within thirty 
miles of Colorado in any direction are practically the same. 
Even two hundred miles west of the town the same favorable 
natural conditions obtain, and El Paso, three hundred and 
eighty-five miles west of it, is a flourishing and. somewhat 
noted resort for tubercular patients. It is not, however, so 
advantageous as places east of it. The area we are describing 
lies nearly in latitude 32*^, and longitude loi®. Its elevation 
varies from 2,000 to 3,000 feet. Farther west, the elevation 
ranges higher ; at El Paso it is 3,700 feet, and at one or two 
points about one hundred miles east of El Paso it reaches 
4,500 feet. 

The soil is sandy or rocky, may be clay or rich earth, vary- 
ing even in narrow limits of territory. It is generally dry. 
The country is undulating prarie, diversified by creeks, by 
cliff-like formations, and by steep and rocky slopes. The 
creeks consist at times of a dry and excavated bed only, 
and again after excessive rains may be roaring torrents of 
water. 

The drainage at any given location is nearly alway excel- 
lent. The drinking water is generally obtained from wells 
varying from forty to three hundred feet in depth, the water 
being pumped by wind-mills. The water is often very hard 



I go I Tuberculosis and the Great Southwest, 393 

but varies considerably. The atmosphere is clear and dry. 
More rain falls in the early spring than at other seasons of 
the year, and varies greatly from year to year. The past sea- 
son (1901) has been exceptionally dry. 

The precipitation of dew is very slight. At times a heavy 
mist in the morning wets the grass and foliage thoroughly. 
During the winter, cold rains, sleet and hail are apt to be fre- 
quent ; of course protection against these should invariably 
be the rule. 

The temperature is most enjoyable from October to Janu- 
ary, being pleasantly cool and bracing during this period. 
From January to March the weather is often very cold, al- 
though varied by mild days. At this period "northers" are 
most frequent, and the norther generally brings with it tem- 
perature below freeezing. 

Here it is well to emphasize the importance of being prepared 
for the northers, for they come up quickly and are attended 
with a sudden drop in the temperature, which remains at a 
comparatively low point for three or four days. The mercury 
does not often reach the zero point, but one feels the cold 
more keenly on account of the frequently mild days. A 
sweater is very valuable and can easily be packed on the sad- 
dle or carried ; an inadequacy of proper clothing is apt to 
be attended with discomfort and risk. From March to Octo- 
ber the temperature is higher. The early days of spring are 
frequently very warm, and the summers are apt to be hot, al- 
though the heat does not seem to be unfavorable to the pa- 
tient. The temperature is variable from year to year. At 
times during the summer it reaches 105® in the shade. Two 
factors aid materially in rendering the summers tolerable and 
even pleasant. There are, respectively, cool nights and daily 
breezes. As soon as night approaches the air begins to cool, 
so that with almost no exception one can enjoy a comfortable 
night's rest even after the hottest day. Still, sultry days are 
infrequent, for the air is usually stirring, and removes much 
of the discomfort incident to a hot summer day. 

The winds are higher and most frequent in the spring and 



394 The New England Medical Gazette, Aug., 

summer. They sometimes bring with them heavy charges of 
sand and dust, and at times constitute veritable sand-storms. 
Cyclones are occasional all through this region. As has been 
previously stated, life in the towns should in general be avoided- 
The towns are small, of the bustling western type, and possess 
hotels not well adapted to the needs of a person seeking 
healthful activity. Life on a ranch is interesting, varied, and 
above all, healthful. Horseback riding is a prominent feature. 
In addition there are wood-chopping, fence-building, work 
among the cattle, farming, and all of it full of interest to one 
who is at all partial to life out-of-doors.. The life is a rough 
and ready one. Lady patients of refined and -delicate taste 
who contemplate a stay here should be impressed with this 
fact and the effect of these new surroundings upon the patient 
should be carefully estimated before advising a journey which 
may perhaps be inconvenient. The ranch houses are gener- 
ally rough, and are invariably unplastered. Each individual 
supplies his own bedding, which may of course be varied ac- 
cording to taste. This had better be procured here, or bought 
after ascertaining particulars from the locality planned as one's 
stopping place. 

The stranger will find the people very warm-hearted and he 
will generally receive courteous and kindly attention. Every- 
one is interested in his state, county, town, and ranch, and is 
glad to point out interesting features of each. Rides over 
the prarie, through the mesquite trees and brush, rounding-up 
handing, farming, — a free and easy open-air existence, life in 
a new and favorable environment with small encouragement 
to continued thought of one's ills and symptoms ; all of these 
forces combined should be as effectual as any in securing to 
an unfortunate phthisical patient a life of cheerfulness, use 
fulness, and of perfect, or comparatively, satisfactory health. 

In closing I wish to express due acknowledgement of assis- 
tance kindly rendered me by Mr. B. S. Van Tuyl, to whom I 
am indebted for most of the data contained above. 

Colorado, Texas, 

May /f, i<)oi. 



IQOI Notes on Pathology, 395 

NOTES ON PATHOLOGY. 



The Protozoon of Cancer. 

HY G. C. FULLER, PATH. WES TBORO STATE HOSPITAL. 

Qaylord, (Amer. Jour. Med, Sciences^ May^ 1901) reports 
the result of his work on the etiology of cancer. Gaylord 
claims that certain bodies — presumably Sporoza, which he 
found in the juices and fresh scrapings of cancer, and in the 
peripeheral blood of cases in which cochexia was advanced, 
bear a direct causative relation to cancer and malignant tumors. 
These bodies he also identifies with certain cell inclusions in 
the cancerous process which may be readily demonstrated by 
special methods of fixations and staining. Dr. Gaylord also 
states that he has succeeded in obtaining pure cultures of the 
organism on Cellis fucus crispus bouillon. 

It is interesting to note that the injection into animals of 
small portions of cancer material, and scrapings and juices 
from cancers have resulted in lesions identical with certain 
cancerous processes. In one experiment, which is given in 
detail, a guinea pig was inoculated with material from an 
adeno-carcinoma in roan, and killed fifty days later showed be- 
ginning foci of adenocarcinoma in lungs. To be sure this re- 
sult and others reported indicate the highly infectious nature 
of the material injected. It is, however, difficult to ascribe 
these results to Gaylord's protozoon, for as has been pointed 
out (editorial in Boston Med. Sur. Jour., May 16, 1901) there 
has been no satisfactory demonstration in his published arti- 
cle of the "pure cultures" of this organism. Certainly at least 
not in the generally accepted sense of the term "pure culture". 
It is to be regretted that this description is reserved for a later 
publication. 

In this connection is of interest the case reported by De- 
Messer.* In a typical epidermoid carcinoma removed from the 
arm of an old man lycopodium spores were found. These spores 

♦Vichow's Archiv. 1901, vol. clxiii, page iii, cited in Progress of I^ath- 
Am. Jour. Med. Science, June, 1901. 



396 The New England Medical Gazette. Aug., 

were found in the connective tissue stroma, in the clefts be- 
tween the cells, or enclosed in giant cells. The man, it was 
learned later, had been using lycopodium as a dusting powder 
before operation. The review of the literature by De-Messer 
showed that the absorption power of granulation tissue under 
certain circumstances was marked, being able to absorb solu- 
ble substances (alkaloids) or insoluble substances (cinibar) or 
living organisms (bacteria). 

The inference to be drawn from this case is natural. The 
blasto-mycetes found in cancerous tissue may have a similar 
origin. Further, the introduction of blasto-mycetes into ani- 
mals by other observers have produced only granulomata; 
still further, the mesoblastic nature of sarcomatous cells may 
possess phagocytic qualities and because of this, ingest wan- 
dering blastomycetes which have but a limited power q^ mo- 
tion. 

The Preliminary Note on tlie Relation of the Form the 

Tubercle Bacillus to the Clinical Aspects 

of Pulmory Tuberculosis. 

Sewall, i^Med, TimeSy Mar. i6, 1901) in his studies on the 
form of the tubercle bacillus proceeded in his investigations 
from two points, (i.) Pure cultures of tubercle bacilli were 
studied as to form and staining qualities ; and (2) the arbitrary 
grouping of tuberculous patients into {a) those recovering, {b) 
those holding their own, and {c) those which were manifestly 
failing. 

Virulent bacilli from pure cultures resisted the action of the 
decolorizing fluid longer than cultures less virulent. The 
plausible assumption is made that the virulent culture, exposed 
to the diffuse light of the laboratory little by little, looses its 
toxic power and its tenacious hold on the aniline dye. Dr. 
Sewall states that the morphology of the bacilli in virulent 
cultures are uniformly like those in the sputum of rapidly tail- 
ing clinical cases examined by him, while no virulent cultures 
presented the features of the so called "good" clinical cases. 



IQOI Notes on Pathology, 397 

He classifies the tubercle bacilli found in sputum as follows: 
(i) a very short, relatively — broad rod ; (2) along form repre- 
sented by a chain of rods ; (3) a long form, homogeneous in 
structure ; (4) a long form of beaded appearance. 

In the sputa of cases examined at the Adirondacks' sanita- 
rium he found in the failing cases with active destruction of 
lung tissue the shortest rod-like form of the bacillus. In 
cases doing well the slender form prevailing while the short 
and pointed forms were few or absent. In old chronic cases 
where the loss of tissue had been great, but in which the dis- 
ease was fairly well arrested, or in which the malady had made 
such extensive havoc that the maintenance of life itself was a 
demonstration of the low virulence of the infecting organism, 
the bacilli were long and beaded. 

The Sputum of the same case varies from month to month, 
depending upon the state of patient regarding the disease. 

Sewall thinks the form of the bacillus in the sputum has a 
prognostic value. 

With regard to the relation of the shape of the tubercle ba- 
cillus, Craig* states that in his experience the beaded form of 
the bacillus is found most often and numerously in the sputa 
of acute rapid ily advancing cases of tuberculosis. This state- 
ment is certainly of interest in this connection. Craig also 
goes into a fuller description of the morphology of the tuber- 
cle bacillus and their probable relation to the clinical aspects 
of the case. The reader is referred to Dr. Craig's report for 
furthur details. 

♦Report Surg. General Army, 1900, page 63. 



Ferrum Phosphoricum in Earache. — This is the remedy 
par excellence in this painful affection. If the attack has 
been induced by wet weather, the pain comes on in paroxysm 
and after the discharge appears there still remains pain, it 
will prove curative in a large number of cases. — Exchange, 



398 The New England Medical Gazette. Aug., 



EDITORIAL. 

Contributions of original articles, correspondence, etc., should be sent to the publishers, Otis 
Cla])p & Son, Boston, Mass. Articles accepted with the understanding that they appear only in 
the GazttU. They should be typewritten if possible. To obtain insertion the following month, 
reports of societies and personal items mmt be rtceived by the t^ih. of the month preceding. 



CEPHALIC HYPERTROPHY. 

It is always interesting to watch the progress and develop- 
ment of the recent graduates, as they begin practice, to note 
their untiring energy, their boundless hope, their self-reliance, 
their ready application of modern methods, in which they 
have been well equipped, and their encouraging optimism. 
All this, of course, provided they are individuals who have in 
themselves the elements of progress and development. 

It is remarkable as it is most gratifying to note how rapid- 
ly they build up a practice and how successfully they manage 
it. Having rapidly and successfully established themselves 
in business, there comes a more or less critical time in their 
existence, a time when they are in danger of a most serious 
complaint, known as cephalic hypertrophy, and happy and 
fortunate is he who escapes. 

A not uncommon manifestation of this condition is the idea 
that the homoeopathic profession is not large enough for a 
proper display of their ability, and they gaze with loving 
eyes toward the allopathic branch of the profession, where 
there are so much larger hospitals, greater and more vigorous 
societies, and, above all, greater social prestige. All this is 
much enhanced if they happen to fall in with some of the 
better, more liberal minded good fellows among " our friends, 
the enemy," who assure them it need make no difference 
with their methods of practice, they can prescribe just as be- 
fore, homoeopathic medicines in the homoeopathic way, if they 
choose, only they must not ally themselves with anything 
called by that name, etc., and they will gain immeasurably in 
their freedom of action and in their social and professional 
position. 



I go I Editorial, 399 

All this is very enticing and very alluring, and the per- 
spective is vast and beautiful. There is only one trouble with 
it ; it is not true. ** What profiteth it a man if he gain the 
whole world and lose his own soul." He will forever be 
looked upon as an outcast by his former associates, and as a 
renegade by his new. He will command the respect of none, 
the detestation of many, and the much sought for social pre- 
ferment will never come. Does he wish to perfect himself 
in surgery ? the competition for opportunity so to do is far 
greater in the old school than the new. Does he desire to 
become an adept in the cure of disease by the application of 
medicines and by a knowledge of what can be done by the 
administration of drugs to that end ? The advancement in 
the old school along this line has been practically nil in the 
last century. If you doubt it, watch the scientific (?), ration- 
al (J) treatment of a case of pneumonia, as we had an oppor- 
tunity of doing within six months. Not one single dose of 
medicine given with the intent or with the pretence of an 
intent to affect the diseased lung tissue in the slightest 
degree. To one wishing to perfect himself in a knowledge 
of drug action, no school offers the chance that the homoeo- 
pathic does, and never was the opportunity greater than now. 

No, my young friends, don't let them fool you with plaus- 
ible talk. If you no longer honestly believe in homoeopathy, 
go, and God-speed ! but if you do, stand up and be counted 
as our fore-bears did, and pray that you may be respected 
for it as they have been. 

There is but one remedy for this rapid, excessive cranial 
development, and that is patience. Therefore, we say to the. 
afflicted, let your *' think-tank " settle a bit, — "say nothing, 
but saw wood " for the next five years, but be sure that the 
wood is good and that you saw it well. Remember that if 
our neighbor's pasture looks greener than our own, should 
we possess ourselves of it, it would no longer be our neigh- 
bor's. 



400 The New England Medical Gazette. Aug., 

EDITORIAL NOTES AND COMMENTS. 



HAnPDEN HOnOEOPATHIC HOSPITAL. 

The executive officer of the Hampden Homoeopathic Hos- 
pital reported at the trustees' quarterly meeting yesterday 
afternoon that the hospital is in a prosperous condition and 
that for three months ending July 1,75 patients were treated 
with only two deaths ; these patients entering the hospital 
moribund. It was also reported that from the opening of the 
hospital 105 surgical operations have been performed without 
a death. Drs. O. W. Roberts and F. M. Bennett were re- 
appointed as members of the executive committee. The res- 
ignation of Dr. H. E. Rice, who is to leave Springfield, was 
accepted with regret and Dr. J. H. Carmichael was appointed 
surgeon-in-chief. Dr. Sidney F. Wilcox, of New York and 
Dr. Nathaniel W. Emerson, of Boston will be consulting sur- 
geons- as heretofore. 

Resolutions of condolence and regret were read upon the 
death of Miss Minnie J. Thrall, a member of the board of 
trustees. D. B. Wesson was elected a trustee to fill the va- 
cancy. The Visitors* Aid Association profited about tyio 
by the lawn party of June 14 on the grounds of President 
Lewis J. Powers. 



Prevention of Pelvic Troubles after Labor. — Durinpj 
labor much may be done to prevent subsequent pelvic 
troubles, (a) Limiting the duration of labor. Vesico-vaginal 
fistula is an outcome of protracted labor, and nuay be pre- 
vented by the timely use of forceps. Too prolonged efforts 
to retard the delivery of the head, in order to prevent lacer- 
ation of the perineum, may give rise to permanent relaxation 
of the muscular structures of the pelvic floor, (b) The im- 
mediate repair of lacerations which endanger the muscular 
structures of the pelvic floor is important. These repairs 
must be made with careful antiseptic precautions. Cervical 
tears need not be immediately repaired unless there is hemor- 
rhage, (c) Rigid attention to asepsis and antisepsis during 
labor will decrease the number of cases of chronic uterine 
and periuterine inflammations. — Medical News, 



igoi Societies, 401 

SOCIETY REPORTS. 



BOSTON HO/Vl<EOPATHIC MEDICAL SOCIETY. 

BUSINESS SESSION. 

The regular meeting of the Society was held at the Boston 
University School of Medicine Thursday evening, June 13, 
igoi, at eight o'clock, the President, T. Morris Strong, M. D., 
in the chair. 

The records of the last meeting were read and accepted. 

Charles W. Bush, M. D., of Newtonville, was elected to 
membership. 

The resignation of W. Louis Chapman, M.D., of Provi- 
dence, R. L, was read and accepted. 

Voted : That a committee of three be appointed to use 
their influence to secure as full reports as possible in the 
local papers of the meetings of the American Institute of 
Homoeopathy. Drs. Wells, Sutherland and Thomas were 
chosen to serve on this committee. 

The following committees were appointed to draw up reso- 
lutions on the deaths of J. K. Culver, M. D., and William 
Woods, M. D. : 

Dr. Culver : Drs. A. B. Church, Mary L. Swain and S. W. 
Windsor. 

Dr. Woods : Drs. Conrad Wesselhoeft, Hiram B. Cross 
and Herbert C. Clapp. ^ 

Report of the Section of Diseases of Children. 

H. L. Shepherd, M. D., Chairman. 
Ckacb Cross, M. D., Secretary. C. £. Montague, M. D., Treasurer. 

The President appointed the following committee to nomi- 
nate sectional officers for the ensuing year : Drs. Colburn, 
Estes and Mosher. The committee reported as follows : 
Chairman, W. T. Hopkins, M. D, ; Secretary, C. C. Burpee. 
M. D. ; and Treasurer, Lucy A. Kirk, M. D., who were duly 
elected. 



402 The New England Medical Gazette. Aug., 

PROGRAMME. 

1. **Some Favorite Remedies for the Summer Diarrhcta 
of Children." Everett Jones, M. D. Discussion opened by 
N. M. Wood, M. D. 

2. *'The Best Diet of Children with Summer Diarrhoea." 
W. T. Hopkins, M.D. Discussion opened by W. N. Emery, 
M. D. 

3. " General Treatment of Summer Diarrhoea in Children." 
H. H. Amsden, M. D. Discussion opened by C. C. Burpee, 
M. D. 

I. Dr. Wood, in opening the discussion of Dr. Jones* 
paper, said, in part : It is rather a difficult question for me 
to discuss this subject, not having had many years' e^cperi- 
ence ; but I have had some experience and learned some 
things. I will speak of one or two of the leading symptoms 
that I know can be depended upon. If I am called to the 
case early and find the child restless and very sensitive, I 
think first of aconite. It must be given in the early stages, 
and by so doing we get very good results. If the child has 
passed that first stage and there are symptoms of tenderness 
in the bowels and perhaps some bloody stools and some 
straining, belladonna is the first remedy, then arsenic. For 
prostration and weakness arsenic is one of the best remedies, 
and can be depended upon more than any other. Nux vomica 
I use on general principles in cases of indigestion caused by 
imprudent eating. The remedy I lisemost is mere, dulcis for 
greenish and slimy stools, and get better results from it than 
from any other. Napthalin I use quite a little in cases of bad 
odor and slimy, waterish stools. I try first to remove the 
cause, while giving remedies. Boiled or distilled water I 
consider the best remedy. Nitrate of silver I consider good 
for chronic pain in the stomach. The three remedies I 
should select would be Aconite, Belladonna and Mercurius 
Dulcis, 

Dr. John H. Sherman : Of course, when one has practised 
medicine as long as I have he has had some experience with 



190 1 Societies, 403 

diarrhcea. I depend more upon management than medicine. 
I prohibit all eating. It will not hurt the child to go without 
food, but a free use of water I believe in. Let them drink 
all they will. I prefer to have them take it warm, then after 
that begin to feed with a little white of egg beaten up with 
the water (two-thirds of a glass), and follow that with malted 
milk. I have had a child pick up nicely on malted milk. I 
think the cause of diarrhoea is bad food. I instruct those in 
care of children to have two nursing bottles, and they should 
be thoroughly cleansed in sterilized water before using a sec- 
ond time. 

I use mercurius dulcis in the first and second triturations, 
but where there are bloody discharges I give mer. cor. 
Colocynth is another remedy I use, giving it in hot water. 

Dr. Sutherland : There are a few other remedies that 
might be mentioned. I should like to get physicians, who 
have been practising fifteen or twenty years, to name their 
favorite remedies. I do not think they would agree on five 
but might agree on one or two. But there are so many reme-. 
dies that will produce diarrhoea, we have a good many to draw 
from. How many are used as cathartics 1 certainly, not 
many. I think we should select our remedies for diarrhoea 
from cathartics. I agree with Drs. Sherman and Wood in 
speaking of calomel first. The first remedies mentioned by 
them are reliable and produce free, easy stools. Mercurius 
dulcis is more closely applicable to the condition in which 
the enteron is found involved; and I am sure that this idea 
will be testified to that mere. cor. will reach the condition 
growing out of ulceration. Aloes is not used a great deal,- 
and produces mucous discharge, with a great deal of flatu- 
lence, and seems to have an affinity for the colon. Rhubarb 
also is a useful remedy. One remedy that is seldom used I 
want to refer to, and that is colchicum. I think it is a drug 
that ought always to be studied when a case of diarrha»a is 
on hand. If you want to get a good picture of the drug read 
the article in the encyclopcxdia. You will find a list of cases 
of poison. In cases of Solera infantum, colchicum and nux 



404 The New England Medical Gazette, Aug., 

vomica, sometimes lead camphor. China is used a great deal, 
but large doses have to be taken before large discharges are 
produced. Castor oil is very effectual and very laxative. I 
do not know that it is generally used. Cascara is one of the 
popular drugs of to-day. 

Dr. Miller : I would like to ask Dr. Wood if he has used 
mercurius in the same way as castor oil ? 

Dr. Wood : I do not know as I have used it in the same 
way. When I find that castor oil does not work and mercu- 
rius is indicated, I use mer. cor. 

Dr. Mosher : Boiled water, or boiled water and listerine, 
will reduce the fever, and there most always is fever, and in 
one or two cases I have known the temperature to come down 
after an enema. I give it once or twice a day and find, if it 
does not do any good, it never hurts and often helps. 

Dr. W. M. Townsend : Does the matter of location have 
anything to do with the selection of the remedy } I know 
that last summer one or two remedies were called for, and 
one of those remedies I have not heard mentioned to-night : 
cuprum arsenite. I used it for some time; it agrees very 
well with our cases of summer diarrhoea. I have used it more 
than all the others. I do not know that I have used them 
because they were favorites, but because there were more in- 
dications of these remedies. 

Dr. A. G. Howard : I have always found it difficult to 
select a remedy for diarrhoea, and in children I find it difficult 
to get the important symptoms.' One remedy has been im- 
pressed upon me from a case, at the dispensary, of head cold 
Arsenicum 3^ was prescribed, one tablet in three hours. If 
worse, a tablet m twenty minutes. The patient took about 
one-half ounce of the 3x, when word came to the dispensary 
that he was dying. I went to the house and found him vom. 
iting, with almost constant movement of the bowels, pressed 
out with considerable pressure, a rapid, weak pulse, very pale 
and prostrated, all typical symptoms of arsenical poisoning. 
It did not seem possible to get a proving from 3X. I saved 



I go I Societies. 405 

the urine from that time and sent a sample (a wine glass two- 
thirds full) to Dr. Wood for examination. He reported a 
considerable quantity of arsenicum found in the sample. I 
wrote back and wanted to know how much, and he replied 
I -10 of one milligram in one sample. Movements and pers- 
piration continued all night after sample was taken, and it 
impressed upon me the value of that drug, and that picture 
has been useful to me when I have found those symptoms 
prominent. With colocynth I have had as successful results 
when there was no pain as when there was any. 

I would like to ask Dr. Wood how important a symptom 
he considers the character of the stool in the child, and if 
pain is an important symptom } 

Dr. Wood : I think it is quite important. Mucous and 
bloody stools you can tell from the action of a child. When 
they are greenish and yellow, I think the color is due to the 
color of the poison which caused the diarrhoea. Children get 
hold of all sorts of things, which get into the stool, but it is 
not always a symptom to be depended upon. Take into con- 
sideration the cause of the diarrhoea, if known, and select the 
remedy that will clean up the intestines. 

Dr. Sherman : I have not seen any diarrhoea from i-io 
tablet of mercurius dulcis. In cases of green discharges I 
think it is indicated and I think it acts as a germicide in the 
intestines. I give it a number of times and then stop it. 

Dr. Carvill : Speaking of the action of mercurius dulcis, 
it acts internally as an antiseptic, but causes profuse secretion 
of bile, and is a wonderful benefit in cases of indigeston, and 
a very excellent remedy. There are some cases where it is 
not suitable. Some adults can not take i-io of a grain. 

2. Owing to the absence of Dr. Hopkins his paper on 
"The Best Diet of Children with Summer Diarrhoea " was 
omitted, and Dr. Emery was not present to open the discus- 
sion. 

Dr. W. M. Townsend : The thing which I deem the most 
important in the average case of summer diarrhoea is rest. I 
think it is one of those diseases which requires rest. Con- 



4o6 The New England Medical Gazette, Aug., 

siderable summer diarrhoea comes from three causes : indiges- 
tion and too rapid feeding, taking food that has undergone 
chemical changes, and sudden changes of temperature from 
heat; to cold. From all conditions you get practically the 
samie result : irritation of the mucous membrane. Absolute 
rest is of great importance, I saw a case in consultation a 
few years ago; the attending physician was trying to give 
food and medicine at the same time. The bowels and stom- 
ach should have absolute rest. There are very few children 
who can not get along very well without food for twenty-four 
hours. When teeth are the irritants, give them distilled 
water. I give them sterilized water in place of the bottle. 
Abstinence from food gives the intestines a chance to rest 
and the bowels to be cleared of all irritants. 

I believe most thoroughly in water as a food and local wash, 
and in all cases I use solution of saline instead of clear water, 
and a generous amount for the time it is used. I prefer it to 
clear water, as it helps to allay thirst. I also give barley 
water ; sometimes white of egg in water is good. In fourteen 
hours, as a rule, the looseness is pretty well under control, 
and the irritation relieved. Barley water without any remedy 
will do a great deal to get the child in better condition. In 
summer time the child is easily upset. I put a child upon 
mutton broth, or chicken broth, instead of milk ; broth does 
well for nourishment and allays irritation, and the bowels are 
got into good condition. I think to prepare the milk with 
barley water, instead of full strength of water, is a good way, 
increasing in strength until the child can go back to the usual 
diet. From twenty-four to forty-eight hours I recommend 
plenty of sterilized water, and in that way get along better 
and there is less chance of relapse. Water and broth are 
better than malted milk and prepared foods. Many cases of 
bowel trouble are from too frequent feeding ; they should 
rest until the irritation is over. Simply get the parents to 
look at it in a sensible manner and not overfeed the child. 

Regarding prepared foods, I use them comparatively little, 
and in many cases I went through the entire summer without 



iQor Societies, 407 

losing a case. But the main thing is to give the bowels and 
stomach a chance to rest, and then keep the food down until 
the stomach has had a chance to rest. 

3. " General Treatment of Summer Diarrhoea in Child- 
ren." Dr. Amsden's paper was a clear and concise rendition 
of a very important subject, and covered the whole matter in 
a very practical way. 

Dr. C. C. Burpee : Dr. Amsden's paper leaves very little 
to be said. Where there is more than one child great care 
should be used in handling the movements. Enema I desire 
to emphasize if the child is feverish, using water a little over 
100^, cooled gradually by ice. Then, if the child is very 
restless, head hot, and as the ice cap is almost impossible to 
fit, I think the water bag is of value at such a time and acts 
very satisfactorily. Another thing, I think we ought to use 
more than we do in summer diarrhoea, where we get more or 
less vomiting, and that is stomach washing. Last summer it 
was very satisfactory, and 1 intend to use it more this season. 
Then, bovinine is of great benefit and more or less stimulat- 
ing, and is one of the best preparations of this kind. After 
a while it is common to find the movements mucous and con- 
siderably conjested. I think then the best thing, for this 
class of cases, is strained cornstarch water. But, as Drs. 
Townsend and Amsden have said, the important thing is to 
keep the child without food lor twenty-four hours, and the 
trouble is with the mother and other relatives and nurse. In 
two cases I have kept them forty-eight hours on sterilized 
water only with very satisfactory results. 

Dr. Shepherd : The ice-bag as a pillow for all brain 
troubles has been followed by most excellent results. Wash- 
ing out the stomach is performed very simply by the nurse 
giving them all the water they want, a pint if they want it, 
and, if thrown up, the stomach is washed out. 

Dr. Wood : In cases of local enteritis I give the enema 
myself, because neither mother nor nurse will give it right. 
Place the child on a pillow, as if catherizing, and give normal 
saline slowly; it goes higher and is more absorptive and acts 



4o8 The New England Medical Gazette, Aug., 

on the diseased membntne. Keep the child in a horizontal 
position, and let it be retained as long as possible. 

Dr. Townsend : I am glad to hear Dr. Wood speak of in- 
jecting saline solution. Three cases last summer demon- 
strated the value of that treatment. Cases that were practi- 
cally hopeless, which had been sick thirty-six or forty-eight 
hours, and were living skeletons, vomited everything. As 
the result of injections of saline, an increase of pulse (which 
had been very weak) was obtained in a short time. The 
children began to show improvement ; local treatment and 
stimulant followed, and life was saved. Of the three cases 
two recovered and one died. It seems to me that it was an 
ideal case for the use of saline. It practically fills up the 
place of blood serum that has been lost, and there is a great 
use for it in such cases. 

Adjourned at 9.35. Edward E. Allen, 

Secretary, 



HASS. SURGICAL AND QYNECOLOQICAL SOCIETY. 

The fifty-seventh session of the Mass. Surgical and Gyn- 
ecological Society was held at the Hotel Nottingham, Boston, 
on June 12. 

The President, Dr. Henry E. Spalding, in the chair. 

The following were elected members : 

Dr. G. F. Allison, East Providence, R. I. 

Dr. E. R. Johnson, Wollaston. 

Dr. F. De Forrest Lambert, Salem. 

Dr. J. Arnold Rockwell, Boston. 

Dr. Harry O. Spalding, Boston. 

The Necrologist. Dr. H. P. Bellows, presented appropriate 
memorial notices of the death during the past year of the fol- 
lowing members : 

Dr. Henry F. Batchelder, Danvers. 

Dr. Sarah E. Sherman, Salem. 

Dr. Jane K. Culver, Boston, 

Dr. William Woods, Boston. 



IQOI Reviews and Notices of Books. 409 

In the scientific session papers were presented by Dr. Geo. 
W. Roberts, of New York City, on The Surgical Treatment 
of Tubercular Disease of the Joints, and by Dr. H. C. Clapp, 
on The Surgical Treatment of Tubercular Diseases of the 
Lungs. These papers elicited a very interesting and free 
discussion. 

Over 100 members sat down to the dinner following the 
session, and the feast of reason and flow of soul were contin- 
ued under the guidance of Dr. Winfield Smith. In this 
'*Clinique Extraordinaire", the demonstrators were Drs. Win- 
field Smith, Geo. W. Roberts, J. P. Rand, and H. C. Clapp, 
and the subjects were, "The Anesthesia", "The Exploratory 
Incision", "The Capture of the Tumor", and "Intravenous 
Saline". 

The next meeting of the Society will be in December, and 
will be the Twenty-Fifth Annual Session. The Bureau of 
Gynecology will report under the Chairmanship of Dr. Mary 
E. Mosher. 



REVIEWS AND NOTICES OF BOOKS. 



Obstetric and Gynecological Nursing. By Edward P. Travis. 

Illustrated. Philadelphia and London : W. B. Saunders & Co. 

1901, pp. 402. $1.75. 

This an excellent and timely book by a writer whose position in 
this profession carries weight and authority, and who has clearly 
written out of the fulness of his own experience. The work presents 
in plain language, free from needless phrases and technicalities, all 
that a Durse should know in her relation to the specialties here in- 
cluded. All rules and directions for her guidance are fully laid 
down, and prefaced in every case by a chart, well considered exposi- 
tion both of the abnormal condition to be met and the operation or 
procedure, in the hands of the operator, at which the nurse's assis- 
tance is demanded. In this way she is not only instructed in the 
technical part of her duties, but have to understand distinctly the 
bearing of these duties to the case in hand and the doctor's work. 



4IO The New England Medical Gazette, Aug., 

She has, in fact, what a modern, fully-equipped nurse so much needs 
here given her in one proportion,- -the theory and practice of ob- 
stetric and gynecologic nursing, and in a form for which she cannot 
be too grateful to the author. 

The subject of diet, the duties and conduct of the nurse in the 
absence of the doctor, the care and feeding of the new-born are 
treated as fully and as wisely as the strictly surgical portions, in all 
of which departments the author proves himself in advance of the 
common practice of the day. We, therefore, recommend the book 
most heartily, not only to nurses, but also to all medical students 
and to any practitioners who earnestly desire, as they should do, to 
know precisely what skilled and intelligent assistance means. 

But it is not to the author alone that those who read and study 
the work should acknowledge their indebtedness. The publishers, 
too, have left nothing undone to make it both useful and attractive 
in the highest degree. The good paper, clear print, careful proof- 
reading — let this be especially noticed in these days of hasty book- 
making — the admirable illustrations, few, but well executed and 
instructive, and the full index, all combine to prove the high standard 
kept in view in placing this book before those for whom it is 
written. w. w. 

CHARACTERISnCS OF THE HOMEOPATHIC MATERIA MeDICA. By M. 

G. Douglass, M. D. L'oericke & Runyon. New York. 1901. 

It is encouraging to find not only that in the field of materia 
medica " the harvest season is not yet over," as the author quotes 
from Dr. Hering, but that there are still among us laborers who wil- 
lingly subject themselves to the arduous task of gleaning after those 
who have already gathered, and of winnowing that which for a cen- 
tury has been garnered. The gathering and gleaning are difficult 
and laborious, but the most difficult of all labors connected with the 
utilization of the rich stores brought in is the winnowing ; the sepa- 
ration of the grain from the chaff, then the separation of the sound, 
full weighted grain from that which is tainted and light of weight. 
We must accord to Dr. Douglass all praise for the fulness of the 
work he has undertaken. He has, indeed, gleaned in many fields ; 
spared no pains, until hardly a medicinal substance anywhere used 
or suggested remains unnoticed. No less than nine hundred and 
thirty remedies are here marshalled for the use of the practitioner 



1 90 1 Reviews and Notices of Books. 4 1 1 

and the memoriziDg of the medical student, Happy and powerful as 
a leader, he who can retain in his memory even a hundredth part of 
all that is here spread before him ! 

Where so much has been done, and in the main done well, it 
would be a relief to say no more. But a book of nearly one thous- 
and pages, and more particularly a book of materia medica, is not 
to be dismissed with a mere laudatory book notice. Whoever comes 
before the profession with a new work on this subject demonstrates 
by this very act his sincere desire to further the cause of homoe- 
opathy by making its resources more available ; and, what is more, he 
does this with a clear understanding, not only of the difficulties, but 
also of the thanklessness of the task. He knows the obstacles to be 
met in attempting to gain not only the needful popularity, but even 
a hearing for his efforts. He cannot fail to be aware of the adverse 
spirit of the day, — the spirit of scepticism, of cavilling, perhaps, of 
gross materialism in all that pertains to therapeutics, or to disregard 
the advances in all those fields which invite to specialism, thereby 
retarding and warping not only the growth of homoeopathy, but of all 
genuine reform practice in so far as it deals with curative action of 
drugs. He must be aware that it is no longer possible to enlist the 
enthusiasm or win the interest of the rising generation of homoe- 
opaths in the subject of pure materia medica, unless, indeed, they 
have been reared from their infancy to respect nothing but the 
labors of Jahr, Hering, Lippb, Raue, and their followers. To these 
this work will unquestionably be a most welcome addition to their 
armamentarium, while to all those who in the multi-parvumness of 
their surgical, obstetrical, gynecological and other practical work, 
can find neither time nor leisure to delve in the diraly-lighted shafts 
of symptomatology, it will probably prove less attractive. This class 
of practitioners, whether right or wrong, is apt to demand that the 
resources of medicinal therapy be not only spread plainly before 
them, but also that it be adapted to their mode of viewing diseases 
and their methods of finding indications for treatment. 

The question, then, arises at once from which point of view to 
consider this book. If we approach it in the simple and childlike 
faith of the pure homoeopathist, of him who comes to every ca§e 
thinking only of the characteristic symptoms and keynotes presented 
by the patient, and to be sought for in the whole range of drug 
pathogenesy, we may be persuaded that nothing of practical impor- 



412 The New England Medical Gazette, Aug., 

tance has been omitted, and that all has been so simplified and re- 
duced to the needs of daily practice that this has now been made 
far more easy than by any known work of equal comprehensiveness. 
We shall observe that nothing has been neglected from A to Z : Aya- 
dirachta, Badrago, Homtyx chysorrhoea and processionea, Comocla- 
dio, Dorris pinnata and Doryphora, Erichthites and Echites, 
Elasis and Epiphegus, Eupion and Fagopyrum, Fragaria, Kedysarum 
and Hydrocodyle, Iteris amara, Itu, Jacaranda, Karakas, Katepo, 
Mancinella and Meticthsma, Musa, Mygale, Napulus, Narzau, 
Osimurss, Oxytropis, Optea Jurinosa, Oxcodaphre, Paracea, Porthos 
and Pyrethrum, Sabbatia angularis, Spiggurus, Stachys betonica, 
Thevetia, Yolotyochitl and Zisia, besides all mineral waters, cis and 
transatlantic; the nosodes with cimex and pediculus, and all the 
hundreds of others more or less familiar to those who use or review 
our work on materia medica. Of all, whether well, or ill, or un- 
known, " only the most characteristic indications have been retained, 
symptoms that the author has himself verified in a practice of twenty 
years, or which have been verified by trustworthy physicians." This 
is the assurance given in the preface. 

But here, unluckily, certain questionings arise in the soul even of 
him who comes with the most simple and childlike faith for aid and 
direction, questionings for which even the most patient research 
fails to bring satisfactory answers. The book contains no word of 
introduction explaining either the comparative value of drugs, or the 
tnanner of their presentation, which differs widely not only for dif- 
ferent drugs, but for the indications which shall guide us in their 
selection and clinical use. Why, for example, should our confidence 
in some remedies be fortified by giving the names of their provers 
or of those who introduced them into practice, while an almost 
equal number of others, especially the newer and less known ones, 
those for which we most need authoritative statements, are present- 
ed without as much as a hint of the origin of the knowledge con- 
cerning them ? And why, in the same way, are the common names 
and the preparations of some drugs, chiefiy those better known, 
carefully mentioned, while not a word in regard to these matters is 
vouchsafed concerning those newly introduced and little known. 
We do not say that these things are absolutely essential in a work on 
materia medica which has for its purpose only the presentation of 
symptoms pathogenic and clinical. But if given in one case, surely 



1 90 1 Reviews and Notices of Books. 4 1 3 

we have a right to demand these in the other. Is adonis vernalis, 
with half a page of indications, less worthy of such additional infor- 
mation than aesculus glabra, with but one line ? For the last named 
are given the common names and pharmaceutical preparation, 
while for the first he who practices far from a homoeopathic pharmacy 
and is often called upon to prepare his own medicine must look 
where he may ior the needful information. 

And, again, in regard to the clinical value of symptoms as deter- 
mined by experience and observation, are Ruchmann and Burt, the 
foremost provers of aesculus hippo castanum, and Bojanus, who 
proved convalaria majalis less authoritative and worthy of mention, 
and Dr. Swan who proved medorrhinuro, or Dr. Mure, of Brazil, who 
proved and introduced, as is said, cimex and pediculus and many 
other drugs of most questionable value ? These are instances of 
what occurs on almost every page of the book, and lead us to fear 
that Dr. Douglass and his editior, who is thanked in the preface for 
his careful work, have either yielded to some prejudice in the matter 
of mentioning authorities, or to some disinclination to take that 
trouble which is absolutely essential when men write in a great 
cause. 

In regard to the verification of symptoms the same doubts and 
questionings arise. The preface is of such very modest length and 
fulness that we are left to guess that the symptoms given in italics 
are those " verified by the author in a practice of twenty years and 
by other trustworthy physicians." We may say at once, and we say 
it cheerfully, that we have nowhere seen the polychrests^-of which, as 
a matter of course, the list has been lengthened since Hahnemann's 
day — more succinctly and practically presented than is here done. 
But the same mode of praise cannot conscientiously be accorded to 
the treatment of that '' large and valuable class of remedies found 
scattered thro' the various society reports, magazines, etc., and now 
gathered in one convenient volume." This treatment here is for 
the most part quite too cursory or " machine-made," if we may use 
the expression, to be of any value practical or scientific. Here, 
however, it is impossible to criticize the author's method, since 
there is nowhere to be found the least evidence of a method or any 
principle of selection or classification from which a method might 
be derived or inferred. All symptoms are made to appear as of 
equal value, unless, indeed, those italicised are intended to represent 



414 ^^^ New England Medical Gazette, Aug., 

the more exact indications. Perhaps there remains as yet the only 
course for a *Miberal homoeopath" who refuses to decide whether 
objective or subjective symptoms, pathological lesions or sensations 
and their modalities are to be accepted as guiding and characteristic 
indications. But when a new book on materia medica is offered to 
the profession with a distinct claim that it contains only that which 
has been verified as clinically valuable, we are warranted in looking 
for a long step in advance of the older authorities. 

It is this advance which, with much regret, we fail to recognize 
here. In fact, no progress in the direction of placing our materia 
medica, our one dislinctive, therapeutic feature, on a sound and 
genuinely practical basis, save by the most careful observation and 
experiment, conducted not alone in private practice, as hitherto, but, 
above all, by collective work, well systematized and planned for the 
exclusion of error. This can be done only in our hospitals, which 
have existed and continue to exist, primarily, for the greater glory 
of homoeopathy, and, secondarily, for the advantage of such patients 
and, we may add, of such practitioners who may choose to take ad- 
vantage of them. That they have in any sense advanced the power 
of our method over disease few will venture to assert. 

Until some concerted action in the direction of greater exactness 
and sounder knowledge, not only in the matter of reproving our 
drugs, but mainly of observing and determining their clinical effects, 
we must gratefully accept from private practitioners such results of 
their experience as they may offer, and doubt their verifications only 
when these are stated in terms too autiquated or too vague. Instan- 
ces of drugs so presented in this new work are so numerous that 
they affect its whole character, otherwise we should be but too glad 
to make no mention of them. What justification can there be to-day 
in a book written in the English language by an American author 
for retaining so many of the old terms, peculiar to early homoeopathic 
literature, which so plainly bear the mark, " Made in Germany " ? 
It is certainly no longer hypercritical to demand that symptoms 
should be expressed in plain English for our use. 

What we must look upon as a more serious fault, however, is the 
utter vagueness and utter inadequacy of so many of the indications 
offered as characteristics. What shall we say, for example, of Mer- 
curius jodatus cum Kali jodatum (sic), under which formidable and 
learned looking head nothing is given but " secondary and tertiary 



1 90 1 Reviews and Notices of Books. 4 1 5 

syphilis " ; or Yosotis : " cough with purulent expectoration *' ; or 
of Phosadendron : " hastens labor and prevents miscarriage " ; and 
many more of the same kind. And, furthermore, can the author 
truly say that he or any other trustworthy physician has verified in 
practice the curative effects of laughing gas, of which the pathogenic 
symptoms, although clearly and distinctly stated, are here introduced 
without any sponsor for their clinical validity ? 

It would lead quite too far to analyze the whole work in the same 
spirit of demanding exactness where as yet no exactness has been 
attained. The criticism we feel called upon to offer is simply this : 
that in so large a number of cases verifications and characteristic 
indications are declared to exist where nothing but vagueness and 
routine are exhibited. The work is in this way made to lose both 
in authoritativeness and practical usefulness in the proportion of its 
increase in size ; a matter to be profoundly regretted where so much 
of unquestionable value has been brought together. That the pub- 
lishers have done their work well goes without saying, although the 
proof reading here and there leaves something to be desired. Paper, 
binding, print and index are excellent. w. w. 

Principles of Surgery. By N. Senn, M. D., Ph. D., LL. D., Pro- 
fessor of Surgery in Rush Medical College in Affiliation with the 
University of Chicago ; Professorial Lecturer on Military Surgery 
in the University of Chicago ; Attending Surgeon to the Presby- 
terian Hospital ; Surgeon-in-Chief to St. Joseph*s Hospital ; Sur- 
geon-General of Illinois ; Late Lieutenant- Colonel of the United 
States Volunteers and Chief of the Operating- staff with the Army 
in the field during the Spanish- American War. Third Edition. 
Thoroughly Revised with 230 Wood- engravings. Half tones, and 
Colored Illustrations. Royal Octavo. Pages, xiv — 700. Extra 
Cloth, J4.50, Net; Sheep or Half- Russia, I5.50, Net. Delivered. 
Philadelphia: F. A. Davis Company, Publishers, 19 14-16 Cherry 
Street. 
To those familiar with the two preceding editions of this work, 

and no surgeon is not famihar with them, comment on this, the third 

edition, is hardly necessary. 

It has added two new chapters, one on " Degeneration," and one 

on " Blastomycetic Dermatitis," which very materially enhance the 

value of the work. The surgical pathology of the various subjects is 



4i6 The New England Medical Gazette, Aug., 

exhaustively considered and well illustrated. The subject matter is 
treated under the following heads : Regeneration, Degeneration, 
Inflammation, Necrosis, Suppurative Ulceration, Osteomyelitis, Sep- 
ticaemia, Pyaemia, Erysipelas, Tetanus, Hydrophobia, Tuberculosis, 
Actinomycosis, Blastomycetic, Dermatitis, Anthorix, and Glanders. 
The illustrations are numerous and good ; the text explicit and 
easily understood. It is a book of value either to the student or 
the practitioner. 

Clinical Pathology of the Blood, by James Ewing, A. M., M. D. 
Lea Brothers & Co., Phila. 

The growth of haemotology within the last decade has materially 
added to the diagnostic ability of the clinician. Unfortunately, 
however, of the several monographs which have appeared there have 
been but few handy for reference to the busy physician. This vol- 
ume of Ewing will, therefore, readily commend itself to the practi- 
tioner who wishes to know the characteristic features of the blood 
in certain pathological conditions, as well as to those who may ap- 
proach the subject from its purely scientific side. 

A valuable feature of the book is the extensive bibliography at 
the end of each section. This gives evidence of a wide acquaintance 
with the literature of the subject, and forces the respect of the reader 
for the opinions and interpretations of Dr. Ewing on those questions 
which are still subjudice. 

An idea of the scope of the work is best obtained by the follow- 
ing enumeration of the different divisions of the text : Part I, Gen- 
eral Physiology and Pathology of the Blood; Part II, Special 
Pathology of the Blood; Part III, Acute Infectious Diseases; Part 
IV, Constitutional Diseases ; Part V, General Diseases of Viscera ; 
Part VI, Animal Parasites. 

The text is illustrated with fourteen colored plates drawn by the 
author. These plates impress us as being largely diagramatic, and, 
perhaps, would have given more correct impressions had smaller 
magnification been adopted. From the above statement we would 
accept the plates illustrating the chapter on malaria, which although 
drawn to the same scale as the others, are far more instructive. 

A section of the work which seems to us worthy of special men- 
tion is the one on malaria. It embodies the recent views on the 



1 90 1 Reviews and Notices of Books, 4 1 7 

disease, as well as most valuable coatributions to our knowledge of 
the subject by the author himself. 

The volume is one which the up-to-date physician can not well 
afford to be without. 

The publishers work is well executed. s. c. t. 

A Text- Book of Embryology. By John C. Heisler, M. D., Pro- 
fessor of Anatomy in the Medico- Clinurgical College, Philadelphia. 
Octavo volume of 405 pages. Cloth, {2.50 net. W. B. Saunders. 
1899. 

It is with keen pleasure in these boasting days of " practical med- 
icine " that one welcomes a book thus systematically and compre- 
hensively treating this fundamental subject. 

The author modestly calls attention to the importance of a 
knowledge of embryology in order that the " proper comprehension 
of human anatomy " may be possible. Anatomy, however, is not 
the only subject related to medicine which cannot be brought into 
proper perspective without an intimate knowledge of the subject of 
this notable work. Because of a growing appreciation of the relation 
between the character of embryological and pathological processes, 
as well as its importance as an aid to the proper study of histology, 
obstetrics and the like, this treatise is in the first sense <* practical." 
Embryology has risen from what were considered the systematized 
vagaries of the biologist to a commanding position in practical 
medicine. 

Commanding because an ever increasing band of physicians 
search for the truth by the light it gives ; and practical because fun- 
damental. 

The text is clear and concise, the illustrations copious, and 
mechanically the book is everything which one expects from the 
Saunders' high- standard press. a. e. p. r. 

The Feeding of Infants — Home Guide for Modifying Milk. 

By Joseph E. Winters, M. D., Professor of Diseases of Children, 

Cornell University Medical College. New York : E. P. Button 

& Co. 1 90 1, pp. 47. Price, cloth, 50 cents. 

Mother's milk, other things being equal, is the ideal food for 
infants. When this is not obtainable a substitute must be provided 
which fairly approximates it. Dr. Winters shows the enormous dif- 



4 1 8 The New England Medical Gazette, Aug., 

ference in mortality between babies naturally and artificially fed, 
and endeavors to teach methods by which the mortality under the 
latter conditions may be greatly lessened. He gives formulae for the 
modification of milk adapted to infants at different ages, and pro- 
vides some excellent hints on such points as the appropriate 
amount of food, dangers of over- feeding, milk supply, pasteurization, 
etc. He has nothing very favorable to say of the prolonged use of 
predigested, or ** Infant Foods " so-called, and we must say we are 
inclined to agree with his strictures. 

Taylor on Genito-Urinarv and Venereal Diseases and Syphilis. 
The Pathology and Treatment of Genito- Urinary and Venereal 
Diseases and Syphilis. By Robert W. Taylor, A. M., M. D., Pro- 
fessor of Venereal Diseases in the College of Physicians and Sur- 
geons, New York. New (2) edition. In one very handsome 
octavo volume of 720 pages, with 135 engravings and 27 full-page 
plates in color and monotone. Cloth, $5.00 net ; leather, W.oo 
7iet ; Lea Brothers & Co., Publishers, Philadelphia and New York. 
Dr. Taylor's reputation among the profession is such, that any- 
thing from his pen on genito- urinary and venereal diseases commands 
at once the attention. 

This is the second and revised edition of his work, the first edi- 
tion of which is already an authority in the profession and the med- 
ical schools. The author's aim is "to present an up-to-date, prac 
tical and compact treatise" ; this he certainly has accomplished. 
The instructions for treatment of the various diseases, especially Gon- 
orrhoea, are given with a minuteness of detail that make them 
especially valuable ; at the same time there is evidenced a conser- 
vativeness of opinion which impresses one with the seriousness and 
gravity of the disease. This work is invaluable in its line and sure 
to maintain its place as among the foremost of our text-books. 

35,000 Questions on Medical Subjects Arranged for Self- Ex- 
amination. Third edition, enlarged. Philadelphia : P. Blakis- 
ton's Son & Co. 1901. Price, 10 cents. 

The above comprises questions only, upon all the main branches 
of medicine. Answers are referred to as found in some sixteen or 
seventeen books, most of which are merely quiz- compends. We 



I go I Reviews and Notices of Books. 419 

think the latter sufficiently cover the ground, and that it is hardly 
advisable for a student to depend too much upon such condensed 
aids. The book under notice, contains the questions given by the 
State Examining Boards of New York, Pennsylvania and Illinois in 
recent examinations. 

International Homceopathic Medical Directory. London : 
Homoeopathic Publishing Co. 1901. pp. 122. Price, 50 cents. 
The International Directory for 1901 gives the names and ad- 
dresses of all homoeopathic physicians practising on the Continent 
of Europe, in the British Empire and in Mexico. It is proposed, 
in a future edition, to include the names of those American homoeo- 
pathic physicians who care to subscribe for the directory at the rate 
of {i each. Any who are interested and desire further infonnation, 
should send their address to the publishers, 12, Warwick Lane, 
London, E. C, who will mail circulars when the next edition is 
being compiled. 

A Manual of Homceopathic Materia Medica. By J. C. Fal- 
mestock, A. M., M. D. Published by the author, Piqua, Ohio, 
1 90 1. For sale by Otis Clapp & Son. Price, cloth, ^1.25. 
Cloth with blank pages, S1.50. Flexible leather, {2.00, net. 
This is a manual for ready reference, giving in brief the character- 
istic symptoms of the remedies. Each alternate page is blank to 
enable one to make additional notes or to emphasize verification. 
The work is thoroughly and painstakingly done and promises to be 
a very helpful one, both to the student and the practitioner. 

William Wood & Co. announce the following recent publications : 

Clinical Lectures on Stricture of the Urethra and Enlarge- 
ment OF THE Prostate. By P. J. Fceyer, M. A., M. D., M. Ch. 
Surgeon to St. Peter's Hospital. Lieut-Colonel Indian Medical 
Service, (Retd). 

An Index of Symptoms as a Clew to Dugnosis. Just published. 
By Ralph Winnington Leftwitch, M. D., late assistant physician to 
the East London Children's Hospital. 

Aphorisms, Definitions, Reflections and Paradoxes. Medical, 
Surgical and Dietetic. By A. Rabagliati, M. A., M. D., F. R. C. S. 
Ed. Late President of the Leeds and West Riding Medico-Chi- 
rurgical Society, etc. 



420 The New England Medical Gazette. Aug. 

PERSONAL AND NEWS ITEMS. 



Dr. J. Fred'k Norwood has removed from Rockport, 
Maine, to Camden, Maine. 

Dr. G. N. Towle has returned from his sojourn in the 
West, and has located in Houlton, Maine. 

Dr. Frank B. Foster, class of '99, B. U. S. of M., has 
removed to Santa Barbara, California. 

During August and September Dr. T. M. Strong will be 
at Nonquitt, Mass. 

Dr. Harry A. Cheney, class of '01, B. U. S. of M., has 
opened an office at Newburyport, Mass. 

Dr. Fred'k M. Sears, B. U. S. of M., '01, has opened an 
office at 50 Bloomfield Street, Dorchester. 

Dr. Frederick C. Robbins, class of '96, B. U. S. of M., 
has removed from Yarmouthport, Mass., to 25 Village Ave., 
Dedham, Mass. 

Announcement is made of the removal of Dr. Howard P. 
Bellows, Dr. Geo. B. Rice and Dr. Geo. A. Suffa from the 
Woodbury Building to the Guildford, comer of Clarendon and 
Newbury Streets, Boston. 

On account of ill health, a homoeopathic physician in a 
large railroad town in eastern New York will dispose of prac- 
tice and complete outfit at a bargain. Fine opportunity for 
a young man. Address Dr. F. C. Brush, 1244 Broadway, 
New York. 

At the June meeting of the Faculty of the Chicago Homoeo- 
pathic Medical College a beautiful loving cup was presented 
by the Faculty to Prof. N. B. Belamater as a token of the 
esteem and affection in which he is held by those who have 
been associated with him during his twenty-five years' service 
in the college. 

Under the management of the new business manager the 
Chicago Homoeopathic Medical College has undergone a 
thorough renovating, having had two new lecture rooms, with 
sub-clinic rooms, and it is in a most excellent condition. The 
college is in excellent financial state, owning property to the 
amount of $100,000, having a debt of but a little over $25,000. 



THE NEW ENGLAND 

MEDICAL GAZETTE 

No. 9. SEPTEMBER, 1901. Vol, XXXVI. 

COMMUNICATIONS. 



A LETTER FROH QERHANY. 

BY HORACE PACKARD. M. D. 

HOMCEOPATHY ON THE CONTINENT A DAY WITH BASSINI 

VIENNA WANING AS A WORLD'S MEDICAL CENTRE PRO- 
FESSOR SCHROTTER AND THE HEILANSTRALT ALLAND 

(hospital for consumptives) BOTTINI'S OPERATION 

AND FRENDENBERG's WORK MEDICAL EDUCATION IN 

GERMANY. 

Berlin, July 21, 1901. 
In my journeyings it has been my pleasure to look up, as 
far as opportunity has offered, the present status of homoeop- 
athy. These inquiries have been made to satisfy my curi- 
osity as to the truth of the claims frequently made that 
homoeopathy is on the decadence in Europe. To such hom- 
oeopathic physicians as I have met, my queries have been 
mainly as follows : — 

1. Is the number of homoeopathic physicians increasing in 
the city or town where you reside ? 

2. Are homoeopathic remedies becoming widely used by 
old school physicians ? 

3. Is the relation now existing between the representa- 
tives of the two schools a friendly one ? 

4. What is the attitude of the public at large toward 
homoeopathy ? 



/ 



422 The New England Medical Gazette. Sept., 

5. What, in your opinion, is to be the final destiny of 
homoeopathy in your country ? 

The first physician with whom I had an interview was 
Dr. Bernard S. Anneply, of Nice, France. To Dr. Anne- 
ply's opinion I attached much weight, for he has travelled 
abroad, has been in the United States for thirteen years, 
was at one time Professor of Theory and Practice in the 
Hahnemann College, Chicago, and is now the foremost 
representative of homoeopathy in Southern France. The 
doctor is a naturalized citizen of the United States and his 
sympathies are all with the free democratic government of 
his adopted country. With tender solicitude for the health 
of a member of his family he returned to the mild climate of 
the Riviera. 

His father. Dr. Pierre Anneply, was the pioneer homoeopa- 
thist of Northern Italy and Southern France. Nice, and 
what is now the French Riviera, was at that time Italian 
territory and the residence of many persons of education, 
wealth and influence. His practice became large and re- 
munerative, and with the aid of his patrons he established a 
homoeopathic hospital which flourished for years. The num- 
ber of homoepathists increased to seven or eight in the few 
succeeding years, but grave political complications arose 
which changed a long stretch of the Riviera, including Nice, 
into French territory. Many of the wealthy Italians who 
had been patrons and supporters of Dr. Anneply and the 
hospital which he established, moved away to regain their 
native soil, and as a result the hospital languished and was 
finally obliged to close its doors. 

The present Dr. Bernard S. Anneply said, ** While homoeo- 
pathy is showing progress in Germany, England and Spain, 
it is at a standstill in France. We find a sturdy group of 
good practitioners in Paris, although there also the older and 
abler men are passing away and are hardly to be replaced 
by men of equal merit. In the provinces we find but few 
representatives of homoeopathy. Our numbers are decreas- 



I go I A Letter front Germany., 423 

ing here in Nice, but I hope to jetrieve lost ground. At 
one time there were seven homeeopathists here, now they 
are reduced to three. My father's followers and supporters 
have become scattered. Young men who study medicine, 
though some of them have a preference for homoeopathy, are 
subject, in their course of study in our established universi- 
ties, to anti-homoeopathic influence and with the attractions of 
specialties, hospital positions, government and army appoint- 
ments, they cast their lot with the old school. In France 
our total number is now about sixty, most of wjiom are in 
the large cities and towns. The use of remedies in homoeo- 
pathic indications by the old school physicians is increasing. 
As I come occasionally in consultation with them I find 
them using bryonia for acute pleuritic affections, Pulsatilla 
for dysmenorrhoea, etc. 

*' It is not very difficult for a well-trained homoeopathic 
physician to make a place for himself in any community 
about here. Cannes, a charming place near Nice, has no 
homoeopathist although it could easily keep two good men 
comfortably busy. In France homoeopathy as a distinctive 
school of medicine is making no progress, but it is being 
quietly amalgamated with the practice of medicine in gen- 
eral. Little if any of the old spirit of intolerance and per- 
secution shows itself. Friendly relations exist, and amicable 
consultations frequently occur." 

In Rome I had a very entertaining interview with Dr. Vin- 
cenzo Liberali. His father was a homoeopathist, and he 
has a son now studying medicine. He said, " We number 
five homeeopathists here in Rome, and about forty in Italy. 
We have a hospital in Turin, which has recently had a 
legacy which will enable it to maintain a capacity of about 
thirty beds. In the larger cities of Italy there are from four 
to six homeeopathists each, but in the smaller towns and 
cities it is unknown. Of increase in numbers there is none, 
and homoeopathy is but little known or practiced among my 
old school colleagues. I occasionally hear of them using 



/ 



424 The New England Medical Gazette. Sept.^ 

glonoine, on homoeopathic indications, for heart troubles, 
but in such large doses that disagreeable cephalic symptoms 
follow. 

" The outlook in Italy for the growth of homoeopathy as a 
school is not hopeful. I include in my practice some of the 
most wealthy and intelligent families of Roitle; and there is 
a place for homoeopathy among the better classes of people. 
All influences, however, lead the young man toward the 
attractions of the old school hospitals, colleges, societies and 
associations. The friendship and good will of the estab- 
lished professors and practitioners seem to them, and are 
stepping stones to practice and a livelihood. After all, with 
most, the latter is the chief incentive." 

Salzburg (Austria, the home of Paracelsus in the sixteenth 
century), a flourishing city of thirty thousand inhabitants, 
directly in the line of travel between Paris, Munich, Vienna, 
and Constantinople, and much visited and admired for its 
beauty by tourists, has one homoeopathist, Dr. Gregor 
Gfrerer. His sign reads, " Physician and Hydrothera- 
peutist.*' He said, " Formerly there were three homoeo- 
pathic physicians here, but one has died, and the other is 
aged. No young men are in view to take their places. 
They all cast their fortunes with the dominant school. 
Homoeopathic remedies are unused and unknown by my old 
school colleagues. The druggists here keep no homoeopa- 
thic preparations. I must send to Leipsic for all my tinc- 
tures and triturations. I am viewed as a charlatan by my 
old school colleagues and homoeopathy is denounced as a 
humbug. My field is difficult. I see but little promise for 
the future." 

Vienna. Dr. Ignatz W. Klauber is one of the foremost 
homoeopathists in Vienna and enjoys a large, lucrative prac- 
tice. He said, "We have two hospitals here under homoeo- 
pathic management : a general hospital of eighty beds and 
a children's hospital of thirty beds. The number of pro- 
fessed homoeopathists here at present is about fifteen. 



I90I A Letter from Germany, 425 

There are many more who practice homoeopathy quietly and 
affiliate with the old school. We have no homoeopathic 
organization in Austria, i,e. no national society, and probably 
homoeopathy never will exist as a separate school, con- 
sequently our young men who believe in and practice hom- 
oeopathy perfer to do so quietly, in which they are not 
antagonized by their old school colleagues, and thus they 
maintain friendly relations with the dorminant organiza- 
tions. 

" No, homoeopathy is not on the decline in Austria. The 
germ of truth enunciated by Hahnemann is penetrating 
more deeply into the body medical. There will always be 
people who want homoeopathic treatment and there will 
always be physicians, and in increasing numbers, who will 
practice homoeopathy. 

" Some of the professors in the Vienna University main- 
tain cordial relations with us and meet us courteously in 
professional consultation." 

In Dresden, Dr, Hermann Elb (member of the Royal 
Saxon Sanitary Commission) is the pioneer homoeopathist of 
Saxony. For many years he held the field alone, but in 
recent times accession to the ranks have occurred. At pre- 
sent there are four physicians practicing homoeopathy in 
Dresden. Dr. Elb said, "Yes homoeopathy is gaining 
strength in Germany. Our National Homoeopathic Medical 
Society has a membership of about two hundred, and meets 
annually in the larger cities, alternately. It convened here 
in Dresden last year, at which time I served as president. 
This year it meets in Frankfort, August 8th — will you 
come } At the present time there is a factional dispute 
over the attenuation question, but that will adjust itself. 
As physicians and scientific men we cannot ignore progress 
in medical science, whether such be in the line of homoeo- 
pathic therapeutics, serum therapy or sanitary science. 
Homoeopathy was never more directly in the line of progress 
than at the present time. There are more physicians prac- 



426 The New England Medical Gazette. Sept., 

ticing homoeopathy, more old school physicians giving ear to 
it than ever before. Dr. Hugo Schultz, Professor of Materia 
Medica and Pharmacology in the Greifswald University (old 
school) is in a quiet way disseminating homoeopathic teach- 
ings. It is an interesting story. He believes in homoeo- 
pathy but his position forbids declaration of such. As a 
child he was cured of some distressing malady by homoeo- 
pathy. As an adult and after he became professor in the 
university he was stricken with a severe enteritis. Nothing 
availed as a cure. At last after seven weeks had elapsed 
he was persuaded by his parents, who were still firm believ- 
ers in homoeopathy, to summon a homoeopathic physician. 
Colchicum was administered. In two days he was well. A 
little while after, he was relating to one of his old school 
colleagues the details of his experience and his rapid recov- 
ery after taking colchicum. His companion said in answer, 
** It is impossible that colchicum could have had anything to 
do with your recovery. Why^ it produces just such symp- 
toms !' The next step is the appearance in old school jour- 
nals of provings of various drugs on Hahnemannian plan by 
Professor Shultz, conducted in a masterly manner, to which 
no objections have thus far been offered by' his old school 
colleagues. It is an open secret that his sympathies are 
with homoeopathy, that he seeks conference with homoeo- 
pathic physicians, but that thus far, from motives of which 
judgment should not be hasty, he does not announce himsetf 
a homceopathist 

In Berlin I found an enthusiastic, hard working coterie 
of homoeopathic physicians numbering about forty. I spent 
a very pleasant evening with Dr. Gisevius and Kroner dis- 
cussing medical education in Germany and the present and 
future of homoeopathy. They said, " We have at present 
about four hundred professed homoeopathic physicians -in 
Germany and about four hundred more who practice hom- 
oeopathy but prefer to affiliate with the old school. We 
conduct three dispensaries here in Berlin and have already 



I go I A Letter from Germany, 427 

in hand seven hundred thousand marks towards the founding 
of a hospital. We are now moving in the matter of the 
establishment of a homoeopathic pharmacy under the same 
governmental regulations which control the old school phar- 
macies. This means much for it will be the first govern- 
mental recognition which has been accorded us. 

" A committee of physicians is now busy upon a new 
work on homoeopathic pharmacy and materia medica. Pro- 
fessor Schultz's work at Greifswald University is doing 
much for the dissemination of homoeopathy among the pro- 
fession at large. Young men who seek training in homoeo- 
pathic materia medica attend his lectures from all over 
Europe. His course is a wise one in making no declaration 
of his homoeopathic convictions. His work is so profoundly 
scientific that he is unassailable by any of his old school 
colleagues who may be chafing at the impetus which he is 
giving to homoeopathy. That his work receives the com- 
mendation of the regents of the university is evidenced by his 
recent advancement to a position of higher dignity. 

" A few years ago Professor Rapp, of Tubigen Univer- 
sity, became a convert to homoeopathy and made open decla- 
ration of the same. He was quietly deposed and sank into 
oblivion. 

" As to the future of homoeopathy here in Germany it is 
rash to prophesy, but there are certainly no signs at present 
of its decadence. 

" Our relations with the old school are tranquil, and ami- 
cable consultations frequently occur. 

" There is a strong friendly feeling on the part of the pub- 
lic towards homoeopathy as is evidenced by recent large con- 
tributions to our hospital fund." 

Conclusion, There is no prospect of the extinction of 
homoeopathy in, Europe in this era of the world's history. 
While in some countries and sections of countries homoeop- 
athy is making little or no progress, e.g.^ Italy and Southern 
Austria, yet it is almost the universal testimony that the 



/ 



428 The New England Medical Gazette. Sept., 

number of physicians who practice homoeopathy is augment- 
ing. In Germany the expected has at last occurred, viz. : 
A professor of materia medica in an old school medical 
college has taken up the investigation of drugs on the Hahn- 
emannian plan, and his work and teachings are accepted 
and incorporated in the latest and most authoratative text- 
book {Lehrbuch der Allgemeinen Therapie und der Thera- 
peutischen Meto die l8g8). 

After this there seems no need to discuss the future of 
homoeopathy. As a therapeutic method it has stood the test 
of a century and it now takes its place in the great field of 
medicine as a method among other methods to be used 
according to the light and convictions of each physician. 

{To be continued,) 



THE MATERNITY DEPARTMENT OF THE MASSA- 
CHUSETTS HOnCEOPATHIC HOSPITAL. 



With a Report of the Services of Walter Wesseihoeft, M.D., 

Obstetrician. 

REPORTED BY J. EMMONS BRIGGS, M. D., ASSISTANT OBSTETRICIAN. 
[Read before Mus. Horn. Med. Society, March 7, 1901.] 

The first definite steps toward the establishment of a 
Maternity Department to the Massachusetts Homoeopathic 
Hospital may be said to have originated with a motion made 
by Dr. Walter Wesselhoeft at a meeting of the Medical 
Board of the Hospital held in June, 1896. His suggestion 
was that a part of the medical wing of the hospital be used 
as an obstetrical department. The matter was placed in the 
hands of a committee who agitated the subject, with the re- 
sult that on April 30th, 1 897, the trustees of the hospital ob- 
tained possession of a large house No. 40 West Newton St, 



I90I Maternity Dept. Mass. Homceopathic Hospital, 429 

Boston, which had previously been remodeled into a private 
hospital. 

During the spring and summer a considerable amount^of 
work was done in adapting the building to the needs of a 
maternity hospital. Finally, on September 5 th, 1897, the 
work was completed and the first patient was admitted. 

The capacity of the hospital is at present seventeen beds. 
On the first floor are the reception-rooms, dining-room for the 
staff and nurses, a ward with a capacity of five beds, a serv- 
ing-room and bath. On the second floor is one small private 
and two large rooms, accommodating two and three patients, 
respectively ; also a bath-room. The third and fourth floors 
are arranged in a similar manner. The fifth floor contains 
the delivery and sterilizing rooms, also a small room, where 
patients wait until the first stage of labor is completed. In 
the basement is the kitchen and a room for the examination 
of patients. The nursery is a large room with a southern 
exposure. There are cribs with accommodations for seven- 
teen babies. There is a porcelain bath tub and all necessary 
appurtenances for their care, including an incubator of the 
latest design. 

The delivery-room, a room 14 x 15, is supplied with over- 
head and northern light. The furnishings are of metal and 
glass and comprise an operating or delivery table, instrument 
and dressing table and porcelain utensils. The room is 
lighted by electricity and gas. Opening out of this is a room 
for instruments and sterilizing. 

The private rooms vary in size from those moderately 
small, at $15 a week, to commodious and very handsomely 
furnished apartments at $30. There is only one general 
ward, and it contains five beds. A limited number of free 
patients can be accommodated. 

The house physicians are appointed for a term of six 
months, the first three months serving as junior and the sec- 
ond as senior housa physicians. The requirements call for 
a graduate in medicine for the position of senior house physi- 



430 The New England Medical Gazette. Sept., 

cian. He, assisted by the junior, is entrusted with the care 
of patients before, during and after confinement, under the 
in>mediate supervision of the attending or assistant obstetri- 
cian. He keeps the records and has authority to admit 
patients in emergency. The internes are usually those who 
have served or have been appointed to a term of twelve 
months at the Massachusetts Homoeopathic Hospital. The 
nursing is under the immediate supervision of the superin- 
tendent of nurses and the matron of the maternity depart- 
ment. 

In the three years during which the hospital has been in 
operation it is a noticable fact that nearly all the private 
cases which have been treated have come from the practice 
of the obstetrical staff. It does not seem to be generally 
known that other physicians who are members of the Massar 
chusetts Homoeopathic Medical Society can bring their 
patients and care for them in the private rooms of this insti- 
tution. Here are all the appliances for meeting emergencies, 
and especially, through its corps of house physicians and 
nurses, for reducing to the minimum the great hazard that 
is sometimes foreseen must attend the approaching parturi- 
tion. 

That you may have an idea of the amount and character of 
the work which this institution is conducting, I have had a 
summary made of all cases treated in the hospital from the 
date of opening to January ist, 1901. 

See Third Annual Report, 



REPORT OF THE SERVICE OF WALTER WESSELHOEFT, M. D., 
OBSTETRICIAN. 

Patients who desire admission to the Maternity Department 
either apply in person or through their family physician. In 
either case they are encouraged to submit to examination as 
soon as practicable. This primary examination is to de- 
termine approximately the position of the foetus, the pelvic 



190 1 Maternity Dept, Mass. Hommopathic Hospital, 431 

diameters, and, in fact, to ascertain whether, there be be any 
abnormality. The urine is examined and the patient instruct- 
ed when to call again. Subsequent examinations are re- 
quested in cases where the position is faulty or other marked 
pathological conditions exist. If the urine is scanty, low in 
specific gravity and urea, and contains albumin or casts, the 
patient complaining of dullness of vision or headache, we in- 
sist upon immediate admission. If any of the above men- 
tioned complications exist, we prefer to have our patient 
under our immediate observation, that any tendencies toward 
uraemia may be immediately discovered and the appropriate 
treatment instituted. 

If everything appears normal in the primary examination 
patients are instructed to enter the hospital at a time which 
is set about one week before the expected confinement. They 
are, however, instructed to report immediately in case labor 
pains occur. 

If patients are in labor when they arrive, if time will allow 
they receive a bath and their bowels are evacuated. They 
then go either to their rooms or the delivery suite, as the cir- 
cumstances require. During the first stage of labor patients 
remain in their rooms, and are encouraged to move about, 
but after the cervix is dilated they are taken to the delivery- 
room. Ether or chloroform are frequently administered as 
the head begins to dilate the vulvar orifice. Here it serves 
two purposes, viz. : to retard and render the propulsive pains 
less violent, and thus give ample time for the soft parts to 
stretch ; also to relieve the woman from the agony often ex- 
perienced as the head is bom and the perineum injured. It 
is impossible at this writing for me to say just what propor- 
tion of cases receive an anaesthetic. 

The perineum is never repaired nor forceps applied 
without anaesthetic. Chloroform is the anaesthetic par excel- 
lence for obstetrical work. It is quick in its action, and, 
unless operative interference is demanded, only a few drops 
need be used on a handkerchief as the patient realizes the 



432 The New England Medical Gazette. Sept., 

oncoming of a pain. Complete anaesthesia is scarcely ever 
employed, nor is it desirable in uncomplicated cases. 

Frequent vaginal examinations are undesirable and add to 
the dangers of infection. After having determined the posi- 
tion of the foetus, and assured oneself that no abnormality of 
the bony pelvis or soft parts exists, nothing is gained by re- 
peated exaniinations. I use the rubber finger cots for exam- 
ining purposes and the rubber gloves during delivery. I 
have formed no opinion as yet as to their merits in obstetrical 
practice, as they were used only during the last term of 
service. No sepsis developed, but it is probable that such 
would have been the record had we not used them. I had 
become an ardent believer in* the rubber glove for surgical 
work, and was anxious to give them a trial in obstetrics. 

Whenever a chemical disinfectant has been required, we 
have used formaline solution, one-half of one per cent. 
Douches are not given during or after delivery unless special- 
ly indicated. A foul lochial discharge appearing a few days 
after delivery is an indication for a douche of sterile water, 
followed by a pint of one-half per cent, formaline solution. 

Lacerations of the cervix are not repaired unless very 
severe and stitches have to be taken to control the hemor- 
rhage. Post-partem hemorrhage is treated by compression of 
the uterus through the abdominal wall, by hot or cool 
douches to which vinegar is added if necessary. If the 
bleeding be occasioned by a cervical laceration the uterus is 
pulled down by the cervix forceps and two or three deep cat- 
gut sutures are adjusted in the cervix in such a way as to 
control the hemorrhage. If patients suffer from an excessive 
loss of blood we have recourse to the intravenous saline 
injection. Ruptures of the perineum are invariably repaired 
immediately, and we exercise as much care in accurate sutur- 
ing as in cases requiring secondary operation. The suture 
material is cat-gut and silk worm-gut, the latter being re- 
moved on the tenth day. Patients with rupture of the peri- 



igoi Maternity Dept. Mass, HomceopatHic Hospital. 433 

neum are allowed to sit up on the fouteenth day and leave 
the hospital on the twenty-first. 

Babies are car^d far in the nursery by a nurse who is de- 
tailed for that w6rk exclusively. They are brought to their 
mothers to be nursed at regular intervals. 

During Dr. Wesselhoeft's terms of service several extremely 
interesting cases have been treated. Lack of time forbids 
me to report them all, and I must select a few. I have de- 
cided, therefore, to give you brief reports of those which ter- 
minated fatally. These comprise two cases of eclampsia and 
one of placenta previa. 

Case I. — Mrs. B., age 23, nationality, English. She en- 
tered the hospital at 10.30 A. M., June 20, 1899, and gave a 
history of having had nephritis for four years. Her father 
and brother both having died from it. During her pregnancy 
she had suffered less than usual. Early in the morning of 
June 20th she had a severe convulsion, which was followed 
by two equally severe, before she arrived at the hospital. She 
was unconscious, and her temperature had risen to 103 
degrees and her pulse was 1 20. Her countenance was livid 
and her skin dry and hot. Examination per vaginam showed 
a cervix undilated. Dr. Walter Wesselhoeft was summoned 
in consultation. As the patient was in a desperate condition, 
her temperature rising at the rate of nearly a degree an hour 
and her pulse increasing in rapidity, with absolute suppression 
of urine, it was thought best to interfere and deliver her as 
soon as possible. With this end in view, forcible and rapid 
dilitation of the cervix was undertaken, but on account of the 
great rigidity of the cervix and the narrow vagina and peri- 
neum, it was quickly found that delivery through the vagina 
could not be accomplished without extensive injuries to the 
soft parts. At the suggestion of Dr. Wesselhoeft, I made a 
Caesarian section and delivered the woman of a living child. 
The placenta being very adherent, and its detachment being 
accompanied by severe bleeding, ligatures were thrown about 



434 Tf^^ New England Medical Gazette, Sept., 

both broad ligaments and the uterus removed. An intra 
venous injection of salt solution was then administered. The 
patient had another convulsion shortly after completion of 
the operation, from which she never rallied, and died about 
8 P. M., about four hours after the operation. The child 
survived only eight hours. 

Comments : This was a typical case of puerperal eclamp- 
sia in its worst phase. The woman had been in convulsions 
and unconscious nine hours. Her temperature and pulse 
were exceedingly high and the cervix not dilatable. There 
was absolute suppression of urine ; less than a tablespoonful 
was procurable by the use of a catheter, and it contained 
eight per cent, albumin and numerous granular and fatty 
casts. No expectation of saving the mother's life was enter- 
tained. By Caesarian section we hoped to save the child. 

Case II. — Miss C, aged 14, Irish parentage;- entered the 
hospital at noon of October 28, 1900, in a semi-comatose 
condition. Her mother found her that morning in convul- 
sions and apparently unconscious. There was a record of 
four well-marked convulsions and several less pronounced. 
A very severe convulsion occurred at 12.15 P. M. I exam- 
ined her at that time and found the cervix partially dilated. 
At Dr. Wesselhoeft*s suggestion chloroform was administered 
and the cervix manually dilated. At 12.30 P. M. the mem- 
branes were ruptured and high forceps applied. The child 
was delivered without any difficulty and with scarcely any 
tearing of the soft parts. Three pints of an intra-venous salt 
solution were given at 1.40 P. M. At 2 o'clock a slight con- 
vulsion occurred, and another somewhat later. Two more 
followed in close succession. At about 3 P. M. several high 
saline enemata were given. Half an hour later the convul- 
sions were very severe and frequent. Only two drams of 
urine could be obtained by the use of the catheter. It con- 
tained eleven per cent, albumin, numerous granular hyaline 
and epithelial casts. Veratrum veride in 5 gtt. doses was 
given and frequently repeated. With every convulsion the 



I go I Maternity Dept. Mass. Homceopathic Hospital, 435 

pulse increased in rapidity. At 5 P. M. the temperature had 
reached 104.5 ; at 7 P. M., 105.8 ; at 9 P. M., 1077, with a 
pulse estimated at 180 per minute. At this hour the convul- 
sions were not so well marked, but there was constant 
twitching and stertorous breathing. She died at midnight in 
a convulsion. Her temperature by rectum was 108.4. 

Comments : In this case the indications were clear as to 
the course to be pursued. The cervix was obliterated and 
the canal was opened sufficiently to admit the finger, there- 
fore the delivery was easily accomplished. This case, how- 
ever, proved more rapidly fatal than case i, where Caesarian 
section was made, and was, likewise, doubtless attributable 
to the total suppression of urine. 

Case III. — Placenta previa. — Mrs. F., aged 30, Irish na- 
tionality. The first seven months of pregnancy progressed 
normally, when suddenly a severe hemorrhage occurred. 
After that date she had several other hemorrhages, but less 
severe. She had been compelled to spend a large portion of 
her time in bed, as exercise was accompanied by loss of 
blood. She entered the hospital June 13, 1898. At this 
time she was flowing badly, and there was a foul odor to the 
discharge. Examination revealed a transverse presentation, 
with the head to the right side. The cerv-ix somewhat dilat- 
ed, and within were clots of blood which protruded through 
the OS. On deeper penetration the placenta was made out 
centrally located. The patient was put in bed and the 
vagina was cleansed by antiseptic douches. 

We kept her under observation one week, during which 
time she flowed quite constantly, but not alarmingly. On the 
20th of June she had a severe hemorrhage. The vagina was 
packed, but the flowing continued. As the hemorrhage 
could not be controlled we thought best to interfere. The 
patient was etherized, and Dr. Wesselhoeft dilated the cervix, 
grasped a foot and delivered forcibly. Considerable difficulty 
was experienced in delivering the aftercoming head. The 
cervix was badly lacerated, the tear extending high to the 



436 The New England Medieal Gazette, Sept., 

left side of the womb. It evidently opened some large ves- 
sel, possibly the uterine artery, for the hemorrhage was pro- 
fuse and the blood bright red and spurting. The patient 
was in collapse, and three quarts of saline solution were in- 
jected. Cat-gut stitches were adjusted in the cervix, which 
controlled the bleeding. The patient's pulse was very rapid 
and soon became imperceptible. She died from hemorrhage 
at I P. M. June 21st. The child was still-bom. 



A CASE OF CHRONIC SUPPURATIVE OTITIS MEDIA. 

F. W. COLBURN, M. D. 

In presenting a report of a case of chronic suppurative 
otitis media, I am well aware that certain points must of 
necessity be brought up which are old and familiar to each 
of you. 

The title in itself suggests a combination of familiar symp- 
toms : a moderate degree of deafness, noises in the ears, and 
a more or less offensive purulent discharge from the ear. 

The case in point had all of the^e and more. 

Mr. H., 49 years of age, married, a native of Finland. 
Until fifteen years ago he was a seafaring man, since that 
time has been employed in a mill. 

Thirty years ago patient was rendered unconscious by 
a blow from a staysail block, received just posterior to the 
right mastoid process. This was accompanied by hemor- 
rhage from the ear. The site of the blow is now marked by 
a large scar and deep depression in the skull at that point. 

The patient rallied from the immediate effects of the 
injury, but from that time until last spring had had a recur- 
ring otorrhoea and has been deaf upon that side. 

His general health has not, however, been impaired until 
the present illness which began about May 25, last. He 
was attacked with severe neuralgic pains extending over the 



igoi Chronic Suppurative Otitis Media, 437 

whole right half of head, radiating apparently from the ear. 
He kept at his work in the mill, however, until May 29, 
when he was seized with vertigo and was absolutely unable 
to ride home upon his wheel at night as was his custom. 
The following day had a chill accompanied by vomiting. 

He sought aid from a local physician and later from one 
of the large hospitals here in the city. Both prescribed, but 
with no beneficial effect. The pain increased and the ver- 
tigo remained. Then as a last resort he visited a homoeo- 
path who sent the patient into the hospital, where I first saw 
him for Dr. Bellows on June 12. 

Patient emaciated, face flushed, inclined to be drowsy ; 
temp. 98 ; pulse 72. Complaining of severe pain in whole 
right side of head, radiating from the ear to and bounded by 
a median plane. Eyes ached, pupillary reflex unimpaired. 

Complains also of weakness and aching in lower extremi- 
ties, especially about the knees. 

Vertigo intense whether in bed, standing or sitting. No 
nausea or vomiting. 

Appetite good. Sleepless nights caused by the nocturnal 
aggravation of the pain. 

Examination of the ear revealed right external meatus 
filled with a brownish purulent discharge with an exceed- 
ingly offensive odor. After cleansing with hydrogen dioxide, 
removing much thick, cheesy material, it was found that only 
a crescent shaped portion of the lower anterior quadrant of 
the membrana tympani remained. The malleus and incus 
were gone. Posteriorly and above appeared a sensitive 
granulation which bled profusely upon the slightest touch 
from the probe. 

The patient was kept in bed for a week or more, having 
the ear thoroughly cleansed with hydrogen dioxide night and 
morning. Liquid diet was prescribed and as the general 
condition began to improve a gradual increase was made in 
the menu. In the course of ten days the patient was able to 
sit up for a short period several times a day. With patient 



438 The New England Medical Gazette, Sept., 

in a sitting posture the granulation which was previously noted 
was easily dislodged and swung downward into the tympanum, 
being suspended from above by a pedicle. This was re- 
moved under cocaine, with the result that the vertigo grad- 
ually but steadily decreased until entirely gone. The pain 
was temporarily relieved. 

A second polypus appeared about August first and was 
removed, only slight relief following. 

From the date of admission to the hospital to the first 
week in August the patient's general health had been 
steadily improving. 

The vertigo was entirely gone and the pain and headache, 
which had been constant, now had periods of amelioration, 
although frequently at night it came with its former severity. 

About August 4, pain again began to increase, and at 
night the patient occasionally became semi-delirious in con- 
sequence. 

On August 10, after consulting with Dr. Colby, operation 
was advised and quickly accepted by the patient as a possi- 
ble relief from such agonizing pain. 

There was not, as is often the case, oedema of the soft 
parts over the mastoid process, neither was there marked 
tenderness upon pressure. Tenderness was limited to a 
small area, over the mastoid antrum, about the size of an old 
fashioned three-cent piece and then only upon hard pressure. 

On the other hand there was a purulent discharge from 
the tympanum, associated with the polypoid growths from 
the additus, and what was far more annoying to the patient 
that severe, persistent, neuralgic pain which was relieved by 
neither hot nor cold appplications, and at night was almost 
intolerable. 

OPERATION. 

After anesthesia was complete, scalp shaved for a radius 
of two and one-half inches from the ear and the field of oper- 
ation rendered as nearly aseptic as possible, incision was 
made through the soft tissues in a line parallel and one- 



IQOI Chronic Suppurative Otitis. Media. 439 

fourth inch posterior to the insertion of the auricle. This 
incision was two and one-half inches long and clean to the 
bone. Bleeding vessels secured and periosteum retracted. 
Ear was then laid forward and membranous canal separated 
from posterior and superior bony walls of external meatus. 

Then with chisel and mallet the mastoid process was laid 
open to the antrum, which in this case, by the way, was the 
only mastoid cell present, and was filled with granulations 
and purulent material. The rest of the process was hard as 
ivory. 

With the antrum as a guide then the opening was ex- 
tended to the middle ear, removing the entire posterior and 
superior bony walls of canal and external wall of the epitym- 
panic space in so doing. 

This done the whole cavity, including antrum, epitym- 
panic space, and tympanum, was thoroughly curetted to 
remove all diseased tissue, the utmost care being taken to 
avoid injuring the semicircular canals or the Fallopian canal 
through which the facial nerve passes on the internal tym- 
panic wall. 

A careful search was then made with a fine probe, for any 
small sinus which might extend deeper. 

None being found the cavity was packed with iod. gauze 
to arrest oozing. 

The membranous canal was then slit from within, out- 
ward on its posterior aspect, to the concha, and the flaps 
reflected upward and downward upon the cut bony surface 
of the cavity, were held in place by a single suture each and 
firm pressure from within by means of gauze introduced 
through the meatus. This left the antrum, tympanum exca- 
vation in the mastoid process and the external canal all in 
one large cavity to be dressed as a unit through both the 
canal and the posterior auricular opening. A sterile gauze 
dressing and bandage and the patient was put to bed to re- 
main until after the first dressing. 

For five days following operation the patient suffered 



440 The New England Medical Gazette, Sept., 

severely from the same persistent neuralgic pain which, if 
anything, was slightly aggravated by the operation. 

The patient was blue in the extreme and I did not much 
blame him, for it was bad enough before. 

The first dressing was made on the morning of the fourth 
day. 

After packing had been removed there was profuse oozing 
from all the cut surface. Cleansed with hydrogen dioxide 
and again packed with iodoform gauze. From this time 
until October i8, dressing was done daily, H^O, and for- 
malin one-half per cent. On the sixth day the pain began 
to abate, and on the ninth the patient was free from pain 
and has so remained. 

The whole cavity remained clean with exception of a 
small spot on the anterior wall of tympanum. This grad- 
uallly cleared and the entire cavity became lined throughout 
with healthy epidermis, an extension of the reflected flaps 
from the canal. 

The posterior auricular opening has been maintained to 
facilitate removal of wax and epithelial debris which is prone 
to collect within the cavity. 

I last saw the case on October lo. The cavity was abso- 
lutely dry and the patient had had no return of the pain. 

His hearing distance for my watch at that time was 
about two inches, a little better than when he entered the 
hospital. 

A few points worthy of note might be mentioned : (i) 
The temperature in this case never rose above 99° until 
after operation, notwithstanding the other symptoms. Im- 
mediately before operation temp, was 98 T, pulse 68; 
on the following morning it had jumped to 103 j and 112 re- 
spectively. On the second day it was normal again and 
remained between that and 99*° until August 23, when il 
reached 100°, but was normal thereafter. 

(2.) The intense vertigo disappearing after the removal of 
the polypus. 

(3.) The relief of pain following operation, and lastly, 
absolute cessation of discharge from the tympanum. 



190 1 Pernicious Anamia in Insane Subjects. 441 

FOUR CASES OP PERNICIOUS ANiCHIA IN INSANE 

SUBJECTS 

With a Consideration of the Co-existin; Nervous Features 
of tlie Disease. 

BY S. C. FULLER, M. D. 
(Preaented to the Section Mental and Nervous Diseases Mass. Horn. Med. Society.) 

Aside from the purely nervous conditions, insane subjects 
are liable to almost any form of disease. It is also true that 
their mental disturbances may be directly traced, in many 
cases, to somatic lesions. 

Just how much the pernicious anaemias have been responsible 
for the nervous and mental disturbances in this series of 
cases or vice versa, or, further still, was simply a condition 
paripassuy will not be easy to determine. The mental dis- 
turbance in at least two of the cases, I think, can be safely 
attributed to the pernicious anaemia. One of these two 
cases improved mentally and physically under treatment 
directed largely to the pernicious anaemia, and was dis- 
charged. Later the case was admitted to the Mass. Gen- 
eral Hospital, where she died. The autopsy confirmed our 
diagnosis of pernicious anaemia. Two of the cases in the 
series died at the Westborough Insane Hospital and were 
autopsied, but in only one of them was the brain and a por- 
tion of the cord examined. In the other case an examina- 
tion of the brain and cord were not permitted. One of our 
cases is still alive. 

In another case which I have tentatively added, the 
autopsy revealed carcinoma of the lower third of the stom- 
ach with metastasis to the mesteneric lymph glands, and to 
the liver. The stomach, however, was freely patent. The dis- 
covery of carcinoma casts a shadow of doubt on the diagno- 
sis of pernicious anaemia in this case. In carcinoma of the 
stomach with marked cachexia and rapidly developing 
asthenia, and especially in those cases where the orifices of 
the organ are not involved and no tumor is discoverable on 
palpation, the differential diagnosis becomes difficult between 



442 The New England Medical Gazette, Sept., 

pernicious anaemia and a grave secondary anaemia subsequent 
to malignant disease. In the above condition Bramwell * has 
pointed out that a survey of the clinical symptoms together with 
the blood examination are necessary to correct diagnosis. 
Cabot ' lays stress upon the presence of a leucocytosis in carci- 
noma of the stomach while in pernicious anaemia leukopenia is 
the rule. Ewin' maintains that " leucocytosis of carcinoma is 
referable largely to complications, and these complications 
are such as appear very constantly in rapid or advanced 
cases." . . . Therefore ** the great variety of these compli- 
cations render it unwise to draw any narrow diagnostic con- 
clusions from the presence or absence of leucocytosis." A 
further characteristic of carcinoma is the low color index 
of the blood, and especially, is this true of visceral carcinoma. 
Leichtenstern*, however, has called attention to the rapid 
increase of Hb. in gastric cancer shortly before death. In 
this case, however, after a review of the literature, the 
increased color index, the leukopenia, the presence of 
myelocytes and megaloblasts determine me in maintaining 
a coexisting pernicious anaemia. The report of this case 
appears below (Case V). 

Lichtheim* in 1887 first described the changes in the 
cord of two subjects dead from pernicious anaemia. He 
discovered degenerations of the posterior columns, aud also, 
though to a less degree, changes in the lateral tracts. 
Later ^' he called attention to the difference between the 
changes in the cord in pernicious anaemia and in tabes. In 
the former disease the sclerosis was most marked in the 
cervical region. The lesions in the cord of pernicious anae- 
mia subjects are not symmetrical, but nearly so, and the 
scleroses in the lateral columns are always separated from 
the posterior horns by areas of normal white matter. These 
findings of Lichtheim have been confirmed by other observ- 
ers. The writer was able to demonstrate the characteristic 
changes in one of the cases sectioned. The lesions are not 
constant as will be seen from one of the cases which was 



I go I Pernicious Anaemia in Insane Subjects, 443 

thoroughly studied in the Pathological Laboratory of the 
Mass. General Hospital. 

In 1 89 1 Putnam' reported a group of eight cases with 
diffuse degenerations of the spinal cord, " in one or two " of 
which " the spinal lesions had been associated with anaemia 
of a profound type, and in the rest with other forms of mal- 
nutrition not definitely classifiable." Later Dana® reported 
cases which confirmed the observations of Putnam. Under 
the heading " The Combined Scleroses of Pernicious Anae- 
mia and Cachectic States," Dana'*, in his recent work, de- 
scribes the histopathologic changes in the cord as consisting 
of two varieties. In the one set the lesions are old, consist- 
ing of comparatively dense scleroses, while in the other set 
the changes are subacute in character. This latter condi- 
tion is manifested by the perforated appearance of the struc- 
ture, a condition suggestive of rapid destruction of nerve 
fibres. There is also oedema of the connective tissue septa. 
In the gray horns the degenerative changes are partly recent 
and partly old. Within the present year Putnam and Tay- 
lor ^^ have contributed to the literature on diffuse degenera- 
tions of the cord a paper in which is represented a clinical 
analysis of fifty cases and five pathological reports. They 
accepted provisionally the classification of Bastinelli", who 
groups the cases of anaemia with diffuse degenerations in 
one class and those of malnutrition in another. They, how- 
ever, maintain that there can be drawn no fast line, for there 
may be gradations between the two groups. In support of 
their claim they cite a case in which "pernicious anaemia 
was present and ran a typical course, yet spinal symptoms 
were recognizable for three years, their onset nearly coincid- 
ing with the onset of pallor and with a loss of flesh." 

Adami^*, considering the etiologic factors in pernicious 
anaemia, lays great stress on infection, either a latent or a 
subinfection. In this process the bacterial flora of the intes- 
tine play quite a role. To combat the toxines thus pro- 
duced, Adami suggests the possibility that the essential cells 



444 ^^'^ A^ifzt/ England Medical Gazette, Sept., 

of the nervous system may successfully resist local infection, 
but in so doing exhaust themselves, and consequently readily 
succumb to later toxic influences. In the formal discussion 
on the intoxications and infections in the pathogenesis of 
mental diseases and neuropathies before the tenth congress 
of the Societa Freniatrica Italiana, D'Abundo^' maintained 
" that infections and intoxications are the most frequent 
sensible and active factors in the pathogenesis of nervous 
diseases in general, in every period of life both intra uterine 
and extra uterine. . . . The infections and intoxications of 
the nervous system facilitate the evolution of secondary in- 
toxications which feed, re-enforce and complicate the clinical 
phenomena and result in complex forms due to multiple 
intoxications.'* The writer has elsewhere" called attention 
to the role of auto-intoxication as a causative factor in the 
production of mental disturbance. It is well, however, to 
bear in mind the possibility of cachectic states supervening 
upon purely nervous conditions. A positive demonstration 
of this is obviously difficult. But I have frequently seen 
insane subjects whose blood examination showed on admis- 
sion, and for a considerable period thereafter nothing of 
import, subsequently develop a profound secondary anaemia, 
and for which there could be discovered no assignable cause 
save the onward progress of their nervous condition. 

From the prevalance of intestinal symptoms in cases of 
pernicious anaemia, a condition which was a feature of the 
majority of the cases in this series, the suggestion of the 
influence of the intestinal flora advanced by Adami seems 
plausible. Ashford" has recently demonstrated the frequent 
association of ankylostomum duodenale with the pernicious 
anaemia so common among Porto Ricans. Chapirou" as far 
back as 1888 reported the case of a boy with pernicious 
anaemia who had associated bothriocephalus latus. 

With regard to the prevelance of pernicious anaemia in 
New England, Cabot" thinks the disease is common. In 
May, 1900, he reported to the Association of Americian 



1 9^1 Pernicious Ancemia in Insane Subjects, 445 

Physicians 1 10 cases which he had collected in seven years. 
He states that one-third of his cases showed nervous symp- 
toms. In more than 700 individuals whose blood the writer 
has examined, all living in New England, pernicious anaemia 
has been observed 9 times. Six of these cases have been in 
insane persons. 

Abstracts from the clinical records and pathological 
reports of five of the cases are. here presented : 

Case I. Mrs. B., aet, 49, was admitted to the Westbo- 
rough Insane Hospital Sept. 1 2, 1 898, her insanity at that 
time being of four months duration. 

Family and previous history unimportant. 

Status PrcBsens. A slightly built and poorly nourished 
female weighing 109 lbs. Heart and lungs normal. The 
urinalysis shows nothing of importance. The pupillary reac- 
tions are normal. The patella reflexes are diminished. 
Mental activity is diminished ; the perceptions, memory and 
will are normal ; the emotions are unstable and the reason- 
ing power weak. 

The blood examination on admission showed an increased 
color index and an increase of small lymphocytes which com- 
prised 44 per cent of the total number of leukocytes. The 
red cells and haemoglobin were not, however, greatly dimin- 
ished, a condition which may have been due to the concen- 
tration of the blood. The patient for four or five months 
made no improvement. She complained of abnormal pain, 
and diarrhoeic attacks began to be common. A blood exam- 
ination at this time revealed Hb., 63 ; red cells, 2,320,ocx); 
leukocytes, 3,320. Differential count of leukocytes : large 
lymphocytes, 3 1-5 per cent. ; small lymphocytes, 47 1-5 per 
cent. ; neutrophils, 49 per cent. ; eosinophils, 2-5 per 
cent.; myelocytes, 1-5 per cent. Normoblasts, macrocytes, 
niicrocytes and poikiolocytes were observed, but no mega- 
loblasts nor microblasts were encountered. Five months 
later the blood picture was worse. Hb. 25 ; red cells, 
1,600,000; leukocytes, 3,000. Differential count: large 



446 The New England Medical Gazette, Sept., 

lymphocytes, 6 4-6 per cent. ; small lymphocytes, 45 per 
cent. ; neutrophiles, 46 per cent. ; eosinophiles, i per cent. ; 
myelocytes, i 2-6 per cent. Normoblasts and poikilocytes. 
were observed. The pallor was now more marked, assuming a 
yellowish tinge, and asthenia and emaciation were progress- 
ing. The administration of iron having failed to produce 
satisfactory results. Fowler's sol. was exhibited with a most 
gratifying outcome. Six months after this time the mental 
and physical condition were much improved. The blood 
picture approached more nearly the normal, but there was 
still a color index of i plus. The patient was discharged, 
having recovered from her insanity which was acute melan- 
cholia. At a later period she was admitted to the Mass. 
General Hospital where she died. I am indebted to Dr. 
James H. Wright, pathologist to that institution, for the 
anatomical diagnosis of the autopsy on this case. 

Anatomical Diagnosis. Pernicious anaemia, fatty degen- 
eration of myocardium, defective closure of foramen ovale, 
ecchymoses on pleura, oedema of lungs, syphilitic hepatitis, 
chronic, passive congestion of spleen, fibro-myomata of 
uterus, polypi of uterus, chronic internal haemorrhagic pachy- 
meningitis, osteomata in pia-mater of spinal cord, and lipoma 
of subcutaneous tissues in the region of the left posterior 
axillary line. 

Microscopical Examination of Cord, Sections of the cord 
from the cervical, thoracic and lumbar regions prepared after 
Vassale's modification of the Marchi method fail to show any 
good evidence of degeneration. Sections stained by Mal- 
lory's method for proliferation of neurologlia or degeneration 
in nerve tracts were negative. Pal's modification of Wei- 
gert's method showed no degeneration (Dr. Wright). 

Case II. Mr. L., an Italian fruit pedler, aet, 30, was 
admitted to the West borough Insane Hospital May 19, 1900. 
Nothing is known of his family history. Of his previous 
history very little is known. He had formerly been an in- 
mate of the New York City Insane Hospital, and had been 



IQOI Pernicious Ancemia in Insane Subjects, 447 

discharged recovered. Six months prior to admission he 
had been an inmate of the Marlborough Almshouse where 
he had acted strangely and given evidence of possessing hal- 
lucinations of sight which led to his commitment. 

Status Prcesens. The patient is a male of slight build, 
weighing 1 26 lbs. Although possessing features of a dark 
cast, pallor, with a decidedly lemon yellow tinge, is marked. 
The heart sounds are normal. The lungs give evidence of 
bronchitis. The urinalysis is negative for kidney lesions. 
The patella reflexes are diminished, the superficial reflex nor- 
mal. There is no Romberg sign, no Babinsky phenom- 
enon. The pupillary reactions are normal. Memory is 
impaired. The blood examination shows Hb., 55 ; red cells, 
1,800,000; leukocytes, 4,520. Differential count: large 
lymphocytes, 1 8 2-6 per cent. ; small lymphocytes, 5 1 2-6 per 
cent. ; neutrophiles, 29 per cent. ; eosinophils, i per cent. ; 
myelocytes, 2-6 per cent. Normoblasts, megaloblasts and 
poikilocytes are present. 

The patient did not respond to treatment although Fow- 
ler's sol. and bone marrow were administered. Repeated 
examinations of the blood showed that the disease was not 
being impeded in its onward march. In the short space of 
two months the Hb. had been reduced from 55 to 11, and 
the red cells from 1,200,000, to 608,000. An increasing 
asthenia, marked and rapid in its development, frequent 
attacks of epistaxis of an exhausting nature, and later pro- 
nounced anorexia were the leading and most distressing 
features in the clinical history of this case. The patient 
toward the end was unable to walk, or even sit up or move 
himself in bed, but this inability, so far as the attending 
physician (Dr. Klopp) could determine, was due to the 
asthenia rather than to paraplegia. The mental feature was 
that of secondary dementia. The patient died after a hospi- 
tal residence of two months and eleven days. Unfortu- 
nately a section was not permitted. 

Case III. Mr. L., act. 63, was admitted to the hospital 



44 8 The New England Medical Gazette. Sept., 

nine years ago (1892). his insanity at that time being of 
three years' duration. His family history is unimportant. 
The patient at the time of admission gave a history of a fall 
ten years previous, with resulting injury to the spine. Until 
August, 1 899, there is nothing of special interest to report. 
He has always had delusions of persecution, and is hypo- 
chondriacal. He has for several years complained of a gir- 
dle-like constriction about the chest. A recent examination 
(Dr. Colby) reveals no spinal deformities, no Babinsky phe- 
nomenon ; and an attempt to elicit the Romberg sign is 
attended with only a slight swaying. There is " flat foot " 
of both sides and a tendency to varicosis. The pupillary 
reactions are normal, the knee reflexes diminished. The 
elbow jerk is absent. The urinalyses show hyaline casts which 
are fairly numerous and which have been persistently present 
for more than two years, but albumin has been observed in only 
the slightest possible trace. The pericardial dullness is in- 
creased, the heart's action weak and irregular, no murmurs 
could be heard. Moderate exertion is followed by shortness 
of breath. There are fine muscular tremors. 

In August, 1899 the attending physician noticed in the 
patient a loss of flesh, an increasing asthenia and pallor, and 
frequent attacks of diarrhoea. Aug. 28, 1899, I examined 
the blood, which showed Hb., 36; red cells, i,6oo,cxx); 
leukocytes, 4,200. Differential count : large lymphocytes, 
3 per cent. ; small lymphocytes, 32 2-10 per cent. ; neutro- 
philes, 63 per cent. ; eosinophiles, i 8-10 per cent., the 
majority of the last being of the myelocyte type. Normo- 
blasts, megolablasts, mibroblasts, poikilocytes and polychro- 
matophilia of red cells were observed. Clinically the patent 
has improved under the treatment directly to the pernicious 
anaemia. While the general condition of the blood is in a 
way better, repeated examinations show a color index of i 
plus, the persistence of myelocytes, microblasts and poikil- 
ocytes. There is no longer pallor, in fact the man has a 
florid complexion and the diarrhoea is not now a factor. He 



I go I Pernicious Ancemia in Insane Subjects, 449 

is becoming more corpulent and has a good appetite. The 
diagnosis of the mental condition is Secondary Dementia. 

Case IV. Mrs. S., was admitted to the Westborough 
Insane Hospital Jan. 5, 1895. Her age at this time was 45. 

Her mother and a sister were insane. The menopause in 
her case was at the age of 30. The physical condition at 
the time of admission is unimportant. For five years her 
physical condition had been such as to enable her to render 
very useful service in the hospital laundry. In July, 1900, 
she began to develop an asthenia, and rest in bed was insti- 
tuted. There was pallor of a waxy appearance, which later 
took on a decidedly lemon yellow tinge, and the asthenia 
became rapid in its" progress. July 23, 1900, the blood con- 
dition was Hb., 30; red cells, 1,280,000; leukocytes, 5,000. 
Differential count : large lymphocytes, 3 8- 10 per cent. ; small 
lymphocytes, 46 6- 1 o per cent. ; neutrophils, 46 8- 1 o per cent, 
eosinophils, i per cent. ; myelocytes, i per cent. Megalc- 
blasts, macrocytes, microcytes and poikilocytes were ob- 
served. Four months later the Hb. was 1 4, red cells, 800,000, 
leukocytes, 3,000 and numerous megaloblasts were present. 
The blood condition grew even worse, so that in the week prior 
to death the Hb. registered less than 10, and the red cells 
540,000. The patient died Jan. 19, 1900. The mental 
condition was paranoia. Autopsy, 26 hours after death. 

Anatomical Diagnosis, Pernicious anaemia, ansemia of 
brain and upper cervical cord (only the upper portion of the 
cord could be autopsied, as much as could be removed with 
a myelotome), " thrush heart," fatty degeneration of the 
myocardium and dilatation of the right ventricle ; pleurisy 
with effusion and hypostatic congestion of the lungs ; paren- 
chymatous nephritis ; fatty degeneration of the liver ; anaemia 
of spleen, stomach and intestines, with old adhesions of the 
last ; osteoma in the upper external quadrant of the right 
mammary gland ; general anasarca of the musculature ; and 
proliferation of bone marrow. 

The most interesting histological changes were the degen- 



4SO The New England Medical Gazette, Sept., 

eration in the posterior and lateral columns of the part of the 
cervical cord studies, the lateral degenerations being sepa- 
rated from the posterior ones by bands of normal white 
matter (Weigert Pal Method). In the marrow of the femur 
there was present the characteristic hyperplasia, the major- 
ity of the red cells were nucleated, and there were but a few 
fat cells present. The sections from the myocardium 
showed characteristic fatty degeneration, as well as those 
from the most degenerated areas in the liver. 

The protocols and full microscopic reports of these cases 
have been omitted so as not to render the article tedious. 

Case V. Ida M., aet, 35, was admitted to the Westbo- 
rough Insane Hospital June 8, 1 898, her insanity was then 
pf one week's duration. 

Her mother was insane, a sister committed suicide and 
there is a brother with unstable mentality. 

Status PrcBsens, The patient is a woman of small build, 
weighing 86 1-2 lbs., and is very poorly nourished. The 
lungs are normal. There is a mitral regurgitant murmur 
of the heart. The urinalysis reveals no kidney lesions. 
The pupillary reactions are normal. The knee reflexes 
absent. No Babinsky phenomenon, and slight swaying 
when the attempt is made to elicit the Romberg sign. 

There is nothing of special interest in the clinical history of 
this case from June, 1898, the time of admission, to Feb. 13, 
1900, on which date a small circumscribed oval growth, 7 
mm. in its longest diameter, was removed from the external 
surface of the upper lip. The clinical diagnosis of this 
growth had been carcinoma, sections of the tumor showed a 
typical adenoma, and the opinion was given that the growth 
was probably non-malignant. The patient made an un- 
eventful recovery and there was never any recurrence of 
the growth. No other evidence of carcinoma could be phy- 
sically determined. 

Pallor, emaciation and asthenia progressed. Late in the 
course of her disease vomiting, after taking nourishment, 



IQOI Pernicious Ancemia in Insane Subjects. 451 

became a prominent symptom. There was tenderness over 
the epigastric region, but no tumor could be outlined. At 
the autopsy the external contour of the organ was normal, but 
on section, the lower third was the seat of an annular 
thicknening which was in some portions as much as 4.5 cm. 
thick, and causing considerable diminution in the calibre of 
the organ, but no obliteration. Oct. 3, 1900, a blood exam- 
ination showed the following : Hb., 52 ; red cells, 2,000,000 ; 
leukocytes, 5,600. Differential count : large lymphocytes, 
2 1 per cent. ; small lymphocytes, 30 per cent. ; neutrophiles, 
37 per cent. ; eosinophils, 4 per cent. ; basophiles, i per 
cent. ; myelocytes, 7 per cent. Normoblasts, megaloblasts, 
poikilocytes and Grawitz degeneration of megaloblasts were 
present. The patient died Oct 29,* 1900. Her insanity was 
mania. Section 8 hours after death. Unfortunately permis- 
sion to examine the brain and cord could not be obtained. 

Anatomical Diagnosis. Mitral insufficiency, degenera- 
tion myocardium ; emphysema of lungs ; anaemic kidneys ; 
metastatic carcinoma of liver ; carcinoma of stomach ; metasta- 
tic carcinomata of mesenteric lymph glands ; chronic inter- 
stitial pancreatitis ; cystic ovaries ; and proliferation of bone 
marrow. 

Histologically the bone marrow showed the characteristic 
changes of pernicious anaemia. 

SUMMARY. 

I. and n. are the cases whose mental condition it is con- 
sidered may have been due to the pernicious anaemia. In 
the case of the Italian fruit pedler (Case H.), there was a 
history of an admission to a hospital several years previous, 
and at which time, it was later learned, he had pernicious 
anaemia. He recovered and was discharged. Presumably 
with a remission of the disease we have a return of the men- 
tal symptoms followed by death. 

Case I., to be sure, gave evidence of syphilis, as shown in 
the syphilitic hepatitis and, perhaps, also in the chronic 



452 The New England Medical Gazette, Sept., 

pachymeningitis, but it is to be remembered that her mental 
condition greatly improved under treatment directed to the 
ansemia. 

Cases III. and IV. did not develop the clinical symptoms of 
pernicious anaemia until after a hospital residence of several 
years. At the period of their admission it was not the cus- 
tom to make systematic examination of the blood. It is 
impossible, therefore, to state the condition of the blood at 
that time. But the apparently fairly good physical condi- 
tion of the two cases, despite the hypochondriacal delusions 
of one case which have been present since admission, war- 
rants the assumption that the nervous and mental disturb- 
ances were etiologic factors in the pernicious anaemia of 
these two cases. 

The influence of pernicious anaemia in the production of 
nervous and mental disturbances was advanced by Lepine^'*, 
Wilks, Coupland, and subsequently illustrated in cases re- 
ported by Curtin. Ewing*', however, in his recent work 
states that " the functional disturbances of the nervous 
system cannot be claimed to act as more than somewhat 
distant predisposing causes." 

Of Case v., which is the one tentatively added, I would 
state that annular carcinomata of the pylorus have been fre- 
quently seen at autopsy where the blood had shown before 
death the typical changes of pernicious anaemia. The ex- 
planation of which is advanced (Ewing) " that there is a 
rapid and general or slow and partial establishment of the 
marrow changes." 

Spinal symptoms were not prominent features of any of 
the cases in the series. 

REFERKNCES. 

1. Bromwell. Anaemia and Some Diseases of the Blood-forming Organs 
and Ductless Glands, p. 92, 1899. 

2. Cabot. Clinical Exam, of Blood, p. 130, 1897. 

3. Ewing. Clin. Path, of the Blood, p. 372, 1901. 

4. Leichtenstern. Ziemsenn's Handbook Bd. 8, p. 344. Cited by Ewing. 



190 1 The Plague in India. 453 

5. Lichtheim. Zur Kentniss Perniciosen Anaemia. Munich Med. Wchn- 
schr. xxxiv, 301. 

6. Cited by Stengel XX. Cent. Practise Med., vol. vii., p. 380. 

7. Putnam. Jour. Mentol, Nerv. Diseases, Feb. 1891. 

8. Dana. Jour. Mental, Nenr. Diseases, Feb , 1891 and Jan., 1899. 

9. Dana. Text-Book Nerv. Diseases, p. 299. 

10. Putnam and Taylor. Jour. Ment., Nerv. Diseases, Jan. and Feb., 1901. 

11. Bastinelli. Bui. Delia Royal Acad. Med. Di Roma, 1895-6, Pasciolo 

I., II. Cited by Putnam and Taylor. 

12. Adami. Annual Address Soc. Internal. Med., Chicago, Nov. 29, 1899. 

13. D'Abundo. Cited in Progress Neurol. Boston Med. Surg. Jour. April 

18, 1901. 

14. Fuller. N. £. Med. Gazette, June, 1900. 

15. Ashford. Army Notes, Boston Med. Surg. Jour., April 12, 1900. 

16. Chapirow. Med. Press, Jan. 25, 1888. 

17. Cabot. Boston Med. Surg. Jour., May 24, 1900, p. 546. 

18. Grawitz. Am. Jour. Med. Science, Sept., 1900, and Deutsches Archiv. f. 

Klin. Med., 1900, No. 67, p. 357. 

19. Lepine, Wilks, Coupland, Curtin. Cited by Stengel, loc. cit., p. 365. 

20. Ewing, loc. cit., p. 183. 



The Plague in India. — In conclusion I will briefly re- 
view the lessons to be learned from Indian experience of 
plague and the difficulties to be contended with. The lesson 
which stands out in large letters is that the compulsory 
measures attempted have failed to have the desirable repres- 
sive effect on the disease, because the populace have, to a 
man, been dead against them and the authorities. . . . The 
main line of objection to plague measures have always been 
a dread of segregation, with separation of members of fami- 
lies ; and Government orders that no wife would be separated 
from her husband, or a mother from her children have not 
succeeded in inspiring confidence. The people display an 
absolute apathy and indifference to plague, as a rule, but let 
the Government suggest means by which they may be spared 
the affliction and a panic ensues. Cases of illness are con- 
cealed with every ingenuitv, and each one vies with his 
neighbor in giving false information. Violation of caste is 
made an excuse for objection to any preventive measures, 
such excuse having no foundation. Facilities have been 
given for the institution of private and caste hospitals, but 
no advantage has been taken of them. Ignorance, distrust 
and predjudice have held their sway, supported by supersti- 
tion. — Major H, E, Deane in Calcutta Journal of Medicine. 



454 ^^^ iV^ze/ England Medical Gazette, Sept., 

MODERN 5URQICAL TECHNIQUE. 

BY GEO. H. EARLE, M. D. 

The title of this paper hardly indicates what is in the 
writer's mind to say. 

My wish is to compare, very briefly, the present surgical 
methods, in operating, with those which prevailed in the old 
days, that is fifteen or twenty years ago. 

You are more or less familiar with the present methods. 
I mean the various plans and devices by which the field of 
operation, the instruments, dressings, and the operator's 
hands are made clean. Cleanliness is recognized as the one 
thing for which to strive. But let us look back for a few 
moments along the road we have traveled and note some of 
the milestones by the way. 

We, as homoeopathic physicians, have much to be proud of 
in this connection, for here in surgical therapeutics, as well 
as in medical therapeutics, time is proving that "the mild 
power is greatest." What was embraced in surgical tech- 
nique twenty years ago } Would not the term dexterity and 
celerity in operating cover it } Very nearly if not quite. 

Pardon me a personal reminiscence. Less than twenty 
years ago, in the amphitheatre of the great institution just 
across the way, the surgeon does an amputation of the thigh, 
clad in a blood-glazed frock coat, which had evidently seen 
long service, and which, between times, hung on its hook 
behind the door. If he washed his hands before operating 
it was not evident, and he certainly handled the coat the last 
thing before beginning. That, to be exact, was seventeen 
(17) years ago this winter. 

Operations upon the eyes were performed, the various 
instruments sticking in the hair of the operator between 
times. At that time the surgeons in our hospital had 
adopted the use of clean, white frocks, while operating. 
These same frocks were a source of more or less amusement 
to our friends, and styled by them " butcher frocks." 



IQOI Modern Surgical Tec/mique. 455 

Operations were performed in the room below us, where 
perhaps an autopsy had been held the day before, and where 
anatomical specimens were in daily use for the purposes of 
teaching. The "cleaning up" process consisted only of a 
few flourishes of the janitor's mop. 

From that time to the present, what has not been done in 
the way of inventing antiseptics.? The complicated and 
cumbrous technique of Lister. The spray, douche, mercu- 
rial compresses, etc., etc. What violence has been done to 
tender, bruised and vulnerable tissues in the name of anti- 
septic surgery! For instance, an amputation of the leg, 
done with a stream of mercurial solution running over the 
field of operation during the entire time. The result is a 
shoughing of the flaps with mercurial ulceration, absorption 
of the infected material, and death from septicaemia. 

In obstetric practice it became fashionable among the ex- 
tremists to administer an intra-uterine mercurial douche 
after any interference, instrumental or manual, within the 
uterus. This was done as a prophylactic against infection. 
Several deaths, with distinct symptoms of mercurial poison- 
ing, discouraged this plan as a routine method 

I can remember that, as a student, I came to feel that an- 
tiseptic surgery practically meant the soaking of everything 
in a solution of carbolic acid ; and that when a surgeon ven- 
tured to operate, after a simple cleansing of the field of 
operation, and with his instruments lying in a pan contain- 
ing clean water and so harmless a drug as calendula, I 
gasped at such foolhardiness. 

But what has the result of all this effort and experi- 
ment been } Just this. That asepsis is recognized in all 
departments of surgical work as the ideal to be striven for, 
and that any plan of antisepsis is only a means to that end. 

Some of the essentials of modern surgical technique are : 
Great care in cleansing the hands and field of operation with 
soap and water and friction. Simple boiling of instruments. 
Live steam under pressure for dressing and sponging mate- 
rial. The least possible handling and the protection of 



456 The New England Medical Gazette, Sept., 

tissues, especially if vulnerable. Dry dressing when practi- 
cable and then severe letting alone. I might add, the avoid- 
ance as far as possible of poisonous antiseptics. 

These things have been instrumental in helping to accom- 
plish the present success of surgery, and do they not justify 
us in claiming that here, also, " The mild power is greatest ? " 



THE ACETIC ACID HEART. 

BY T. C DUNCAN, M. D., CHICAGO. 
(Professor Diseases of Chest, Clinician Cook Co. Hospital.) 

This drug, like most of the acids, first slows the heart, 
through the vagus, and then follows, tachycardia and weak 
heart. The alkalinity of the blood is supposed to be less- 
ened so that the muscularity is weakened. This will explain 
these cardiac symptoms : " Heart beats more frequently ; " 
"heartbeat cannot be felt by the hand;" "pulse 96 and 
full " (poisoning); "pulse accelerated and small, contracted ;" 
" pulse weak and small " (Vide Cyclopaedia of Drug Path 0- 
genesy). 

It is believed that the constant use of vinegar tends to 
produce a small heart and is a direct predisposing cause of 
pulmonary tuberculosis. This acid causes wakefulness so 
that the relief from its use is by urine, skin or lungs. The 
urine is profuse and the skin thickens. " All the lobes of 
the lungs are filled with tubercles somewhat like a bunch 
of grapes." Therefore, we would expect " haemoptisis " and 
"angina pectoris." "Likes to lie on stomach." Perhaps 
the Mexican people are immuned from tuberculosis because 
they do not use vinegar. 

The characteristic symptoms of weak heart would suggest 
this drug. It may be indicated in mitral stenosis and attend- 
ant upon phthisis. Here we often have haemoptisis as well 
angina 

CEdema is a pathognomic symptom (Vide Cyclopoedia). It 
has been curative in dropsy after digitalis has failed. How 



1901 The Acetic Acid Heart, 457 

it doesitmaybe of interest. It maybe from its relaxing 
action. Grauvogl says on evaporation it appears electro 
negative. In the respiratory tract and skin it may so act 
and prove curative. 

On account of the general use of vinegar we should know 
its relations and antidotes. Before Hahnemann's day it was 
regarded as a universal andidote. It antidotes the action of 
aconite, asarum, coffee, euphorbium, hepar, ignatia, opium, 
stramonium, tobacum and alcohol. It aggravates the action 
of belladonna, mercurius and lachesis. It follows well after 
cinchona. Disagrees when given after borax, causticum, nux, 
vomica, ranunculus b. and sarsaparilla. 

The antidotes to acetic acid are : Large doses magnesia or 
calcarea (lime water) ; small doses, for the depressing, agoniz- 
ing feeling, tobacum or aconite; for gastric, pulmonary and 
febrile symptom, natrum mur. high may be followed by sepia 
(see phosphorus). The general use of vinegar should put 
us on our guard in cardiac cases. Attacks of "weakness of 
the heart " may be due to this condiment and call for one of 
its antidotes or analogues. 



The Rich Family of Mitsui, of Tokio, has offered an 
extensive site in that city for the erection of a university for 
women, and three other citizens have, between them, contrib- 
uted a sum of $120,000 for the cost of the necessary buildings. 
The work is already in progress, and it is hoped the new uni- 
versity will be opened the coming spring. It is not likely 
there will be any want of students, as, in recent years, very 
many young ladies of good family have applied to be admitted 
to the university courses, especially to the Faculty of Medi- 
cine and the Polytechnic School. The latter institution is in- 
tended for the training of civil engineers, a circumstance 
which seems to show that Japan is about to set an example 
to Europe in opening up a new sphere of labor for the women 
of the future, — Med. Times. 



458 The New England Medical Gazette. Sept., 



EDITORIAL. 

Contributions of original articles, correspondence, etc.» should be sent to the publishers, Otis 
Clapp & Son, Boston, Mass. Articles accepted with the understanding that they appear only ia 
the Gazftit. They should be typewritten if possible. To obtain insertion the following month, 
reports of «ocieties and personal items must 6e received by th* i^ik of the m0Htk preceding. 



The letter from our good friend, Dr. Packard, in the pres- 
ent number is very interesting. The information it contains 
concerning the status prcBsens of homoeopathy on the conti- 
nent is thoroughly reliable, from men capable of passing the 
best judgment. The doctor's questions were to the point, 
and our thanks are due him for the information obtained. 
While it is evident that homoeopathy does not advance with 
such strides as in this country, still there seems legitimately 
to be no basis for the claim that our method is losing ground. 
As regards the outlook for future growth, however, there 
seems to be the same danger there as here, that while our 
method grows apace, our school does not. The tolerance of 
the old school is and always will be much more dangerous 
than its open hostility. The only way to combat this dan- 
ger is to so educate our students and to so conduct ourselves 
as to make the name homoeopathy synomymous, not only 
with the highest professional skill and learning, but with the 
very best development in every way. To be a homoeopath 
should be an honor. 



EDITORIAL NOTES AND COMMENTS. 



From the Detroit News of July we have that the Trustees 
of the Detroit Homoeopathic Hospital have purchased a new 
site with building admirably adapted for their purpose. 
The location, we judge, is a central one, and an emergency 
department is to be established, an ambulance being on 
duty. 

Our Detroit friends are to be heartily congratulated. 



IQOI Items of Interest. 459 

ITEMS OF INTEREST. 



Acquired and Inherited Syphilis. — Wm. S. Gottheil 
{Med. Standard, Dec, 1900) says : As in cases acquired in 
the ordinary manner, congenital syphilis can only be trans- 
mitted during the primary and secondary stages of the 
disease in the parents. Cases showing only the tertiary phe- 
nomena cannot, as a rule, transmit the disease to their 
offspring. 

The fetus may be infected in two ways ; in the first place 
the zoosperm or ovum or both of them may contain the 
virus ; and in the second p!ace, the mother, gravid with a 
healthy fetus, may transfer the affection by the placenta to 
the child. In either case the course of the disease is the 
same. 

The first and most marked effect of syphilis on the fetus 
is the interruption of pregnancy. In 330 syphilitic gravidi- 
ties Kossourtz saw abortion or premature delivery in 127 or 
about 2-5 ; only 3-5 reached term. The essential cause of 
this is placental disease, which may either be an endarteritis 
or gummatous in its nature. The nearer conception is to 
infection the more certainly does interruption of the gravid- 
ity occur. Gradually, however, the intensity of the specific 
influence becomes less. Where many conceptions occur in 
such cases, the earliest ones end in abortion ; later ones ter- 
minate in the delivery of dead children ; then occurs the 
premature delivery of living children ; then the delivery of 
full-term syphilitic children; and, finally, that of full-term 
healthy children. 

Infection is most certain and severe when both the par- 
ents are syphilitic. The prospects for the child are almost 
as bad if the mother only is affected. When the father alone 
is syphilitic the earlier conceptions terminate in the same 
way as when both parents have the disease. But while the 
maternal influence is persistent and abortions and the birth 
of syphilitic children may occur for years when that is pres- 



460 The New England Medical Gazette, Sept., 

ent, the parental influence i^ less enduring, and the symp- 
toms of hereditary poisoning become less and less in a 
comparatively short time. 

When the mother becomes infected after pregnancy has 
occurred (postconceptional syphilis), the child is usually poi- 
soned through the placental circulation. During the first 
month this invariably occurs ; but after the fifth month many 
of the children escape, and during the last two months hered- 
itary transmission does not occur. Profeta's law is the name 
given to the fact that children who thus escape placental in- 
fection, and do not contract the disease intra-partum are, as 
a rule, immune to lues. 

Colles' law is to the effect that the mother of a syphilitic 
child, even when she has shown no evidence whatsoever of 
the disease, is immune against it. She never becomes in- 
fected on the nipple, no matter what the condition of the 
mouth of her child ; nor can her husband infect her. Exper- 
imental inoculations by Caspery, Neumann and Finger 
show that it is impossible to give such a woman syphilis. 
On the other hand, the child is very contagious to non-pro- 
tected women. 

When neither abortion nor the delivery of a dead child 
is the result of a syphilitic pregnancy, the child may be 
born showing some of the early symptoms or it may be 
apparently healthy. In the latter case the first signs may 
appear immediately after birth, usually manifesting them- 
selves during the first three or four weeks of extrauterine 
life. In exceptional cases they are postponed till the third 
or fourth month, and they never appear later than the sixth 
month. — Pediatrics. 

True Dental Stigmata of Syphilis. — These become 
more easily understood when we remember that hereditary 
syphilis is a disease already present in ntero, and that its 
malign influence is at hand, as a rule, during the entire de- 
velopmental period of the unborn infant. This explains why 
teeth not appearing till the fifth year when perhaps the child 



I go I Items of Interest, 461 

has been for several years cured to all intents and purposes 
of the initial rashes, mucous patches, or what not, may yet 
show a fundamental defect. 

In the order of their diagnostic importance we may men- 
tion these changes in the second teeth as follows : 

1. Irregular decay — cupping or hollowing, or general 
"callapse," This may be suspicious but is too often seen 
elsewhere to be of great value. 

2. Furrows (dents ray^s). Certain of these may be cause 
for serious consideration ; the " sulciform erosion " of Parrot 
belongs to this class. 

3. Microdontism, This is emphasized by Fournier. He 
attributes greatest significance to the "dwarfism" of the in- 
cisors, and particularly of the two middle upper incisors. If 
these be " doll-teeth," the diagnosis of syphilis is nearly cer- 
tain to be confirmed by signs of lues elsewhere. In the 
same class may be placed tuberosites and projections 
" Amorphism " of the teeth in the stricter sense {e.g.^ incisor 
for canine), and genuine monstrosities fall (through with less 
certainty of specific relation) under the same heading. 

4. Atrophy of the crown. This may occur as far back as 
the first molar, giving the top of the tooth a shrunken and 
wrinkled look, comparable to a small tobacco pouch with the 
strings pulled tight. The same tooth in the region of the 
incisors is apt on first emergence to have a narrow, brittle, 
cutting edge, from which two or more fine spines project. 
The spines soon break, the cutting edge of the tooth decays 
somewhat more at the centre than the margins, and we thus 
finally get the tapering tooth with concave "half-moon " cut- 
ting edge, which was first described by Jonathan Hutchinson 
and which, when occurring in the upper middle incisors is 
practically pathognomonic of heredity syphilis. 

5. Chalk lines (sillons blancs). These are equally charac- 
teristic though far more rare. They are described by Fournier 
as "milky" or "chalky" in color, being in fact discolorations 
and not erosions. They should be found on the two upper 
front permanent teeth and are as permanent as the teeth 



462 The New England Medical Gazette, Sept,, 

themselves. They are horizontal, symmetrical, about i mm. 
in width, and occur about midway between the gum and the 
crown. Their rarity detracts, unfortunately, from their 
semeiological value. — Pediatrics, 

Hemorrhoids. — The following suppository is recom- 
mended by La Presse Medicale for hemorrhoids : Aqueous 
extract of ergot, 3^ grains ; Oil of theobroma, i dram. — 
American Medicine. 

Dose of Antitoxin. — Dr. Wm. H. Park, in a paper on the 
" Quantity of Diphtheria Antitoxin Required in the Treat- 
ment of Diphtheria," published in the Archives of Pediatrics y 
says : " From my observation in both hospital and private 
practice, I have been led to adopt the following dosage : 

**Very mild cases, 1000 to 1500 units for the first dose. 
Moderately severe cases, 2000 to 3000 units for the first 
dose. Very severe cases, 4000 to 5CXX) units for the first 
dose. Laryngeal cases, according to tiieir severity, 2000 to 
5CXX) units. 

" For children under one year I should give about one- 
third less than for older children and adults, I believe the 
condition of the throat as to swelling, extent and nature of 
the membrane, etc., to be a better guide to antitoxin dosage 
than the general condition of the patient. The duration of 
the disease influences the curative power of the antitoxin 
rather than the dosage. 

" If at the end of twelve hours after the injection the in- 
flammation is advancing, or if at the end of eighteen hours 
the inflammation has not clearly begun to subside as shown 
by lessened congestion and swelling, I believe a second 
dose of antitoxin should be injected. In a very few cases a 
third dose is required at the end of twenty-four to thirty-six 
hours. For the broncho-pneumonia and sepsis complicating 
some of the worst cases antitoxin is generally of no avail. 
Although I cannot agree with Dr. McCollom in regard to the 
necessity of from 40,000 to 60,000 units in the very bad 
cases, nevertheless, his results certainly encourage us to give 



I go I Items of Interest, 463 

all the antitoxin that we think indicated. It is better to give 
too much rather than too little. I think I am correct in 
saying that it is the opinion of the visiting physicians at the 
hospital that moderate doses accomplish as good results as 
very large ones. — Cleveland Medical Gazette. 

Inebrity. a Study of its Causes, Duration, Pro- 
PHYLAXSis, AND MANAGEMENT. By Dr. Charlcs L. Dana. — 
The author's opinion is that drinking is largely a matter of 
habit and environment. The victims of it have always some 
neuropathic or temperamental basis, of which excessive 
drinking is only the accidental expression. It would seem 
that the capacity for a man to get drunk over a thousand 
times was rare, and that two thousand was the maximum 
limit in any ordinary inebriate experience. The agencies for 
preventing and lessening the injury done by alcohol consist in : 
(1) Teaching; (2) control of the sale; (3) regulation of mar- 
riages between alcoholics ; (4) personal supervision of those 
who become inebriates. The ideal treatment is supervision 
of the case in an institution, insuring absolute abstinence 
from alcohol in all forms for at least one year. Further per- 
sonal supervision and watchfulness are needed for two years. 
The next best thing a drinker can do is to take some kind of 
a "cure" under the care of his own physician. The treat- 
ment should be planned to last a year. The patient should 
stop drinking and, usually, smoking also, and should take for 
three weeks a mixture of nux vomica, capsicum and cinchona. 

Receipe : Tinct. nucis vomicae, one ounce ; Tinct. capsici, 
one drachm ; Tinct. cinchonae rubrae, five ounces. 

M. Sig. : One teaspoonful three times a day, increased by 
twenty drops daily to half an ounce. 

The maximum dose should be continued for a week, and 
then reduced as it was increased. Two weeks' rest should 
then be taken, before repeating the course, then a months* 
interval, and so on for a year. The patient should be fed 
well and very often, and should avoid getting tired and 
hungry. — Medical Record, 



464 The New England Medical Gazette, Sept., 

Arsenicum in Skin Diseases. — Theskinof thearsenicum 
patient is white, pale, waxy with ecchymosed looking spots ; 
pale blue skin, with blue lips and blue nails, with a tendency 
to edema. This speaks of a venous stasis, and directly 
points you back again to a weakened circulation. 

The next consequence will be a dry skin, an inactive skin, 
a skin that is deficient in its nutrition. Let us reason fur- 
ther: A skin that is defective in its nutrition must neces- 
sarily tend toward necrosis, therefore we see the arsenicum 
patient constantly throwing off quantities of dry epithelial 
scales, which is a mild process of necrosis of the skin. Nor 
does this process limit itself here, for necrosis of tissue may 
also occur, and is beautifully told by the language of the 
meteria medicist, thus : Gangrenous ulcerations, with blue 
margins and foul discharges, purulent and fetid discharges. 

Acne vulgaris in people of a lowered vitality with many 
comodones and pustules again showing the sluggish nature of 
the cases covered by arsenic ; edema about the eyes and pur- 
plish zones about the acne papules point to a vasomotor 
paralysis. Therefore arsenic is more often useful in the 
chronic, the latent, dry, indolent and scaly stages of disease 
than in the acute, inflammatory, moist or bullous. 

The diseases in which arsenicum is most often called for 
are chronic dry eczema, subacute acne, seborrhea-sicca, ich- 
thyosis, varicosis and psoriasis. — The Clinique. 

Don'ts in Connection with Heart Disease, — Don't feel 
called upon to give digitalis as soon as you hear a murmur 
over the heart. Study and treat the patient, not the murmur. 

Don't conclude that every murmur means disease of the 
heart. 

Don't forget that the pulse and general appearance of the 
patient often tell more than auscultation. 

Don't neglect to note the character of the pulse when you 
feel it. Possibly you may look at the tongue to satisfy the 
patient ; feel the pulse to instruct yourself. 

Don't think that every systolic murmur at the apex indi- 



I go I Items of Interest, 465 

cates mitral regurgitation; every systolic murmur at the 
aortic interspace, aortic stenosis. The former may be trivial ; 
the latter may be due to atheroma of the arch of the aorta. 

Don't say that every sudden death is due to heart disease. 

Don't forget that the most serious diseases of the heart 
may occasion no murmur. A bad muscle is worse than a 
leaky valve. 

Don't examine the heart through heavy clothing. 

Don't give positive opinions after one examination. — Phil- 
adelphia Medical Journal. 

The Therapeutic Indications of Cannabis Indica. Dr. 
H. Edwin Lewis finds in pain not due to distinct pathological 
lesions the chief indication. In migraine, hemicrania, the 
various neuralgias, and the headaches due to eyestrain, it may 
be used with marked success. In the pain of multiple neu- 
ritis and tabes dorsalis, it is one of the best of anodynes, and 
to relieve the chest pains of phthisis it is often very serviceable. 
In the various neuroses of pregnancy and the climacteric, and 
the particularly violent nerve storms of the artificial meno- 
pause, it is satisfactory. Dysmenorrhea, not due to anatomi- 
cal or inflammatory causes, is promptly relieved, with few 
after effects. Impotence more or less complete, which is due 
to urethral hyperesthesia, is certainly benefited by the seda- 
tive or analgesic action of cannabis indica. In several instan- 
ces of diabetes mellitus improvement has followed its use. It 
will relieve the intolerable itching and burning of various skin 
neuroses. 

The dose is one fourth to one grain of the assayed solid ex- 
tract. A quarter of a grain may be repeated every one, two 
or three hours as required. Merck's Archives. 

Effects of Ether on the Kidneys. — Dr. Dudley 
Buxton, anaesthetist to the University College Hospital, 
London, and Dr. A. G. Levy, have published the results of 
their investigations, which were conducted in the Laboratory 
of Pathological Chemistry in University College, London. 



466 The New England Medical Gazette. Sept., 

The authors do not consider that any specific ether effect 
and consequent kidney ischaemia and albuminuria should 
ever occur in the course of ether anaesthesia for operative 
purposes, provided the administration is performed with rea- 
sonable care. They think, however, that in the case of 
ether, owing to its comparative safety as far as the vital cen- 
tres are concerned, there is a danger lest, owing to a false 
sense of security, excessive quantities are administered. 
Where quantities of ether are given — where the patient is 
"soaked" with ether — we meet with "ether effects" on the 
kidneys. Such effects are probably transient in most cases, 
and produce no acute or lasting mischief ; but even these 
are not necessary, and are, in fact, the result of the abuse 
rather than the use of ether. — New York Medical JouniaL 

Painless Removal of Adherent Dressing. — Patients 
as well as practitioners, are familiar with the suffering en- 
tailed by the removal of gauze dressings, these dressings 
having the drawback of adhering very closely to the granula- 
ting surfaces owing to their loose texture. Anesthesia has 
abolished the pain attending surgical operations, but leaves 
the patient exposed to the pain of repeated renewal of the 
dressings. Dr. von Mikulicz, of Breslau, suggests an easy 
means of obviating this drawback, viz., by wetting the dress- 
ings with oxygenized water. This provokes a copious evolu- 
tion of bubbles of gas, the mechanical effect of which is to free 
the gauze and allow its removal without causing pain. The 
method is so simple as to deserve the notice of surgeons. — 
Med. Press and Circular. 

Death of an Eminent Foreign Professor. — Joseph 
Fodor, M. D., professor of hygiene at the University of Bud- 
apest, has recently died. He was born in 1843, studied under 
Pettenkofer at Munich, and later under Baron Liebig. Dr. 
Fodor was, after his master Pettenkofer, the best known of 
the European sanitarians, and did much toward rendering Bud- 
apest the healthy and beautiful city it now is. He was a man 
of many gifts and was for .some time joint editor of the med- 
ical journal, Orvosi Hetilap, 



190 1 Revieius and .Notices of Books, 467 



REVIEWS AND NOTICES OF BOOKS. 



Orthopedic Surgerv. By Royal Whitman. 

This book is one which is sure to be of great service to the gen- 
eral practitioner as well as to the special student of orthopedic 
surgery. 

Special attention is paid to the causes and prevention of deform- 
ities, and it is in the early recognition of diseases which cause de- 
formities that the general practitioner oftenest fails. 

Most of the four hundred and forty- seven illustrations are new 
and many of them especially clear and instructive. 

The colored plates showing the attachment of muscles concerned 
in movements of the foot are especially good. 

The gymnastic treatment of lateral curvature receives the atten- 
tion which it deserves and the photographs illustrate the move- 
ments and their effects almost like a clinical demonstration. 

Any physician who has the least mechanical ability would be able 
with the assistance of this volume to make and apply apparatus 
which would be efficient in the beginning of ordinary deformities. 

Each detail in diagnosis and treatment, as well as in measuring 
for apparatus, is given minutely and clearly. g. h. e. 



Pocket Manual of Homceopaihic Materia Medica. Comprising 
the characteristic and cardinal symptoms of all remedies, by Will- 
iam Boericke, M. D., San Francisco. Boericke & Resuyou Co., 
1901. 

This is a convenient pocket edition of the Materia Medica. Ar- 
ranged alphabetically after the usual schema. It also contains symp- 
toms of some hundred and twenty "minor drugs" which are in- 
dexed. The book is conveniently gotten up and valuable for those 
who find it necessary to look up the case at the bedside. 



468 ^he New England Medical Gazette, Sept. 

PERSONAL AND NEWS ITEMS. 



Dr. a. Miller, the oldest homoeopathic physician in 
Chicago, died July 29, in his ninety-second year. 

Dr. Horace Packard will return from Europe in season 
to resume practice October i. 

Dr. J. Arnold Rockwell, Class of '99, B. U. S. of M., has 
opened an office in the Hotel Kensington, 685 Boylston St., 
Boston. Office hours 11.30 to 1.30 and by appointment. 
Telephone, Back Bay 418. 

There is an opening for an homoeopathic physician at 
Yarmouthporth, Mass., and one is wanted for the place. Dr. 
F. C. Robbins, Dedham, Mass., who has recently moved from 
Yarmouthport, will be glad to advise in regard to the location. 

We have received the following notice : " A splendid loca- 
tion for a homoeopathic physician, information of which can 
be obtained by addressing Lock Box 244, Uhrichsville, Ohio, 
or by addressing Dr. Thos. M. Stewart, Secretary of Pulte 
Medical College, 704 Elm St., Cincmnati, Ohio." 



\ 



THE NEW ENGLAND 

MEDICAL GAZETTE 

No. lo. OCTOBER, igoi. Vol. XXXVI. 

COMMUNICATIONS. 



A LETTER FROM QERHANY. 

BY HORACE PACKARD, M. D. 

(Concluded.) 
A DAY WITH BASSINI. 

In the little city of Padua, Italy, about thirty miles from 
Venice, Professor Bassini has lived and labored faithfully and 
modestly as surgeon of the Hospital and Professor of Surgery 
in the University of Padua. About ten years ago his name 
began to be heard in surgical circles as the author of a new 
operation for inguinal hernia. His published results were 
so much superior to anything before attained that the atten- 
tion of the whole surgical world was turned to him. Time 
has shown that his claims were well supported, for at present 
his method is followed by surgeons in all civilized countries. 

In response to his courteous invitation, I presented myself 
in the amphitheatre of the Padua General Hospital. 

He is apparently over sixty years of age, with gray hair 
and beard, sharp, penetrating eyes, spare and tall but slightly 
stooping. He welcomed me in broken English, and after- 
wards spoke freely in German. His operative technique is 
very simple, and he does everything possible himself, from 
the preparation of the field of operation to the last detail of 
the dressing. He has but one immediate assistant besides 



470 The New England Medical Gazette, Oct., 

the anaesthetist. His armamentarium is very simple and un- 
assuming. He has nothing of the modern equipment in the 
way of steam-pressure sterilizer. His instruments, dressings, 
etc., are boiled in ordinary porcelain pots over a gas flame. 
His person and clothing are protected by a long rubber 
apron, which he does not change between cases, but mops 
off himself with sublimate solution. He uses silk exclusive- 
ly for all ligatures and sutures, both superficial and buried. 
He thinks if all the details of the operation are aseptic, the 
buried ligatures become encysted and suppuration never oc- 
curs. His clean wounds are not drained. He assured me 
that he rarely has suppuration, and in evidence showed me 
an abdominal wound made eight days before, then dressed 
for the first time — not a trace of suppuration was apparent. 

I marvel at his results when I looked about his operating 
room. Although the operating area was fairly neat and up 
to date with its terezzo floor, the bank of seats, walls and 
ceiling were grimy with the dust and dirt of time. Areas 
from which the ceiling had fallen had been recently plastered 
without attempt to harmonize the whole by fresh whitening. 
All soiled water from hand washing and scrubbing of the 
patient, as well as blood and bits of tissue from the operation, 
went onto the floor and gravitated toward a drain opening in 
the middle. 

All these unfavorable surroundings only impressed me 
more profoundly with the genius of the man. In this com- 
monplace environment, and with meagre equipment, he has 
attained world wide eminence in the field of hernial surgery. 
His name is probably now as widely known over the whole 
world as any surgeon who has ever lived. 

He kindly gave me opportunity to watch every detail of 
his operations. The first was an ordinary right inguinal her- 
niotomy, which went off without incident. The second was 
for left inguinal hernia, with adhesion of the bladder to the 
sack. In the process of clearing away the sack, the bladder 
was accidentally opened. This he closed with silk sutures 



I go I A Letter from Germany. 471 

and dropped back into the pelvis. The operation was com- 
pleted in the usual way without drainage. 

Some details of his method of operating were slightly dif- 
ferent from anything I had seen or read of before. 

I was told afterward that the poverty of the public hospi- 
tals in Italy is very great, and the apparently inexcusable 
lack of tidiness is unavoidable. 

VIENNA AS A MEDICAL CENTRE. 

Vienna no longer holds its former prestige as the world's 
greatest medical centre. At present not more than one- 
quarter the former number of foreign physicians visit it for 
study. The Allgemeine's Kraukenhans is totally out of date 
as a hospital, and impossible of remodeling on modern lines. 
A rumor is afoot, and I am told it is founded on fact, that 
plans are already matured for removal to the suburbs, and 
construction of new buildings according to modern ideas. 

It is twenty years since I spent the autumn, winter and* 
spring here in study. Great changes have occurred. Fine, 
wide streets have been cut through the old parts of the city ; 
a magnificent city hall has been erected ; new university 
buildings have been constructed ; a Museum of Fine Arts 
and Natural History established ; and a comprehensive system 
of electric street cars installed. 

But few of my old professors and instructors are remain- 
ing. Billroth and Albert, who conducted the principal 
clinics in surgery in 1881, are no more ; Mikulicz is professor 
of surgery in Breslau ; Schrotter, under whom I took courses 
in physical diagnosis, is now sixty-three years old, but vigor- 
ous and progressive. He welcomed me most cordially, and 
through his invitation I visited Heilanstatdt Alland (Hospital 
for Consumptives), which has been established through his 
persistent and resolute efforts. He said, "I have put not 
only the sweat of my brow but my heart's blood into this 
enterprise." It is a fine institution about twenty-five miles 
out of Vienna, nestling in a natural amphitheatre, with a 



472 The New England Medical Gazette. Oct., 

southern exposure, overlooking a wide expanse of country. 
In answer to my question as to treatment, I learned that no 
systematic medical treatment is attempted. Dependence is 
wholly upon maintenance of a pure atmosphere, hypemutri- 
tion and rest. Harrassing cough is ameliorated with opium. 
In about fifty per cent, of the cases the disease is arrested. 
The patients are kept under the strictest discipline. From 
seven o'clock in the morning until ten at night every hour 
has its allotted duty. The regulations run as follows : 

7.00. Arise and dress. 

7.30. Breakfast. Cofifee or cocoa, milk, white bread. 

8.00. Exercise upon the terrace or in the grounds and 
woods. 

9.00. Rest in recumbent posture. 

9.30. Lunch. Milk, bread and butter. 
10.00. Rest in recumbency. 
12.30. Dinner. Soups, meat, vegetables, salad, desert. 

1 .00. Promenade on the terrace for fifteen minutes. 

1.15. Rest in recumbency for i j^ hours. 

2.30. Walk in the fields and woods. 

4.00. Lunch. Coffee, bread and butter. 

4.30. Rest for one hour. 

5.30. Gentle exercise out of doors. 

7.00. Supper. Roast meat, vegetables, salad, i glass beer. 

7.30. Reading, games, music, light work about the house. 

9.30. Retire. 
10.00. Lights out, all quiet. 

Regulations regarding expectoration are very strict. Every 
patient carries a cup with him, and on no pretense is promis- 
cuous expectorating about the grounds permitted. The cups 
are sterilized every day by boiling. The patients are per- 
mitted — ^not compelled — to work in the fields at light farm 
work if they feel inclined. A farm of sufficient size to pro- 
duce vegetables and milk for the institution is maintained. 

The dining-room is large, sunny and cheerful. As I 
entered it I saw upon the opposite wall an inscription which 



I90I A Letter from Germany, 473 

I supposed was an appropriate German legend. On drawing 
near, to my surprise and amusement, it read in bold English, 
" Eat Quaker Oats/' 

FRENDENBERG AND THE BOTTINI INCISION. 

It was my intention, on leaving America, to look up, as far 
as possible, recent progress in the surgical treatment of 
prostatic hypertrophy. Interest in this annoying affection 
has of late been much aroused through the reported results 
of Dr. Bottini, of Parvia, Italy. Frendenberg, of Berlin, has 
probably done more to popularize the operation, through 
published writings and improvements in instruments, than 
the originator. I called upon him, and derived therefrom 
much pleasure and profit. He is fully convinced of the value 
of the operation, but much judgment and discretion must be 
observed in the selection of cases. He deems it quite un- 
wise to make it upon cases accompanied with severe cystitis 
and pyelitis. To secure the desired result, it should be done 
before the patient's general strength and vigor have too far 
deteriorated. He precedes the operation by a careful cysta- 
scopic examination. As a rule he makes three incisions, two 
lateral and one posterior. The operation is made under 
local anaesthesia of cocaine and eucaine, unless, because of 
great fear or nervousness, general anaesthesia is deemed ad- 
visable. In cases not yet prostrated with long continued 
cystitis and pyelitis, the operation is without mortality. He 
has a book in press which will soon be issued, giving all the 
literature upon the subject and his own results up to the 
present time. ^ 

MEDICAL EDUCATION IN GERMANY. 

Germany leads the world in medical education. It is in- 
teresting to inquire into the cause of this superiority. In the 
first place, the popular ideals regarding education in general 
are high. There is no greater social disgrace than ignorance. 
Professional attainments carry distinction of no inferior order. 



474 The New England Medical Gazette, Oct., 

beause it is a long and difficult climb to reach them. The 
course of study in the medical department of the German 
universities is five years ; and after this it will be six. The 
sixth year is to be a service in a hospital, or a year with a 
physician, assisting him in his every-day practice. The uni- 
versity course includes two terms annually of five and four 
months, respectively, with vacations during April, August 
and September. Each applicant must have had previous 
educational training equivalent to the course of study in a 
" gymnasium,'* what corresponds to our high and latin schools. 
If he has not had that training, he must satisfy the faculty 
that he possesses equivalent knowledge derived from other 
sources before he is allowed to enter upon the medical course. 

The required studies of the first year are : Inorganic and 
Organic Chemistry, Physics, General and Human Anatomy, 
Dissections, Osteology and Syndesmology, Zoology, Micro- 
scopic Technique, Principles of Botany. Besides the above, 
the following are recommended, but not obligatory : Mathe- 
matics, Meteorology, Physical Geography, Mineralogy and 
Geology, Anthropology, Psychology, Logic. 

The second year the required subjects are : Dissections, 
Physiology, Comparative Anatomy, Laboratory Chemistry, 
Histology, Pathological Anatomy and Evolution. Recommend, 
ed, but not obligatory: Physiological, Embryological 
Zoological and Botanical Experiments and Analysis, Special 
Lectures in advanced Anatomy and Physiology, Topograph- 
ical Anatomy, Physiological Chemistry. 

The third year includes General and Special Pathology 
and Therapy, Surgery, Fractures and Dislocations, Pharma- 
codynamics and Hydro Therapy, Auscultation and Percus- 
sion, Obstetrics, Medical and Surgical Clinics, Minor Sur- 
gery. Recommended, but not obligatory : Pathological 
Chemistry, Toxicology, Laboratory work in Pharmacology 
and Toxicology, Prescriptions. 

The fourth and fifth years comprise lectures upon Hygiene, 
Gynaecology, Materia Medica, History of Medicine, Sanitary 



190 1 A Letter from Germany, 475 

Science, Ophthalmology and Legal Medicine. Attendance 
upon Medical, Surgical, Obstetrical, Gynaecological and 
Ophthalmological Clinics, also clinics for diseases of chil- 
dren, mental and nervous diseases. Pathological Anatomy, 
Pathological Histology, Laboratory Hygiene, Practical work 
in Obstetrics, Surgery, Ophthalmology, Vaccination, Laryng- 
oscopy, Bandaging. Recommended, but not obligatory: 
Special clinics for Syphilis, Skin Diseases, Otology, Clinical 
Diagnosis, Electro Therapy, Dentistry, Legal Medicine. 

Sixth year : Assistantship in Hospital or with a physi- 
cian satisfactory to the faculty. The final examinations are 
rated not in percentages, but as bad, good, superior and ex- 
cellent. Those rated as bad withdrawn from studentship, or 
again take the course in which they are deficient. The 
others are granted a diploma which entitles them to take the 
government examination. Applicants without a university 
medical diploma have no footing with the Government Board 
of Medical Registration, hence the gateway to the practice 
of medicine is closed and barred to all except those who have 
had a broad preparatory education and a most rigid training 
in medicine. 

It will be seen from the above that the way to a Doctorate 
in Medicine in Germany is no easy road. How much more 
in keeping with the dignity of the medical profession is such 
a course than that in many of our American colleges ? Our 
past record is unpleasant to think of. The future must be 
marked with progress. 



Dogs in Ambulance Service. — Scotch collies are trained 
for ambulance and bearer work in the German army. Their 
saddle bears a red cross, a flask and first-aid dressings. It is 
claimed that these red-cross canines will scent wounded men 
who under ordinary circumstances must be overlooked by 
litter-bearers and left on the battlefield to die. — Exchange, 



4/6 The New England Medical Gazette. Oct., 

ON THE FAITH IN THE EFFICACY OF REMEDIES. 

[To the American Institute of Homoeopathy ; Read in the Section on Materia Medica. J. B. 
Gregg Curtis, M. D , Chairman.] 

BY CONRAD WESSELHOEFT, M. D. 

The topics announced by the Chairman of this Section are 
worthy of the closest study and thoughtful discussion. No. 2 
reads : " Is faith in the efficacy of remedies in the treatment 
of disease on the decrease among physicians t *' This timely 
circular letter of the Chairman of this Section raises some 
other very appropriate questions regarding the scepticism of 
students, recent graduates, etc., toward the materia medica. 
All this is very true, and the causes require some reflection, 
which in the following has been drawn from an experience of 
thirty years in struggling with the best way to teach materia 
medica. 

To begin with, it matters less how much of it is taught in 
each of our numerous homoeopathic colleges, than it matters 
what the quality of the instruction is, and upon what accurate 
knowledge it is founded. 

The difficulty in teaching and learning materia medica is 
threefold. The first difficulty lies in the subject itself. The 
various attempts to "purify" the materia medica, to separate 
the wheat from the chafiF, were all very well so far as carried 
out, but the subject is too vast for even one generation to ac- 
complish anything. So there is little else for the teacher to 
do than to assure his hearers that, after pointing out certain 
faults of the materia medica, there is still much left which, if 
rightly understood and used, will place our school in advance 
of any other in successful healing of the sick. 

The second difficulty lies in the teacher and his faulty 
methods. He can produce a certain kind of result by a real 
or assumed enthusiasm which he may succeed in imparting 
to his students, who on the strength of imbibed faith and 
belief will do wonders in the way of learning symptom-lists 
regardless of their real value. Such a student can then per- 
form miracles by virtue of his furor homceopathicus, but he 



190 1 On the Faith in the Efficacy of Remedies, 477 

will not win the confidence of his more conservative col- 
leagues. This is one way to teach materia medica, but not 
the most reliable one. There is a better way. 

What the student most needs is not only to learn the 
symptoms of drugs, but first of all he should see, touch and 
smell of the actual drugs themselves. These he hardly ever 
sees ; all he knows of them is that they are white pellets, 
tablets or colorless dilutions. But how they became such he 
never asks, and is but very imperfectly informed. No student 
nor physician can be expected to acquire enthusiasm or 
actual knowledge of proving-effects and the value of prover's 
symptoms if he has to refer them entirely to meaningless 
pellets, dilutions, or, if it comes high, to a colored tincture of 
the origin of which he has seen as little as he has of tritura- 
tions or dilution-potencies. And yet hundreds of our students 
go out into the world with no other idea of homoeopathic 
medicine than that of abstract notions of perfectly meaning- 
less white tablets or dilutions. No matter how transcendent- 
ally spiritual one may be inclined, he will now and then have 
an ungovernable longing to see and touch something in the 
material world, and it is but the natural result that he will 
fly to the opposite extreme and try some big doses of visible, 
tangible stuff in which he finds himself only too well sup- 
ported by the more material minded intra et extra muros. 

This can and must be avoided. It has been urged here 
and elsewhere that before burdening and mystifying a stu- 
dent's mind with symptom lists of the source and origin of 
which he knows nothing, he should be instructed in practical 
pharmacology. He should see and smell and taste the sub- 
stances he is to study. He should see and hold in his hand 
the plants, the minerals and the animal products from which 
these substances are derived. He should not only see how 
the tinctures are made, but he should make them himself. 
He should not only be told that a certain substance is ground 
for an hour with milk sugar, but he should himself grind 
it for an hour once, twice and three times ; and then should 



47'^ The New England Medical Gazette. Oct., 

use his microscope to see just how far he had succeeded in 
reducing the substance. Having become familiar with these 
things, he should then proceed to prove the products of his 
labors upon himself. Such a student will not lament his 
want of knowledge. But this is by no means all that is 
needed in providing for proper instruction in materia medica 
and its symptomatology. 

One of the gravest errors committed by teachers, next to 
ignoring pharmacology or pharmaceutics, is the habit of fol- 
lowing the alphabetical order in their descriptions ; or, what 
amounts to the same thing, of following no systematic or 
natural order. It is this which makes the student heart sick. 
Pages of symptoms either reeled off ex cathedra^ with vain 
attempts on the part of the student to commit to memory 
what seems to the learner to possess neither head, nor limbs, 
nor body. Why need this be when Nature is so perfect in 
her order, and when the human mind has succeeded in re- 
recognizing this beautiful order and arranging it for the use 
of those who wish to be guided by it } 

Materia medica is called difficult ; it is shunned ; it is put 
off to the last and approached only with set teeth and dogged 
determination. As well might one try to learn a language 
by memorizing the dictionary as to learn materia medica in 
the way mostly taught. The way it probably will be taught in 
the future will be by teaching the class that if they will 
acquaint themselves with one member of an order, or even of 
a genus of medicinal plants, they will already have acquired 
some rudiments of the other members of that genus or order. 
Thus, if they have seen the belladonna plant, have learned 
how to prepare its tincture and have proved it a little, when 
they have carefully read its pathogeny in reliable provings, 
they will already know considerable about hyoscyamus, stra- 
monium, tobacco, capsicum and others of this genus, for they 
will see that these substances have many points in common, 
from which the singular and characteristic effects are then 
easily differentiated and, above all things, remembered. 



igoi On the Faith in the Efficacy of Remedies, 479 

The same applies to animal (e. ^., snake poisons) and to 
chemically related groups of metals to be found in every text- 
book. 

Of course, if this is discouraged by shrugs and winks, the 
student will lose confidence and he will fall back upon his 
discouragement, or go where the teaching is more in accord- 
ance with his prejudices. 

The third cause of the student's reluctance to approach 
materia medica is to be sought for in the mental ability and 
condition of the student himself. Under existing circumstan- 
ces in the United States a majority of medical students, 
though of natural excellent mental endowments, do not bring 
with them that degree of mental training which results in 
ready receptivity of any new branch of science. Sudh a 
student can learn only from ocular demonstration what he 
can not acquire by didactic lectures or reading. 

Why is it that students think anatomy, pathology and 
chemistry easy, while they are actually afraid to touch 
materia medica ? The answer is that it is so difficult to learn 
symptoms by heart, and they shrink from voluminous text- 
books or provings. That is their reply, but not the true 
reason : This is that they are not made to see and feel 
materia medica as they are made to see and feel, as it were, 
anatomy and chemistry. What teachers of materia medica 
will have to do now and in the future is to demonstrate 
materia medica from pharmacy up to proving, and from this 
to the didactic and clinical course, which the student then 
will comprehend. When, after this, he sees his preceptor 
administer pellets, dilutions and triturations he will no longer 
be mystified, but he will recall the drug and remember its 
sick-making power. The pellet will then have a meaning for 
him which it never had before. The pellet or the liquid will 
in his mind be brought into harmony with the law of cure ; 
this will become luminous and intelligible now that the stu- 
dent has discovered the animal, vegetable or mineral source 
whence comes the power now associated and inseparably con- 



480 The New England Medical Gazette, Oct., 

nected with the pellet, tablet or dilution which his preceptor 
is prescribing. 

These are at least the principal difficulties in teaching and 
learning materia medica to be applied according to similia 
similibus. But there are others. Has not homoeopathy 
been taught from the beginning as being easy of application } 
The first thing the student or beginner grasps is the perfect 
simplicity of the law and its application : Select the remedy 
according to the law : that is, seek the remedy whose proving 
effects correspond to the case to be treated, and a cure will 
follow. Nothing could be simpler and nothing easier. So 
thinks the student, and so he is taught. The most sanguine 
and enthusiastic teacher will inadvertently impress this upon 
the learner, who even feels that the"'* organon " is very posi- 
tive on the subject. The result is that the student's first 
clinical attempts are disappointing. He comes to complain 
of this to his teacher, who has to encourage and to uphold 
the student in his faith as best he can. 

Is not too much usually promised } It seems that in our 
enthusiasm we have often, without due qualifications, pro- 
mised the student too rapid a realization of success. The 
qualification rests on the conditions under which medicines 
are prepared ; on the conditions under which they are proven, 
and on the conditions under which they are administered. 

Right at the outset of his career the student, instead of 
being simply made enthusiastic, should be carefully instructed 
in the actual and probable difficulties in the way of realizing 
quick curative results. He should be told of the imperfec- 
tions with which pharmacy and the art of proving is still 
beset. That in the nature of the limitations of the human 
intellect in its attempts to perfect those sciences, imperfec- 
tions must still hamper hoped-for results. He must be 
taught that he must not be discouraged at the absence of 
startling cures. He must be taught how to recognize each 
imperfection in order to select from among provings that, and 
that only, which is most likely to be reliable. 



190 1 Study of Temp, in Puerperal Complications. 481 

It will do the learner at the beginning no good to indivi- 
dualize and diflFerentiate in applying a faulty proving to a 
case. Therefore, let us avoid promising too much ; it will 
drive the beginner to disappointment and from homoeopathy 
to the other extreme of polypharmacy and nostrum vending. 
Buty supposing a student is aware of the difficulties, then 
the teacher can go ahead with a clear conscience, having no- 
thing to conceal. His enthusiasm, now freed from that latent 
shade of self-mistrust which he would gladly hide from the 
student, will now burst forth into renewed delight, and 
impart itself to the learner who feels that his teacher is honest 
and can be trusted, and student and teacher will be carried 
along by that bond of mutual respect and understanding 
which alone insures success in any branch of instruction. 

These are a few suggestions of which it is hoped that they 
will aid in strengthening the faith' in the efficacy of remedies 
in the treatment of disease among physicians, that they will 
give support to the teacher and confidence to the learner. 



A BRIEF STUDY OF TEHPERATURE IN CERTAIN 
SERIOUS PUERPERAL COMPLICATIONS. 

It would be impossible in one paper to even mention all the 
post partum conditions in which abnormal temperature may 
be found, so I shall not make the attempt, but shall limit my 
paper to a few observations suggested by cases seen by Dr. 
Earl and myself, during the last quarter at the Maternity. 

I am hoping that they will prove equally suggestive to the 
members present so that we may profit by the experiences 
thus brought out. 

At this time I am not reporting operative proceedures, for 
while no one can see more plainly than I the necessity for 
such treatment under the proper conditions, and we had those 
during the quarter just past, yet I appreciate the fact th 



482 The New England Medical Gazette, Oct., 

most confinement work appeals, or should appeal, to us, not 
as mechanics but as physicians. 

Before proceeding to the consideration of the cases that 
prompted this paper, I shall venture to recall to your minds 
certain facts that are doubtless very familiar. 

It is always satisfactory and even essential to know the 
normal conditions in order to recognize deviations therefrom, 
so for a moment let us consider the manner in which normal 
temperature, or an equilibrium, is maintained. 

We know that two factors enter into this contract, viz.: 
production of heat on the one hand, and loss of heat on the 
other, so that we may expect to find a state of pyrexia, either 
from increased heat production or decrease in heat loss. In 
the healthy individual when from any cause there is an in- 
creased production of heat there will at once be a counter- 
balancing loss of heat, which maintains the body within a nar- 
row range, known as normal temperature. Simple but inter- 
esting tests have been made for the purpose of finding out 
how adjustment is brought about between the production and 
loss of heat in the human body. One, with the Turkish bath 
showed an elevation of temperature in three-quarters of an 
hour to 103.2^ followed by the loss of 185.7 mg. of sweat, and 
normal temperature after another half hour. 

A more commonplace test, but reported not so popular with 
the performer, is the old process of sawing wood, by which a 
healthy man working industriously for an hour will raise his 
temperature 2.1 Fahr. with such compensating loss of heat 
that no condition of pyrexia follows. From such simple ob- 
servations as these we gain the idea that back of the two fac- 
tors of heat production and heat loss there must be some 
regulating force which gets out of order before a condition of 
pyrexia can be said to exist, and this to my mind takes us 
back to the mainspring of life, call it Nature's vital force or 
what you will. When this is deranged, we have not only py- 
rexia but general lack of harmony and the picture of disease. 
One, Samuel Hahnemann said, "In sickness this spirit-like, 
self-acting vital force, omnipresent in the organism, is alone 



I go I Study of Temp, in Puerperal Complications. 483 

primarily deranged by the dynamic influence of some morbific 
agency inimical to life. Only this abnormally modified vital 
force can excite morbid sensations in the organism and deter- 
mine the abnormal functional activity which we call disease. 
This force, itself invisible, becomes perceptible only through 
its effects upon the organism, makes known and has no other 
way of making known its morbid* disturbance to the observer 
and physician than by the manifestation of morbid feelings 
and functions ; that is, by symptons of disease in the visible 
material organism." 

Pyrexia is not then to be treated as an entity and sup- 
pressed by sheer force, but rather regarded as one of the im- 
portant symptoms of a disarrangement which we are to bring 
back into harmony in the shortest, most reliable and safest 
manner according to clearly intelligible reasons, removing in 
each case any obstacles in the way of recovery. 

The woman who has just passed through the activity of la- 
bor is in a peculiarly susceptible condition, not only from the 
immediate struggle but from the antecedent nine months* 
strain upon the whole system, and unless her vital force is in 
healthy, active power we shall experience a change from the 
usual happy physiological appearance to one of discord and 
dismay. 

It is wonderful to see how, in the majority of cases, equilib- 
rium is maintained in spite of the extreme muscular activity 
and nervous excitement. The great beads of sweat mean that 
our good friend Nature is at work conducting to and radiating 
from the surface the excess of heat produced, and unless some 
morbific influence disturbs the controlling principle the puer- 
•periun will be calm and uneventful. 

In the cases which I present we shall follow the tempera- 
ture during disturbance manifested through three important 
systems, viz. : the respiratory, the cerebro-spinal, and the re- 
nal. In the first two there was no apparent reason for antici- 
pating serious complications; in the third, we were forewarned 
by the condition existing when the patient entered the mater- 
nity. 



484 The New England Medical Gazette. Oct., 

Mrs. G. recommended by Dr. Wood of Charlestown, 
entered the Maternity at 3.30 Sunday afternoon, February 3. 
At that time examination revealed the cervix obliterated, the 
OS dilated to the size of a quarter and a foot presenting within 
the bag of membrane. The position was diagnosed as a sacro, 
left out. Dilatation proceeded as well as usual under the cir- 
cumstances; the patient was a principara of rather slender 
build, and in manner very reserved and uncommunicative; 
did not want to talk and complained very little, so that in the 
short time before delivery nothing was said of a "cold" from 
which her husband afterwards said she had been suffering. 
The second stage began about 8 P. M. and progress seemed 
very slow on account of the size of the child, slight assistance 
was given by traction from below and pressure from above 
and the after coming head delaying, it was delivered somewhat 
rapidly, thus incurring a second laceration, which under the 
circumstances I considered justifiable. The baby, a fine boy 
weighing a trifle over 9 lbs., was soon crying lustily and plays 
no further part in the story except as a very agreeable boarder 
in the nursery for the next seven weeks. During the last 
pains of labor ether was administered to the patient but not 
to profound anaesthesia. 

The placenta and membranes were delivered not quite so 
perfectly as I like to see, but considering it safer not to enter 
the uterus unless necessary, and there being no sign of hem- 
orrhage, the perineum was quickly repaired and the patient 
taken to her room. 

February 5. The patient seemed to have much irritation 
in the bronchial tube, with cough, some soreness in left chest 
on inspiration, thirst and temperature rising, morning loi*^, 
evening 104^. Bry.^ and we prescribed for her. 

February 6, Morning temperature 102^, evening tempera- 
ture 1051**, pulse 130. 

The lochial discharge was apparently normal and there was 
no suspicious soreness, but remembering the somewhat ragged 
condition of the membrane an intra-ut douche of warm sterilized 
water, followed by a little peroxide, was given. Some debris 



IQOI Study of Temp, in Puerperal Complications, 485 

was then removed. The next day, Feb. 7, Dr. H. C. Clapp 
examined the patient and pronounced her suffering from pneu- 
monia and upon examination of the vaginal discharge the 
micro-pneumococci of pneumonia were found. It was some- 
what difficult to get symptoms from the patient; she was 
hoarse anyway and at times would not speak at all. Indiffer- 
ence, then anxious apprehension. The respiration was diffi- 
cult and shallow ; sputa profuse. Dr, Clapp prescribed phos- 
phorus. A second douche was given, which came away so 
clear and the uterus itself seemed so normal that this was not 
repeated. 

February 7 and 8th were more encouraging and the 9th 
seemed so regarding temperature and pulse, but the patient 
developed a kind of sly cunning and that evening broke out 
into mild delirium or mania, in which she suspected everyone 
about her and startled by anyone coming in. Her eyes were 
wild, with pupils dilated, face flushed and pulse full and throb- 
bing. Bell, was the prescription. 

February 10. Temperature and pulse better, but mental 
condition not much improved so that an attendant was with 
her from this time on for several weeks. 

The temperature and pulse for the next day had another ex- 
acerbation with an abrupt fall to nearly normal on the 12th; 
this was accompanied by great prostration, a peculiar death-like 
pallor and sweat, short, anxious respiration, with distressed 
appearance of the face. We thought the prognosis very bad 
at this time and hardly expected her to rally. Arsenicum 
was given. 

Next morning a temperature of 105 greeted us but the pa- 
tient's mind was clearer, and a peculiarity after this for some 
days was that with an increase of temperature the patient was 
more rational. The chart from this time shows the decline of 
the disease which did not extend evidently beyond its first 
bounds. Nourishment was carefully administered all the time 
and was well borne. 

From February 23d, when you will see there was a sharp 
tall, the temperature ran a little below normal for five days 



486 The New England Medical Gazette. Oct., 

and then continued just about normal for the remaining weeks 
she was with us. Her mental condition became normal. 
Arsenicum was repeated at intervals and food was given as 
the patient regained her appetite, which she fortunately did so 
that she was growing steadily stronger when she left the Ma- 
ternity on March 23. She was, however, one who suggested 
tuberculosis and ought to be watched and directed for some 
time. In looking back, I wondered whether ether might have 
aggravated condition. 

The second case was one who had been confined once 
before and at the Maternity, a somewhat difficult labor. She 
entered this time on February 9, at 3.30 R M., having regular 
pains which began at 9 A, M. She was nervous and appre- 
hensive, saying that she knew she was going to die, and this 
was her constant cry. Although this may mean nothing, 
yet it often indicates a lack of the persistence that will help 
a woman through hard places. The second stage began at 
5.35 and the baby was born in good condition at 6.40 with 
slight tear into old cicatricial tissue. Placenta came naturally 
in twenty minutes. The patient was put to bed and every- 
thing went well except that the patient was nervous and ap- 
prehensive until two days later, on February 11, when she 
complained of a pain in the left side of her head which she 
said was a touch of her old neuralgia. Temperature was nor- 
mal and she passed a comfortable night and part of the next 
day ; in the afternoon she complained of shifting pains and 
feeling of coldness, and although she gave no definite signs of 
chilliness her temperature arose to 103.6^ and pulse to 128. 

We could discover no local condition to account for this, 
the local discharge was free, bright with no odor, and it 
seemed more like an hysterical condition than anything else. 

The next day, February 13, the patient complained of head- 
ache, soreness all over, with sore throat and it seemed as if 
she might be starting a grip attack. The symptoms seemed 
to call for bryonia. 

February 14. Patient passed an uncomfortable day with 
temperature ranging from 103.6-105.6^, pulse 128. That night 



I go I Study of Temp, in Puerperal Complications. 487 

she slept and the temperature (iSth) was down to 102.4 in the 
morning but the day brought on a kind of delirious condition ; 
she said she could not move her arms or talk though she could 
do both. She was given a high enema followed by free evacu- 
ation of the bowels. She was very much depressed and given 
to much weeping and complained of shifting pains, and puis, 
was given. On the i6th the temperature came down to 
101.80; pulse, 138-114, though the delirium was marked, and 
there were involuntary movements of the bowels. The next 
day the patient was etherized and the uterus wiped out with 
gauze, nothing abnormal could be found. Dr. Wesselhoeft 
saw the case in consultation and it was thought best, on 
account of the prominent nervous symptoms, to ask Dr. 
Colby to see the patient. He (17th) accordingly did so, and 
diagnosed the case as some form of puerperal meningitis 
(non-septic) and prescribed cicuta (18th). That day and the 
next there seemed slight improvement ; ice bags were 
applied to the head with some apparent relief and the patient 
was quieter. Speech was thick and indistinct. The next 
three days (19, 20, 21) the brain symptoms increased, though 
now and then there would be rational gleams. The respira- 
tion became shallow, there were convulsive twichings of the 
muscles, rolling of the head with sharp cries, involuntary 
urine, difficult swallowing, and a general hopeless appear- 
ance. Stuper finally supervined, broken by occasional cries, 
and death came to her relief the morning of February 22. 
There was no examination after death, but from the onset 
and course of the disease it comes near to the description of 
results arising from '' acute sporadic inflammation of the pia 
mater of the convexity or upper surface of the brain." This 
seemed to me a hopeless case at the time we had dealings 
with it, but that something might have been done to affect 
the diseased system by judicious previous treatment. This 
is one place where a family physician has a chance to do 
good work. If this patient had been known from her birth 
and her antecedents known as we afterwards learned them 
there might be two little motherless children the less. It 



488 The New England Medical Gazette, Oct., 

seems that the mother of our patient, at the birth of her 
second child died from some brain affection ; of the two girls 
thus left one had died not long before our case, also with her 
second child, and from brain trouble, so that there are four 
children of the third generation left to perpetuate their kind. 

In one of the latest text-books on nervous diseases I found 
the following rather apt conclusion : 

" Experience teaches that the diseases of the nervous sys- 
tem may be divided with respect to their localization into 
two great groups, into systematic and non-systematic diseases, 
By systematic or system diseases we understand those affec- 
tions in which only nerve cells and nerve fibres, that is 
neurons which have a definite physiological function, are 
attacked. The aggregate of all the neurons which subserve 
a definite physiological function is called a neurons system. 
The interesting fact that sometimes only the neurons which 
belong to a certain physiological system becomes diseased, all 
the other neurons remaining perfectly normal is to be ex- 
plained, as far as our present knowledge goes, as follows : 
first, clinical facts show that certain neurons systems are ab- 
normally weak and sickly in some persons from birth. What 
the primary cause is we do not know but very frequently it 
presents itself most distinctly as a hereditary or family affec- 
tion.'* Since, as the writer frankly states, we do not know 
the primary cause, the best treatment of such cases will con- 
tinue to be removal of all obstacles to recovery, careful in- 
dividualization in accordance with our law. The third and 
last case which I must tax your patience with is brief and 
cheerful. 

The efiEect of pregnancy on the kidneys has been so gen- 
erally discussed that I do not need to enter upon the subject 
here except [to repeat how easy it is to pass from the so- 
called " physiological albuminuria '* of pregnancy to the 
pathological state in which large quantities of albumen and 
casts are found together with decrease in urea. 

On February 12 our little Italian was admitted to the 
maternity. I call her little because I saw her after she had 



igoi Study of Temp, in Puerperal Complications, 489 

shrunk to her normal dimensions and she was small then, 
but when she was brought in about 1 1 o'clock at night on a 
stretcher her face was so swollen that it looked about a foot 
broad, and as we examined farther we found the same condi- 
tion existing, swollen feet, hands, legs and arms, while the 
labia were so oedematous that the thighs were widely sepa- 
rated. . The history that we gained from a relative, for the 
patient herself could not speak a word of English, was to 
the effect that she had had a miscarriage seven years ago ; 
that she is now nearly at full time ; thatjfor two weeks at 
least she has had this swelling ; two days ago she had a 
convulsion, biting her tongue badly ; this morning another 
severe one, and now complains of pain through her head and 
eyes. Dr. Earl and I pondered over the case and finally con- 
cluded to follow a conservative course as labor had not even 
begun and the condition was not threatening life. The first 
thing ordered was a hot tub bath to give the pores of her 
skin a chance. She seemed very loathe to lose the soil of 
sunny Italy that she had evidently brought with her, but was 
finally persuaded mostly by pantomime, and after that she 
was put into a pack and arsenicum was prescribed. Towards 
morning she had a severe convulsion. The temperature was 
104.0 when she came in but the next day it had dropped to 
nearly normal, and it was decided to give Nature a chance to 
deliver. The labia were punctured, allowing the escape of 
much fluid. Large quantities of pure water, milk and lemon- 
ade, which the patient especially enjoyed, were 'given. A 
sample of urine was obtained after some time, the patient 
losing most of it involuntarily, and an analysis was 
made : 

Apis was decided upon for the remedy. 

Early on February 1 5, three days after coming into the 
Maternity, having had no more convulsions, pains began, 
and labor was allowed to proceed under careful watching 
until the baby was delivered at 11.30 A. M., still born. 
There was no occasion for interference, although we were 
ready to assist at the first intimation of danger. The 



490 The New England Medical Gazette, Oct., 

following day the patient looked very uncomfortable and 
the temperature was two degrees above normal, but the 
same treatment was carried on and a steady improve- 
ment followed, the temperature not rising above 100.8*^ 
at any time. Owing to lack of data we could not decide 
to which of the three classes of kidney complication this 
case belonged. Whether this was (ist) chronic Bright's 
disease which existed at the beginning of pregnancy, (2d) 
condition existing previously but apparently cured at the 
time of the beginning of pregnancy, (3d) a condition in 
which albumen began as a consequence of the existence of 
pregnancy; probably the last was her condition. In any 
event the patient returned to her home thin and on the high 
road to health ; with the delightful uncertainty of obstetrics, 
the case that threatened the most serious consequences 
before labor was in the best condition when she left us. 



THE SURGICAL CLINIC5 OF THE MASSACHUSETTS 
HOMCEOPATHIC HOSPITAL. 

SERVICE OF NATHANIEL W. EMERSON, M.D. 
[For Quarter ending March 31, 1901.] 

As some features of the present year's service seem 
worthy of notice, this method is taken of making a record of 
them. The service was the largest in the experience of the 
writer, and again shows a remarkable increase in the propor- 
tion of the abdominal to all other cases. 

ABDOMINAL CASES. 

In doubtful abdominal cases where accurate diagnosis 
cannot be made — and how many of such there are — the 
writer would urge an earlier consideration by counsel. Ex- 
perience has taught that the prompt investigation of obscure 
abdominal cases is a brilliant success. While not every case 
is saved in this way, a very large number are, and those that 



190 1 Surgical Clinics of ike Mass, Horn, Hospital, 491 

prove inoperable are rarely complicated in their subsequent 
course by the operation or its results. If anything has been 
proven, it is that an exploration in competent hands is a safe 
measure, and that in obscure cases patients do not die 
because of the operation, but because of the disease which 
is uncontrolled by interference. In looking over the data 
here recorded consider the story of appendicitis as told by 
the following summary : 

Seven (7) Suppurative Cases, Three (3) Deaths 

Thirteen (13) Acute Cases, No Deaths 

Twenty-nine (29) Intermittent Cases, No Deaths 

Nineteen (19) other cases in which the appendix was so 
diseased that it was removed. In many of these, affection 
of the appendix caused acute conditions and was itself more 
or less acutely inflamed and the real cause of the precipi- 
tation of a crisis, yet appendicitis was secondary to other 
processes in themselves sufficient to require operation. 
None of these nineteen cases were lost. 

Sixty-eight (68) cases in all ; three (3) deaths. Death 
rate 4.4 per cent. 

Here are sixty-eight cases from which the appendix has 
been removed for various causes in three months ; they pre- 
sented themselves in all stages of disease, some in extremis. 
The acute and suppurative cases were operated upon at 
whatever hour of the day or night they presented, with no 
opportunity to select time or perfect preparations and with 
the operator not always in the pink of condition, yet the 
results are consistent with what we have been led to expect ; 
all cases of election get well ; all acute cases are immediately 
cut short and also get well ; and those which are fatal are 
the suppurative cases — really neglected cases — which 
never rally after the operation. They die, not because of 
the operation, but in spite of it, and the operation does not 
appreciably precipitate the end. It would seem as if the 
whole story of appendicitis has been told^ as indeed it practi- 
cally has, but it is far from being wholly learned. 



492 The New England Medical Gazette. Oct., 

In the above estimate the previous history of each fatal 
case clearly shows that the danger-line was far past when 
the operation was undertaken and that usually abundant 
warning had been given, an interpreter being lacking, how- 
ever. It is a conservative statement of fact, borne out by 
abundant experience, that nine out of ten fatal cases of sup- 
purative peritonitis, or appendicitis, could have been saved 
if they had been operated earlier. 

It is in no spirit of self-satisfaction that the above is writ- 
ten, but rather in the fulfillment of the promptings of duty. 
I consider a position such as mine in the hospital, in a meas- 
ure, a professional trust and endeavor so to conduct it. 
Unusual opportunities come for cumulative observation 
along certain lines which should be made of practi- 
cal benefit to the profession at large and which are not 
usually open to it. Therefore, whatever observations are 
here presented are offered with a well defined intent on my 
part to demonstrate the actual local state of affairs as 
regards suppurative peritonitis, and to make a sustained 
endeavor to materially reduce the death rate in this disease, 
not by alleged skilfulness and attention on my part, but by 
going to the real heart of the whole matter and showing that 
an early consideration of siich cases means a remarkable 
and satisfactory diminution of the number of deaths. 

Of the nine deaths here recorded, seven were in abdominal 
cases. One of these was an old umbilical hernia which had 
become incarcerated, the patient being seventy years old, 
and death was certain without releasing it ; hence an 
attempt was made, recognizing it as a forlorn hope. This 
is a type of case which occurs with sufficient regularity to 
cause a constant death rate in a large series of cases and is 
not under discussion. Of the other six deaths, three were 
from general suppurative peritonitis having its origin in 
appendicitis ; and every one of the three could have been 
saved if the operation had been at an earlier date. Not one 
in a hundred of these cases which does not show abundant 



igoi Surgical Clinics of the Mass. Horn, Hospital, 493 

warning in the previous history. And these are the cases to 
which I wish to draw especial attention. They are often 
reported as obscure in the early stages when as a fact they 
are not at all obscure except to the individual who is in charge. 
I really believe that ninety-nine out of every hundred of 
such cases which are now fatal could be saved by a more 
prompt consideration of them by an experienced diagnosti- 
cian and expert operator ; and it certainly is no presumption 
to claim that the surgeons of our hospital, with their remark- 
ably ripened experience in abdominal work, may be included 
in this class. Therefore, we urge those who rely upon the 
hospital to send their acute ^bdominal cases at an early 
stage of the disease, always remembering that peritonitis 
demands prompt investigation, and in ninety-five cases in 
one hundred in man means appendicitis, and in a very large 
proportion in woman means appendicitis or tubal disease, 
one or both, and that safety to the patient, as well as subse- 
quent health, lies through an operation. 

Of the three remaining deaths in abdominal cases, much 
that has been said above applies. They were all cases of 
gall stones and only one of four was successful. 

Mrs. C, age 55 years, had been married 32 years, and 
had five children. There had been no menstrual difficulties 
and the menopause had been normal. She had been sub- 
ject to severe attacks of colic ever since she was fourteen 
years old, occuring about once a year, except for the last 
four or five years, when there had been none. Four months 
ago she had a very severe attack lasting several days, since 
which time she has had sixteen distinct attacks. The pain 
was in the right hypochondrium and passed to the left and 
backwards. She was jaundiced in the attack four months 
ago and has been so ever since. Several years ago she 
passed three gall stones about the size of a pea, which were 
gray in color and rough, except where faceted. At the 
operation the gall bladder was opened and about fifty stones 
removed together with soft, clayey masses which were diffi- 



494 ^^^ New England Medical Gazette, Oct., 

cult to handle because they were so pasty they could not be 
grasped. She did very well at first but the discharge from 
the wound became excessive, vomiting occurred, and a fatal 
result followed. 

Mr. C, age 65, had had malaria and several attacks of 
inflammation of the bladder ; had been jaundiced several 
times in the past. He was as well as usual up to the previous 
five days when he had a severe chill and a pain in the stomach 
'* like hot lead " extending to the back. Next day the pain 
was more diffuse. The pain continued through the two fol- 
lowing days and was worse at night, somewhat better on the 
third day with the exception of general abdominal soreness. 
That night the pain was of such severity he was sent to the 
hospital. The ride in the ambulance relieved him and he 
remained comfortable afterwards. At the operation a num- 
ber of stones were removed together with soft, clayey masses 
and very dark plaques which were closely applied to the walls 
of the bladder and were removed only by stripping them off. 
He died on the third day with no remarkable elevation of 
temperature. 

Mrs. C, age 38 years. She had had two children and two 
miscarriages. Had had attacks of asthma but none dur- 
ing the last two months. Had been in pain since the previ- 
our May ; pain was worse during menses. Bowels were 
regular and stools were dark. The pain was now constant 
with daily exacerbations and she was jaundiced all the time. 
At the operation a number of soft stones and ill-defined, 
clayey aggregations were removed. She was much troubled 
in breathing after the operation and coughed a good deal. 
Bowels active and satisfactory, fecal matter and gas passing, 
but the coughing and obstructed respiration continued. 
Complained much of oppression of the chest and on the 
eighth day after the operation she vomited blood admixed 
with a green mucus containing some brown particles. She 
died on the ninth day. 

Just what the clinical significance of these forms of chole- 



I go I Surgical Clinics of the Mass. Horn. Hospital. 495 

lithiasis is I am unable to determine. It is a fact, however, 
so far as memory serves me, that all cases where there has^ 
been a soft, clayey mass, difficult to manipulate, which must 
be scooped away, have proved fatal ; in all cases where the 
concretion takes the form of plaques applied closely to the 
underlying part and coming away in flakes, the road to 
recovery has been a difficult one. This pasty condition 
obtained in all the above cases. 

Continued observation of these cases, with corresponding 
increase of experience, convinces me that here again safety 
lies in promptness. The cases of gall stones which die are 
the old ones with complete obstruction of the common duct 
and corresponding jaundice and cholemia. It is universally 
accepted that patients saturated with bile are unfit for opera- 
tion, and that they are exceedingly liable to uncontrollable 
secondary hemorrhage and are very prone to sepsis. Also, 
the old cases require most extensive intra-abdominal 
manipulation. This necessitates a larger incision to be- 
gin with, with the breaking up of dense adhesions and a 
difficult manipulation in the most inaccessible parts of the 
abdomen. The common duct is deeply placed, of very 
limited mobility, the latter becoming practically lost after 
it has been inflamed, and in no portion of the abdomen do 
adhesions more certainly mask the normal relationship of the 
parts and make it difficult to find, and keep in mind, guiding 
landmarks. Then the duct is small, and from the mechani- 
cal standpoint does not lend itself readily to manipulation. 
Therefore, patients deeply jaundiced and worn out with pain 
are not tolerant and a fatal result seems to be easily induced. 
If rupture of the gall bladder or duct has taken place, caus- 
ing a sepsis already existent at the time of operation, the 
danger is materially increased. 

On the other hand where the gall bladder and duct are 
free from old inflammatory adhesions and still intact and are 
readily demonstrable, and when stones can be removed 
through the gall bladder itself, most favorable results may 



496 The New England Medical Gazette. Oct., 

be expected. Indeed no class of cases is more satisfactory 
in the promptness of relief afforded and the gratifying 
recovery. 

Of many interesting abdominal cases which were success- 
ful, the following are noticed because of some points of 
special interest : Mrs. E. B. W., age 39. The pelvis and 
lower abdomen was so packed with a solid mass that until 
the patient was etherized the tumor resembled a fibroid. 
Upon exploration, however, it was found to be a multiple 
cyst of both ovaries, each cyst filled to extremest extension 
and the general mass closely adherent throughout. These 
cysts, together with the tubes were removed. Further ex- 
amination of the gall bladder showed it to be full of stones, 
and a nice mechanical problem presented itself. The in- 
cision through which the pelvic manipulation had taken 
place was in the median line just above the pubis and barely 
admitted the hand, and it was out of the question to open 
the gall bladder through this, without extending it above 
the umbilicus. This meant at best, unless the abdomen was 
opened throughout to the ensiform cartilage, a difficult 
approach to the gall bladder. It was also thought that any 
leakage of the gall bladder, either at time of operation or 
later, would be more likely to cause general abdominal 
sepsis if one large incision was made than if two separate 
and smaller ones were used. Therefore the first incision in 
the median line above the pubes was closed in the usual 
way ; then a second opening was made over the gall bladder 
through the right rectus muscle, the gall bladder opened 
and two stones removed, after which the gall bladder was 
attached to the abdominal peritoneum above the incision and 
drained with a rubber drainage tube. This whole procedure 
was conducted as an entirely independent operation. Never 
before had I made two such distinct and individual operations 
on the same patient at the same time ; she was observed with 
much interest. The first twenty-four hours were rather more 
stormy and painful than usual, but after gas began to pass 



I go I Surgical Clinics of the Mass. Horn. Hospital, 497 

freely relief was prompt and she made more than an ordi- 
narily gratifying recovery. 

Mrs. F., age 63 years, was an unusual case. She had had 
ten children, one miscarriage which preceded the last five 
children ; youngest child twenty-two years old. Eleven 
years since menopause. Two years ago she began to flow 
again, a little at a time but quite constant. Recently the 
flow had been severe and she had had two bad hemorrhages 
which reduced her very much. She had had two or three 
attacks of pain across the abdomen lasting two or three days 
each, with nausea and vomiting, which were called "gall- 
stone colic.*' She was very fat and unwieldy and apparently 
not a desirable patient from the standpoint of physique. 
There was a multiple fibroid of the uterus which was well 
up to the capacity of the vagina for delivery and her symp- 
toms were difinite and becoming urgent ; as the tumor 
seemed to be growing and the flow increased both in fre- 
quency and in quantity, I unhesitatingly advised removal. 
A vaginal hysterectomy was undertaken and the mass of 
fibroid was fully up to the limit of size capable of being 
extracted by way of the vagina. This, could only be done 
by morcellment. After the left half of the uterus was 
removed, with the tube and ovary, a tumor of considerable 
size was still attached to the right half and above it. Had 
the vagina not been very capacious this could not have been 
removed except through an abdominal opening above the 
pubis. The whole hand, however, was introduced through 
the vagina into the abdomen and the tumor so brought 
down by the aid of pressure from above, that it could be freed 
and made to engage in the vagina. It was finally delivered 
and removed and found to be a true dermoid cyst, con- 
taining muth hair and a peculiar greasy, oily substance. It 
was oval in shape and as large as the head of a child weigh- 
ing ten pounds at birth. There was no difficulty in remov- 
ing the right half of the uterus with its tube and ovary. 
This patient made a complete and satisfactory recovery. 



498 The New England Medical Gazette, Oct., 

GENERAL CASES. 

The other two deaths were in cases requiring amputation 
of the middle of the thigh ; the first one was because of 
diabetic gangrene of foot and was the expected result in 
this case. 

The last case was an amputation through the middle of 
the thigh and could have been saved, I believe, by a greater 
experience than mine at that time. It is worth a more 
extended notice here, because it is a most unusual one and 
also because it points to a lesson missed by me on this occa- 
sion. Mr. F. H. C, age 55 years, previous good health, 
while sitting in his office felt a sting in the calf of his leg, 
and before his attention had been fully attracted to it, it was 
gone. It ,was but a short time before the sensation was 
repeated and more prolonged than previously, yet quickly 
passed away. This occurred several times, but caused no 
more than a passing notice until he started for home at the 
end of his day's work. He then found pain and difficulty 
in walking, which increased rapidly and so severely that it 
was only with great exertion and difficulty that he made the 
last stage of his journey from the car to his house. The leg 
was then beginning to swell, was very painful, and he passed 
an uncomfortable night. In the morning the leg was so 
much swollen that the family physician was called, but the 
pain and swelling increased with such rapidity that the fol- 
lowing day I was asked to see him in consultation. The leg 
from the knee down was enormously swollen and oedematous 
and the pain intolerable. I had him removed to the hospital 
and the following day opened the calf of the leg, finding a 
quantity of pus, without odor, which had dissected the mus- 
cles along the plains of aponeuroses in a very extensive and 
unusual manner. A free opening was made and the leg 
thoroughly washed out with peroxide of hydrogen, full strength 
and drained with gauze. Previous to this the temperature 
fluctuations had been extreme, going as high as 102 degrees 
in the evening and falling to subnormal in the morning, 



I go I Surgical Clinics of the Mass, Horn, Hospital, 499 

going to 100 degrees the next evening. After that it went 
higher, reaching loi and 102 degrees in the evening. 
Microscopic examination of the pus showed that there was 
a streptococcus infection of the leg, and for the next five 
days he was given twice daily a hypodermatic injection of 
ten c.c. of antistreptococcus serum. This, however, did not 
apparently affect his condition in any appreciable way. 
There was a copious discharge of pus from day to day with- 
out marked improvement and as there did not seem so be a 
proper drainage about the ankle, eleven days after the pre- 
vious operation he was anaesthetized and free openings made 
about the ankle. Two days later he was anaesthetized with 
the intention of amputating his leg at the middle of the 
thigh, but after he was etherized there seemed to be so 
much local improvement in the deeper portions of the leg 
that amputation was deferred and additional means of drain- 
age furnished. Again it was washed out with pure peroxide 
of hydrogen and enveloped in a compress, moistened with 
one-half of one per cent, formalin solution. His general 
condition not being improved, the next day he was again 
anaesthetized and the leg amputated at the middle of the 
thigh. Everything went well for forty-eight hours when a 
marked change in his condition rapidly developed. He be- 
came violently delirious, went into a state of clonic convul- 
sions and episthotonos, and died five days later. This case 
is not detailed at this length merely because it is unique, 
but rather to record the conclusions drawn from it. I could 
find little in the literature to assist me in the conduct of this 
case and I believe I made a serious mistake in delaying 
radical measures for so long a time. I also believe that had 
I amputated the leg as soon as I had made a diagnosis of 
streptococcus infection the man's life would have been 
saved. Therefore, in a similar case I would urge a more 
prompt and radical operation. 

The case of A. B., age 10 years, is worthy of brief men- 
tion. This lad was hit on the left side of the head by a 



Soo The New England Medical Gazette, Oct., 

stone thrown by another boy from a distance of about fifty 
yards. Although he was knocked down and received a 
scalp wound from which there was considerable hemorrhage, 
he was not considered seriously hurt and received domestic 
care only. The next day he was up and about and shoveled 
snow, and made no complaint. On the following day, how- 
ever, February 23, he complained of headache and was 
inclined to be dull and stupid, and his temperature went as 
high as 1 01 degrees. On the 24th, he was even more dull 
and stupid, was not readily aroused from an appearance of 
drowsiness, vomited several times, and his temperature went 
to 102 degrees. On the next day, the 25th, he was sent to 
the hospital. We found him without pain with the exception 
of a slight headache, very drowsy and dull, only responding 
when spoken to and the question often requiring repetition. 
His answers were correct but rather slow in coming. He 
had the appearance of being asleep most of the time and 
was aroused with increasing difficulty. The wound on his 
head was puffed and angry looking and not healing by first 
intention. He made no complaint. On the 26th, all the 
above symptoms were aggravated, and after consultation 
with Dr. E. P. Colby and with his approval, I decided to 
trephine. I therefore removed a button of bone at the point 
of impact of the stone but could not determine that either 
plate of bone was depressed. The wound in the soft parts 
was septic and there was a sharply defined dent in the outer 
plate of bone. The dura was congested and inflamed and 
bulged into the opening. The wound was drained by a 
bundle of rubber tissue and dressed as usual. The subse- 
quent course was very interesting. After the trephining he 
grew rapidly worse, becoming at first very restless and more 
stupid, then wildly delirious, muttering and talking much of 
the time, with rising temperature and pulse. On March i, 
the evening temperature was 1043-5 degrees, by rectum, 
and the pulse was 120; at 8.30 that evening he had a con- 
vulsion beginning in the hands and arms but soon becoming 



I go I Surgical Clinics of the Mass, Horn. Hospital. 501 

general and lasting four minutes. Following it he went into 
a state of complete coma. From this time until March 8, 
he was entirely unconscious and had almost innumerable 
convulsions, at times as many as four in an hour. On 
March 8, following a two-minute convulsion, he complained 
of the light, which was the first symptoms of consciousness. 
The convulsions were more brief, and for the first time he 
seemed to have short naps of natural sleep. The tempera- 
ture was still high, 103 degrees, and the pulse 112. At 
midnight of the 8th he perspired very freely and after 3 a.m. 
had some sleep. In the forenoon he again noticed his sur- 
roundings, complaining this time that the room was dark, 
although he could see. There was some swelling of the 
neck and of the bridge of the nose. On the night of the 
9th he slept about five hours, and on the morning of 
the loth the temperature had declined to 1002-5 degrees, 
and the pulse 88, which was decidedly lower than at any 
time for ten days. On the night of the loth he slept even 
more, but in the moyning there was no doubt about his hav- 
ing contracted measles, and he was removed to the isolation 
cottage. He had an ordinary attack of measles, following 
which, an abscess formed in the axilla and was opened on 
April 5. He finally made recovery sufficient to be dis- 
charged on May 8. The unusual features about this case" 
are the long continuance and violence of the brain symptoms 
with the final recovery, although the recovery was compli- 
cated by measles. 



SUMMARY OF CASES. 



DiACNOcn. 


• 
Opbration. 


11 


"1 
^1 


I 


Improved. 
Improved. 


1 


1 


ABDOHINAL SECTIONS. 
















Appendicititf acate. 


Appendicectomy 


II 


II 


7 








4 


" " ; CTstonutU of ovary. 


" ; resection of ovary 














a 


, int. 




>4 


»4 


n 








t 


" , int. ; cvstomata of ovaries. 
" , int.; nematoma of broad 


" ; resection of ovaries 






4 










Appendioectomv ; tubo-ovariotomy, r. 






I 










ligamenti r. 


















Appendicitis, sup. 

" , sap.; gen. tup. peritonitis. 


Appendicectomy ; drainage 
Abdominal section ; drainage 






3 
1 






a 
I 


1 


Gardnoma uteri. 


Vaginal hysterectomy 






I 










Cholelithiasis. 








1 






S 




Cystomau of ovaries. 


Ovariotomy, 1. ; resection of ovary, r. 






1 








I 


(( f« •« 


Resection of ovaries 






3 








1 


(( i( It 


Tubo-ovariotomy, r. ; resection of ovary, 

1.; appendicectomy 
Tubo-ovariotomy, d. ; ventral suspen- 






1 








I 


*' " ;appendicitb,int. 






1 


























(« «l U II II 














1 


endometritis ; ruptured perineum. 


tomy ; curetting ; perineorrhaphy 
















" •• " , I ; retroversion 








' 








1 




















Cystomau of ovary, r. ; retroflexion uteri 


Resection of ovary, r. ; ventral suspen- 
sion 
Curetting ; trachelorrhaphy ; perineor- 














1 


Endometritis, tubercular ; lac. cervix ; 






I 










rupt« perineum. 


rhaphy ; vaginal hysterectomy 
















Extra-uterine pregnancy. 


Abdominal section ; removal of foetus ; 
drainage 






1 










" ;appendidtU.int. 
" " " ; cystomau of 






I 










Tubo-ovariotomy, r.; reaection of ovary, 1. 














1 


ovary, 1. 


















Extra-uterine pregnancy, rupt. 


Tubo-ovariotomy, r. 






1 










Fecal fistula. 


Abdominal section ; enterorrhaphy 






3 








a 


Hernia, ind. ing. 


Herniotomy 






5 








1 


" '• : strangukted. 
" , umbilical. 


If 

fl • 














I 
a 


; Incarcerated. 


If 












1 




" , ventral. 


It 






3 








1 


" ;fistu]ainano. 


*' ; opened, curetted anddrained 






1 










Hydro-Salpingitis. 


Tubo-ovariotomy, d. ; ventral suspen- 
sion 

Tubo-ovariotomy, r. ; salpiregectomy, I. ; 
appendicectomy 

Tubo-ovariotomy, d. ; ventral suspen- 














1 


" *' ; appendidtU, int. 






1 








1 

1 


" *' : cystomau of ova- 






I 






1 


ries ; cholelithiasU. 


sion; choiecystotomy 
















Curetting : vaginal hysterectomy 
Abdominal hysterectomy 






X 








MyomaU uteri. 






3 






1 


<i II 


Curetting 










1 




If •« 


" ; vaginal hysterectomy 


1 




1 






, 


u u 


Not treated 










I 






fl 11 


Vaginal hysterectomy 






5 








1 


" " : adeno-fibroma mammae 


" '• ; extirpation mam- 






I 










" ; appendidtU, int. 


mas 

tomy 
Myomectomy ; reieotion of ovaries 






3 










" " ; cystomau of ovaries. 






3 










" " ; hydro-salpingitis, d.; 


Myomectomy ; tubo-ovariotomy, d. ; vent. 














( 


adenoma mamnue. 


Myomectomy ; tubo-ovariotomy, d. ; 
















appendicitis, int. 
MyomaU uteri ; pyo^salpingitis, d.; ap- 














( 


vent, suspension ; appendicectomy 
















Myomectomy; tubo-ovariolomy,d. ; vent 














1 


pendidtU, int. 


suspension : appendicectomy 














Procidentia uteri. 


Ventral fixation 






I 






I 




Abdominal hysterectomy; appendicec- 
tomy 
Tubo-ovariotomy, d. ; appendicectomy 






3 






t 


U « II If 






a 






a 


41 11 II li 


*' " ventral suspen- 
sion; appendicectomy 












1 1 


" " ; cyst of ovary, 1.; appen- 


No operation 












' 1 


didtis, int. 
















Recto-vesical fistula. 


Abdominal section ; inguinal colstomy 








I 




1 




Ventral suspension 






X 






I 




Viginal hysterectomy : clamps & cautery 






' 









SUMMARY OF CASES.— Continued. 



Diagnosis. 


Opbratxon. 




2| 


t 


•8 

> 

a 


^1 


t 


1 


Salpingitis ; cystomata of ovaries. 


Tubo-ovariotomy, d. ; ventnd suspen- 


3 


3 


J 








a 


" , 1.; cystomata of orary, r.; 


sion 
Tubo-ovariotomy, 1. ; resection of ovary, 


I 


X 


X 










rctroTcrsion ateri. 


















Sinus following appendicitis. 


Abdominal section 


X 


X 


z 















«37 


«46 


87 


' 


a 


7 


40 


GSNERA 


X CASSS. 




Abortion, septic 


Curetting 
















AUcessof 


Extraction of teeth; opened, curetted 
















Alveolar process. 


and drained 
















Arm. 


Opened, curetted and drained 
















AzUla. 


n <( II 








X 








Ch^w^ 


t« ti II 
•1 «i II 
















Leg. 


(» 1* II 
















; streptococcus infection. 


- - " ; amputa- 
tionofli^ 
Opened, curetted wmi^kmmtA 












■ 




Neck. 
















Pelvis. 


II II II 


















ti «< II 
















Peri-rectal. 


II II it 
















Adenitis, axillary ; tubercular. 


Extirpation of gUnds 






' 










«« •< ' u 


Opened, curetted and drained 














X 


" , cervical. 


Extirpation of glands 








a 








" " , suppurative. 


Opened, curetted and drained 














X 


AmpnUtion of fingers. 


Rrmoval of stitches 








z 








Atony of bladder. 


Not treated 










X 






Atrophy of mamma. 


Exthrstion 
Excision ; resection 
















Bunions ; exostoses of feet. 
















Bom of leg. 


No operation 
















Carcinoma of clitoris. 


Extirpation 
















•* cervical glands. 
" " cervix uteri. 


Opened, curetted and drained 
No operation 










I 




X 


" face. 
'* mammae. 


Extur^tion 














z 


Carcinoma vaginx. 


Extirpation 








X 








Oca