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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  phvsiJmid^RtA  fee^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 

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10 

2 
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22 

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TlmeofOp'n 


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344 


64 


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21 


23 


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31 
II 

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32 

5 

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280 


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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 

Ocatrix  of  face,  bum. 

Skin  grafting 

Cystocele ;  rectocele. 

Ant.  and  post  colporrhaphy 

Dislocation  of  coccyx. 
"  shoulder. 

Ant.  colporrhaphy ;  perineorrhaphy 

Castration 

X 

Coccygectomy 
Reduction 

z 

"  tarsus. 

II 

Dapoytrens  contraction. 

Open  tenotomy 
Curetted 

i6 

14 

jj 

a 

X 

a 

<f 

X 

t  hemorrhoids. 

Curetted;  proctorrhaphy 

;  lac  cervix. 

"        ;  trachelorrlU/hy 

xa 

"       •*     :  fissure  ani. 

"       ;             "              ;  excision 

"  ;  rupt.  perineum 

"       ;             •'              ;  perineorrha- 
phy 
Curetted ;  trachelorrhaphy ;  perineorrha- 

17 

i<             «       «<       «i           « 

Endometritis ;  lac.  cervix ;  urethral  car- 

nvcle. 
Endometritis ;  rupt.  perineum. 

phy  ;  ant.  and  post,  colporrhaphy 
Curetted ;  trachelorrhaphy ;  extirpation 

z 

•*                   "              ;  extirpation 

X 

ant.  vaginal  wall. 
Eodometritis ;  stenosis  os  uteri. 

"        ;  dilatation 

Epithelioma  of  lip ;  enlarged  cervical 

^ands. 
Epithelioma  of  nose. 

Excision ;  extirpation  of  glands 

Extirpation 

"  cheek. 

II 

Erosion  of  cervix. 

Curetted 

Extrophy  of  bladder. 

Not  treated 

X 

Fistula  in  ano. 

Opened,  curetted  and  drained 

a 

Fracture,  Colles. 

Reduction  and  fixation 

"        of  coccyx. 

"        of  femur,  ununited. 

ResecTion  and  wiring 

X 

"        of  fibula. 

Reduction  and  fixation 

"        of  hip. 

Fixation  by  extension 

I 

'*        of  leg ;  retention  of  urine. 

2 

"        of  ulnar. 

Reduction  and  fixation 

SUMMARY  OF  CASES.— ContinuccL 


Diagnosis. 

Opsration. 

3 

j 

i 

^ 

Gangrene  of  foot,  diabetic. 

Amputation,  thigh 

1 

1.! 

Hemorrhoids. 

Clamp  and  cautery 

I 

I 

•( 

Not  treated 

a 

" 

(Proctorrhaphy 

I 

I 

Hydrocele. 

Aspiration 
Extirpation  of  sac 

^           '•      ;  dilautton 

1 

z 

I 

I 

"        ;  phimosis. 

a 

I 

"        ;  synovitis  of  knee. 

"            "     ;  aspiration 

3 

I 

Aspiration 

3 

3 

Hypertrophy  of  prostate  gland. 

Bottini's  operation 

I 

Hypospadias.                                     t 

Urethrotomy 

1 

1 

Hysterical  knee. 

Not  treated 

I 

Laceratedcervix. 

Extirpation 

I 

I 

Trachelorrhaphy 

X 

z 

"                ;  clamp  and  cautery 

z 

"             '*      ;  nipt,  perineum. 

Amputation  of  cervix ;  perineorrhaphy 

z 

Trachelorrhaphy ;  perineorrhaphy 

6 

3 

Lipoma  of  abdominal  wall. 

Extirpation 

z 

z 

■ 

"  back. 

n 

1 

1 

"       "  forehead. 

tt 

X 

1 

"       "  shoulder. 

n 

I 

1 

Loose  cartilage  in  knee. 

Exploration 

z 

I 

Movable  kidney. 

Lumbar  fixation 

z 

z 

NecrosU  of  tibia. 

Curetted 

3 

'    a 

Needle  in  finger. 

Exploration ;  not  found 

I 

z 

"        "  thigh. 

Extraction 

I 

1 

No  diagnosis. 

Not  treated 

lO 

zo 

Osteo-myclitis  of  tibia. 

Opened,  curetted  and  drained ;  exsection 
of  tibia 

a 

I 

Phimosis. 

Circumcision 

5 

5 

" 

Dilatation 

X 

Extirpation 

I 

z 

Prejjnancy. 

Abortion 

Not  treated 

z 

Puerperal  metritis. 

Curetted 

Recto-urethral  fistula. 

Primary  closure  ;  dilatation  of  urethra 

■ 

Rupt.  perineum. 
•'            "         complete. 

Perineorrhaphy 

1 

1 

Sarcoma  of  neck. 

Extirpation 

z 

(<        (•    <i 

Tracheotomy 

I 

Scirrhtts  mammx. 

Extirpation 

Sepsis  of  hand. 

Opened,  curetted  and  drained 

5 

I 

1 

Sinus  of  abdominal  wall. 

*^,«       '          n                 .. 

z 

' 

•*      "  rectum. 

K                           «                           « 

'  1     I 

I  I 

Splinter  in  hand. 

Removed 

I           X 

Sprain  of  ankle. 

Fixation  in  plaster 

1 

"       ••  knee. 

"    sil.  of  potash 

Stenosis  vaginse 

DilaUtion 

z 

!        1 

Stone  in  bladder. 

Litholapaxy 

2 

1 

Stricture  of  rectum. 

Dilatation 

Z 

"                 "      ;  phimosis. 

a 

Synovitis  of  knee. 
Talipes  equinus. 
Trauma  of  foot. 

Fixation  in  plaster 

1 

Tenotomy 

z 

1        '    » 

No  operation 

X    1 

, 

••  hand. 

Opened,  curetted  and  drained 

1 

1        1 

"        "  head,  septic. 

Trephining;  drainage 

X 

I 

Tuberculosis  of  ankle. 

Fixation  in  plaster 

1 

"  femur. 

Opened,  curetted  and  drained 

3 

I 

"  hip. 

•^  41                             tt                           It 

a 

z 

"  tibU. 

Curetting;  trephining;  exsection 

3 

'        '    I 

Ulcerated  tooth. 

Extraction 

z 

1 

Ulceration  of  rectum. 

No  operation 

1 

Urethro-perineal  fistula. 
Varicocele ;  fissure  ani. 

Dilatation  of  urethra 

> 

. 

X 

Extirpation  of  veins ;  curetted 

2 

1 

Varicose  ulcer. 

No  operation 

z 

Varix  of  tongue. 

Injection  of  alcohol 

3 

3 

Wen  of  back 
"      "  forehead. 

Extirpation 

z 
z 

1 
z 

1 

_^ 

^_« 

_^ 

Total  gtfUTctl  cases              . 

ao3 
'37 

^ 

15 

«9 

I 

aa 

"7  *5 

Total  abdominal  casts 

a 

7     40 

Total  of  all  cases 

340    " 

aaa 

ao 

Q   j   6i 

•"•' 

"' 

_ 

Total  cases,  340.        Total  deaths,  9.         Percentage  of  deaths,  2.65  per  cent. 


I  go  I  Temperature  in  Puerperal  Cases,  505 

TEHPERATURE  IN  PUERPERAL  CA5B5. 

BY   DR.   SARAH   E.   WINSOR 
[Read  before  Mass.  Homoeopathic  Medical  Society.] 

It  was  suggested  by  the  chairman  of  this  bureau  that  it 
might  be  interesting  to  see  how  much  variation  in  tempera- 
ture there  has  been  among  the  patients  attended  by  the 
Students  from  the  Dispensary  during  the  last  year  or  two. 
I  have  accordingly  studied  the  records  of  cases  for  two  years, 
judging  that  to  be  a  sufficient  length  of  time  for  giving  the 
desired  information. 

I  wish  I  might  give  in  each  case  the  cause  of  the  elevation 
of  temperature,  but  in  many  of  the  reports  the  elevation  was 
of  such  brief  duration  as  to  merit  no  comment  from  the 
attending  students.  From  this  very  fact  we  may  infer  that 
the  condition  was  not  serious  at  any  time. 

The  homes  of  the  Dispensary  patients,  as  we  think  of  the 
surroundings,  are  surely  not  the  places  to  look  for  ideal  tem- 
perature in  obstetrics. 

Aseptic  conditions  are  almost  impossible,  and  compared 
tvith  our  private  work  as  with  hospital  practice,  everything  is 
unclean  from  beginning  to  end.  No  sterilized  sheets  or  pads 
are  at  hand,  and  many  times  the  patient  lies  on  an  old  quilt 
without  even  a  sheet  or  any  protection  for  the  salva.  Yet 
with  all  these  discouraging  conditions  not  a  patient  has  been 
lost  in  the  Dispensary  practice  for  years,  and  the  tempera- 
tures are  for  the  most  part  normal  or  about  a  degree  above. 

In  the  records  for  the  last  two  years,  out  of  six  hundred 
cases,  four  hundred  and  ninety-one  were  within  the  normal 
range,  that  is,  below  99°.  Sixty-nine  were  between  99  and 
100^.  These  were  due  to  the  establishment  of  lactation  or 
an  over-loaded  bowel.  Twenty-one  were  from  100  to  loi®. 
Of  this  group  one  patient  had  a  post-partem  hemorrhage, 
another  Grip,  another  articular  rheumatism.  Eight  patients 
had  a  temperature  between  100  and  102*^,  Of  these,  one  was 
due  to  an  over-loaded  bowel,  and  as  soon  as  the  cause  was  re- 
moved the  temperature  went  down  to  normal.  Another  case 
was  due  to  lactation,  another  had  Grip.     Seven  cases  were 


5o6  The  New  England  Medical  Gazette,  Oct., 

between  102  and  103^.  Among  these,  was  one  of  abortion, 
another  of  indigestion  ;  the  remainder  not  specially  reported. 
Four  cases  had  a  temperature  of  103  to  104**.  One  was  due 
to  an  over-loaded  bowel,  and  the  temperature  fell  to  normal 
as  soon  as  the  mass  was  removed.  A  second  case  was  due  to 
an  old  clot  which  caused  sapraemia.  The  clot  passed  on  the 
eighth  day  and  the  temperature  went  down  immediately. 
The  third  patient  was  well  until  the  first  day  she  sat  up,  when 
she  complained  of  soreness  m  the  uterine  region  The  next 
day  the  temperature  was  normal  and  nothing  further  reported. 
The  fourth  case  was  one  of  abortion. 

We  thus  see  that  only  nineteen  out  of  6cx)  cases  were  re- 
ported to  have  a  temperature  above  loi^  and  even  among 
these  nineteen  there  were  no  indications  of  sepsis. 

It  sometimes  seems  a  mystery  how  these  patients  with 
almost  no  care  at  all,  get  along  better  than  the  one  who  has 
everything  done  in  the  best  approved  methods  of  the  present 
day. 

It  has  been  demonstrated  that  there  are  cocci,  staphylo- 
cocci and  bacilli  in  the  genital  discharge  even  in  normal  cases, 
and  under  these  circumstances  it.seems  as  if  the  clinical  symp- 
tomatology must  necessarily  depend  on  the  resisting  power 
of  tjie  person  in  whose  body  the  micro-organisms  have  obtained 
a  foothold.  A  puerpera  weakened  by  previous  diseases  ob- 
viously will  resist  the  onset  of  these  infective  elements  to  a 
far  less  degree  than  the  woman  who  has  reached  full  term  and 
has  passed  through  her  labor  with  undiminished,  or  rather, 
un weakened  vital  forces. 

The  hard  working  woman  seems  to  be  the  one  who  has  the 
most  resistive  power,  unless  we  conclude  that  if  the  coating 
of  dirt  is  only  thick  enough  the  person  may  be  immune. 


The  Boston  Food  Fair  will  open  Monday,  Oct.  7,  in 
Mechanics'  Building,  Huntington  Avenue,  with  the  greatest 
attractions  New  England  has  ever  seen.  Six  acres  of  ex- 
hibits.    All  the  latest  new  foods.     Admission,  25  cents. 


igoi  Editorial.  507 

EDITORIAL. 

CwiilbutioM  of  orlgliiAl  utid«s,  correspondenc*.  etc.,  should  be  tent  to  the  pabliaben,  Otis 
Clapp  &  Son,  Boston,  Mass.  Articles  accepted  with  the  understanding  that  they  appear  only  in 
the  GoMtU.  They  should  be  typewritten  itpoesible.  To  obtain  insertion  the  followinf  month, 
reporto  of  societies  and  personal  items  mmt  Ar  netived  hf  tkt  tjih  •/tht  mmUk  prtctdmg. 


THE  CASE  OF  THE  LATE  PRESIDENT. 

The  death  of  President  McKinley  plunged  the  whole  peo- 
ple into  grief,  but  upon  no  portion  did  that  grief  fall  more 
poignantly  than  upon  our  profession,  for  upon  it  rested  the 
responsibility  of  the  attempt  to  save  his  life.  The  attempt 
failed ;  and  because  it  failed  the  profession  has  the  right,  we 
believe,  to  examine  and  review  the  case  as  managed  by  its 
representatives. 

Briefly  the  facts,  as  reported  to  the  New  York  Medical 
yournal  by  its  own  special  reporter,  are  these :  The  Presi- 
dent was  shot  on  the  afternoon  of  September  6,  at  4.07  p.m. 
At  6.50  P.M.,  two  hours  and  forty-three  minutes  after  the 
deed  was  committed,  the  President  had  been  removed  to  a 
hospital,  operated  upon,  and  the  wound  closed.  The  opera- 
tion consisted  in  tracing  the  course  of  the  bullet  through  the 
abdominal  wall,  both  walls  of  the  stomach,  whence  its  ap- 
parent course  was  into  the  deep  muscles  of  the  back.  The 
lacerations  of  the  stomach  were  repaired,  the  external  wound 
closed  and  the  bullet  left  to  look  out  for  itself.  At  the 
close  of  the  operation  the  pulse  was  122,  respiration  32. 
After  the  operation  the  patient  was  removed  to  the  house  of 
his  host,  Mr.  Milbum,  and  the  outcome  was  waited  in  breath- 
less suspense. 

From  this  time  until  the  loth  inst.  the  case  apparently 
progressed  favorably,  the  temperature  ranging  from  104.4 
to  99.8  (most  of  the  time  temperature  about  loi),  the  respi- 
ration from  24  to  34  and  the  pulse  from  104  to  146,  most  of 
the  time  about  1 20.  During  this  time  encouraging  bulletins 
were  given  to  the  public,  and  to  anxious  inquirers  about  the 
bullet  assurance  was  given  that  it  was  imbedded  in  thick 
muscular  tissue  where  it  would  do  no  harm. 


5o8  The  New  England  Medical  Gazette.  Oct., 

On  the  nth,  at  lo  p.m.,  we  were  assured  "the  President's 
condition  continues  favorable,"  notwithstanding  the  pulse 
had  risen  in  the  past  thirty-six  hours  from  104  to  120  and 
temperature  from  99.8  to  100.4.  Ii^  the  same  bulletin  we 
are  told,  "  He  is  able  to  take  more  nourishment  and  relish 
it,"  from  which  we  infer  that  he  was  being  fed  by  the 
mouth.  During  the  1 2th,  the  bulletins  continued  favorable, 
the  temperature  remaining  at  100.2  and  the  pulse  at  116  to 
120.  After  3.30  P.M.  of  the  13th  the  President's  condition 
grew  gradually  worse,  the  temperature  becoming  lower  with 
a  gradually  accelerated  pulse,  until  the  good  man  passed 
away  at  2.15  a.m.,  September  14. 

The  autopsy  showed  that  the  course  of  the  bullet  had 
become  gangrenous  throughout  but  as  no  mention  is  made 
of  any  gangrene  about  the  external  wound,  we  believe  the 
inference  is  just  that  it  extended  from  within  out,  from 
the  location  of  the  bullet.  The  bullet  has  never  been 
located.  While  it  would  be  unjust  in  the  extreme  to  pass 
judgment  on  the  management  of  the  case  until  all  available 
data  are  at  hand,  and  while  no  one  can  doubt  for  an  instant 
that  those  in  attendance  put  their  best  effort  and  skill  into 
the  management  of  the  case,  there  are  certain  questions  that 
continually  arise  in  the  medical  mind  which  for  the  honor  of 
the  profession  we  hope  in  the  near  future  will  be  satisfactorily 
answered.  Some  of  these  questions  which  have  suggested 
themselves  are  :  Taking  into  account  the  extreme  mortality 
in  gun-shot  wounds  of  this  character,  varying  from  one  re- 
covery in  three  thousand  cases  before  the  days  of  modern 
surgery  to  a  mortality  of  from  52  to  90  per  cent,  in  modem 
times  (see  PhiL  Med,  Journal,  Sept.  14,  1901)  were  the 
optimistic  reports  during  the  first  week  justified,  especially 
considering  the  marked  inequality  between  the  pulse  and 
temperature  rates  t  If  so,  on  what  grounds  is  such  extreme 
optimism  based  1 

Ought  not  the  discrepancy  above  mentioned,  between  the 
pulse  and  the  temperature,  have  given  a  hint  at  least  that  the 


igoi  Editorial,  509 

bullet  was  not  behaving  as  innocuously  as  was  claimed  and 
led  to  the  employment  of  the  X-ray,  whereby  the  bullet 
might  be  located  and  possibly  removed  and  proper  drainage 
established  ?  Why,  on  the  sixth  day  after  a  laparotomy,  was 
food  put  into  the  stomach  with  two  gun-shot  wounds  in  it  ? 
Why  was  the  bullet  not  located  at  the  autopsy  ? 

That  "in  a  multitude  of  counsellors  there  is  strength," 
there  is  no  doult  but  it  is  equally  true  sometimes  that  '*  too 
many  cooks  spoil  the  broth,"  and  it  has  occurred  to  us  on 
some  previous  occasions  that  distinguished  patients  have  had 
their  chances  of  recovery  imperiled  by  too  much  advice. 


ITEMS   OF  INTEREST. 


Criminals  and  Defectives;  How  Best  to  Reduce 
Their  Number.  By  Dr.  J.  C.  McCassey. — The  author 
points  out  that  it  is  more  economical  to  put  forth  every 
effort  to  prevent  the  formation  of  bad  habits  in  the  young 
than  to  try  to  reform  confirmed  transgressors.  Before  the 
issuance  of  marriage  license,  a  certificate  should  be  filed  show- 
ing that  the  applicants  are  free  from  insanity,  criminality, 
and  other  hereditary  taints.  For  the  cure  of  the  social  evil, 
the  author  proposes  :  Extension  of  manual  education  and  in- 
dustrial schools  ;  improvement  in  motherhood  ;  discontinu- 
ance of  the  lease  system  ;  extension  of  the  reformatory  plan ; 
adoption  of  the  intermediate  sentence;  improvement  in  jails; 
extension  of  the  probation  system  for  youths  and  adults,  as 
in  Massachusetts  ;  work  for  prisoners  —  sending  a  portion  of 
their  earnings  to  their  families.  Physicians  should  be  war- 
dens of  penitentiary  and  executive  officers  of  reformatories. 
—  New  York  Medical  Toumal. 


S  lo  The  New  England  Medical  Gazette.  Oct., 

Therapeutic  Application  of  Liquid  Air. — At  the  an- 
nual meeting  of  the  American  Medical  Association  at  Atlan- 
tic City  a  few  months  since,  Dr.  A.  C.  White  of  New  York 
read  a  paper  on  the  value  of  liquid  air  in  medidne  asd  sur- 
gery. Among  other  things  he  said  that,  wliQi  applied  to  a 
part  of  the  body  ligBiitair  produces  a  complete  anemia,  the 
limb  losing  all  blood  and  all  sensation.  Soon,  however,  the 
circtilation  returns  and  the  part  is  richer  in  blood  than  before. 
Thus,  when  the  vitality  of  the  germs  is  suspended  the  tissues 
have  time  to  recover  from  the  effects  of  their  activity.  The 
anesthesia  lasts  for  some  time  after  the  circulation  has  re- 
turned, and  it  can  be  secured  in  a  few  minutes  without  any 
ill  e£Fects  upon  the  part  except  a  slight  desquamation  of  the 
epithelium.  Liquid  air  is  therefore  useful  in  small  operations 
and  where  general  anesthesia  is  for  some  reason  contra-indi- 
cated. In  neuralgia  it  has  also  been  found  useful,  the  pain 
ceasing  almost  immediately,  but  in  old  persons  ulceration  of 
the  skin  takes  place  at  the  point  of  application.  It  is  the  best 
remedy  he  knows  of  in  the  local  treatment  of  boils  and  car- 
buncles. The  carbuncle  is  first  sprayed  with  liquid  air  and 
an  absorbent  dressing  is  put  on.  When  the  circulation  re- 
turns the  pus  is  discharged  from  the  openings  in  the  carbun- 
cle. The  application  may  be  repeated  if  necessary.  The 
liquid  air  cautery  has  given  good  results  in  lupus,  chronic  ul- 
cers, etc.,  as  a  stimulant  to  cicatrization.  For  quickly  re- 
moving naevi  without  scars  it  is  very  good.  Carcinoma  has 
been  treated  with  it  successfully,  even  after  other  means,  in- 
cluding operation,  had  failed.  Dr.  Fox  showed  a  case  at  the 
Vanderbilt  Clinic  in  which  epithelioma  was  cured  with  but  a 
small  scar.  In  general  and  contagious  diseases  liquid  air  may 
be  used  as  a  general  bath  for  the  reduction  of  temperature. 
It  is  more  simple  to  apply  and  more  pleasant  than  water.  In- 
halations of  liquid  air  may  be  used  in  phthisis  and  in  other 
lung  affections  as  well  as  in  hay  fever.  The  results  of  these 
cases  are  still  speculative  but  probably  they  will  be  good. — 
Pcediatrics. 


I  go  I  Items  of  Interest  511 

Justus  Test  in  Syphilis. — The  so-called  "Justus  test" 
is  based  upon  the  following  proposition :  Mercury  destroys 
the  hemoglobtin  of  the  blood.  In  the  non^syphilitic  subject, 
the  organism  rapidly  replaces  the  lost  pigment.  In  the  s)rph- 
ilitic  patient,  however,  the  percentage  being  reduced  by  the 
disease,  the  organism  cannot  at  once  restore  the  still  further 
reduction  caused  by  the  use  of  mercury.  Consequently  the 
the  first  examination  after  an  inunction  or  injection  of  mer- 
cury will  show  a  distinct  fall  of  from  10  to  20  per  cent.  This 
reduction  is  in  turn  followed  as  treatment  is  continued  by  a 
steady  rise  to  the  normal,  where  it  remains  so  long  as  treat- 
ment is  continued.  Based  upon  their  application  of  the  test 
in  29  cases  and  their  study  of  it  as  to  its  diognostic  value, 
H.  M.  Christian  and  Otto  H.  Foerster  {Univ,  Med.  Mag,^ 
November,  1900)  have  arrived  at  the  following  conclusions : 
(i)  That  in  the  diagnosis  of  doubtful  idcers  it  is  of  no  value. 
(2)  That  it  seems  to  occur  in  a  certain  proportion  of  cases  of 
acute  secondary  syphilis,  where  it  appears  to  be  a  symptom 
of  the  disease  and  can  in  no  sense  be  considered  a  true  test, 
as  the  diagnosis  in  such  cases  is  already  complete.  (3)  That 
as  a  test  it  is  not  reliable,  occurring  as  it  does  in  conditions 
other  than  syphilis. — Med.  News, 

Medicine  in  Thibet. — Dr.  Susie  Carson  Rijnhart,  in  her 
book,  **With  the  Thibetans  in  Tent  and  Temple,"  says  that 
there  is  no  medical  art  worthy  to  be  called  such  in  Thibet. 
She  writes  :  "For  headache,  large  sticking  plasters  are  applied 
to  the  patient's  head  and  forehead ;  for  rheumatism,  often  a 
needle  is  buried  in  the  arm  or  shoulder ;  a  tooth  is  extracted 
by  tying  a  rope  to  it  and  jerkin^:  it  out,  sometimes  bringing 
out  a  part  of  the  jaw  at  the  same  time ;  a  sufferer  with 
stomach-ache  may  be  subjected  to  a  good  pounding,  or  to  the 
application  of  a  piece  of  wick  soaked  in  burning  butter  grease, 
or,  if  medicine  is  to  be  taken  internally,  it  will  consist  proba- 
bly of  a  piece  of  paper  on  which  a  prayer  is  written,  rolled  up 
in  the  form  of  a  pellet,  and,  if  this  fails  to  produce  the  desired 
effect,  another  pellet  is  administered  composed  of  the  bones 
of  some  pious  priest," — Cleveland  Med.  Gaz, 


5 1 2  The  New  England  Medical  Gazette,  Oct., 

Sterility  and  Fecundity. — At  the  recent  session  of  the 
Gynecological  and  Obstetrical  section  of  the  American  Med- 
ical Association  there  was  probably  no  more  interesting  dis- 
cussion than  that  which  followed  the  reading  of  the  paper  by 
Dr.  George  J.  Engelmann,  of  Boston,*  on  "  The  Increasing 
Sterility  of  American  Women."  Aside  from  the  moral  ques- 
tions that  were  touched  upon  by  this  distinguished  statistician, 
who  holds  the  enviable  position  of  the  world's  leading  author- 
ity in  his  chosen  line  of  investigation,  the  subject  has  a  bear- 
ing of  great  civic  and  national  importance.  Long  accustomed 
as  we  as  a  nation  have  been  to  consider  ourselves  a  fruitful 
and  progressive  people  in  marked  contrast  with  some  of  the 
races  of  Southern  Europe,  notably  the  French,  Dr.  Engel- 
mann*s  statement  that  to-day  we  are  the  least  fruitful  people 
of  the  world,  comes  with  appalling  frankness.  As  clearly 
portrayed  by  figures  that  will  admit  of  no  controversy,  to-day 
the  American  born  people  show  a  fecundity  of  less  than  2 
children  per  marriage.  That  is  to  say,  there  are  barely  two 
children  born  to  a  family  among  those  who  can  claim  to  be 
native  white  Americans.  One  hundred  and  more  years  ago, 
during  the  colonial  period,  the  fecundity  stood  at  6  per  mar- 
riage, while  to-day  the  general  European  fecundity  is  4.5  per 
marriage  and  the  French  Canadians  show  the  enviable  record 
of  9. 1  per  marriage.  Closely  associated  with  the  foregoing 
statement  is  the  occurrence  in  Europe  of  one  miscarriage  to 
every  3.3  labors,  while  in  this  country  a  premature  expulsion 
of  the  ovum  occurs  in  2.8  labors.  Dr.  Puff,  of  Pittsburgh,  in . 
the  animated  discussion  that  followed,  emphasized  the  impor- 
tance of  suppressing  the  obnoxious  advertisements  with  which 
the  pages  of  the  daily  journals  teem,  and  reiterated  his  belief 
that  dire  calamity  will  fall  upon  the  editorial  managements  of 
these  journals  for  admitting  such  dangerous  and  non-patriotic 
advertisements  to  the  columns  of  their  papers.  It  is  undoubt- 
edly high  time  that  we,  as  a  people,  should  give  this  matter 
of  fecundity  and  sterility  careful  attention,  and  still  more  that 
we  physicians,  as  the  medical  guardians  of  the  nation's  wel- 
fare, take  such  measures  as  will  tend  to  suppress  vice  and  en- 


igoi  Items  of  Interest,  513 

courage  the  propagation  of  the  race.  Dr.'  Duff's  suggestion, 
which  was  unanimously  endorsed  by  the  meeting,  that  here- 
after the  United  States  Census  take  note  of  the  paternity 
(parental  nativity),  sterility  and  fecundity  of  the  people,  is  a 
most  excellent  one.  The  publication  of  such  records  would 
do  much  to  open  the  eyes  of  the  best  element  of  the  country 
to  the  danger  that  is  impending.  It  is  also  most  important 
that  the  blame  of  sterility  be  placed  where  it  properly  belongs, 
and  that  the  great  frequency  of  double  epididymitis  as  a  caus- 
ative factor  be  more  generally  appreciated.  As  to  the  willingr 
ness  of  individuals  to  assume  the  important  responsibilities 
of  maternity  or  paternity,  this  is  a  phase  of  the  subject  that 
can  be  influenced  only  by  appealing  to  the  morals  of  the 
people.  As  was  suggested  by  one  of  the  women  delegates, 
an  improvement  in  this  direction  might  be  instituted  by  sub- 
stituting the  questions :  "Are  you  willing  to  become  a 
mother  V^  "Are  you  willing  to  become  a  father.^"  at  the  tim6 
of  issuing  the  marriage  license.  Failure  to  acquiesce,  in  her 
view,  would  be  deemed  ample  reason  for  refusing  the  license 
on  the  ground  that  legal  prostitution  could  not  be  counte- 
nanced.— PhiL  Med,  Jour. 

KuMYSs  AS  A  Therapeutic  Agent.  An  experience  of 
six  years  with  kumyss  (fermented  mare's  milk)  in  the  treat- 
ment of  various  maladies,  enables  the  author  to  draw  the  fol- 
lowing interesting  conclusions  (N.  Y.  Med.  Journal^  :  (i)  In 
all  cases  of  anemia  (twenty-nine)  and  in  the  cases  of  neuras- 
thenia and  hysteria  treated  by  him  with  kumyss  he  has  ob- 
served improvement  of  the  general  condition  as  well  as  in  all 
the  symptoms.  (2)  He  has  observed  aggravation  of  the  pain 
in  some  cases  of  hepatic  and  renal  colic  after  the  use  of  ku- 
myss. (3)  Negative  results  were  obtained  in  the  cases  of 
heart  disease  and  in  diseases  of  the  vessels.  As  the  result  of 
the  difficulty  of  the  heart's  action  in  consequence  of  the  great 
quantities  of  liquid  present  in  patients  who  take  kumyss  treat- 
ment there  were  symptoms  of  tachycordia,  stenocardia,  etc^ 
in  some  instances.     (4)  Negative  results  were  also  obtained 


5 1 4  The  New  England  Medical  GoMette,  Oct., 

in  cases  of  tuberculosis  in  which  several  organs  were  afifected 
at  the  same  time,  in  cases  of  acute  pulmonary  tuberculosis  in 
young  persons,  and  in  cases  of  extensive  chronic  tuberculosis. 
(5)  In  early  cases  of  tuberculosis  very  good  results  were  ob- 
tained by  the  use  of  kumyss;  all  the  symptoms  were  im- 
proved and  the  general  health  was  greatly  benefitted.  (6) 
The  treatment  with  kumyss  must  be  continued  as  long  as  pos- 
sible. (7)  The  diseases  in  which  kumyss  is  contraindicated 
are  as  follows:  Atheroma  and  heart  disease,  abdominal 
plethora,  rheumatism  and  gout,  cerebral  hyperemia,  the  lasi^ 
stage  of  phthisis,  hepatic  and  renal  colic 

The  Cure:  of  Corns  on  the  Sole  of  the  Foot. — If 
the  patient  will  give  the  toes  free  play  by  adopting  boots  and 
soeks  having  a  straight  inside  line,  avoid  the  conventional 
eversion  of  the  foot,  and  acquire  the  habit  of  pressing  the 
toes  against  the  ground  in  every  step,  the  callossities  will  dis- 
appear. They  are  due  to  defective  function  of  the  toes.  Re- 
moval may,  of  course,  be  hastened  by  the  use  of  solvents, 
such  as  a  mixture  of  salicylic  acid  and  collodion. 

Another  correspondent  writes  that  he  has  found  that  corns 
on  the  sole  of  the  foot  rarely  resist  the  following  treatment : 
A  piece  of  salicylic  and  creosote  plaster,  muslin  as  suggested 
by  Unna,  is  cut  rather  larger  than  the  corn,  and  applied  to  it. 
This  is  removed  each  or  every  alternate  day.  As  much  of  the 
com  as  is  then  removable  is  ground  off  with  a  pumice  stone, 
and  another  piece  of  the  plaster  muslin  applied,  and  so  on, 
until  the  part  is  normal.  He  uses  the  muslin  plaster  contain- 
ing acid  salicylic  twenty  per  cent.,  creosote  forty  per  cent., 
and  has  found  that  it  is  more  comfortable  to  wear  if  it  is 
"backed"  with  one  or  two  thicknesses  of  ordinary  plaster. 
Of  course  a  properly  fitting  boot  with  a  sufficiently  thick  sole, 
is  a  sine  qua  non. 

Still  another  writer  suggests  that  the  best  relief  he  found 
was  to  take  a  piece  of  moderately  thick  leather,  circular,  about 
two  inches  in  diameter,  and  cut  a  small  hole — size  of  the  corn — 
in  the  middle.  There  is  no  need  of  fastening  the  leather  to 
the  foot ;  he  found  it  retained  its  position  on  fixing  it  in  place 
after  putting  on  his  sock. — Brit,  Med,  Journal 


IQOI  Reviews  and  Notices  of  Books.  515 

REVIEWS  AND  NOTICES  OF  BOOKS. 


Eichhorst's  Practice  of  Medicine,  A  Text-book  of  the  Prac- 
tice of  Medicine.  By  Dr.  Herman  Eichhorst,  Professor  of 
Special  Pathology  and  Therapeutics  and  Director  of  the  Medical 
Clinic  in  the  University  of  Zurich.  Translated  and  edited  by 
Augustus  A.  Eshner,  M.D.,  Professor  of  Clinical  Medicine  in  the 
Philadelphia  Polyclinic.  Two  octavo  volumes  of  over  600  pages 
each;  over  150  illustrations.  Philadelphia  and  London:  W.  B. 
Saunders  &  Co.     1901.     Price  per  set,  cloth,  $6  net 

Rarely  indeed  is  it  that  the  medical  profession  is  graced  by  a 
man  who  has  not  only  the  inclination  and  ability  but  the  courage  to 
produce  such  a  book. 

Dr.  Eichhorst  has  covered  the  entire  field  of  general  medicine 
including  the  careful  consideration  of  subjects  not  ordinarily  incor- 
porated in  books  on  general  practice.  Some  of  these  are  diseases 
of  the  urinary  bladder,  the  male  sexual  organs,  the  nose,  the  larynx, 
the  pharynx,  the  mouth,  the  muscles  and  the  skin. 

The  sections  devoted  to  the  diseases  of  the  nervous  system,  the 
gastro-intestinal  tract,  the  blood,  the  spleen,  and  the  disorders  of 
metabolism  should  be  emphasized  as  of  unusual  value.  Especial 
attention  has  been  given  throughout  to  etiology  and  to  directiom 
for  securing  by  modem  methods  the  various  chemical  and  friiysical 
data  for  diagnosis.  The  illustrations  are  profuse  and  o(  unusual 
excellence.  The  arrangement  of  the  text  in  different  types  and  the 
very  complete  indices  render  the  work  a  most  valuable  addition  to 
the  reference  library  of  the  practitioner.  So  well  divided  and  pro- 
portioned is  the  material,  and  so  condensed,  concise,  and  practi- 
cal its  treatment  that  it  should  at  once  take  rank  as  among  the  few 
best  books  for  student  use. 

If  this  is  a  sample  of  the  work  done  in  internal  medicine  in  Ger- 
many one  does  not  feel  inclined  to  contend  the  claim  that  in  this 
department  of  medicine  that  nation  leads  the  world.  Comment 
upon  the  mechanical  features  of  the  book  is  unnecessary — ^the  press 
is  "  Saunders." 

A.  E.  P.  R. 


5 1 6  Personal  and  News  Items,  1 90  \ 

PERSONAL  AND  NEWS   ITEMS. 


A  PRACTITIONER  is  Wanted  in  Mt.  Vernon,  N.  H.  Com- 
municate with  Willard  P.  Wood,  Mt.  Vernon,  N.  H. 

The  Hospital  Leaflet  for  September,  1901,  contains  a  very 
complimentary  obituary  of  Dr.  Jessie  Shepard  who  died  at 
Buffalo,  Aug.  24,  1901.  She  graduated  from  Boston  Univer- 
sity, 1888,  and  was  for  one  year  surgical  assistant  at  the  Mass 
Homoeopathic  Hospital. 

Dr.  a.  p.  Ohlmacher  has  been  appointed  Professor  of 
Pathology  in  the  Northwestern  University  Medical  School 
(Chicago  Medical  College).  Dr.  Ohlmacher  has  been  con- 
nected with  the  Pathological  Laboratory  of  the  Ohio  Hospi- 
tal for  Epileptics  at  Gallipolis,  Ohio,  and  will  for  the  time 
being  continue  the  direction  of  that  Laboratory. 

Dr.  Asa  D.  Smith  has  removed  to  1623  Dorchester 
Ave.,  Dorchester. 

Dr.  H.  E.  Rice,  of  Springfield,  Mass,  has  given  up  gen- 
eral practice  and  will  hereafter  limit  his  practice  to  gynecol: 
ogy  and  surgery.  During  the  past  year  or  more  he  has  been 
engaged  in  special  work  in  some  of  the  leading  hospitals  of 
this  country  and  Europe. 

Dr.  James  B.  Comins  has  purchased  the  practice  of  Dr. 
H.  E.  Rice,  of  Springfield,  and  will  be  found  at  No.  6  Maple 
St.,  Springfield,  hereafter. 

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

Francis  H.  McCarthy,  M.  D.,  has  removed  from  39 
Hancock  St.  to  20  Joy  St.,  Boston. 

Dr.  Anne  E.  Perkins,  B.  U.  S.  M.,  1897,  of  Concord, 
N.  H.,  sailed  for  Naples  on  the  7th  of  September,  on  the 
S.  S.  Hoehenzollern.  She  expects  to  spend  a  year  abroad  in 
travel  and  study. 


THE  NEW  ENGLAND 

MEDICAL    GAZETTE 

No.  II.  NOVEMBER,    1901.  Vol.  XXXVI. 

COMMUNICATIONS. 


Address  delivered  before  Qraduatins:  Class  of  1901  of 
Boston  University  Medical  School. 

BY    PROF.    E.    P.    COLBY,    M.    I). 

Ladies  and  Gentlemen  of  the  Graduating  Class: 

I  fully  appreciate  the  compliment  of  being  called  upon  to 
represent  the  faculty  before  this  the  first  class  of  the  twen- 
tieth century.  To  each  one  of  you  I  would  say  as  I  stand 
here,  my  feeling  is  like  that  of  a  workman  who,  at  the  launch- 
ing of  some  finely  turned  craft,  is  stationed  with  mallet  in 
hand  to  knock  away  the  final  prop  and  allow  the  vessel  to 
glide  down  the  ways  of  graduation  and  float  upon  the  great 
ocean  of  professional  life,  while  your  alma  mater  breaks  the 
foaming  flask  upon  the  bow,  exclaiming,  "  I  christen  thee 
Doctor ! "  Your  years  of  tuition  are  nominally  closed  and 
you  have  passed  your  so-called  final  examinations.  But  this 
is  not  really  true  and  you  are  about  to  enter  upon  a  wider 
field  of  study  where  the  examination  is  continuous  and  the 
examiner  is  the  great  public,  from  whose  markings  there  is 
no  appeal. 

Rather  than  to  address  you  in  those  scholarly  terms  which 
have  greeted  preceding  classes,  I  have  chosen  to  continue 
those  intimate  relations  which  have  ever  existed  between  us, 
and   ask  you  to  receive  instead  a  few  words  of  practical, 


5 1 8  The  New  England  Medical  Gazette.  Nov., 

homely,  but  most  friendly  advice.  I  am  sure  you  have  not 
chosen  the  profession  of  medicine  without  a  recognition  of  its 
exacting  demands,  equal  as  they  are  to  those  of  any  calling 
followed  by  man. 

The  duties  are  so  many  and  so  varied  that  but  few  in- 
stances can  be  now  cited.  Your  first  great  duty  is  to  your 
patients,  after  which  follow  the  demands  of  the  profession,  in- 
cluding your  Alma  Mater ^  the  community,  the  cause  of  hom- 
oeopathy, and  yourselves.  Remember  that  your  patients  em- 
ploy you  because  of  their  confidence  in  your  skill,  integrity, 
and  interest  in  your  profession.  This  confidence  should  never 
be  forfeited  by  any  act  of  yours.  So  long  as  it  continues, 
you  can  gain  from  them  a  full  and  free  expression  of  their 
feelings,  so  necessary  to  a  thorough  understanding  of  the  con- 
dition to  be  treated.  There  are  many  points  in  which  family 
history  and  a  knowledge  of  personal  indiscretions,  become  of 
immense  value  in  forming  your  opinion.  If  the  patient  sus- 
pects your  loyalty,  you  will  be  thus  much  handicapped.  With 
all  this,  you  must  ^use  the  best  of  judgment  in  selection,  as 
from  self  interest  or  a  morbid  desire  for  sympathy,  facts  may 
be  so  magnified  or  twisted  in  the  narration  as  to  be  wide  of 
the  truth.  Therefore,  be  caieful  that  sympathy  never  ob- 
scures good,  sound  common  sense.  There  are  but  few  points 
at  which  the  patient  of  fiction  and  the  patient  of  fact  run  in 
parallel  lines.  Patients  desire  decision  and  prompt  action, 
but  they  welcome  it  most  when  it  is  quietly  exhibited. 
Therefore,  never  bustle  in  the  sick-room.  It  gives  the  im- 
pression of  rudeness,  or  that  you  have  not  sufficient  time  to 
give  their  case  due  attention.  However  much  you  may  be 
hurried  in  your  daily  work,  do  not  carry  the  evidence  of  it  to 
the  bed-side.  Leave  it  with  your  outside  wraps  in  the  hall, 
and  never  wear  either  of  them  in  the  sick-room.  Should 
your  patient  become  too  garrulous,  you  can  arrest  it  on  the 
ground  that  it  is  not  material  to  the  case.  On  the  other 
hand,  do  not  make  unnecessarily  long  calls  in  pleasant  places. 
The  pleasure  may  be  more  one-sided  than  you  suspect.     An- 


I  go  I  Graduation  Address  B,  U,  S,  M,  519 

ecdote  and  gossip  are  much  better  relished  by  the  patient 
after  the  professional  part  of  your  visit  is  attended  to,  and 
then  a  little  humorous  period  may  have  an  exhilerating  in 
fluence.  As  far  as  in  you  lies,  both  enter  and  leave  the  sick- 
room with  a  cheerful  countenance  and  manner,  but  never  let 
it  degenerate  into  buffoonery.  Patient,  family  and  nurse  will 
often  give  cause  for  righteous  indignation  on  your  part,  but 
this  should  always  be  exhibited  before  the  patient  in  a  calm 
and  dignified  way.  Nurses  are  often  exasperating ;  never 
scold  and  berate  them  before  the  patient.  Let  all  your  most 
strenuous  arguments  be  conducted  outside.  It  is  often  be- 
cause of  indefinite  instruction  that  nurses  go  astray.  There- 
fore be  very  careful  that  you  do  not  blame  the  nurse  for  what 
is  your  own  fault. 

It  goes  without  saying  that  you  will  have  incomparable  op- 
portunity for  giving  moral  lessons  to  your  patients,  and  as 
good  citizens  you  will  make  judicious  use  of  this  advantage, 
but  exercise  great  care  that  this  never  becomes  an  infliction. 
A  sick  sinner  makes  an  easy  but  an  unstable  convert.  A  few 
well-selected  words  of  salutary  admonition  may  be  like  seed 
sown  in  good  ground,  but  constant  nagging  upon  some  moral 
hobby  eventually  begets  ridicule  and  a  suspicion  of  hypocrisy. 
If  you  make  statements  of  a  scientific  nature  bearing  upon 
moral  problems,  make  sure  that  your  information  is  accurate 
and  specific,  as  one  unstable  postulate  may  lead  the  reasoning 
hearer  to  doubt  your  every  statement,  and  thus  do  much  real 
harm.  Finally,  deal  honestly  with  your  clients.  Never  for 
purposes  of  material  gain  make  unnecessary  visits  and,  still 
more,  never  neglect  due  attention  to  those  who  are  nec- 
essarily the  object  of  your  charity.  You  will  often  be  most 
dreadfully  imposed  upon,  but  medicine  is  not  a  trade,  and 
the  worthy  poor  are  often  as  sensitive  as  unfortunate.  In 
your  earlier  years  it  may  occur  that  attention  to  a  charity 
case  will  be  like  "  bread  upon  the  waters  which  shall  return 
to  you  after  many  days." 

At  infrequent  intervals  there  may  be  presented  a  trying 


520  The  New  England  Medical  Gazette,  Nov., 

problem  for  your  solution.  In  a  given  case,  it  may  seem  im- 
possible that  any  or  all  human  agency  can  ward  off  impending 
dissolution.  Are  you  on  this  account  to  cease  all  effort  ?  It 
is  in  the  experience  of  many  physicians  that  in  some  of  these 
rare  instances  the  vital  spark  is  not  extinguished,  and  by  per- 
sistent aid  may  be  fanned  into  a  flame  and  a  life  saved. 
You  can  never  tell  just  which  case  belongs  to  this  class. 
Therefore,  while  fully  recognizing  the  seriousness,  do  not 
cease  your  labors  until  suspense  becomes  a  certainty.  This 
condition  is  more  likely  to  occur  in  acute  than  in  chronic  dis- 
eases. One  last  word  of  advice  in  this  connection  may  seem 
to  partake  of  the  nature  of  expediency,  but  if  carried  out  with 
honest  intentions  is  even  praiseworthy.  All  sick  humanity  is 
subject  to  impatience  and  demands  activity  on  the  part  of  the 
medical  attendant.  In  other  words,  patients  expect  you  to 
become  immediately  active  in  their  behalf.  Two  rules  may 
govern  your  action.  First,  do  nothing  which  is  injurious. 
Second,  do  something.  It  may  not  be  possible  for  you  to  se- 
lect the  proper  remedy  at  once,  but  there  are  various  other 
measures,  not  medicinal  but  salutary,  which  you  can  adopt. 
Change  in  diet,  rest  in  bed,  baths,  hot  or  cold  water  foment- 
ations, fixation  of  parts.  These  things  quiet  the  mind,  gain 
the  confidence,  and  give  you  freedom  to  plan  the  campaign. 
The  time  allotted  me  speeds  so  rapidly  that  I  must  omit  other 
remarks  guiding  you  with  the  patient,  and  speak  of  your  duty 
to  the  profession  which  you  are  entering.  You  will  find  that 
all  codes  of  ethics  are  but  variations  of  the  good  old  "  golden 
rule."  If  you  are  in  doubt,  always  impartially  put  yourself 
in  the  place  of  the  other  man  and  act  as  you  would  yourself 
ask  to  be  treated  in  his  place,  not  asking  the  question  of  how 
he  would  treat  you  under  similar  circumstances. 

As  you  start  in  practice,  you  may  hear  that  your  colleagues 
of  the  opposing  school  are  saying  very  hard  things  of  you. 
Do  not  retaliate  by  decrying  them.  Give  them  due  credit 
for  every  talent  they  possess  and  in  course  of  time  you  will 
shame  them  into  respect. 


I  go  I  Graduation  Address  B.  U.  S.  M.  521 

As  you  gain  in  experience,  impart  of  your  knowledge  to 
the  profession,  and  to  this  end  become  a  member  of  some  one 
or  more  of  the  medical  societies  and  take  an  active  interest 
in  their  meetings  and  discussions.  In  your  relations  to  the 
profession,  single  out  for  special  loyalty  your  Al'^-a  Mater. 
Remember  that  what  she  has  given  you,  represents  the  ulti- 
mate product  of  many  generations.  During  all  these  decades 
there  has  been  going  on  a  process  of  increase  and  selection 
for  your  benefit.  The  least  return  you  can  offer  is  your 
fealty  to  the  agent  through  which  you  received  it.  The  fac- 
ulty may  not  always  conduct  the  affairs  of  the  school  to  meet 
your  approval.  If  such  be  the  fact,  find  some  way  of  con- 
veying your  advice  in  a  friendly  way.  Take  pains  to  keep  in 
touch  with  the  methods  of  teaching  and  as  far  as  they  meet 
with  your  approval,  let  it  be  made  manifest.  It  is  like  a 
stimulating  draught  for  an  instructor  to  see  a  once  familiar 
face  in  his  class.  If  you  take  the  position  in  the  community 
to  which  your  education  should  entitle  you,  it  does  not  in  the 
least  absolve  you  from  the  ordinary  responsibilities  of  citizen- 
ship. You  may  be  called  to  some  office  in  municipal  life. 
If  so,  do  not  forget  that  every  earnest  citizen  owes  it  to  the 
public  that  he  should  at  some  time  devote  a  portion  of  his 
life  to  the  general  welfare.  It  is  too  much  the  custom  for 
responsible  men  to  shirk  the  drudgery  of  small  offices,  and 
thus  leave  them  to  be  filled  by  low-grade  oflBce-seekers  and 
wire-pullers.  If  you  have  adopted  the  homoeopathic  wing 
of  medical  practice  earnestly  and  honestly,  as  I  believe  you 
have,  acknowledge  your  indebtedness  to  the  constant  labors 
of  the  founders  and  do  all  that  in  you  lies  to  forward  its  prin- 
ciples. 

There  are  errors  and  vagaries  in  our  materia  medica 
which  should  be  eliminated,  and  therefore,  throughout  the 
country,  bands  of  re-provers  are  being  formed  for  the  purifi- 
cation of  the  symptomatology.  In  your  first  years,  when 
other  cares  are  less,  and  while  you  are  yet  robust,  you  are 
just  the  ones  to  aid  in  this  work,  and  it   is  to  be  sincerely 


$22  The  New  England  Medical  Gazette,  Nov., 

hoped  you  will  not  neglect  the  duty,  but  will  unite  in  these 
provings. 

Your  studies  are  no  longer  under  the  control  of  the  faculty, 
but  our  interest  in  your  success  dots  not  abate,  on  the  con- 
trary it  takes  on  a  new  phase,  for  we  now  look  forward  to  the 
fruition  of  our  joint  efforts. 

This  class  has  left  the  impression  that  it  is  equal  to  good, 
hard  work,  that  it  possesses  more  than  ordinary  reasoning 
power.  Continue  to  cultivate  the  sterling  qualities  and  our 
wishes  for  your  success  will  not  be  disappointed. 


REPORT   OF   A   CASE   OF    SMALL-POX. 

BY    H.    H.   AMSDEN,    M.  I). 
[Read  before  Boston  Hora,  Society.] 

The  case  of  small-pox  which  I  am  to  report  to  you  to-night 
ran  a  mild  and  uneventful  course,  I  am  glad  to  say,  and  in  it- 
self presents  no  unique  or  unusual  features.  My  reason  for 
reporting  it  is  because  I  desire  to  arouse  discussion  as  to  the 
possible  value  of  the  homoeopathic  remedy  in  cases  of  this 
sort,  and  to  emphasize  some  points  in  the  differential  diag- 
nosis between  small-pox  and  other  eruptive  diseases  in  which 
an  accurate  diagnosis  is  of  supreme  importance,  not  merely 
to  the  patient,  but  in  a  far  greater  degree  to  the  family  or 
even  to  the  whole  community. 

On  January  lo,  1901,  I  was  called  to  see  Mrs.  Annie  G, 
aet.  34,  native  of  Nova  Scotia,  resident  in  Attleboro  seventeen 
years.  Patient  gave  following  history  :  She  had  been  feeling 
ill  for  a  day  or  two,  general  malaise,  headache  and  backache, 
and  on  previous  day  had  a  severe,  long,  lasting  chill,  with  in- 
tense headache  and  backache,  nausea  and  vomiting,  followed 
by  high  fever  and  later  in  day  by  sweating.  At  time  of  my 
first  visit  found  following  conditions :  Patient  in  bed,  temp. 
104^,  pulse  120,  mind  clear,  marked  prostration,  headache 
and  backache  not  so  severe  as  on  previous  day,  nausea  and 


IQOI  Report  of  a  Case  of  Small-Pox,  523 

vomiting  of  food  and  drink  as  soon  as  they  reached  stomach, 
marked  rattling  cough.  Physical  examination  of  chest  re- 
vealed numerous  coarse  mucous  rales  generally  diffused 
through  both  lungs.  On  questioning  patient,  it  was  learned 
that  she  had  been  in  Central  Falls,  R.  I.,  most  of  the  time 
since  Christmas,  caring  for  her  husband  who  had  been  in- 
jured, and  who  was  under  the  care  of  a  physician  for  several 
days  ;  that  this  same  physician  had  been  treating  one  or  more 
cases  of  small-pox  at  the  same  time,  and  at  the  present  time 
was  himself  ill  with  some  eruptive  disorder,  the  nature  of 
which  was,  for  obvious  reasons,  not  generally  made  known. 

On  examination  of  the  patient  no  vaccination  scar  could  be 
discovered.  The  case  seemed  suspicious  enough  to  order  a 
provisional  quarantine.  The  next  morning  a  visit  was  made 
in  company  with  members  of  the  local  board  of  health,  and 
at  this  time  a  well-marked  papular  eruption  appeared  on  the 
forehead,  having  the  characteristic  feeling  of  grains  of  shot 
imbedded  under  the  skin.  The  temp,  was  lOO*',  pulse  90, 
and  the  patient  felt  quite  a  good  deal  better.  The  diagnosis 
seemed  clear,  so  quarantine  was  established  and  the  husband 
installed  as  nurse,  there  being  no  other  members  of  the 
family.  It  was  found  that  he  had  been  successfully  vacci- 
nated, but  the  operation  was  repeated  with  successful  result. 
The  case  was  seen  by  Dr.  Swarts  of  the  R.  I.  State  Board 
of  Health,  also  by  Dr.  Morse  of  the  Mass.  Board,  both  of 
whom  pronounced  it  a  well-marked  case  of  small-pox. 

On  the  following  day  —  fourth  of  disease  —  the  temp,  was 
99^  and  the  eruption  had  extended  over  the  body  and  limbs, 
being  more  marked  on  limbs,  and  had  assumed  the  papular 
form.  The  general  systemic  symptoms  had  largely  subsided. 
On  the  fifth  day  the  papules  were  changing  to  vesicles,  temp. 
99^.  On  the  sixth  day  the  vesicles  were  markedly  umbili- 
cated  and  were  beginning  to  show  the  red  areola,  the  temp, 
continuing  about  the  same.  On  the  eighth  day  pustulation 
was  well-marked  all  over  the  body,  the  areolae  around  pus- 
tules very  marked,  but  the  secondary  fever  was  absent  and 


524  The  New  England  Medical  Gazette,  Nov., 

the  temp,  did  not  rise  above  99^  during  the  subsequent 
course  of  the  disease.  The  pustules  remained  discrete  with 
the  exception  of  a  few  on  the  forehead  and  around  the  nose 
which  became  confluent,  and  these  were  the  only  ones  show- 
ing marked  suppuration.  Most  of  the  remainder  dried  up 
without  suppuration,  but  isolated  pustules  on  various  parts 
of  the  body  ruptured  and  discharged  their  contents,  a  scab 
then  forming.  The  patient  suffered  a  great  deal  from  itching, 
but  aside  from  this  and  the  mental  anxiety  naturally  incident 
to  the  disease,  did  not  complain  much  after  the  first  three  or 
four  days.  Secondary  fever  and  the  so-called  characteristic 
odor  were  absent. 

At  present,  pigmentation  is  quite  marked,  but  the  scars 
are  superficial,  and  with  the  exception  of  a  few  marks  on  the 
forehead  and  around  the  nose  she  will  not  be  much  disfigured. 
Aside  from  anemia,  no  sequelae  developed. 

Treatment.  Aconite  gx.  was  given  for  first  24  hours. 
After  the  diagnosis  was  established.  Ant.  tart.  2x.,  one  grain 
every  hour  for  a  week,  then  at  intervals  of  two  to  four  hours 
for  two  weeks.  Carbolized  vaseline  was  used  to  relieve 
itching  and  aid  in  preventing  the  spread  of  the  disease.  The 
diet  consisted  largely  of  eggs  and  milk.  No  stimulants  of 
any  sort  were  used.     Blaud's  pills  were  given  for  anemia. 

One  of  the  most  interesting  features  of  this  case  is  the  re- 
lation of  the  homoeopathic  remedy  to  the  course  and  outcome 
of  the  disease.  It  is  unwise  to  attempt  to  make  deductions 
from  a  single  case,  but  until  physicians  of  the  present  day 
can  treat  homceopathically  and  report  a  series  of  cases,  we 
must  draw  our  conclusions  from  isolated  cases.  Tartar 
emetic  was  apparently  homoeopathic  to  this  case.  It  is  not 
necessary  for  me  to  enter  into  details  concerning  symptoms 
of  provings,  poisoning  cases,  etc.,  which  are  well  known  to 
all  of  you  :  the  sudden  onset,  marked  prostration,  nausea, 
vomiting,  headache,  backache,  bronchial  symptoms  and  cutan- 
ous  lesions  correspond  closely  to  the  symptoms  of  tartar 
emetic.     Most  old-school  authorities  mention  the  close  reseni- 


iQOi  Report  of  a  Case  of  Small-Pox.  525 

blance  between  the  cutaneous  lesions  of  tartar  emetic  and 
those  of  small-pox,  but  of  course  the  analogy  stops  there  and 
they  do  not  mention  it  as  a  possible  remedy  in  small-pox. 
Homoeopathic  literature  gives  it  the  preference  as  a  remedy 
in  this  disease  both  from  clinical  experience  and  from  symp- 
tomatic resemblance  through  provings  and  poisoning  cases. 

In  connection  with  the  diagnosis  of  these  cases  of  eruptive 
disease  I  will  briefly  mention  two  more  cases,  one  of  which 
occurred  in  my  own  practice,  the  other  I  saw  by  courtesy  of 
Dr.  C.  S.  Holden  of  Attleboro. 

Case  second.  Swedish  domestic,  aet.  25.  She  had  com- 
plained of  headache  and  malaise  for  a  day  or  two,  seized  with 
chill,  severe  headache  and  backache,  temp.  102^,  followed  in 
24  hours  by  macular  eruption  mainly  on  trunk  and  arms,  two 
or  three  on  face.  These  developed  in  24  hours  more  to  ves- 
icular eruption,  vesicles  small,  filled  with  clear  serum,  super- 
ficial, not  umbilicated,  most  marked  on  body  and  arms. 
Most  of  these  vesicles  developed  in  center  of  a  pale  reddish 
macule  three  or  four  times  as  large  as  vesicle.  Several  crops 
of  these  vesicles  appeared,  so  that  three  stages  of  macule, 
vesicle  and  scab  could  be  seen  at  same  time.  The  temper- 
ature fell  to  normal  on  appearance  of  eruption.  There  was 
a  history  of  exposure  to  chicken-pox  and  a  well-marked  vac- 
cination scar  on  arm.     This  case  was  doubtless  chicken-pox. 

Case  third.  Young  man,  aet.  24,  history  of  malaise  of 
several  days'  duration,  followed  by  severe  chill,  temp.  103^, 
backache,  headache,  nausea  and  vomiting.  After  48  hours 
symptoms  largely  subsided  and  on  fourth  day  of  illness  a 
maculo-papular  eruption  appeared,  confined  almost  entirely 
to  face  and  neck,  few  spots  on  limbs  and  trunk.  The  ves- 
ices,  many  of  which  were  umbilicated,  were  surrounded  by  a 
narrow  red  areola,  and  in  24  hours  changed  from  vesicles  to 
pustules.  No  secondary  rise  of  fever  occurred.  The  erup- 
tion ran  its  course  in  six  or  seven  days,  the  pustules  drying 
up  and  forming  a  crust,  leaving  no  scar,  though  pigmentation 
is  still  present.     There  was  a  well-marked  vaccination  scar 


526  The  New  England  Medical  Gazette,  Nov., 

on  arm  and  several  scars  from  a  previous  attack  of  chicken- 
pox  were  discovered.  Several  cases  similar  to  this  occurred 
within  a  radius  of  five  or  six  miles,  and  in  at  least  one  other 
case,  which  occurred  in  an  adult,  chicken-pox  scars  could  be 
found  as  well  as  a  vaccination  scar.  No  direct  exposure  to 
small-pox  could  be  traced.  While  this  case  was  diagnosed 
as  chicken-pox  by  a  physician  of  considerable  experience  in 
small-pox,  I  cannot  help  feeling  that  it  was  really  varioloid. 
The  eruption  being  confined  almost  entirely  to  face  and 
neck,  all  lesions  being  of  same  degree  of  development  at 
same  time,  passing  through  a  well-marked  pustular  stage,  and 
the  pustules  being  situated  on  an  inflamed  base  surrounded 
by  a  narrow  red  areola,  are  points  very  suggestive  of  vario- 
loid. The  onset  in  this  case  was  much  more  severe  than  is 
usual  in  chicken-pox,  though  it  is  an  undoubted  fact  that 
some  cases  of  chicken-pox  do  begin  with  dull  fever,  headache, 
backache,  etc.,  these  symptoms  appearing  24  to  36  hours  be- 
fore the  eruption,  and  my  limited  experience  has  led  me  to 
think  that  the  disease  is  much  more  likely  to  begin  with  these 
severe  symptoms  in  adults  than  in  children  in  whom  the  first 
symptoms  are  frequently  the  cutaneous. 

One  interesting  query  suggests  itself  in  regard  to  the  hus- 
band of  my  small-pox  case.  He  was  apparently  immune  to 
infection  with  small-pox,  as  he  certainly  had  every  oppor- 
tunity to  contract  the  disease.  This  being  the  case,  why 
was  it  that  vaccination  could  be  successfully  performed  ? 
Why  was  he  not  immune  to  vaccination  as  well  as  apparently 
to  small-pox  ? 


Vaccination.  For  generations  China  has  believed  in  and 
practiced  vaccination.  Their  method  is  to  snuff  the  virus  up 
the  nose  and  inoculate  the  mucous  membrane.  Since  the  in- 
troduction of  carefully  prepared  animal  virus  by  medical  mis- 
sionaries, many  native  physicians  have  adopted  their  method 
and  vaccinate  on  the  arms,  three  places  on  each  arm.  Shang- 
hai has  an  excellent  institution  for  the  cultivation  of  animal 
virus. — Exchange. 


190 1  Some  Experiences  with  Bubonic  Plague.  527 

50nE   EXPERIENCES   WITH   BUBONIC   PLAQUE. 

BY    \V.    H.    WATERS,    M.  D. 
[Read  before  Boston  Horn.  Society.] 

Mr  Chairman  and  Members  of  the  Boston  Homoeopathic 
Medical  Society: 

Within  the  last  decade  the  attention  of  the  world  has  been 
directed  toward  a  disease  frightful  in  its  mortality  and  once 
wide-spread  in  its  occurrence,  but  which  prior  to  1 893  was 
supposed  to  be  rapidly  disappearing.  In  the  early  history  of 
the  world  any  disease  spreading  to  such  an  extent  as  to  be  a 
genera]  epidemic,  was  spoken  of  as  a  plague.  Gradually, 
however,  as  medical  knowledge  increased,  the  meaning  of  the 
term  became  limited  until  at  present  it  is  confined  to  that 
malady,  contagious  in  nature,  which  is  characterized  by  en- 
largement of  the  lymphatic  glands  in  various  parts  of  the 
body. 

In'  looking  over  records  of  outbreaks  of  plague  or,  as  it  is 
better  named,  bubonic  plague,  we  find  mention  of  it  almost 
as  far  back  as  history  itself  goes.  In  492  b.  c.  Athens  is  re- 
ported to  have  lost  a  third  of  its  population  in  a  single  year. 
Western  Asia  seems  to  be  the  home  of  the  malady,  from 
whence  it  spreads  in  great  waves,  now  to  Europe,  now  to 
Africa,  now  involving  both  continents,  but  always  leaving  the 
same  marks  behind.  One  such  wave  appeared  during  the 
sixth  century  in  Europe,  and  history  narrates  the  death  of 
io,cxx)  people  in  Constantinople  in  a  single  day.  Another 
great  wave  swept  over  Europe  eight  centuries  later,  de- 
creasing the  population  by  25,000,000.  Up  to  the  year  1664, 
England  was  exempt  from  any  severe  epidemic,  but  this  and 
the  following  year  London  alone  lost  68,000  inhabitants. 
The  disease  then  appeared  to  recede  gradually  eastward  to 
such  an  extent  as  to  give  hopes  of  a  speedy  extinction.  All 
hopes  were  in  vain  however.  In  1893,  bubonic  plague  ap- 
peared in  Hong  Kong  and  soon  spread  to  India.  This  epi- 
demic still  continues.     In  seven    years  Bombay  presidency 


528  The  New  England  Medical  Gazette.  Nov., 

alone  has  reported  220,000  cases  with  164,000  deaths,  or  a 
mortality  of  75  per  cent.  Western  Europe  was  invaded  in 
1899,  when  cases  of  plague  appeared  in  Oporto,  Portugal. 
This  year  was  also  notable  as  marking  the  first  appearance 
of  the  disease  in  the  Western  Hemisphere  :  it  appeared  in 
Brazil  and  later  at  the  quarantine  in  New  York.  The  latest 
outbreak  to  interest  and  closely  concern  the  Anglo-Saxon 
world,  took  place  in  Glasgow  last  Summer.  All  of  these 
modern  invasions  of  countries  where  sanitary  and  hygienic 
laws  are  enforced  have  been  devoid  of  their  rapidly  epidemic 
qualities  and  high  rate  of  mortality,  thus  giving  an  important 
clue  to  their  prevention. 

The  disease  is  now  known  to  be  caused  by  a  certain  bacil- 
lus, the  bacillus  pestis,  which  is  easily  conveyed  from  one  to 
another.  Certain  concomitants  must  be  present  however,  for 
the  best  propagation  of  the  micro-organism,  among  which 
may  be  mentioned,  poor  water,  Overcrowding,  filth  and  ignor- 
ance of  laws  of  sanitation. 

The  bubonic  plague  is  an  acute  febrile  disease  character- 
terized  by  inflammation  of  the  lymphatic  glands.  The  stage 
of  incubation  is  from  36  hours  to  1 1  days.  The  onset  is 
sudden,  with  a  chill  and  often  vomiting,  followed  by  a  mod- 
erate fever.  The  early  course  is  somewhat  active,  but  later 
the  patient  becomes  apathetic  with  a  peculiarly  vacant  ex- 
pression :  the  speech  is  slow  and  hesitating,  each  syllable 
being  pronounced  by  itself.  The  expression,  speech,  and 
presence  of  buboes,  accompanied  by  a  thick,  white-coated 
tongue  with  red  edges,  is  supposed  to  be  characteristic  of  the 
plague. 

Several  varieties  occur :  the  pneumonic,  the  bubonic,  the 
septicaemic,  and  the  ambulant. 

Pneumonic  form.  This  is  similar  to  broncho-pneumonia 
and  is  very  infective  on  account  of  the  sputum  containing 
almost  a  pure  culture  of  bacillus  pestis.  In  this  variety 
malaise  is  very  pronounced,  temperature  varies  from  102^  to 
105^,  there  is  cough  with  expectoration  of  a  thin,  rusty  sputum 


igoi  Some  Experiences  with  Bubonic  Plague.  529 

Bubonic  form.  This  is  more  characteristic.  Buboes  ap- 
pear at  the  beginning  of  the  illness  in  the  groin,  axilla,  or 
neck,  and  are  extremely  tender  and  painful.  When  death 
does  not  take  place  within  7  to  8  days,  these  glands  become 
soft  and  oedematous.  They  then  either  disappear  by  reso- 
lution or  suppurate  and  slough. 

Septiccemic  form.  As  its  name  indicates,  the  bacilli  ap- 
pear in  the  blood.  The  condition  is  most  virulent  and  death 
comes  early. 

Ambulant  form — Pestis  minor,  A  mild,  non-fatal  variety, 
but  the  one  most  liable  to  prove  dangerous  to  the  community 
on  account  of  failure  to  recognize  it.  This  may  last  several 
months. 

Death  usually  comes  in  from  2  to  8  days  from  the  beginning 
of  the  attack,  the  real  cause  being  a  toxaemia.  In  severe 
cases  haemorrhages  under  the  skin  or  mucous  membrane  oc- 
cur. It  is  these  cases  that  gave  the  disease  its  name,  "black 
death."  The  mortality  of  bubonic  plague  taken  world-wide 
is  90  per  cent. 

Having  thus  in  a  brief  manner  covered  the  history,  etiology 
and  clinical  symptoms  of  our  subject,  we  reach  the  real  goal 
of  the  discussion,  its  pathology.  The  best  way  to  handle 
this  topic  seems  to  the  speaker  to  be  a  short  description 
of  his  experiences  obtained  during  the  recent  outbreak  in 
Glasgow. 

About  the  15th  of  August  last,  a  dock  laborer  named 
Molloy  died  and  a  "wake"  was  held.  The  cause  of  death 
given  on  the  death  certificate  was  broncho-pneumonia. 

About  8  to  10  days  later,  several  cases  of  glandular  enlarge- 
ments coming  to  the  notice  of  the  authorities  were  all  traced 
to  this  wake.  Plague  was  suspected.  The  matter  was 
placed  in  the  hands  of  Prof.  Robert  Muir  who,  with  two  as- 
sistants, one  from  Glasgow  the  other  from  Boston,  made  the 
following  investigations. 

In  most  cases  the  inguinal  glands  were  the  ones  most  in- 
volved.    Therefore,  after  freezing  the  skin  with  chloride  of 


530  The  New  England  Medical  Gazette,  Nov., 

ethyl,  blood  and  broken-down  glandular  matter  were  obtained 
by  using  an  aseptic  syringe.  Part  of  the  material  was  then 
inoculated  into  a  guinea-pig  and  part  used  to  make  cultures 
which  were  themselves  later  inoculated  into  other  guinea- 
pigs.  Upon  examining  the  culture  tubes  the  next  day,  the 
blood  serum  was  seen  to  be  covered  by  a  moist  grayish  layer, 
the  agar-agar  showing  minute  spots  with  irregular  edges. 
The  bouillon  showed  the  most  characteristic  development,  al- 
though less  so  than  that  described  by  Haffkins,  which  is  as 
follows :  "  When  the  inoculated  bouillon  culture  is  allowed 
to  stand  perfectly  at  rest  for  24  to  48  hours,  small  islands  ap- 
pear just  below  the  surface,  which  in  about  two  days  longer 
grow  downward  in  long  stalactite-like  masses,  the  fluid  re- 
maining clear." 

Microscopically  were  seen  short,  thick  bacilli  with  rounded 
ends,  non-motile,  and  not  stained  by  Gram's  method.  Those 
bacilli  obtained  directly  from  the  tissues  exhibited  the  typical 
polar  staining,  appearing  at  times  almost  like  cocci  close  to- 
gether, organisms  from  the  cultures,  however,  took  the  stain 
evenly  as  a  solid  rod.  Thionin  and  gentian  violet  proved  the 
most  satisfactory  stains.  These  cultures  were  then  emulsi- 
fied and  injected  into  animals  as  already  stated.  Our  first 
guinea-pig  died  in  about  three  days,  which  was  the  average 
time  of  survival  for  the  entire  number.  In  some  of  these 
death  was  caused  by  a  septicaemia  due  to  the  bacillus  pestis 
alone,  in  others  a  mixed  infection  was  discovered. 

At  the  seat  of  inoculation  was  some  induration  and  in  one 
case  a  necrosis.  The  inguinal  glands  were  usually  degener- 
ated, as  were  frequently  various  other  lymph  nodes.  The 
spleen,  sometimes  enlarged,  sometimes  not,  was  soft  and  dif- 
fluent. Peritonitis,  although  not  constant,  was  the  rule.  The 
specific  bacillus  was  readily  found  in  smears  from  the  spleen, 
enlarged  glands,  exudate  on  the  peritoneum,  and  heart's  blood. 

Thus  we  had  fulfilled  Koch's  four  postulates  in  determining 
the  relations  existing  between  the  micro-organism  and  the 
disease. 


IQOI  Some  Experiences  with  Bubonic  Plague,  531 

1 .  The  bacillus  was  constantly  associated  with  the  disease. 

2.  This  bacillus  was  isolated  and  studied. 

3.  When  injected  into  animals  it  caused  death  from  plague. 

4.  It  was  again  recovered  from  the  inoculated  animals. 

It  is  needless  to  say  that  the  above  procedure  was  not 
carried  out  in  all  cases.  Once  a  positive  diagnosis  of  bubonic 
plague  was  made  by  bacteriological  investigation,  later  cases 
were  diagnosticated  by  clinical  symptoms. 

To  illustrate  both  the  importance  of  microscopical  examin- 
ation and  the  similarity  that  other  diseases  bear  to  that  one 
under  discussion  a  single  illustration  may  not  be  out  of  place. 
Our  studies  were  all  carried  on  in  the  building  where  we  also 
did  the  pathological  work  for  the  Western  Infirmary,  a  hos- 
pital of  about  450  beds.  One  of  the  patients  here  had  been 
troubled  with  a  painful  inguinal  gland  which  was  supposed  to 
be  of  a  specific  nature.  One  day  this  discharged  and  after 
curettment  the  contents  were  sent  to  the  pathological  depart- 
ment. It  chanced  to  come  to  the  writer  for  examination  and 
was  pronounced  to  be  in  all  probability  a  case  of  plague. 
Further  consultation  corroborated  the  diagnosis.  You  may 
picture  the  consternation  following  by  imagining  a  similar 
case  occurring  in  our  own  hospital  with  its  dangers  of  an  epi- 
demic and  unenviable  publicity  following.  We  were  fortun- 
ately in  time  in  removing  this  case,  no  epidemic  followed,  and 
even  the  knowledge  of  it  was  confined  to  a  limited  number. 
No  paper,  however  brief,  would  be  complete  without  mention 
of  one  of  those  products  of  modern  bacteriology,  the  serum- 
therapy.  Quite  extensive  use  of  serum  was  made  here,  all 
doctors,  nurses,  or  other  attendants  being  inoculated  with  the 
Haffkins  preparation,  which  is  preventive  only.  The  serum 
prepared  after  Yersin's  directions  is  not  only  prophylactic 
but  also  modifies  the  disease  even  when  used  after  infection 
has  occurred.  Both  of  these  are  of  use  and  decrease  the 
mortality  in  a  marked  degree,  but  what  seems  of  greater  im- 
portance as  proved  by  the  Glasgow  outbreak,  is  proper 
sanitary  precautions. 


532  The  New  England  Medical  Gazette,  Nov., 

Rats  are  the  most  active  in  spreading  the  plague,  therefore 
in  all  epidemics  in  Anglo-Saxon  countries,  rat-catchers  occupy 
a  prominent  place,  catching  and  burning  the  animals.  Flies 
and  certain  animal  parasites  are  also  capable  of  transmitting 
the  disease. 

Just  here  lies  the  importance  of  our  bacteriological  studies 
which  is  merely  an  example  of  the  results  being  obtained  in 
other  diseases.  Twenty-five  years  ago,  not  knowing  the 
cause  of  plague,  physicians  found  a  mortality  of  75  to  95  per 
cent  following  it.  Now  we  know  more  about  it  and,  being 
able  to  treat  it  intelligently,  can,  whenever  our  treatment  is 
allowed,  reduce  the  death  rate  very  greatly.  If  this  has  been 
done  with  even  one  disease,  then  have  the  years  of  labor 
been  well-spent,  and  we  should  go  forward  with  courage  to 
search  for  real  causes,  preventive  and  curative  measures 
that  will  enable  us  to  grapple  more  successfully  with  con- 
ditions in  other  diseases  as  yet  obscure. 


CATARRHAL  CHILDREN. 

HY    EDWARD    BEECHER    HOOKER,    M.  D.,    HARTFORD,    CONNECTICUT. 

The  title  of  this  paper  may  not  be  strictly  scientific,  but  it 
is  undoubtedly  expressive  and  hardly  needs  definition.  But 
for  the  sake  of  accuracy  I  will  say  that  I  refer  to  a  large  class 
of  children  who  are  particularly  subject  to  acute  and  chronic 
inflammations  of  the  upper  air  passages.  Such  children  are 
forever  catching  cold  and,  between  the  acute  attacks,  blowing 
and  snuffing,  hawking  and  hemming,  with  nasal  passages 
wholly  or  partially  obstructed  and  their  secretions  altered  in 
character  and  amount.  They  are  mouth  breathers  in  many 
instances,  their  hearing  is  impaired,  and  they  are  afflicted 
with  lymphoid  hypertrophies,  especially  of  the  tonsils  and 
vault  of  the  pharynx,  though  this  is  by  no  means  a  constant 
accompaniment.  Such  children  are  pale,  anaemic,  with  fickle 
appetite,  and  extremely  sensitive  to  changes  of  air,  from 
which  they  are  jealously  and  zealously  guarded  by  fond  and 


I  go  I  Catarrhal  Children.  533 

anxious  parents.  These  children  are  a  lucrative  source  of 
income  to  the  family  doctor  and  specialist,  and  it  is  the  height 
of  unselfishness  to  attempt  to  cure  them  and  to  prevent  others 
from  becoming  affected  in  like  manner.  Yet  it  is  to  the  pre- 
vention and  cure  of  this  form  of  disease  that  I  especially  call 
your  attention.- 

The  conclusions  at  which  I  have  arrived  are  largely  the 
result  of  my  own  observations,  the  combined  experience  of  a 
general  practitioner  and  specialist.  If,  therefore,  they  smack 
more  of  homely  common  sense  than  of  the  bacteriological  and 
pathological  laboratory,  it  is  not  because  I  am  not  a  firm  be- 
liever in  laboratory  methods,  for  I  am  most  heartily  so,  but 
because  I  can  give  you  no  first-hand  account  of  them  and  am 
trying  to  tell  you  what  I  have  thought  out  for  myself,  im- 
perfect though  it  be. 

The  first  and  most  important  step  is  to  discover  the  cause 
of  this  widespread  catarrh,  from  which  few  are  free,  either 
adults  or  children,  in  this  climate,  and  the  consequences  of 
which  may  be  so  grave.  To  begin  at  the  beginning,  heredity 
has  in  the  past  been  considered  a  large  causative  factor.  But 
heredity  is  a  thing  of  the  past  and  I  believe  that  here,  as  well 
as  in  other  diseases,  its  influence  has  been  greatly  overesti- 
mated. In  fact  I  do  not  feel  sure  that  any  disease  except 
syphilis  is  really  hereditary,  that  is,  that  the  disease  itself  is 
actually  transmitted  from  parent  to  child.  I  do  firmly  believe 
that  certain  tendencies  are  transmitted,  that  a  certain  delicacy 
or  vulnerability  of  tissue  may  be  hereditary.  Tuberculosis  is 
rarely,  if  ever,  transmitted,  but  a  constitution  which  lacks 
power  of  resistance  may  be  and,  alas,  too  frequently  is  the 
heritage  of  many  persons.  If  such  persons  never  come  in 
contact  with  the  bacilli  of  consumption  they  will  never  be- 
come affected  with  it,  but  if  they  do  encounter  these  germs, 
they  will  be  more  susceptible  than  others  not  thus  organized. 
So  with  catarrh,  I  believe  that  a  delicacy  of  tissue  may  be 
hereditary,  which  renders  the  individual  particularly  liable  to 
catarrhal  inflammations.  But  this  question  is  not  one  easily 
answered,  for  the  surroundings  of  the  child  being  for  the 


534  ^^^  ^^'^  England  Medical  Gazette,  Nov., 

most  part  identical  with  those  of  the  parent,  it  is  extremely 
difficult  to  discriminate  between  hereditary  and  acquired  traits. 

It  is  much  the  same  with  morals  as  with  health.  I  do  not 
believe  lying  is  an  hereditary  vice,  but  a  mendacious  father 
is  likely  to  have  an  untruthful  son,  and  who  can  tell  whether 
the  moral  weakness  of  the  father  is  transmitted  to  the  son  or 
the  evil  habit  of  the  son  acquired  by  companionship  with  the 
unstable  father.  In  either  case,  thank  the  Lord  if  there  is  a 
good  mother,  and  there  generally  is. 

The  environment  of  the  child  is  in  my  opinion  the  most 
potent  causative  factor  in  catarrh ;  and  by  that  I  mean  clim- 
ate, housing,  dress,  food  and  habits  generally,  all  combining, 
in  the  civilization  of  the  century,  to  produce  a  nervous,  sensi- 
tive, delicate  child,  with  too  little  power  of  resistance.  The 
mischief  is  often  begun  in  the  first  days,  even  the  first  hours, 
yes,  the  first  minutes  of  a  child's  life,  and  the  doctor  and  the 
nurse  are  responsible  for  some  of  it.  When  a  woman  is  de- 
livered, it  not  infrequently  happens  that  the  new-born  child 
lies  for  several  minutes,  before  the  cord  is  cut,  in  a  pool  of 
blood  and  water,  or  at  least  on  wet  sheets  or  cloths,  while  we 
are  waiting  for  the  pulsations  of  the  cord  to  cease,  or  while 
respiration  is  becoming  established.  If  the  latter  is  delayed 
or  imperfect,  the  child  is  sprinkled  with  cold  water  or  spatted 
with  a  cold,  wet  hand.  This,  while  necessary  and  proper, 
does  not  add  to  the  salubrity  of  his  immediate  surroundings, 
and  thus,  if  he  escapes  a  malign  heredity,  he  immediately  be- 
comes the  victim  of  his  environment.  But  fortunately  en- 
vironment can  be  changed,  if  heredity  cannot,  and  the  remedy 
is  simple.  As  soon  as  respiration  is  established,  immediately 
wrap  the  child  in  flannel.  He  has  come  from  a  home  where 
the  temperature  was  99^  to  a  cold  world  of  70^,  and  while  the 
shock  of  the  cold  air  is  a  splendid  tonic  to  start  his  lungs  into 
action,  a  small  dose  is  enough  and  the  skin  needs  prompt  pro- 
tection. Do  not  wait  too  long  for  the  pulsation  of  the  cord 
to  cease.  If  the  uterus  has  contracted  well,  the  placenta  is 
already  in  the  cervix  or  vagina,  and  the  placental  circulation 
has  ceased.     You  may  perhaps  feel  pulsations  two  inches 


I90I  Catarrhal  Children,  535 

from  the  navel  of  the  child,  but  twelve  or  fifteen  inches  away 
there  are  none  and  there  is  no  advantage  in  waiting.  Before 
the  child  reaches  the  world,  be  sure  that  you  have  flannel 
enough  on  hand  to  properly  cover  him,  and  do  not  be  satisfied 
with  the  one  old  flannel  skirt  which  is  not  infrequently  the 
receptacle  which  receives  him  when  he  leaves  your  hands. 

The  nurse  is  likely  to  be  the  next  sinner  and  in  an  exactly 
opposite  way. "  The  skin  of  all  animals  except  man  adapts  it- 
self to  the  climate  in  which  the  animal  naturally  belongs,  and 
is  covered  with  hair,  fur  or  feathers,  as  the  environment  ren- 
ders necessary,  according  to  the  nature  of  the  animal.  Man 
alone  has  to  be  artificially  clothed.  The  respiratory  apparatus 
on  the  other  hand  is  able  to  adapt  itself  to  changes  of  temper- 
ature and  climate,  and  does  not  require  protection  as  does  the 
skin.  Hence,  while  the  skin  of  a  new-born  child  needs  to  be 
well  coated  with  wool,  there  is  no  good  reason  for  covering 
his  mouth  and  nose.  Yet  I  cannot  recall  a  single  instance  of 
childbirth  in  which  I  have  not,  before  leaving  the  house, 
parted  the  coverings  about  the  child's  face  and  given  it  more 
freedom  of  respiration  while  equally  well  shielding  its  eyes 
from  too  bright  a  light.  While  the  lungs  are  protected  by 
the  hose  and  throat  against  changes  in  temperature,  there  is 
no  sense  in  training  a  child  in  the  beginning  to  breathe 
through  wool. 

Climate  itself  is  the  most  productive  cause  of  catarrh  and 
especially  the  climate  of  the  Atlantic  sea  coast  and  the  great 
lakes.  If  the  climate  were  steady,  reliable,  either  hot  or  cold, 
it  would  not  so  much  matter,  but  the  sudden  changes  make 
the  mischief,  and  the  most  trying  of  all  features  is  the  hu- 
midity of  the  atmosphere.  Science  has  not  yet  been  able  to 
control  the  weather,  and  our  only  hope  is  to  adapt  ourselves 
to  it  and  increase  our  powers  of  resistance.  Yet  to  weaken 
this  necessary  power,  we  habitually  overheat  our  houses  in 
winter,  thus  magnifying  the  difference  between  the  temper- 
ature within  and  without.  On  a  keen,  wintry  day,  what  doc- 
tor does  not  dread  the  overheated  house  from  which  he  will 
emerge  in  a  sweat  after  his  visit,  to  face  a  northeast  wind  — 


536  The  New  England  Medical  Gazette,  Nov., 

if  he  lives  in  Boston.  If  he  does  not  dread  it,  he  is  either 
vigorous  beyond  his  fellows,  or  a  Christian  scientist.  Over- 
heated houses,  poorly  ventilated  schools  and  public  places 
of  assembly,  either  for  worship  or  amusement,  overheated 
draughty  cars  —  these  are  causes,  predisposing  and  exciting, 
of  catarrh.  We  are  slowly  learning  to  improve  these  con- 
ditions, but,  like  the  climate,  they  will  always  exist  to  some 
extent.  It  behooves  us,  therefore,  to  render  ourselves  su- 
perior to  them,  in  other  words,  to  toughen  ourselves  so  that 
we  can  resist  their  harmful  influence. 

There  is  no  tissue  of  the  body  which  needs  toughening  so 
much  as  the  skin  and  the  process  should  be  commenced  in 
early  life.  The  most  effective  methods  are  cold  salt  bathing, 
dry  friction,  proper  clothing,  cool  sleeping  rooms,  systematic 
exposure  of  the  surface  of  the  body  during  exercise,  and  an 
outdoor  life.  The  quality  of  the  underclothing  is  of  great  im- 
portance. It  should  be  at  once  warm  and  porous,  capable  of 
retaining  heat  and  allowing  evaporation  of  moisture.  Ordi- 
nary woolen  goods  retain  heat,  but  do  not  readily  permit  the 
drying  of  the  skin  when  wet  with  perspiration.  The  best 
fabric  that  I  know  of  is  a  combination  of  wool  and  cotton, 
called  the  Jaros  underwear.  This  is  made  out  of  a  layer  of 
wool  next  the  skin,  not  woven,  but  laid  against  a  cotton  base, 
with  the  wool  fibres  running  in  the  direction  they  naturally 
take  when  on  the  back  of  the  sheep.  Moisture  on  the  skin 
travels  along  these  fibres  and  is  taken  up  by  the  layer  of  cot- 
ton, leaving  the  wool  dry  and  the  skin  beneath  it  warm  and 
dry  also.  I  think  well  too  of  the  linen  mesh  underwear, 
though  I  have  not  personally  investigated  it.  Indigestion, 
caused  by  improper  quality  and  quantity  of  food,  combined 
with  too  rapid  eating,  is  so  well  known  as  a  cause  of  catarrhal 
trouble  that  I  shall  simply  mention  it  and  nothing  more. 

If  a  child  could  be  brought  up  in  the  sensible,  hardy  way  I 
have  indicated,  I  believe  he  would  have  but  little  catarrh, 
even  in  our  climate,  and  would  rarely  catch  cold.  But  what 
about  germs,  you  ask }  The  germs  we  have  always  with  us, 
but  a  vigorous  person,  child  or  man,  need  have  small  fear  of 


igoi  Catarrhal  Children.  537 

them.  I  am  a  firm  believer  in  the  germ  theory  of  disease, 
and  a  still  firmer  believer  in  our  ability  to  resist  their  attacks 
and  to  destroy  them  if  they  enter  the  system.  Probably 
every  tissue  and  fluid  of  the  body  (except  the  waste  products) 
is  endowed  with  germicidal  properties  and,  if  they  are  in  good 
working  order,  the  germs  will  die  which  come  in  contact  with 
them. 

The  cases  which  reach  the  doctor's  office  are  already  well- 
advanced  forms  of  catarrh  and  what  can  be  done  for  them  ? 
Institute  at  once  a  mode  of  life  in  harmony  with  what  I  have 
suggested  and  begin  the  toughening  process.  If  the  naso- 
pharynx is  obstructed,  open  it  out,  not  too  radically,  be 
cautious  and  conservative.  Reduce  hypertrophied  turbinated 
bodies,  establish  free  nasal  respiration  and  drainage.  Recent 
investigations  have  shown  the  important  part  in  keeping  up 
chronic  catarrh  which  the  accessory  cavities  about  the  nose 
play.  Their  openings  must  be  free,  and  the  especially  crit- 
ical region  is  that  about  the  middle  turbinated  body.  Remove 
all  tumors,  clear  the  vault  of  redundant  adenoid  tissue,  and 
remove  hypertrophied  tonsils.  Reduce  the  lingual  tonsil,  if 
hypertrophied.  Cut  off  projections  of  the  septum  of  the  nose 
and  straighten  its  deflections,  but  again  I  say  be  cautious  and 
conservative.  Do  not  destroy  mucous  membrane  that  can  be 
saved,  for  the  new  membrane  that  forms  over  the  denuded 
tissues  is  never  quite  perfect  in  function.  Avoid  the  use  of 
actual  cautery,  if  possible  \  use  milder  means,  such  as  elec- 
trolysis, which  is  effective  and  without  danger.  It  is  im- 
portant, when  once  free  respiration  and  drainage  are  secured, 
to  keep  the  passages  clear  by  bland  sprays  and  washes. 
Think  of  the  amount  of  dust  that  the  nasal  tissues  sift  from 
the  air.  The  hairy  sieve  in  the  nostrils  holds  back  a  great 
deal,  yet  very  much  passes  through  and  is  collected  on  the 
septum,  floor  and  turbinated  bodies  of  the  nose,  A  normal 
membrane  can  take  care  of  this  invasion  and  protect  itself 
and  the  system  which  it  guards,  but  a  diseased  one  is  less 
active  and  vigorous  in  function  and  needs  help.  I  believe  in 
keeping  the  nose  clean,  as  a  part  of  the  toilet,  as  we  brush 


S38  The  New  England  Medical  Gazette,  Nov 

the  teeth.  A  simple  catarrh,  even  if  chronic,  can  be  cured, 
if  no  surgical  help  is  needed,  by  thorough,  persistent  cleans- 
ing and  disinfection  of  the  nose.  The  application  of  very 
hot,  dry  air,  about  temperature  of  400^,  is  a  helpful  measure 
in  both  acute  and  chronic  catarrh. 

In  connection  with  local  measures,  surgical  and  nonsurgical, 
attend  to  the  general  condition  of  the  patient.  When  we 
spray,  burn  arid  cut,  we  are  dealing  with  the  products  of  dis- 
ease and  however  valuable  these  procedures  maybe  —  and 
they  are  often  absolutely  indispensable  —  we  should  try  to  go 
to  the  root  of  the  trouble  and  deal  with  the  system  so 
that  these  pathological  products  shall  not  occur  or  recur.  In 
addition  to  the  hygienic  measures  I  have  suggested,  I  most 
earnestly  advise  a  painstaking  search  for  the  drug  which  the 
individual  you  are  treating  needs  to  restore  that  equilibrium 
and  elasticity  of  the  vital  forces,  the  harmonious  action  of 
which  is  health.  I  wish  I  could  tell  you  how  to  find  this 
blessed  remedy  quickly,  easily  and  safely,  but  I  know  of  no 
path  which  leads  to  it  other  than  that  of  close  observation 
and  patient  study. 

And  if  you  find  the  indicated  remedy,  meaning  thereby  the 
drug  which  bears  a  Homoeopathic  relation  to  the  case  under 
consideration,  you  may  be  disappointed  if  you  administer  this 
remedy  and  do  nothing  else.  However  powerful  for  good  it 
may  be  in  its  own  sphere,  it  cannot  do  everything.  There 
are  times  when  the  system  calls  imperatively  for  iron  and 
nothing  else  will  take  its  place,  but  it  may  not  bear  a  homoe- 
opathic relation  to  the  case.  Quinine  and  strychnine  in  ap- 
preciable doses  are  at  times  curative  agents  of  great  value, 
and  I  know  of  no  reason  why  we  should  not  use  them  and 
give  thanks  that  we  possess  weapons  so  powerful  to  combat 
disease.  Catarrh  not  infrequently  follows  an  acute  disease 
such  as  measles,  scarlet  fever,  grippe  or  diphtheria,  and  I 
have  with  benefit  used  iron,  quinine  or  strychnine,  to  help 
build  up  the  patient  afterwards  and  aid  the  system  to  take 
and  assimilate  more  nourishment,  for  nutrition  is  the  founda- 
tion of  all  progress  in  such  cases.     I  have  usually  given  these 


IQOI  Catarrhal  Children,  539 

remedies  one  at  a  time  and  tried  to  individualize  them,  what- 
ever the  dose.  I  used  formerly  to  despise  iron  and  look  upon 
its  use  as  a  rather  crude  routine  practice,  but  I  have  greatly 
changed  my  ideas  of  late  and  believe  that  I  have  given  more 
iron  in  the  last  three  years  of  my  practice  than  in  the  previous 
twenty.  I  regard  the  preparation  known  as  pepto-mangan  as 
one  of  great  merit,  and  under  its  use  I  have  seen  pale,  listless* 
tired  children  become  rosy,  active  and  vigorous.  And  why 
not }  If  the  hemoglobin  of  the  blood  is  deficient  in  iron,  it 
cannot  carry  the  proper  quantity  of  oxygen  to  the  tissues  and 
oxidation  is  imperfectly  carried  on,  and  that  means  malnu- 
trition. You  may  pump  oxygen  into  the  lungs  and  pour  beef 
juice  into  the  stomach,  but  if  the  red  blood  corpuscles  cannot 
take  up  oxygen  the  tissues  will  not  be  supplied  and  assimila- 
tion will  be  deficient,  no  matter  how  much  nourishment  may 
be  taken  into  the  stomach. 

The  examination  of  the  blood  and  secretions  by  modern 
laboratory  methods  is  opening  a  new  field  in  medicine  of  the 
utmost  importance  both  for  diagnosis  and,  I  believe,  also  for 
therapeutics.  And  it  is  here  that  the  provings  of  our  rem- 
edies are  deficient.  What  definite  knowledge  have  we  of  the 
effect  of  drugs  upon  the  composition  of  the  blood }  When 
suppuration  is  threatened  or  has  occurred  and  the  system  is 
rallying  its  forces  to  overcome  it,  and  has  raised  an  army  of 
white  blood  corpuscles  to  fight  the  foe,  until  their  number  is 
increased  to  three  or  four  times  the  size  of  the  regular  stand- 
ing army,  what  remedy  shall  we.  give  so  far  as  the  blood 
examination  throws  light  on  the  situation  t  And  yet  we  can- 
not ignore  this  knowledge  which  science  is  yielding  us,  for  on 
our  own  principles  we  must  base  our  prescription  upon  the 
totality  of  the  symptoms.  I  say  frankly  that  we  shall  fall 
hopelessly  and  deservedly  to  the  rear  unless  we  bring  our 
methods  up  to  the  requirements  of  the  more  accurate  and 
scientific  standards  of  the  day.  There  was  a  time  when  there 
was  nothing  so  good  in  the  whole  field  of  medicine  as  homoe- 
opathy, though  the  eyes  of  a  great  majority  of  physicians 
were  closed  and  could  see  nothing  in  it.     Prejudice  closed 


540  The  New  England  Medical  Gazette.  Nov., 

their  eyes.  But  that  time  has  passed.  Homoeopathy,  and  I 
speak  the  name  with  reverence,  has  stood  still,  serenely  con- 
fident in  the  universality  and  immutability  of  its  law,  while 
medicine  in  general  in  all  directions  has  made  immense  strides. 
Let  us  not  be  blind  or  prejudiced,  as  were  the  physicians  of  a 
century  ago,  but  make  use  of  the  knowledge  that  the  passing 
years  bring  forth,  carrying  our  beloved  art  of  healing  into  the 
front  rank  of  scientific  methods.  But,  if  it  prove  true  that  there 
are  efficient  means  of  restoring  the  sick  to  health  which  are 
different  from  ours,  and  especially  if  they  prove  to  be  the 
better,  let  us  be  broad  enough  and  wise  enough  to  use  them 
and  to  be  grateful  that  we  possess  them. 


THE  TREAXriENT    OF    RHEUilATISn,    NEURITIS  AND 
NEURALGIA    BY   ELECTRICITY. 

HY    GEORGK    E.    PERCY,    M.    D. 
[Read  before  Boston  Horn.  Med.  Society,  Oct.  17,  1901. J 

It  would  not  be  an  easy  matter  to  choose  three  diseases 
more  commonly  met  with,  in  the  treatment  of  which  so  great 
a  want  of  harmony  as  to  methods  employed  is  manifest.  I 
was  prompted  to  respond  to  the  call  of  the  secretary  of  this 
Bureau  because  of  my  desire  to  gain  information  in  a  field  of 
work  comparatively  new  to  me,  but  one  in  which  I  have  had 
a  deep  interest.  I  must  take  issue  with  Johnson  in  his  lines 
to  Boswell  to  the  effect  that  no  man  can  help  others  that 
wants  help  himself,  for  where  one  might  not  be  able  to  give 
anything  original  on  a  subject  of  this  nature,  he  can  at  least 
by  suggestion  elicit  a  discussion  which  cannot  fail  to  be  of 
profit.  In  the  treatment  of  these  diseases  by  electricity,  as 
given  by  different  authorities,  particularly  that  of  rheumatism,* 
one  finds  the  same  want  of  agreement,  the  same  positivism 
and  skepticism,  which  has  ever  characterized  the  life  of  other 
therapeutic  agents.  As  Dr.  Dake  has  well  said,  "  Nowhere 
in  the  field  of  human  study,  owing  largely  to  a  disposition  to 
theorize,  have  there  been  greater  obstacles  in  the  way  of  cer- 


igoi     Treatment  of  Rhetifnatisniy  Neuritis^  Neuralgia,    541 

tainty  than  in  those  pertaining  to  therapeutics,  and  nowhere 
in  which  there  has  been  a  greater  tendency  to  see  a  propter 
hoc  where  there  has  been  only  a  post  hoc''  But  this  should 
not  longer  obtain  in  electro-therapeutics,  for  with  the  in- 
creasing exactness  of  electrical  methods,  coupled  with  a  better 
clinical  knowledge,  we  must  approach  more  closely  to  an 
exact  treatment. 

First,  let  us  consider  the  most  formidable  of  these  three 
diseases,  rheumatism.  It  is  needless,  if  not  hopeless,  to  at- 
tempt any  description  of  this  affliction  which  has  such  a  hold 
upon  humanity,  whether  it  be  a  microbic,  lactic  or  uric  acid 
disease  or,  as  some  have  claimed,  due  to  a  form  of  malaria, 
of  this  we  are  sure,  it  is  dependent  upon  faulty  metabolism, 
a  want  of  balance  between  the  fuel  put  into  the  body  and  the 
fire  of  force  by  which  it  is  consumed  and  transformed  into 
energy.  Rockwell  says,  '*  In  acute  articular  rheumatism  elec- 
tricity in  any  form  is  of  doubtful  value,  and  further,  while 
general  and  local  palliative  treatment  may  give  great  comfort 
to  the  patient  and  occasionally  may  prevent  complications, 
it  is  yet  doubtful  whether  an  attack  of  acute  rheumatism  can 
be  very  much  shortened  by  any  method  of  treatment." 

This  is  not  a  very  optimistic  outlook,  and  is  it  strange  that 
electrical  treatment  is  not  more  generally  resorted  to  by  the 
profession  when  we  consider  the  exacting  details  necessitated 
in  its  proper  application  ?  The  past  record  would  on  the 
whole  give  color  to  this  pessimistic  view,  but,  as  I  have  al- 
ready intimated,  a  more  careful  and  studied  use  of  the  various 
currents  with  a  great  deal  of  patience  and  an  effort  on  our 
part  to  treat  symptoms  rather  than  disease,  may  make  just  the 
difference  which  made  for  therapeutic  advance  by  which  those 
of  the  new  school  have  profited. 

In  the  treatment  of  acute  muscular  rheumatism  and  my- 
algia by  electricity  the  results  are  brilliant,  but  the  expecta- 
tion to  meet  with  similar  success  in  sub-acute  or  chronic 
affection  will  be  doomed  to  speedy  disappointment.  Electro- 
therapeutics has  suffered  no  little  from  such  unreasonable 
demands  upon  its  resources. 


542  The  New  England  Medical  Gazette,  Nov., 

In  the  treatment  of  acute  rheumatism  or  rheumatic  fever 
proper  I  have  had  little,  if  any,  experience  with  electricity.  I 
have  always  felt  that  the  nodal  diffusion  of  the  selected  hom- 
oeopathic remedy  would  be  worthy  of  trial  and  have  myself 
attempted  it  in  a  few  cases. 

If  electricity  were  useless  in  other  forms  of  rheumatism, 
its  value  in  muscular  forms,  notably  lumbago,  is  so  marked 
and  satisfactory  that  it  can  almost  be  classed  as  a  specific- 
It  is  here  that  the  static  machine  shows  definite  and  lasting 
results,  and  right  here  I  should  like  to  report  a  case  illustra- 
ting the  efficiency  of  this  treatment  in  an  attack  of  lumbago 
which  followed  six  months  after  a  siege  which  was  treated  by 
remedies  alone. 

A.  F.,  36  years,  phlegmatic  temperament,  subject  to  light 
attacks  of  rheumatism,  never  severe  until  March  10,  1900, 
when  was  attacked  with  acute  muscular  pain  in  lumbar  muscle. 
He  kept  about  his  business  the  first  day,  taking  bry.  and  cim. 
March  11,  confined  to  bed,  unable  to  turn  on  account  of  ex- 
cruciating pain  and  spasm  of  lumbar  and  gluteal  muscles. 
Hot  fomentations  and  later  dry,  hot  batting  were  kept  to  the 
parts  and  the  remedial  treatment  modified  to  meet  the  symp- 
toms. There  was  little  if  any  fever,  and  the  digestion  was 
not  much  disturbed.  The  pain  yielded  gradually  and  the 
sixth  day  the  patient  was  discharged.  About  six  months 
later,  this  patient  called  at  my  office  with  the  same  symptoms, 
hardly  able  to  get  about,  had  not  straightened  his  back  during 
the  day.  He  had  been  overworking  and  had  already  felt  the 
effect  of  it.  He  anticipated  another  six  days  of  suffering  in 
bed.  After  twenty  minutes  of  negative  insulation  wooden 
ball  electrode,  posterior  spray,  followed  by  a  few  moments  of 
massage  with  roller  to  the  muscles  of  back  and  hip,  he  left 
the  office  free  from  pain,  resumed  his  duties  the  following 
day,  and  a  second  treatment  on  the  following  day  relieved  the 
symptoms  entirely. 

The  treatment  of  these  cases  of  acute  and  sub-acute  mus- 
cular rheumatism  with  static  electricity  is  one  of  the  most 
satisfactory  experiences  with  which  I  have  ever  been  favored 


190 1     Treatment  of  Rheumatism^  Neuritis^  Neuralgia,    543 

and  it  rarely  disappoints  one  if  the  method  of  application  is 
judiciously  made  and  persevered  in. 

I  have  some  very  strong  leanings  toward  Alexander  Haig*s 
theories  as  to  the  causation  of  rheumatism.  He  has  given 
unlimited  time  to  this  study  and  has  brought  to  bear  a  vast 
amount  of  experimentation  of  a  thoroughly  scientific  nature 
upon  his  subject  which  cannot  be  ignored.  You  have  heard 
it  said  that  the  way  to  a  man's  heart  is  through  his  stomach, 
and  any  theory,  however  logical,  that  imposes  upon  this  latter 
organ  a  fleshless  diet  must  needs  have  great  weight  to  secure 
converts. 

Dr.  Haig  believes  that  anything  that  diminishes  the  alka- 
linity of  the  blood,  improper  alimentation,  fevers,  etc.,  may 
produce  acute  rheumatism  or  rheumatic  fever.  He  further 
says,  speaking  of  the  etiology  of  rheumatism,  "  So  long  as  we 
persist  in  believing  that  rheumatism  is  due  to  some  unknown 
cause,  miasm  or  microbe,  we  shall  continue  to  say  that  the 
patient  has  an  attack  or  relapse  with  endo-carditis  which  re- 
sulted in  a  serious  heart  lesion  and  a  crippled  life,  and  shall 
regard  these  things  as  inevitable,  much  as  do  the  jury  who 
bring  in  a  verdict  of  *  death  by  the  visitation  of  God.'  But 
once  we  realize  that  these  diseases  depend  solely  upon  the 
quantity  and  solubility  of  uric  acid  in  the  blood,  we  shall  see 
that  these  deadly  diseases  are  not  the  result  of  unpreventable 
causes  but  of  our  own  dietetic  follies,  and  that  our  children 
need  not  be  crippled  or  decimated  by  them  if  we  allow  them 
to  live  according  to  their  own  inclinations,  on  milk  and  garden 
products  and  abstain  from  the  stimulating  but  deadly  products 
of  animal  metabolism  and  equally  poisonous  and  stimulating 
vegetable  alkaloids."' 

The  quotation  is  somewhat  irrelevant,  but  the  point  I  wish 
especially  to  bring  up  is  that  whether  or  no  the  dietetic  errors 
are  chief  causes  of  this  changed  condition  of  blood  which 
favors  the  rheumatic  invasion  and  the  precipitation  ol  the 
urates  in  the  joints,  we  have  the  results  to  deal  with,  and  this 
theory  should  be  ever  in  our  minds  in  treating  these  chronic 
lesions.    We  have  in  electricity  an  agent  that  surely  promotes 


544  The  New  England  Medical  Gazette.  Nov., 

local  and  constitutional  nutritional  change.  The  fibrous 
structures  and  cartilages  of  the  joint  are  poorly  supplied  with 
blood  vessels,  and  it  is  a  fact  that  as  the  alkalinity  of  the 
joint  is  diminished  the  tendency  to  arthritis  with  deposit  is 
proportionately  increased. 

It  was  my  good  fortune  a  short  time  since,  after  many  fail- 
ures, to  score  a  success  in  treating  a  typical  case  of  arthritis 
deformans.  The  patient,  a  woman  of  sixty,  had  a  history  of 
several  rheumatic  invasions  extending  over  a  period  of  years. 
The  carpal  and  metacarpal  joints  of  both  hands  were  involved, 
having  gradually  grown  worse  for  several  years.  At  the  time 
she  presented  herself  for  treatment,  she  was  entirely  helpless 
as  far  as  her  hands  were  concerned,  being  unable  even  to  feed 
herself.  It  was  a  typical  case  and  the  prognosis  was  unfavor- 
able. My  only  hope  was  to  remove  the  pain  and  possibly  re- 
store a  little  motion  to  the  joints  less  seriously  affected.  As 
there  were  few  constitutional  symptoms,  the  disease  being 
distinctly  localized,  the  treatment  was  directed  entirely  to  the 
different  joints,  taking  each  one  separately.  I  used  the  fine 
coil  faradic,  the  hand  in  hot  saline  solution,  applying  one 
electrode  to  the  joint;  the  palm  of  the  hand  resting  upon  a 
large  copper  plate  in  the  saline  bath.  Vigorous  friction  was 
made  over  each  joint  for  several  minutes,  making  the  whole 
seance  half  an  hour.  These  treatments  were  continued  bi- 
weekly for  nearly  five  months.  The  only  change  being  made 
was  in  the  solution,  one  of  kali-bi-carb.  and  ichthyol  being 
substituted  for  the  sod.  chlor.  At  the  end  of  this  long  siege 
the  pain  was  the  first  to  subside,  the  joints  although  enlarged 
were  certainly  reduced  one-half  in  size,  and  mobility  was  re- 
stored so  far  as  to  enable  the  patient  to'  dress  herself  and  to 
attend  to  her  household  duties.  Two  years  later,  without 
treatment  in  the  interval,  she  reported  in  quite  as  good  con- 
dition. I  report  this  case  because  it  is  the  only  very  bad  one 
that  I  have  ever  seen  where  such  good  results  were  obtained 
and  that  were  so  lasting. 

I  have  had  some  slight  experience  with  cataphoresis  in  this 
class  of  cases  which  I  hope  to  report  at  some  future  time.     I 


igoi     Treatment  of  Rheutnatistn,  Neuritis,  Neuralgia.    545 

should  like  to  say  in  this  connection,  however,  that  I  believe 
this  to  be  a  very  fertile  field  for  study  and  one  which  has 
been  too  long  neglected.  It  would  seem  that  much  greater 
success  would  attend  our  efforts  in  this  work  if  we  took  more 
carefully  into  consideration  the  fact  that  drugs  can  be  made  to 
enter  the  body  as  well  against  as  with  the  flow  of  the  galvanic 
current  on  the  condition  that  we  are  able  to  determine 
whether  the  agent  used  is  electro-negative  or  positive  and 
choose  the  pole  accordingly. 

Neuritis.  The  treatment  of  actual  inflammation  of  nerve 
structure  either  from  traumatism  or  cold  has  brought  out 
some  of  the  most  remarkable  effects  in  static  electricity.  In 
this  disease  the  fixed  pain,  early  and  persistent  tendency,  with 
manifestation  of  trophic  changes  and  localized  anaesthesia, 
enables  one  to  differentiate  from  the  functional  disturbance 
of  the  nerves  which  we  term  neuralgia.  When  this  disease 
is  distinctly  localized  and  of  recent  origin,  I  believe  that  a 
large  proportion  of  cases  can  be  undoubtedly  cured  by  a  few 
applications  with  the  positive  spray  from  the  pointed  wooden 
electrode,  first  holding  the  electrode  at  some  distance  from 
the  seat  of  pain  and  gradually  approaching  it  as  toleration 
will  permit.  I  have  in  mind  a  case  of  traumatic  neuritis  of 
superior  maxillary  nerve  caused  by  the  extraction  of  a  tooth 
and  a  subsequent  cold.  The  patient  called  at  my  office  at 
midnight,  suffering  from  most  agonizing  pain.  The  tooth 
had  been  extracted  two  days  before,  and  the  pain  came  on 
that  night.  He  sought  medical  advice  and  was  given  mor- 
phine in  one-fourth  grain  doses  every  two  hours.  This  he 
took  during  the  night  and  part  of  the  next  day,  and  failing  to 
get  relief,  was  given  large  doses  of  antikamnia.  This  failed 
to  make  any  impression  upon  the  pain  which,  if  possible,  in. 
creased  in  severity  up  to  the  time  he  called  at  my  office.  The 
only  relief  he  could  get  was  to  hold  large  pieces  of  ice  in  his 
mouth  and  the  moment  it  melted  he  was  in  frenzy  until 
another  piece  was  in  contact  with  his  gums.  I  realized  that 
the  man  was  well  saturated  with  morphine  and  antikamnia, 
and  I   had  little  courage   in    prescribing   the  well-indicated 


546  The  New  England  Medical  Gazette,  Nov 

coffea.  Instead  I  placed  him  upon  the  static  platform  and 
began  with  a  very  mild  positive  spray  with  a  wooden  elec- 
trode, applying  it  along  the  course  of  the  nerve  and  finally 
directing  the  spray  immediately  to  the  seat  of  pain  at  the 
point  where  the  tooth  was  extracted.  I  was  enabled  after  a 
few  moments  to  put  the  point  of  the  electrode  directly  into 
the  socket.  The  relief  was  almost  instantaneous  after  this 
close  proximity  of  the  spray.  The  patient  went  to  his  home 
free  from  pain  and  slept  eight  hours.  The  treatment  the  fol- 
lowing day  and  evening,  and  one  the  second  day  after, 
entirely  relieved  the  trouble. 

There  is  a  form  of  neuritis  complicating  rheumatism  not 
infrequently  met  with.  We  find  the  local  tendency  of  nerve 
structure  with  fixed  pain  and,  if  of  long  duration,  the  trophic 
changes  and  disturbed  sensation.  The  treatment  should  be 
directed  to  the  constitutional  condition  as  well  as  to  the  local 
manifestation.  For  the  latter  I  have  found  the  galvanic  cur- 
rent, regarding  its  well-established  rule  of  positive  pole  to  the 
seat  of  pain,  current  8  to  lo  milliamperes,  the  most  satisfac- 
tory method  of  treatment.  I  recently  had  under  my  care  a 
case  of  this  kind  which  for  some  reason  that  I  am  unable  to 
explain  was  aggravated  by  the  farad ic  current  as  well  as  by 
the  static,  and  yielded  almost  immediately  to  galvanism.  In 
the  more  choreic  form  of  neuritis  with  atrophied  muscle  and 
trophic  changes  of  skin,  I  have  thus  far  seen  little  to  inspire 
me  in  the  belief  that  the  lost  function  of  nerve  can  be  re- 
stored. Doubtless  the  disease  can  be  held  in  check  and  nu- 
trition improved,  but  beyond  this  it  is  questionable  how  much 
any  form  of  electricity  can  do. 

Neuralgia  may  be  described  as  a  nervous  disorder  charac- 
terized by  pain  which  is  usually  paroxysmal,  with  marked 
exacerbation  succeeded  by  definite  intermission,  and  existing 
independently  of  inflammation.  In  true  neuralgia,  where 
there  is  disturbance  of  nerve  centers  without  much  muscular 
disturbance,  the  galvanic  current  is  usually  indicated.  The 
positive  electrode,  applied  to  the  seat  of  pain  and  moved  along 
the  course  of  the  nerve  with  a  current  of  meter  strength  5  to  10 


190 1     Treatment  of  Rheumatism^  Neuritis^  Neuralgia,    $47 

milliamperes,  will  usually  afford  relief.  In  severe  cases  it 
may  be  necessary  to  resort  to  cocaine  or  morphine,  in  which 
cases  they  should  of  course  be  placed  under  the  positive  elec- 
trode. 

In  a  debilitated  subject  with  marked  nutritional  change, 
the  faradic  current  of  tension  will  be  of  most  service,  giving 
first  a  general  faradic  followed  by  local  application.  There  is 
usually  considerable  aggravation  in  the  beginning  of  a  treat- 
ment, particularly  if  a  strong  current  is  used,  and  this  is  fre- 
quently necessary.  I  believe  it  is  important  to  treat  this 
class  of  patients  night  and  morning  for  a  few  days,  giving  a 
seance  of  twenty  minutes  each  time. 

Who  has  not  had  the  misfortune  to  meet  with  that 
wretched  form  of  hysterical  patient  afflicted  with  neuralgia  ? 
I  am  sure  most  of  us  have  heard  the  groans  and  vainly  tried 
to  get  a  symptom  picture  of  these  sufferers  until  a  score  of 
remedies  had  flashed  upon  our  mental  horizon  as  the  true 
similimum,  only  to  be  dissipated  in  turn  by  a  fresh  invasion  of 
aches  and  pains.  If  anything  will  reconcile  a  man  to  the 
the  trials  and  freaks  of  his  static  machine  in  damp  weather  it 
is  the  satisfaction  which  comes  from  the  treatment  of  these 
patients  with  a  generous  spray,  followed  by  positive  insulation 
with  graded  negative  for  30  minutes. 

In  conclusion,  I  would  like  to  urge  a  careful  trial  of  cata- 
phoresis  with  the  indicated  remedy  in  the  treatment  of 
rheumatic  fever.  Second.  In  treating  acute  muscular  rheum- 
atism, lumbago  or  myalgia,  use  static  electricity  and  never 
allow  the  patient  to  get  down  from  the  platform  with  pain. 
Third.  In  chronic  articular  rheumatism  prepare  for  a  long 
siege,  remembering  that  you  have  a  constitutional  disease  to 
deal  with  and  that  dietetics  and  hygiene  are  friendly  to  elec- 
trical methods.  Give  the  hot  alkaline  and  saline  bath  a  trial 
with  the  anodal  diffusion  of  indicated  drug.  Fourth.  In 
treating  neuritis  make  a  bold  fight  from  the  start  with  the 
positive  spray  closely  applied  in  acute  cases,  and  in  chronic 
ones  be  guarded  in  prognosis  for  there  are  limitations  even 
to  electricity.     Miracles  are  not  common.     Fifth.    Neuralgia 


548  The  New  England  Medical  Gazette.  Nov., 

like  the  feline  species  is  endowed  with  nine  lives  and  each 
life  presents  a  different  phase  of  existence.  Select  the  cur- 
rent, if  possible,  with  reference  to  the  cause  of  the  disturb- 
ance and  its  manifest  symptoms,  the  fine  coil  faradic  for 
simple  neuralgia  and  the  static  for  the  hysterical  subjects. 

The  progress  of  electro-therapeutics  must  be  along  the  line 
of  clinical  work,  for  we  can  secure  no  proving  of  this  agent 
for  a  working  basis  since  its  sick-making  properties  in  ordi- 
nary doses  is  practically  nil.  It  is  imperative,  therefore,  in 
order  to  build  up  this  branch  of  therapeutic  work,  that  we 
exercise  greatest  care  in  the  study  of  each  case  and  in  the 
choice  of  current,  noting  failures  as  well  as  successes.  A 
given  current  of  measured  strength  and  duration,  applied  for 
certain  well-defined  similar  conditions,  should  give  unvarying 
results,  and  if  not  our  method  and  not  the  agent  is  at  fault. 


Intussusception  in  Children,  i.  Try  inflation  only 
when  case  is  seen  within  a  few  hours  of  onset,  and  is  not  of 
a  very  acute  character.  In  the  great  majority  of  hospital 
cases  it  is  better  to  open  the  abdomen  at  once. 

2.  Inflation  may  be  tried  in  certain  other  cases  for  the 
purpose  of  reducing  the  main  portion  of  the  intussusception 
and  enabling  the  incision  to  be  made  directly  over  the  cecum. 

3.  When  reduction  is  found  impossible  in  chronic  cases, 
a  resection  may  be  generally  done  through  an  incision  in  the 
ensheathing  bowel. 

4.  In  acute  cases,  and  especially  if  gangrene  is  present 
or  the  condition  of  the  bowel  requires  its  removal,  a  wide 
resection  should  be  undertaken  as  widely  as  possible,  and  the 
ends  brought  outside  the  abdomen  ;  continuity  should  be  re- 
stored at  a  subsequent  operation. 

5.  In  exceptional  cases  of  enteric  intussusception,  resec- 
tion and  immediate  restoration  of  continuity  gives  the  only 
chance . — British  Medical  Journal, 


I  go  I  Editorial.  549 

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  Gaztitt.  They  should  be  tyi>ewritten  if  possible.  To  obtain  insertion  the  following  month, 
reports  of  societies  and  personal  items  m»ut  m  rtctivedby  tk*  r^k  ofth§  mpttth  preceding. 


THE   PRESENT   DANGER. 

Some  time  ago  we  referred  casually  to  the  danger  to 
the  existence  of  our  school  therapeutics  in  the  present 
attitude  of  indifference  of  the  old  school.  The  thought 
was  induced  by  Dr.  Packard's  very  interesting  letter 
on  the  condition  of  Homoeopathy  on  the  Continent,  from 
which  we  gathered  that,  although  the  practice  of  Homoeo- 
pathy was  increasing,  the  number  of  its  avowed  practitioners 
did  not  increase  in  the  same  ratio.  That  the  same  state  of 
affairs  exists  in  our  own  country  we  believe  to  be  eminently 
true.  This  condition  of  affairs  will  continue  to  exist  so  long 
2iS  practical  Homoeopathy  is  taught  by  the  dominant  school, 
whereby  the  student  may  learn  to  cure  his  patient  tutOy  cito 
et  jucunde,  and  still  possess  himself  of  whatever  prestige  there 
may  be  in  belonging  to  a  dominant  school. 

To  assure  oneself  that  practical  Homoeopathy  is  taught  by 
the  old  school,  one  has  only  to  read  a  most  interesting  article 
in  "  The  American  Medicine^'  for  June  i,  1901,  entitled 
"Simplicity  in  Therapeutics,"  by  Edwin  W.  Pyle,  M.  D. 
Homoeopathy  is  here  treated  under  the  euphonious  title  of 
"Elective  Affinity."  We  are  told  that  "Podophyllin  has  an 
affinity  for  the  small  intestines,"  that  "  Cantharides  actively 
congests  the  kidneys  and  urinary  passages,"  "  Colocynth  in- 
fluences the  colon,"  "Aconite  the  vascular  system,"  "  Gel- 
semium  the  cerebro-spinal  centers,"  etc.  But  not  alone  this. 
The  author  also  states :  "  We  hazard  the  opinion  that  when  a 
special  part  or  organ  becomes  inflamed  or  disturbed  in  func- 
tion, the  physiologically  selected  medicine  acts  as  a  stimulant 
to  restore  balance  of  forces,  when  given  in  small  and  fre- 
quently repeated  doses,  but  irritates,  congests  or  paralyzes 
recuperative  power,  thereby  aggravating  the  malady,  when 


5  50  The  New  England  Medical  Gazette.  ■  Nov., 

given  in  large  doses  at  long  intervals,  precisely  as  Alcohol 
influences  the  system  under  like  administration."  And  then 
again  :  "Aconite  influences  the  vascular  system  and  Bryonia 
limits  effusions  of  serous  membranes.  (Phillips.)  In  sick- 
ness characterized  by  fever,  quick  pulse,  labored  breathing, 
pleuritic  pain  and  rusty  sputa,  5  to  lo  drops  of  these  strong 
tinctures  into  20  teaspoonfuls  or  a  half-glass  of  water,  i  or  2 
teaspoonfuls  given  every  hour  or  two  hours  (dose,  gtt.  ^to  i), 
constitutes  an  early  treatment  for  pleurisy  and  pneumonia 
that  has  given  results  incredible  to  those  who  have  been  ac- 
customed to  large  doses  and  severe  antiphlogistic  measures. 
This  fact  has  been  verified  by  years  of  experience  and  is  no 
longer  in  the  '  primary  stage  of  laudation.'  Dr.  Cooper  writes : 
*  In  asthenic  cases  of  pneumonia  I  rely  on  minute  doses  of 
aconite  and  bryonia,  frequently  repeated,' and  adds,  'under 
the  treatment  we  should  not  lose  over  5  per  cent,  of  our 
cases.*  The  probable  explanation  is  that  the  small  dose  stim- 
ulates and  equalizes  without  interfering  with  the  essential 
vis  medicatrix  naturae y 

And  again  :  "Belladonna  determines  blood  to  the  capillary 
circulation  with  heat  and  redness ;  rhus  tox.  will,  in  addition, 
produce  a  vesicular  eruption.  If  in  erysipelas  either  of  these 
medicines,  depending  on  the  character  of  the  eruption,  be 
given  as  above  directed,  the  results  are  fewer  deaths  and 
quicker  recoveries,  cceteris paribus,  than  when  tr.  ferri.  chl.  is 
administered  in  unwelcome  doses.  We  disclaim  any  estimate 
of  the  value  of  this  medication,  we  only  know  that  nature 
thus  simply  treated,  gives  better  results  than  when  burdened 
by  an  irritating  product,  and  in  this  particular  instance  we 
are  supported  by  the  testimony  of  Cushney,  the  H6tei  Dieu 
(Paris),  and  the  Royal  Infirmary  in  Edinburgh. 

"  Phytolacca  is  a  specific  irritant  of  the  throat.  It  is  physi- 
ologically indicated  in  follicular  tonsilitis  with  fetor  of  the 
breath,  and  in  small  doses  is  a  most  positive  remedy.  Jabo- 
randi  produces  diaphoresis,  yet  in  small  doses  will  check  the 
sweating  of  tuberculosis. 

"Nitroglycerin  causes  congestive  headaches  with  intense 


I90I  Editor  taL  551 

throbbing ;  when  properly  selected  for  morbid  conditions  of 
similar  character,  gtt.  1-1,000  doses  will  give  relief. 

"Apomorphin  acts  upon  the  medulla,  produces  convul- 
sions, rapid  breathing  and  great  prostration.  A  small  hypo- 
dermic dose  will  stimulate  the  spinal  centers,  relieve  hysteria, 
stop  the  convulsions  in  childhood,  and  abort  the  pains  of 
vasomotor  disturbances. 

"  Ipecac  and  calomel,  both  nauseants,  correctly  prescribed, 
will  stop  bilious  vomiting.  Colocynth,  universally  known  as 
a  purgative,  will,  in  small  doses,  relieve  diarrhoea  character- 
ized by  griping,  umbilical  pain.     (Hughes.) 

"  Fractional  doses  of  podophyllin  relieve  a  form  of  diarrhoea 
characterized  by  dark-colored  movements,  cutting  pains  and 
worse  in  the  mornings.  (Ringer.)  Less  than  i  drop  doses 
of  cantharides  relieve  the  distress  of  cystitis  and  hematuria. 
(Mayer.) 

"Arsenic,  in  minute  doses,  is  extolled  in  the  coryzas  of 
childhood,  and  in  the  vomiting  of  drunkards.  (Murrell). 
Potas,  bichromate  in  gr.  i-ioo  doses,  relieves  hoarseness  and 
aphonia.  (Phillips.)  Calomel  in  gr.  1-20  doses  every  hour, 
relieves  irritable  stomach  (Aulde),  and  every  two  hours  is  a 
clinical  routine  treatment  for  certain  systemic  dyscrasia. 
(Knapp.)  Strychnin  arsenate,  in  doses  of  gr,  1-134,  every 
hour,  makes  *the  most  permanent  tonic  stimulant.'  (Jack- 
son.) " 

And  last  of  all  he  says  :  "The  single  remedy  hygienically 
given  in  whatever  dose,  not  only  simplifies  prescribing,  but  is 
scientifically  correct.  Polypharmacy  is  largely  the  result  of 
physicians  writing  their  own  histories  and  never  taking  their 
own  medicines." 

Does  anybody  know  of  any  better  homoeopathy  than  this  } 
All  these  interesting  facts  which  are  so  scientifically  (.?)  por- 
trayed in  this  article,  have  been  the  common  property  of 
practising  homoeopaths  for  a  greater  part  of  the  last  century, 
and  his  great  discovery  of  the  simplicity  of  the  single  dose 
was  insisted  on  by  Hahnemann  more  than  a  century  ago. 

It  can  readily  be  seen  that  in  such  teaching  as  this,  under 


552  The  New  England  Medical  Gazette.  Nov., 

whatever  guise  it  may  be  presented,  so  long  as  it  is  not 
taught  under  its  true  name,  Homoeopathy,  lies  a  most  subtle 
and  cunning  danger.  It  can  only  be  met  in  our  judgment  by 
the  utmost  honesty  in  our  own  claims,  and  by  the  constant 
insistance  that  Homoeopathy,  wherever  found,  shall  be  called 
Homoeopathy,  and  not  be  allowed  to  masquerade  under  other 
names  such  as  **  Elective  Affinity,"  etc. 


EDITORIAL  NOTES  AND  COMMENTS. 


The  article  in  last  issue  of  Gazette,  published  under  the 
authorship  of  Dr.  S.  S.  Windsor,  should  have  been  credited 
to  Dr.  Lena.  H.  Diemar,  and  the  article  entitled  *'  A  Brief 
Study  of  Temperature  in  Certain  Serious  Puerpural  Compli- 
cations," to  Dr.  S.  S.  Windsor. 

Both  were  read  before  the  Mass.  Homoeopathic  Society. 


Bubonic  Plague  in  California.  The  ^^Bee^'  of  Sacre- 
mento,  California,  for  October  17,  1901,  publishes  a  report 
issued  by  the  State  Board  of  Health  reversing  its  former  de- 
cision and  now  announcing  that  there  is  not  only  no  case  of 
bubonic  plague  in  San  Francisco,  but  that  the  disease  has 
never  obtained  lodgment  there  nor  elsewhere  in  California. 

Ledum  in  Gout.  Ledum  is  a  useful  remedy  in  gout,  as 
well  as  in  many  articular  troubles.  We  have  the  symptom 
that  the  ball  of  the  great  toe  is  swollen,  soft,  and  painful  on 
stepping,  drawing  pains  worse  from  warmth,  pressure  and 
from  motion.  It  has  also  gouty  nodosities  on  the  joints,  it 
differs  from  bryonia  in  having  a  scanty  instead  of  a^  profuse 
effusion,  it  is  perhaps  better  adapted  to  hot  swelling  of  the 
hip  joint  than  is  bryonia.  All  the  pains  of  ledum  travel  up- 
wards. Ledum  is  also  useful  after  abuse  of  colchicum.  It 
may  be  the  first  remedy  to  use  when  the  patient  comes  from 
allopathic  hands,  having  been  dosed  with  larger  doses  of  col- 
chicum, which  is  a  very  asthenic  remedy,  producing  great 
muscular  weakness,  as  we  have  seen. — Medical  Century. 


1 90 1  Societies,  553 

SOCIETY  REPORTS. 


MASSACHUSETTS   HOilCEOPATHIC  MEDICAL 
SOCIETY. 

The  sixty-first  semi-annual  meeting  of  the  Society  was  held 
in  Pilgrim  Hall,  14  Beacon  Street,  Tuesday  evening,  October 
8,  and  Wednesday,  October  9,  1901, 

EVENING    SESSION. 

The  meeting  was  called  to  order  by  the  President,  George 
S.  Adams,  M.  D. 

Report  of  the  Committee  on  Materia  Medica. 

Charles  H.  Thomas,  M.  D.,  Chairman. 

I  "  Some  observations  on  the  waters  of  Gastein/'  Walter 
Wesselhoeft,  M.  D. 

2.  '*An  Involuntary  Proving  of  Antimony."  Fred  B. 
Percy.  M.  D. 

3.  **A  Brief  Proving  of  Pilocarpine."  G.  Forrest  Martin, 
M.  D. 

WEDNESDAY    SESSION. 

The  meeting  was  called  to  order  by  the  President,  George 
S.  Adams,  M.  D.  As  no  quorum  was  present,  the  Society 
proceeded  with  the  Scientific  Session,  opening  with  the 

Report  of  the  Committee  on  Surgery. 

WiNFiRLD  Smith,  M.  D.,  Chairman. 

1.  "A  Complicated  Fracture."     N.  W.  Emerson,  M.  D. 

2.  "A  Secondary  Celiotomy  for  Adhesion  of  the  Bowel." 
W.  F.  Wesselhoeft,  M.  D. 

3.  "The  Incision  in  Appendicectomy."  James  B.  Bell, 
M.  D. 

4.  "Asepsis  in  Vaccination."     A,  Howard  Powers,  M.  D. 

5.  "  Report  of  the  Surgical  Service  of  the  Massachusetts 
Homoeopathic  Hospital  for  July,  August  and  September, 
1901."     Winfield  Smith,  M.  D. 


554  The  New  England  Medical  Gazette,  Nov., 

At  12.30  p.  M.  the  records  of  the  last  meeting  were  read 
and  approved. 

The  Executive  Committee  recommended  the  following 
change  in  the  By-Laws  and  it  was  referred  to  the  Committee 
on  By-Laws : 

To  amend  Art.  XVIII,  by  dropping  the  word  '•upon,"  line 
three,  and  inserting  the  words  "three  years  after."  Inserting 
after  the  word  "  election,"  line  three,  the  words,  "  providing 
he  is  in  good  standing."  Also  dropping  the  word,  "therefor," 
at  the  end  of  line  three.  When  amended  the  Article  shal' 
read :  "  Every  applicant  for  membership  shall  deposit  with 
his  application  in  the  hands  of  the  Recording  Secretary  the 
sum  of  five  dollars,  and  shall,  three  years  after  his  election, 
provided  he  is  in  good  standing,  receive  the  diploma  of  the 
Society,  signed  by  the  President  and  Secretary.  Should  an 
applicant  fail  of  election,  the  money  shall  be  refunded  to 
him." 

The  following  candidates  for  membership,  approved  by  the 
Board  of  Censors  and  recommended  by  the  Executive  Com- 
mittee, were  elected : 

Henry  H.  Braley,  M.  D.,  Concord  ;  Clarence  Crane,  M.  D., 
Boston  ;  Frederick  W.  Dodge,  M.  D.,  Boston  ;  Adelbert  M. 
Hubbell,  M.  D.,  Haverhill  ;  Seth  Ames  Lewis,  M.  D,  Spring- 
field ;  Abby  Swan  Morse,  M.  D.,  Gloucester ;  Myrton  B. 
Raynes,  M.  D.,  Melrose;  H.  Leon  Steele,  M.  D.,  Norwood  ; 
John  F.  Valentine,  M.  D.,  Danvers. 

At  12.45  P-  ^-  the  Society  adjourned  for  lunch. 

The  Society  was  called  to  order  by  the  President,  George 
S.  Adams,  M.  D,,  at  1.45  p.  m.,  and  the  Annual  Oration,  en- 
titled Progressiveness  of  Medicine,  was  delivered  by  Amand. 
C.  Bray,  M.  D.     The  oration  was  followed  by  the 

Report  of  the  Committee  on  Ophthalmology,  Otology, 
Rhinology  and  Laryngology. 

N.  H.  Houghton,  M.  D.,  Chairman. 

I.     "Mastoiditis  with   Report  of  Cases."     Frederick  \V. 

Colburn,  M.  D. 


igoi  Societies.  555 

2.  "  Catarrhal  Children."    Edward  Beecher  Hooker,  M.  D. 

3.  "  Purulent  Contagious  Ophthalmia  Neonatorum."  John 
H.  Payne,  M.  D. 

Report  of  the  Committee  on  GYNj^teoLOGY. 

William  F.  Wkssblhobft,  M.  D.,  Chairman. 

1.  "The    Prevention   of    Pelvic   Disorders."     Helen    S. 
Childs,  M.  D. 

2.  "A  New  Operation  for  Cystocele."  James  B.  Bell,  M.  D. 

3.  **  Diagnosis  a  Necessity  in   the  Treatment  of   Pelvic 
Diseases."     Winslow  B.  French,  M.  D. 

Report  of  the  Committee  on  Dermatology,  Syphil- 

OLOGY.    AND    GeNITO  UrINARY    DISEASES. 
Orrbn  6.  Sandkrs,  M.  D.,  Chairman. 

1.  "The  Clinical  Value  of  a  Urinalysis  in  Some  of  the 
Common  Diseases."     Solomon  C.  Fuller,  M.  D. 

2.  "Treatment  of  Latent   Gonorrhoea  in   the    Female." 
George  R.  Southwick,  M.  D. 

3.  "Eczema  in  the  Adult."     John  L.  Coffin,  M.  D. 
Adjourned  5.30  p.  m. 

The  papers  and  discussions  will  be  found  in  full  in  the 
volume  of  transactions. 

Frederick  L.  Emerson,  M.  D. 

Recording  Secretary. 


BOSTON    HOMCEOPATHIC  riEDICAL  SOCIETY. 

BUSINESS    SESSION. 

The  regular  meeting  of  the  society  was  held  at  the  Boston 
University  School  of  Medicine,  Oct.  3,  1901,  at  eight  o'clock, 
the  President,  T.  Morris  Strong,  M.  D.,  in  the  chair. 

The  records  of  the  last  meeting  were  read  and  accepted. 

Thomas  E.  Chandler,  M.  D.,  13  Sparhawk  St.,  Brighton, 
was  proposed  for  membership. 

The  resignation  of  Dr.  L.  M.  Kimball  was  read  and 
accepted. 


556  The  New  England  Medical  Gazette,  Nov., 

Dr.  D.  W.  Wells,  for  the  committee  on  securing  full  re- 
ports of  the  meeting  of  the  American  Institute  by  the  press, 
reported  that  the  whole  matter  had  been  left  to  Dr.  C.  H. 
Thomas  and,  leaving  the  city  soon  after,  he  was  unable  to  say 
what  had  been  done. 

The  President  stated  that  he  had  been  told  by  a  member 
of  the  Associated  Press,  who  reported  for  some  of  the  New 
York  papers,  that  he  gave  close  attention  to  it  and  that 
nothing  came  over  the  wire  that  could  be  made  use  of,  which 
may  account  for  the  brief  notices  of  the  meetings  which  ap- 
peared in  the  papers,  and  will  also  explain  why  the  committee 
can  not  show  more  result. 

Voted:  That  the  Medico-Legal  Section  report  Nov.  21, 
1 90 1,  instead  of  Oct.  17. 

Report  of  the  Section  on  Electro-Therapeutics. 

T.  R.  Griffith,  M.  D.,  Chairman. 
Lucy  Barnby-Hall,  M.  D.,  Secretary.  C.  Y.  Whntworth,  M.  D.,  Treasurer. 

The  President  appointed  the  following  committee  to  nomi- 
nate sectional  officers  for  the  ensuing  year :  Drs.  H.  O. 
Spalding,  Ellen  H.  Gay  and  D.  W.  Wells.  The  committee 
reported  as  follows :  Chairman,  Caroline  Y.  Wentworth, 
M.  D.;  Secretary,  Chas.  J.  Douglas,  M.  D.;  Treasurer,  Clara 
C.  Simmons,  M.  D.,  who  were  duly  elected. 

programme. 

"Treatment  of  Neuralgia,  Neuritis  and  Rheumatism  by 
Electricity."  Two  papers  by  Eliza  T.  Ransom,  M.  D.,  and 
George  E.  Percy,  M.  D.  Discussion  by  Dr.  Frank  C.  Rich- 
ardson, Dr.  Edward  P.  Colby,  Dr.  Clara  E.  Gary,  Dr.  Martha 
E.  Mann,  Dr.  A.  Howard  Powers,  Dr.  Nelson  M.  Wood. 

As  only  a  few  members  were  present,  it  was  voted  to  post- 
pone the  report  of  this  Section  until  October  1 7. 

Adjourned  at  8.25. 

liDWARD  D.  Allen, 

Secretary, 


1 90 1  Societies,  557 

HOnCEOPATHY   IN   THE  SOUTH.. 

The  seventeenth  annual  session  of  the  Texas  Homoeopathic 
State  Society  was  held  at  Dallas,  October  8  and  9,  with  a  large 
attendance  and  a  gratifying  number  of  applications  for  mem- 
bership. Several  of  the  recent  graduates  who  have  located 
in  our  state  made  their  initiatory  bow,  and  the  meeting  as  a 
whole  was  pronounced  enthusiastic. 

The  officers  for  the  ensuing  year  are  :  President,  Dr.  W.  D. 
Gorton,  Austin ;  ist  Vice-President,  Dr.  W.  F.  Thatcher, 
Dallas ;  2d  Vice-President,  Dr.  E.  E.  Davis,  Dallas ;  Secre- 
tary, Dr.  Julia  H.  Bass,  Austin ;  Treasurer,  Dr.  T.  J.  Crowe, 
Dallas. 

Texas  has  over  one  hundred  of  the  most  promising  towns 
for  Homoeopaths  to  settle  that  can  be  found  in  any  land  or 
clime.  Fees  and  collections  are  good.  Our  new  medical  law 
provides  for  a  Homoeopathic  Board  of  Medical  Examiners 
and  exempts  from  examination  holders  of  state  certificateis 
whose  credentials  are  first-class.  Correspondence  invited 
from  all  who  desire  a  change  for  the  better,  as  well  as  from 
the  recent  graduate. 

Julia  H.  Bass,  Secretary, 

Austin,  Texas. 


In  Treating  Tuberculosis.  Rest  is  imperative  in  all 
cases  of  tuberculosis  in  which  the  temperature  is  above 
normal.  Exercise  is  of  importance  and  should  be  judiciously 
taken,  with  due  regard  to  its  effect  on  the  temperature  and 
pulse.  If  these  are  materially  increased  by  it,  the  exercise  is 
beyond  the  powers  of  the  patient.  The  diet  should  be  as 
generous  as  can  be  digested,  in  febrile  cases  the  heaviest 
meals  being  given  in  the  early  part  of  the  day,  as  the  temper- 
ature is  usually  normal  then.  In  the  way  of  treatment,  the 
first  place  should  be  attached  to  whatever  will  improve  the 
powers  of  digestion,  and  everything  that  tends  to  disturb  this 
function  scrupulously  avoided. — Exchange, 


558  The  New  England  Medical  Gazette.  Nov., 

REVIEWS  AND  NOTICES  OF  BOOKS. 


Operative  Surgery,  Vol.  II.  By  Joseph  D.  Bryant,  M.  D.,  Prof- 
essor of  the  Principles  and  Practice  of  Surgery,  Operative  and 
Clinical  Surgery,  University  and  Bellevue  Hospital  Medical  Col- 
lege ;  Visiting  Surgeon  to  Bellevue  and  St.  Vincent's  Hospitals, 
etc.,  etc.     D.  Appleton  &  Co.,  New  York. 

The  second  volume  of  Dr.  Bryant's  "  Operative  Surgery  "  is  now 
before  the  profession  and  it  completes  a  surgery  worthy  of  very  care- 
ful consideration.' 

This  volume,  of  some  700  pages,  considers  operations  on  the 
mouth,  nose  and  oesophagus,  the  viscera  connected  with  the  peri- 
toneum, the  thorax  and  neck^  scrotum  and  penis,  and  miscellaneous 
operations. 

It  is  amply  supplied  with  plates  and  illustrations,  827  in  all,  in- 
cluding 40  colored  plates. 

The  subjects  are  skilfully  treated  and  abundant  reference  is  given 
to  various  methods  used  by  different  operators  of  note,  thus  adding 
to  its  value  as  a  reference  book. 

The  illustrations  are  profuse,  but  none  the  less  instructive,  and 
the  sections  on  abdominal  surgery  especially  well  depicted.  Under 
scrotum  and  penis  we  find  an  up-to-date  consideration  of  that  branch 
of  surgery,  of  great  value  to  the  general  practitioner. 

The  well-chosen  idea  of  photographic  plates  of  instruments  re- 
quired in  different  operations  is  continued  in  this  volume  to  ad- 
vantage. 

It  would  seem  that  Dr.  Bryant  had  contributed  an  excellent  ad- 
dition to  the  field  of  surgery,  and  his  efforts  should  be  rewarded  by 
a  large  circulation  of  this  work. 

The  publishers'  work  is  of  high  grade  as  usual. 

J.    A.    R.    JR. 

Saunders'  Medical  Hand  Atlases.  Atlas  and  Epftome  of  the 
Nervous  Sysiem  and  Ii^  Diseases.  By  Professor  Dr.  Chr. 
Jakob,  of  P^langen.  From  the  Second  Revised  German  Edition. 
Edited  by  Edward  D.  Fisher,  M.  D.,  Professor  of  Diseases  of  the 


190 1  Reviews  and  Notices  of  Books,  559 

Nervous  System,  University  and  Bellevue  Medical  College,  New 
York.  With  83  plates  and  copious  text.  Philadelphia  and  Lon- 
don :  W.  B.  Saunders  &  Co.,  1901.     Cloth,  $3.50  net. 

In  this  Atlas  the  author  has  portrayed  an  instructive  section  of 
medicine  which  is  usually  extremely  difficult  of  mastery  by  students 
and  practitioners.  This  work  will  be  of  great  value  to  the  physician. 
The  matter  is  divided  into  Anatomy,  Pathology  and  Description  of 
Diseases  of  the  Nervous  System.  The  plates  illustrate  these  divis- 
ions most  completely.  There  is  probably  no  work  in  existence  in 
which  so  much  is  compressed  within  so  small  a  space.  The  book  is 
comprehensive  and  practical. 

Saunders'  Medical  Hand  Atij^ses.  Atl.\s  and  Ephome  of  Oph- 
thalmoscopy AND  Ophthalmoscopic  Diagnosis.  By  Prof.  Dr. 
O.  Haab,  Director  of  the  Eye  Clinic  in  Zurich.  From  the  Third 
Revised  and  Enlarged  German  Edition,  Edited  by  Geo.  E. 
De  Schweinitz,  Professor  of  Ophthalmology,  Jefferson  Medical 
College,  Philadelphia.  With  152  colored  lithographic  illustrations 
and  85  pages  of  text.  Philadelphia  and  rx)ndon  :  W.  B.  Saunders 
&  Co.,  1 901.     Price,  $3.00  net. 

The  great  value  of  Prof.  Haab's  Atlas  of  Ophthalmoscopy  and 
Ophthalmoscopic  Diagnosis  has  been  fully  established  and  entirely 
justifies  an  English  translation  of  his  latest  edition.  Not  only  is  the 
student  made  acquainted  with  carefully  prepared  ophthalmoscopic 
drawings  done  into  well-executed  lithographs  of  the  most  important 
founders  changes,  but  in  many  instances,  plates  of  the  microscopic 
lesions  are  added.  The  whole  furnishes  a  manual  of  the  greatest 
possible  ser\ice,  not  only  to  the  beginner  in  ophthalmic  work,  but  to 
one  who  has  already  far  advanced  and  desires  to  compare  the  obser- 
vations of  his  own  service  with  those  of  the  rich  clinic  from  which 
Prof.  Haab  has  gathered  his  plates. 

The  American  Illustrated  Medical  Dictionary.  A  new  and 
complete  dictionary  of  the  terms  used  in  medicine,  surgery,  den- 
tistry, pharmacy,  chemistry  and  the  kindred  branches,  with  their 
pronunciation,  derivation  and  definition,  including  much  collateral 
information  of  an  encyclopaedic  character.  By  VV.  A.  Newman 
Dorland,  A.  M.,  M.  D.,  Assistant  Obstetrician  to  the  University 
of  Pennsylvania  Hospital,  Editor  of  the  American  Pocket  Medical 


S6o  The  New  England  Medical  Gazette.  Nov., 

Dictionary,  Fellow  of  American  Academy  of  Medicine.  With 
numerous  illustrations  and  24  colored  plates.  Philadelphia  and 
Ix>ndon  :  W.  B.  Saunders  &  Co.,  1900. 

This  is  a  very  practical  dictionary.  By  being  well-printed  on  thin 
paper,  the  publishers  have  been  enabled  to  get  a  complete  dictionary 
within  very  serviceable  limits.  Besides  the  usual  anatomic  and  clin- 
ical tables,  it  has  specially  prepared  tables  of  Tests,  Stains  and 
Staining  Methods.  Several  of  the  subjects,  such  as  Amputations, 
Arteries,  Bandages,  Casts,  Cells,  Fractures,  Hernias,  Ligaments,  etc., 
are  admirably  illustrated.  The  book  is  finely  made-up  with  flexible 
covers  and  should  be  found  on  every  physician's  desk. 

Price,  ^4. 50  plain,  or  J5.00  indexed. 

The  Ready  Reference  Handbook  of  Diseases  of  the  Skin.  By 
George  Thomas  Jackson,  M.  D.,  Chief  of  Clinic  and  Instructor 
in  Dermatology,  College  of  Physicians  and  Surgeons,  New  York ; 
Consulting  Dermatologist  to  the  Presbyterian  Hospital,  New  York, 
etc.,  etc.  Fourth  Edition,  with  80  Illustrations  and  3  Plates. 
Lea  Bros.  &  Co. 

Those  familiar  with  Dr.  Jackson's  earlier  editions  will  appreciate 
what  an  aid  his  handbooks  are  to  the  general  practitioner  and  stu- 
dent of  skin  diseases.  This  fourth  and  last  edition  of  some  650 
pages  is  very  complete  for  a  hand  book  and  yet  not  filled  up  with 
unnecessary  discussion  of  debatable  subjects.  Its  subject  matter  is 
well  up  to  date. 

Crocker's  classification  of  skin  diseases  is  followed  and  brief  ref- 
erence to  the  most  "  prominent  primary  lesion  "  is  made  opposite 
each  disease  in  question. 

The  appendix  of  formulae  for  the  treatment  of  skin  diseases  is 
of  value  especially  to  beginners. 

The  cuts  are  clear  and  the  general  appearance  of  the  book  does 
credit  to  the  publishers. 

Annual  and  Analytical  Cyclopaedia  of  Praciical  Medicine. 
By  Charles  E.  de  M.  Sajous,  M.  D.,  and  One  Hundred  Associate 
Editors,  assisted  by  Corresponding  Editors,  Collaborators  and 
Correspondents.  Illustrated  with  Chromo- Lithographs,  Engrav- 
ings and  Maps.  Volume  VI.  Philadelphia,  New  York,  Chicago  : 
F.  A.  Davis  Company,  Publishers,  1901. 


1 90 1  Reviews  and  Notices  of  Books,  5  6 1 

This,  the  sixth  volume  of  Sajous'  work,  completes  the  series.  It 
contains  in  alphabetical  order,  various  subjects  from  ''Diseases  of 
the  Rectum"  to  "Zinc,"  inclusive.  The  same  care  and  thorough- 
ness is  evidenced  in  this  volume  as  in  the  preceding.  Taken  all 
together,  as  a  completed  work,  it  is  invaluable  for  ready  reference, 
enabling  one  to  see  at  a  glance  the  best  of  the  most  recent  literature 
on  any  given  subject. 


REPRINTS   AND   MONOGRAPHS   RECEIVED. 


Roentgen  Rays  in  the  Treatment  of  Diseases  of  the  Skin.  By 
Wm.  A.  Pusey,  M.  D.  Reprinted  from  the  Journal  of  the  Amer- 
ican Medical  Association ^  Sept.  28,  1901. 

Congenital  Anterior  Dislocation  of  the  Tibia  Treated  by  Arthrot- 
omy.  By  John  B.  Roberts,  M.  D.  Reprinted  from  Annals  of 
Surgery^  August,  1901. 

Endo- Cardiopathies.  By  Thomas  E.  Satterthwaite,  M.  D.  Re- 
printed from  Virginia  Medical  Semi-Monthly^  April  26,  1901. 

Bottini's  Operation  for  Enlarged  Prostate,  with  Report  of  Five 
Cases.  By  Henry  H.  Morton,  M.  D.  Reprinted  from  the  Medical 
Record,  Sept.  17,  1898. 

The  Doctor's  Fee,  A  Plea  for  Honorable  Dealing.  By  John  B. 
Roberts,  M.  D. 

A  Study  of  Burns,  with  A  Plea  for  Their  More  Rational  Treat- 
ment. By  Frederic  Griffith,  M.  D.  Reprinted  from  the  Medical 
News,  Aug.  24,  1 90 1. 

Acute  Endocarditis.  By  Thomas  E.  Satterthwaite,  M.  D.  Re- 
printed from  the  Medical  Times,  May,  iQoi. 

Abstract  of  the  Eleventh  Census,  1890.  Department  of  the  In- 
terior, Census  Division,  Washington,  D.  C,  1896. 


562  The  New  England  Medical  Gazette.  Nov., 

ITEMS  OF  INTEREST. 


Dry  Lymph.  It  has  been  demonstrated  again  and  again 
that  the  unpleasant  local  effects  that  sometimes  follow  vaccin- 
ation are  seldom  the  result  of  any  original  contamination  of 
the  virus,  and  they  never  will  be  if  the  most  ordinary  precau- 
tions are  taken  ;  hence  the  addition  of  a  germicide  is  not  at 
all  necessary,  especially  that  of  a  feeble  one  like  glycerin, 
which,  whatever  else  it  may  do  to  vaccine,  certainly  dilutes 
it,  and  so,  one  would  suppose,  diminishes  its  potency.  Given 
a  vaccine  free  from  noxious  contamination  —  and  dried  lymph 
should  always  be  that — what  is  wanted  is  one  that  will  act 
quickly  and  produce  typical  pocks.  Such,  we  believe,  is  dried 
lymph  properly  prepared,  properly  transplanted,  and  properly 
used. — New  York  Medical  JoumaL 

Effect  of  Temperature  on  Bacillus  Pestis.  The 
effect  of  temperature  on  bacillus  pestis  is  very  remarkable. 
It  is  very  sensitive  to  slight  changes.  In  fact,  temperature 
seems  to  be  the  most  important  factor  in  the  viability  of  the 
organism.  It  may  be  kept  alive  and  virulent  a  very  long 
time  in  the  cold,  even  though  dry,  but  it  can  not  live  long 
when  dry  at  the  temperature  of  the  body.  High  temper- 
atures, such  as  70^  C.  or  more,  are  invariably  fatal  in  a  few 
minutes. 

The  bacillus  is  not  as  sensitive  to  temperature  when  kept 
moist,  for  under  such  conditions  it  will  live  a  very  long  time 
in  albuminous  media  at  37^  C. — Surgeon  Rosenau,  Marine 
Hospital  SenncCy  Modem  Medicine. 

Cancer  of  the  Uterus.  While  Gaylord,  of  the  New 
York  laboratory,  has  done  something  toward  establishing  the 
parasitic  theory  of  the  disease,  his  claim  is  criticized  by  so 
eminent  a  man  as  Cullen,  and  should  be  held  "sub  judice.'* 
Still,  there  is  no  doubt  that  while  he  may  not  be  on  the  right 
track,  his  efforts  are  certainly  commendable. 

As  yet,  in  the  treatment  of  cancer  of  the  uterus,  the  early 


190 1  Personal  and  News  Items,  563 

recognition  of  the  disease  and  the  early  application  of  the 
surgeon's  knife  with  a  view  to  sacrificing  all  suspicious  sur- 
rounding tissues  seems  to  meet  with  continued  favor,  and 
justly  so. 

This  brings  to  my  mind  the  necessity  of  a  renewed  appeal 
to  the  general  practitioner  to  examine  all  women  who  are  ap- 
proaching the  menapause,  whenever  the  danger  signals  in  the 
way  of  hemorrhage,  etc.,  are  sounded. — St,  Louis  Medical 
Journal, 

Our  Late  President.  The  lives  of  great  men  are  object 
lessons  ;  they  teach  others  how  to  live ;  and  in  thus  teaching 
others  they  regenerate  and  perpetually  rejuvenate  the  world. 
They  also  in  a  striking  manner  exemplify  upon  what  traits  of 
character  the  world  at  large  places  the  highest  value.  Thus, 
with  a  full  appreciation  of  President  McKinley's^political  wis- 
dom, his  high  executive  ability,  his  "safety"  as  a  ruler  and 
leader,  it  is  after  all  the  true  goodness  of  the  man,  his  loyalty 
to  the  companion  of  his  life  and  to  his  friends,  his  gentleness 
resting  upon  rugged  strength,  which  made  him  the  "  well- 
beloved  "  President  of  the  American  people.  No  other  Pres- 
ident of  the  United  States,  it  is  safe  to  affirm,  has  ever  re- 
ceived during  his  lifetime  so  many  marks  of  personal  devotion, 
so  unstinted  and  ever-increasing  a  flow  of  love,  and  that  be- 
cause he  was  fortunately  so  placed  that  the  simple  goodness 
and  purity  of  the  man  was  at  no  time  overshadowed  by  the 
dignity  of  the  oflSce  which  he  held. — Pacific  Coast  Journal  oj 
HomcBopathy, 


PERSONAL  AND   NEWS   ITEMS. 


Dr.  J.  M.  HiNSON  has  removed  to  601  Boylston  St.,  on 
Copley  Square. 

Edward  R.  Snader,  M.  D.,  has  removed  to  1919  Arch 
St.,  Philadelphia,  Pa. 

Dr.  Anna  Temple  Lovering,  Librarian  of   the   Boston 


564  The  New  England  Medical  Gazette.  Nov., 

University  Medical  Library,  has  returned  from  Europe  and 
has  removed  to  13  St.  James  Ave.,  Boston. 

J.  Herbert  Moore,  M.  D.,  of  Brookline,  has  removed  his 
office  to  1339  Beacon  St.  He  will  have  office  hours  there 
from  8  until  9  a.  m.  and  from  4  until  6  p.  m. 

For  Sale. — Two  second-hand  six  plate  Waite  &  Bartlett 
Static  Machines,  and  one  four  plate  Knott  Static  Machine. 
These  machines  are  on  exhibition  at  Otis  Clapp  &  Son's,  and 
may  be  purchased  at  a  bargain. 

Dr.  E.  R.  Johnson,  of  Wollaston,  is  making  a  specialty  of 
diseases  of  the  nose,  ear  and  throat.  He  will  be  associated 
with  Dr.  George  B.  Rice  and  will  have  office  hours  at  No.  220 
Clarendon  St.,  Boston,  on  Wednesdays  and  Saturdays, 

The  Rio  Chemical  Co.  have  removed  from  St.  Louis  to 
56  Thomas  St.,  New  York  City.  This  step  is  taken  because 
of  the  superior  facilities  New  York  offers  tor  foreign  trade, 
as  well  as  for  greater  ease  in  obtaining  the  ingredients  that 
enter  into  their  preparations. 

Connecticut  Homceopathic  Medical  Society.  The 
above  society  will  hold  its  semi-centennial  celebration  at 
Unity  Hall,  Hartford.  Ncrvember  18  and  19.  Among  the 
speakers  will  be  Dr.  J.  P.  Sutherland,  of  Boston,  whose  topic 
will  be  "The  Homoeopathic  Materia  Medica." 


THE  NEW  ENGLAND 

MEDICAL    GAZETTE 

No.  12.  DECEMBER,   1901.  Vol.  XXXVI. 


COMMUNICATIONS. 


A  COMPLICATED  FRACTURE. 

BY    NATHANIEL   W.   EMERSON,    M.  D. 
[Read  before  Mass.  Horn.  Society.] 

In  the  latter  part  of  November,  1900,  I  was  asked  to  see 
Mr.  G.  H.  W.,  who  gave  the  following  history :  On  October 
I,  1900,  he  was  knocked  with  great  violence  from  a  moving 
freight  car  by  coming  in  contact  with  a  bridge.  It  was  not 
known  what  was  the  nature  of  his  flight  to  the  ground. 
Later  in  the  day  competent  professional  attendance  was  af- 
forded him,  and  examination  showed  a  compound  fracture 
of  the  femur  in  the  middle  third,  with  the  end  of  the  upper 
fragment  pushed  through  on  the  outer  aspect  of  the  thigh. 
There  was  no  serious  laceration  of  the  soft  tissues,  and  no 
unusual  difficulty  in  reducing  the  fracture.  The  leg  was  put 
up  with  extension,  and  a  long  side  splint  reaching  to  the 
axilla,  a  long  posterior  splint  and  a  long  inside  splint,  and  a 
few  days  later  the  case  was  seen  by  an  expert  and  the  method 
of  treatment  approved.  The  wound  healed  in  about  three 
weeks,  in  five  weeks  the  splints  were  taken  off  for  inspection 
and  the  contour  of  the  leg  was  correct.  The  splints  were 
put  back  as  before,  except  that  the  external  lateral  splint  was 
shortened  and  extension  discontinued.  When  next  the 
splints  were  removed,  about   a  week  later,  some  deformity 


566  The  New  Engianel  Medical  Gazette,  Dec, 

was  apparent,  and  I  was  asked  to  see  the  case.  An  examin- 
ation showed  an  incomplete  union  of  the  bony  parts,  de- 
formity of  the  thigh,  and  much  shortening  of  the  whole  limb, 
although  accurate  measurements  could  not  be  made  at  the 
time.  I  advised  his  removal  to  the  Hospital  and  the  use  of 
the  X  ray,  and  this  was  accomplished  on  the  same  day. 
Skiagraphs  of  the  seat  of  fracture  showed  an  overlapping  of 
the  ends  of  the  bone,  and  I  therefore  advised  cutting  down 
upon  them  and  wiring.  Measurement  also  showed  a  short- 
ening of  between  two  and  three  inches.  Consequently,  on 
November  21,  under  ether,  a  curved  incision,  five  to  six 
inches  long,  was  made  over  the  anterior  and  outer  aspect  of 
the  thigh  down  to  the  muscles.  These  were  then  separated 
until  the  end  of  the  upper  fragment  was  exposed,  and  further 
dissection  showed  that  the  ends  of  the  bone  overlapped  from 
two  and  a-half  to  three  inches,  the  upper  end  lying  on  the 
outside.  They  were  so  bound  together  and  to  the  soft  parts 
that  reduction  was  impossible,  and  yet  at  the  same  time  there 
was  no  stability  to  the  union,  all  appearances  of  a  provisional 
callous  being  lacking.  The  lower  fragment  could  be  moved 
in  any  direction.  It  was  therefore  necessary  to  break  up  all 
adhesions  between  the  soft  parts  and  the  bone.  After  the 
bones  were  thus  freed,  forcible  extension  reduced  the  frac- 
ture, but  it  was  found  impossible  to  retain  it  in  position. 
The  moment  extension  was  discontinued  the  ends  of  the  bone 
instantly  returned  to  the  faulty  position.  A  more  careful  in- 
spection discovered  a  large  sequestrum  from  the  posterior 
surface  of  the  bone,  irregularly  triangular  in  shape,  about 
one  and  five-eighths  inches  in  the  longest  diameter,  and  some- 
thing over  one  inch  in  the  shorter  diameter.  This  fragment 
came  from  the  posterior  portion  of  the  shaft  of  the  bone,  was 
traversed  by  the  linea  aspera,  and  embraced  the  whole  thick- 
ness of  the  bone.  It  was  so  shaped  that  it  prevented  the 
retention  of  the  ends  of  the  bone  in  coaptation,  and  there 
were  no  signs  that  any  special  effort  had  been  made  by 
nature  to  include  this  fragment  in  the  process  of  repair  and 


190 1  'A   Complicated  Fracture.  567 

it  was  therefore  removed.  This  left  an  irregularly  shaped 
cone  at  the  end  of  each  fragment,  and  when  brought  into  ap- 
position the  areas  in  contact  were  so  small  that  the  irregular- 
ities of  the  upper  fragment  were  sawed  off  and,  by  traction 
upon  the  foot,  elongation  sufficient  to  coaptate  was  secured. 
The  bones  were  then  wired  into  position  with  two  silver 
wires,  one  on  the  anterior  and  the  other  on  the  external  lat- 
eral surface  of  the  bone.  The  soft  parts  were  united  by  con- 
tinuous catgut  sutures,  two  rows  of  which  were  buried,  and 
three  silk-worm  gut  sutures  for  stay  sutures.  The  wound 
was  covered  with  a  collodion  dressing,  a  long  strap  of  adhe- 
sive plaster  applied  upon  either  side  of  the  leg,  and  the  whole 
leg  from  the  ankle  to  the  hip  was  bandaged  with  roller  band- 
ages. After  being  put  to  bed,  the  leg  was  placed  upon  an 
inclined  plane,  the  outer  end  of  which  was  carried  outward 
and  upward,  and  extension  was  continued  in  this  direction, 
ten  lbs.  being  put  on  at  first  with  the  intention  of  increasing 
it  to  fifteen  lbs.  later.  Large  sandbags  were  placed  at  the 
side  of  the  pelvis,  and  the  foot  of  the  bed  elevated  about 
eight  inches. 

On  November  22  the  leg  was  so  painful  that  the  weights 
were  reduced  to  ten  lbs.  and  afterwards  increased  to  twelve 
lbs. 

November  27.  The  leg  has  been  very  comfortable  up  to 
the  present  time,  paining  him  almost  none  at  all.  It  was 
dressed  to-day  for  the  first  time,  by  opening  the  bandages 
down  to  the  limb.  The  wound  was  without  irritation  and 
healed  by  first  intention,  and  the  silk-worm  stitches  were  re- 
moved. While  there  has  been  a  rising  temperature  with 
morning  and  evening  fluctuations,  showing  pus,  examination 
of  the  wound  reveals  nothing. 

December  4.  Temperature  fluctuations  have  been  more 
extreme  and  gradually  growing  higher.  The  site  of  the  old 
scar  made  at  the  time  of  the  original  injury  having  become 
red  and  inflamed,  under  aseptic  precautions  and  the  use  of 
ethyl  chloride,  an  incision  was  made  over  the  old  scar  and  a 


568  The  New  England  Medical  Gazette,  Dec, 

considerable  amount  of  inodorous  pus  was  evacuated.  A  cu- 
rette was  passed  down  to  the  bone  and  came  in  contact  with 
denuded  bone,  and  there  was  probably  not  the  slightest  at- 
tempt at  bony  union ;  on  the  contrary  there  was  apparent 
necrosis  of  the  ends  of  the  fragments,  thus  necessitating  in 
all  probability  further  operation.  A  drainage  tube  was  in- 
serted. This  caused  the  temperature  to  fall  so  rapidly  that 
by  December  6  it  was  again  normal.  The  appearance  of  the 
leg,  however,  was  not  satisfactory,  it  was  swollen  and  oedem- 
atous  and  pasty  looking,  and  a  bacteriological  examination  of 
the  pus  showed  that  the  affection  was  due  to  the  strepto- 
coccus. I  felt  that  the  case  was  more  than  usually  a  serious 
one,  and  although  the  temperature  continued  satisfactory,  the 
general  appearance  of  the  patient  was  far  from  being  so,  and 
it  seemed  to  me  that,  if  the  case  continued  as  it  was  now 
going,  the  best  that  could  be  hoped  for  would  be  to  save  the 
patient's  life,  but  with  the  loss  of  the  leg  close  to  the  hip. 
After  consultation  with  the  family  and  physician,  and  placing 
the  whole  matter  before  them,  I  advised  another  operation. 
My  idea  was  to  expose  the  ends  of  the  bone  and  go  back  far 
enough  upon  the  shaft  to  remove  these  ends  through  the 
whole  diameter  of  the  bone,  then  to  butt  these  broad-ended 
fragments  directly  together  and  wire  them  there,  recognizing 
that  if  union  took  place  there  would  be  two  and  a-half  inches 
or  more  of  shortening.  If  union  failed,  it  seemed  then  as  if 
the  leg  would  have  to  come  off. 

On  December  ii,  I  again  opened  the  leg  to  the  fracture, 
making  a  semilunar  incision  just  inside  the  former  one. 
Considerable  callous  was  found  about  both  fractured  ends  of 
bone,  which  was  a  symptom  of  encouragement,  inasmuch  as 
the  previous  operation  had  shown  there  was  not  the  slightest 
development  of  callous.  It  seemed  to  indicate  that  the  ability 
to  secrete  a  callous  was  not  lacking,  only  the  proper  con- 
ditions for  the  same.  The  ends  of  the  bone  were  found  in 
apposition  and  the  effort  at  repair  had  been  so  successful 
that  at  first  sight  it  seemed  remarkable  that  there  was  failure. 


190 1  A   Complicated  Fracture,  569 

Separating  and  exposing  the  ends  of  the  bones,  an  irregular 
piece  of  bone  from  one-half  to  two-third  inches  long,  and 
of  considerable  width,  was  sawed  off  from  the  upper  frag- 
ment at  right  angles  to  the  long  axis  of  the  shaft,  and  in 
doing  this  I  unwittingly  got  at  what  I  believe  to  be  the  root 
of  the  whole  trouble,  as  will  be  explained  shortly.  Then 
from  the  lower  fragment  a  piece  from  one  and  a-quarter  to 
one  and  a-half  inches  long  was  removed.  This  was  necessary 
because  periosteum  was  lacking  for  this  distance  and  it  was 
thought  wiser  to  go  sufficiently  far  to  get  a  section  through  a 
thoroughly  nourished  part  of  the  shaft.  The  ends  of  the 
bone  were  then  accurately  fitted  together  and  secured. 

Examination  of  the  fragments  showed  that  the  upper  one 
was  pyramidal,  somewhat  honeycombed  in  appearance,  and 
easily  broken  up  into   additional  pieces. 

In  the  centre  of  the  medullary  substance  of  this  piece  was 
found  a  bit  of  the  external  part  of  the  shaft,  pyramidal  in 
shape  and  completely  imbedded.  The  periosteal  surface  was 
flush  with  the  sawn  surface  of  the  fragment.  It  was  entirely 
shut  in,  and  must  have  found  its  present  location  as  the  re- 
sult of  extreme  and  sudden  violence.  Also,  in  this  same 
fragment  is  a  small  piece  of  steel  or  iron,  completely  imbed- 
ded, bright  and  glistening,  and  surrounded  by  softened  and 
discolored  tissue  with  sinuses  leading  to  it,  and,  in  my  opinion, 
this  was  the  cause  of  the  difficulty  in  obtaining  a  proper 
union  after  the  last  operation.  Manipulation  at  that  time  al- 
lowed access  of  air,  which  in  turn  favored  the  development 
of  germs  which  up  to  that  time  had  been  encapsuled. 

Inflammation  following  this  last  operation,  progress  was 
not  satisfactory,  and  on  December  18  all  dressings  were  re- 
moved and  the  wound  was  found  to  be  septic.  The  leg  was 
oedematous  and  enormously  swollen.  The  wound  was  opened 
throughout  and  down  to  the  bone,  there  being  a  profuse  dis- 
charge of  creamy  pus.  This  was  all  washed  out  with  sterile 
water  and  afterwards  with  peroxide  of  hydrogen,  and  the 
wound  left  wide   open.      Microscopical  examination  showed 


570  The  New  England  Medical  Gazette,  Dec, 

the  inflammation  was  caused  by  the  streptococcus.  It  was 
therefore  dressed  daily,  improved  quickly,  and  the  bony  union 
was  finally  satisfactory  except  the  shortening.  He  was  dis- 
charged March  14,  entirely  well,  but  with  about  two  and  a 
half  inches  shortening  of  the  affected  side. 

My  own  explanation  of  all  this  is  that  in  the  first  instance, 
while  reduction  was  complete,  it  was  well  nigh  impossible  to 
maintain  it  with  so  large  a  loose  fragment  from  the  linea 
aspera.  This,  together  with  the  fractured  bone  ends,  caused 
a  series  of  inclined  planes,  besides  preventing  a  blending  of 
the  parts  by  a  provisional  callous. 

The  fracture  was  originally  caused  by  a  direct  impact  of  a 
metal  such  as  a  bolt  or  rod,  which  penetrated  the  soft  parts 
to  the  bone  in  the  course  of  his  flight  to  the  ground.  This 
blow  was  delivered  with  such  force  that  it  broke  out  the 
large  fragment,  from  the  linea  aspera,  and  at  the  same  time 
left  a  chip  from  itself  behind.  This  was  so  forcibly  driven 
into  the  bone  that  it  was  shut  in,  and  when  my  first  operation 
opened  to  it  and  exposed  it,  somewhat  indirectly  to  be  sure, 
but  enough  to  light  up  infection,  did  it  show  itself,  and  this 
interfered  with  the  union  at  that  time  and  probably  was  the 
entire  cause  of  failure.  The  second  operation,  removing 
more  bone,  exposed  the  deeper  parts  and  also  showed  the  be- 
ginning necrosis  of  the  end  of  the  bone,  the  latter  being 
secondary  to  the  former  operation.  Then  followed  the  strep- 
tococcus infection. 

Had  union  occurred  under  the  first  dressing,  the  probabil- 
ities arc  that  there  would  have  been  trouble  at  some  future 
time,  since  it  is  hardly  probable  that  so  much  comminuted  bone 
and  foreign  matter  could  have  been  successfully  encapsuled 
and  sterilized.  Amputation  was  seriously  considered  at  one 
time,  and  this  case  is  recorded  merely  as  encouragement  for 
somebody  else  under  like  circumstances. 


IQOI  Notes  on  the    Waters  of  Gastein,  571 

NOTES  ON  THE  WATERS  OF   QA5TEIN. 

BY    WALTKR    WESSELHOKFT,  M.  D. 

The  observations  I  venture  to  offer  at  this  time  are  by  no 
means  new.  But,  like  many  other  forgotten  or  half-forgotten 
experiences,  they  have  a  value  which  I  think  we  should  recog- 
nize and  build  upon.  In  the  earlier  homoeopathic  literature 
the  waters  of  Gastein,  a  health  resort  in  the  Austrian  Tyrol, 
with  their  peculiarly  obscure  chemical  and  physical  prop- 
erties and  their  centuries-old  fame  for  curative  powers,  were 
repeatedly  the  subject  of  original  investigation  and  both 
scientific  and  practical  essays,  such'  as  we  rarely  see  in 
these  days.  Indeed,  since  the  manufacturing  chemist  has 
come  to  be  the  teacher  of  the  physician  in  all  matters 
pertaining  to  medicinal  therapeutics,  and  claims  to  pro- 
duce substances  curative  for  almost  every  known  form  of 
disease,  we  are  too  apt  to  overlook  the  fact  that  nature  also 
possesses  a  laboratory  in  which  she  compounds  remedial 
agents  of  jgreat  purity  and  much  efficacy.  For  us,  the  waters 
of  Gastein,  celebrated  as  they  are  throughout  the  continent 
of  Europe,  should  continue  to  have  a  very  special  interest, 
since  their  qualities  were  first  studied  scientifically  by  a  mem- 
ber of  our  own  school.  It  was  the  late  Dr.  Trolle  who  sub- 
jected them  to  modern  chemical  and  physical  tests  and 
called  the  attention  of  Liebig,  Rettenbach  and  others  to  the 
results  he  obtained.  During  the  last  two  years,  at  the  in- 
stance of  the  town  authorities.  Prof.  Von  Thau,  of  Buda- 
pest, has  once  more  taken  up  these  inquiries,  and  gives  in 
his  text-book  of  electro-chemistry  some  remarkable  data  which 
we  would  do  well  to  contemplate  with  some  care.  His  exper- 
iments are  not  yet  concluded  and  are  only  partially  published, 
but  when  complete  will  undoubtedly  afford  some  degree  of 
comfort  to  those  who  retain  a  lingering  regard  for  the  genius 
of  Hahnemann. 

The  origin  of  these  waters,  like  much  else  concerning  them, 
is  still  a  matter  of  conjecture.  They  gush  in  some  twenty- 
three  springs  from  the  mountain-side  at  an  elevation  of  be- 


572  The  New  England  Medical  Gazette.  Dec, 

tween  three  and  four  thousand  feet  above  the  sea  level,  their 
temperature  varying  according  to  location  from  120^  to 
1 70^  F.  Although  they  pass  through  gneiss  and  conglom- 
erate rock,  it  can  be  shown  that  they  derive  none  of  their 
chemical  constituents  from  these  formations.  They  are  col- 
lected in  reservoirs  admirably  constructed,  and  distributed 
through  wooden  and  galvanized  iron  pipes  to  the  various 
hotels  and  baths,  where  they  are  used  by  thousands  of  patients 
anually  for  a  great  variety  of  ailments. 

Their  temperature  makes  it  evident  that  they  come  from  a 
great  depth  beneath  the  earth's  surface,  but  unlike  other  hot 
springs  and  geysers,  their  chemical  composition  gives  no  clue 
to  the  strata  in  which  they  take  their  origin.  Like  the  waters 
of  Poland  Springs,  in  Maine,  they  are  as  pure  as  spring  waters 
can  well  be,  containing  in  10,000  parts  less  than  three  parts 
of  solid  matter.  From  this  it  is  assumed  that  they  originate 
in  steam  produced  at  an  intense  heat  and  condensed  in  the 
cooler  strata  through  which  they  pass  to  the  surface.  These 
matters  are  still  under  investigation.  To  us  they  are  of  int- 
erest only  in  consideration  of  the  unusual  purity  of  the  water 
and  its  unquestioned  effect  upon  certain  pathologic  states, 
proved  by  many  centuries  of  experience. 

The  chemical  and  physical  properties  of  all  the  springs  are 
the  same,  showing  them  all  to  be  of  one  origin  although 
escaping  through  different  channels. 

The  chemical  analysis  of  Prof.  Ludwig  and  others  shows 
the  water  to  contain  potash,  soda,  lithia,  caesium,  rubidium, 
calcium,  strontium,  magnesium,  aluminium,  iron,  manganese, 
arsenic,  chlorine,  fluorine,  sulphuric,  phosphoric,  carbonic  and 
titanic  acids,  and  one  or  two  volatile  organic  acids.  With  the 
figures  in  fractions  of  the  quantitative  analyses  I  will  not 
weary  you.  Suffice  it  to  say  that  these  substances  are  pres- 
ent in  almost  infinitesimal  amounts,  of  which  the  sum  is,  as 
before  stated,  between  two  and  three  parts  in  10,000  or,  to  be 
exact,  2.421  parts  in  10,000,  Which  of  these  constituents 
may  be  the  bearer  of  the  curative  virtues  no  one  can  say. 
For  us  these  waters  constitute  one  substance  or,  better,  one 


190 1  Notes  on  the   Waters  of  Gastein,    '  573 

remedial  agent,  in  the  same  way  that  any  other  composite 
substance,  organic  and  inorganic,  constitutes  a  single  drug 
with  a  peculiar  effect  of  its  own. 

The  physical  attributes  of  the  waters,  too,  are  not  without 
scientific  interest,  although  as  yet  they  throw  no  light  on  its 
therapeutic  qualities.  The  specific  gravity  is  no  more  than 
I.CKD034  (one  and  thirty-four  hundred-thousandths).  The 
water  is  absolutely  tasteless,  odorless,  perfectly  transparent 
and  clear,  and  wholly  free  from  fixed  organic  admixture  and 
of  micro-organisms.  In  greater  quantities  it  shows  a  faint 
bluish  tint,  as  in  the  clear  white  and  deep-tiled  basins  into 
which  it  is  drawn  for  baths.  But  it  is  a  noteworthy  fact  that 
distilled  water,  when  so  exposed  in  a  clear  glass  cylinder  as 
to  throw  a  shadow  on  a  white  surface,  gives  a  similar  bluish 
tinge.  The  use  of  the  water  in  bathing  and  for  other  pur- 
poses shows  its  remarkable  softness.  .In  consequence  of  its 
great  purity  it  refracts  light  strongly,  and  is,  as  a  matter  of 
course,  an  effective  solvent.  For  the  same  reason  it  favors 
in  an  unusual  degree  all  processes  of  endosmosis  and  exos- 
mosis,  and  to  this  may  unquestionably  be  ascribed  its  influence 
on  the  metabolism  of  the  human  organism. 

A  very  peculiar  physical  property  is  seen  in  the  relation  of 
the  water  to  the  electric  current.  It  was  first  demonstrated 
by  Dr.  Trolle,  and  afterwards  confirmed  by  Liebig,  Reisacher 
and  Von  Wallendorf,  that  this  water  permits  of  the  passage 
of  the  electric  current  6.1  times  more  easily  than  does  distilled 
water.  And  here  it  is  to  be  noted  that  at  one  time  water 
was  regarded  as  the  only  electrolyte,  but  it  is  found  that  the 
purer  the  water  is  the  less  does  it  conduct  electricity.  Kohl- 
rausch  and  Nippoldt  have  shown  that  the  presence  of  one 
ten-millionth  of  sulphuric  acid  is  sufficient  to  account  for  its 
observed  conducting  power,  so  that  the  weight  of  evidence 
goes  to  show  that  water  is  not  an  electrolyte  at  all.  {Ency- 
clopcedia  Brittannica)  These  are  old  established  facts,  but 
the  phenomenon  appears  to  me  so  important  that  I  must  ask 
your  attention  to  its  explanation,  so  far  as  an  explanation  can 
be  offered  to-day     We  gain  some  light,  if  we  consider  the 


574  rhe  New  England  Medical  Gazette.  Dec, 

fact,  now  established  beyond  a  doubt,  that  solutions  of  salts, 
acids  and  bases  in  a  highly  diluted  state,  possess  the  power  of 
conducting  electricity  more  readily  the  more  these  substances 
are  subdivided,  dissociated  as  the  term  is,  in  their  solutions. 
This  ability,  therefore,  to  conduct  the  electric  current  is  de- 
pendent on  the  peculiar  molecular  arrangement  of  the  ele- 
ments contained  in  the  water;  their  division  into  ions  (a  term 
coined  by  Faraday  to  denote  the  separated  component  parts 
of  substances  attracted  respectively  by  the  anode  and 
cathode.)  But  it  would  lead  us  too  far  to  enter  further  into 
the  intricacies  of  electrolysis.  It  is  important  to  note,  how- 
ever, that  these  ions,  or  dissociated  molecules,  possess  a  high 
degree  of  electrical  tension  or  stress.  They  are  in  fact  the 
real  bearers  of  electricity. 

In  the  same  way  the  fixed  constituents  of  the  Gastein 
water  are  dissociated,  separated  into  their  ions,  and  are  known 
to  have  all  the  attributes  of  this  form  of  matter,  that  is,  mat- 
ter in  a  state  of  extreme  subdivision,  dissociation.  But,  if  we 
pursue  this  observation  a  step  farther,  we  shall  see  that  the 
process  of  reducing  matter  to  its  dissociated  molecular  form 
may  not  only  be  effected  experimentally  by  the  electric  cur- 
rent, but  that  it  occurs,  as  in  these  waters,  in  nature's  own 
laboratory  under  the  action  of  forces  of  which  as  yet  we  know 
little  or  nothing.  That  which  interests  us  particularly  is  the 
fact  that  it  occurs.  And  the  question  arises  whether  we  can, 
by  any  technical  devices  within  our  power,  bring  about  a  like 
state  of  subdivision  and  stress  or  tension  of  force  or  forces 
without  the  aid  of  electricity. 

No  answer  can  come  to  this  question  save  by  the  means  of 
repeated  experiments  in  the  hands  of  experts.  I  had  hoped 
to  present  the  results  of  some  simple  experimentation  with 
the  electrometer  on  several  pure  spring  waters  and  on  distilled 
water.     But  these  must  be  reserved  for  a  future  occasion. 

In  the  meanwhile,  I  believe  that  we  are  warranted  in  ac- 
cepting these  electro-chemical  facts  as  the  starting  point  for 
new  investigations  into  the  effects  of  medicinal  substances  in 
a  state  of  extreme  comminution.     To  advance  fresh  theories 


190 1  Notes  on  the    Waters  of  Gastein,  575 

on  the  subject  would  be,  as  we  know  too  well,  the  idlest  pos- 
sible expenditure  of  energy.  Here  we  have  it  in  our  power 
to  deal  with  matter  in  its  molecular  form  (which  is,  of  course, 
a  theoretical  assumption,  since  molecules  are  neither  visible 
nor  measurable),  but  we  know  matter  to  be  present  in  appre- 
ciable and  actually  measurable  quantities.  The  quantitative 
analysis  enables  us  to  determine  the  precise  amount  as  the 
qualitative  analysis  enables  us  to  judge  of  its  chemical  char- 
acter and  relations.  We  are  not,  therefore,  dealing  with 
purely  hypothetic  assumptions,  but  may  proceed  on  strictly 
practical  and  scientific  lines  within  the  range  of  positive  ob- 
servation and  without  opening  again  those  discussions  which 
from  the  first  have  retarded  our  progress  and  in  so  great  a 
degree  paralyzed  our  efforts. 

I  am  well  aware  that  even  conclusive  experiments  con- 
ducted in  the  laboratory  with  the  most  delicate  instruments 
afford  no  proof  whatever  of  the  medicinal  or  curative  virtues 
of  substances  in  minute  quantities  in  the  most  perfect  state 
of  separation  or  subdivision.  This,  it  is  not  given  to  any 
physical  science  to  do.  But  we  shall  gain  knowledge  of  the 
most  useful  character  if  we  can  succeed  in  demonstrating^  fur- 
ther that  our  medicinal  substances  in  their  dissociated  form 
and  in  quantities  extremely  minute  are  capable  of  manifesting 
clearly  showable  and  controllable  effects.  The  clinical  ex- 
periment alone  can  avail  to  prove  by  what  substances  and  in 
what  quantities  the  disturbed  harmony  of  the  organism  is  to 
be  restored.  But  we  must  constantly  aim  to  discover  the 
missing  links  between  the  physical  experiment  and  the  clin- 
ical test. 

In  Gastein,  this  clinical  test  has  been  in  progress  for  many 
centuries.  It  has  resulted  in  attracting  to  the  baths  year 
after  year  the  people  who  are  able  to  command  the  best  med- 
ical advice.  Cases  of  debility  in  various  forms,  ancemia,  neur- 
asthenic conditions  of  many  kinds,  the  weakness  arising  from 
overwork  and  from  advancing  age,  seem  to  be  most  favorably 
affected  ;  likewise  obstinate  cutaneous  affections.  I  will  not 
enumerate  all  the  hundreds  of  ailments  for  which  the  waters 


5/6  The  New  England  Medical  Gazette,  Dec, 

are  recommended,  nor  attempt  to  expound  the  theoretical  ex- 
planations of  the  modus  operandi  of  the  waters,  but  certain 
effects  which  I  had  the  opportunity  of  observing,  I  beg  to 
mention  in  conclusion.  Among  these  observations  were  several 
pronounced  cases  of  brain  fag  and  nervous  fatigue.  It  was  truly 
surprising  to  see  the  rapid  rise  of  the  vigor  and  joy  in  living, 
the  improved  appetite  and  sound  sleep,  after  a  series  of  six 
or  eight  baths,  in  a  number  of  weary  and  despondent  people. 
In  the  same  way  I  had  occasion  to  notice  the  prompt  disappear- 
ance of  obstinate  acne  rosacea  which  had  resisted  much  treat- 
ment for  many  months,  the  marked  improvement  in  a  case  of 
acne  pustulosa,  and  another  of  eczema,  both  of  many  years 
standing.  Strange  to  say,  the  effect  of  the  water,  in  those 
who  use  it  to  excess,  is  very  often  to  produce,  among  other 
disturbances,  persistent  skin  affections,  pustulous,  vesicular 
and  squamous  in  character,  and,  likewise,  forms  of  debility 
closely  resembling  that  of  hypochondria,  neurasthenia  and 
melancholia.  A  striking  instance  of  such  neurotic  derange- 
ment was  that  of  an  elderly  man  who  had  been  much  bene- 
fitted by  the  baths  but,  against  the  doctor's  advice,  insisted 
on  pushing  their  use  beyond  the  prescribed  course.  He  was 
soon  thrown  into  a  state  of  extreme  hypochondriacal  despond- 
ency, nervous  irritability  with  disturbed  sleep  and  deranged 
digestion,  which  represented  most  faithfully  the  affections  for 
which  Gastein  is  most  frequently  prescribed.  In  reading 
certain  article's  by  Dr.  Trolle,  who  had  made  provings  of  the 
Gastein  and  had  much  experience  in  their  use,  I  was  struck 
with  the  fact  that  he  himself  had  repeatedly  observed  similar 
unhappy  results  from  the  Incautious  use  of  the  water,  showing 
this  to  be  far  from  indifferent  in  its  effects  as  by  the  scep- 
tical it  is  supposed  to  be.  And  there  are  still  those  who  refuse 
to  believe  that  minute  quantities  of  medicinal  substances  can 
produce  either  pathogenic  or  curative  effects. 

As  yet  the  indications  for  the  use  of  Gastein  remain  most 
vague,  and  despite  the  glamour  of  scientific  phrases  with 
which  its  physiologic,  pathogenic  and  therapeutic  action  is 
set  forth,  its  use  is  wholly  empirical.     My  aim  in  calling  at- 


igoi  Notes  on  the    Waters  of  Gastetn,  S77 

tention  to  its  chemical  and  physical  properties,  in  connection 
with  its  healing  virtues,  is  not  only  to  stimulate  reflection 
among  ourselves  on  the  true  relation  of  these  things,  but  also 
to  arouse  in  those  who  are  in  a  position  to  conduct  accurate 
experiments  along  these  lines  an  interest  in  such  investiga- 
tions as  will  aid  us  in  solving  some  of  those  therapeutic  prob- 
lems before  which  the  profession  still  stands  in  too  much 
darkness.  It  appears  to  me,  therefore,  that,  in  the  new  prov- 
ings  and  re-provings  to  which  we  are  all  bidden  to  lend  our 
aid,  the  physical  and  chemical,  as  well  as  the  pathogenic, 
properties  of  drugs  should  receive  attention.  And,  what  is 
more,  it  is  growing  daily  more  evident  that  the  investigation 
of  certain  pure  spring  waters  known  to  possess  distinct  thera- 
peutic virtues,  cannot  fail  to  throw  much  needed  light  on  the 
action  of  medicinal  substances  in  a  state  of  extreme  sub- 
division. If  nothing  more,  it  will  be  no  small  gain  if  in  this 
way  much  blind  prejudice  and  unreasoning  scepticism  can  be 
overcome. 

If,  for  example,  we  can  see  that  the  fraction  of  a  ten- 
thousandth  part  of  arsenic,  or  lithia,  or  manganese,  etc.,  in 
solution  may  be  demonstrated  to  cause  a  distinct  deflection 
of  the  electric  needle,  or  the  ten  millionth  part  of  another 
substance  so  change  the  electrolytic  behavior  of  distilled 
water  as  to  produce  a  visible  effect,  we  shall  not  err  in  con- 
cluding that  the  curative  power  of  many  medicinal  substances 
resides  in  their  dissociated  molecules.  By  many  experiments 
with  different  substances  under  varying  conditions  of  dilution 
and  admixture,  we  shall  also  be  able  to  define  and  classify 
these  curative  powers  and  thereby  raise  them  out  of  the  vague 
uncertain  field  of  empirical  use  to  the  level  of  something 
nearer  to  scientiific  certainty,  which  the  physiological  and 
clinical  experiment  alone  will  scarcely  accomplish. 


57^  The  New  England  Medical  Gazette,  Dec, 

A    FACTOR   IN   WOUND  DISTURBANCE. 

BY    WILLIAM    F.    WESSELHOEFT,    M.  D. 
[Read  before  Boston  Horn.  Med.  Society.] 

The  problems  that  present  themselves  to  the  surgeon  to- 
day in  dealing  with  clean  wounds  deliberately  made,  are  very 
different  in  degree  from  those  before  the  days  of'  Lister. 
Before  the  era  which  he  inaugurated  there  were  no  known 
methods  to  certainly  avoid  the  inflammatory  complications 
we  now  know  to  be  due  to  infection  introduced  from  without, 
and  every  surgeon  undertaking  an  operation  then  had  to  face 
dangers,  many  of  which  are  no,w  happily  eliminated.  The 
fearful  terrors  of  hospital  gangrene,  epidemic  erysipelas,  py- 
aemia, and  septicaemia,  are  to  most  of  us  of  historical  interest 
only,  and  we  do  our  work  in  surgery  secure  from  endangering 
the  lives  of  our  patients  from  diseases  that  are  practically 
wiped  out  of  ordinary  existence.  On  the  other  hand,  this  se- 
curity in  operating  has  opened  great  fields  of  surgical  work 
impossible  in  former  days,  and  the  quality  of  surgical  work 
has  kept  pace  with  the  advance  in  surgical  methods,  so  that, 
instead  of  a  surgeon's  responsibilities  being  lessened,  they 
are  really  largely  increased. 

Methods  of  avoiding  infection  are  now  greatly  altered  since 
the  days  of  Lister.  Study  and  experience  have  changed  and 
improved  each  detail.  Methods  more  certain,  more  direct, 
and  more  simple,  have  been  developed,  so  that  to-day  we 
may  feel  sure  that  the  sources  of  infection  of  wounds  made 
by  the  .surgeon  are  limited  to  his  hands,  the  patient,  and  the 
atmosphere.  Everything  else  may  be  subjected  to  absolutely 
certain  processes  of  sterilization.  Instruments,  dressings, 
sutures,  and  ligatures,  including  tho.se  of  animal  material,  are 
sterilized  by  a  degree  of  moist  heat  high  enough  to  absolutely 
annihilate  organic  life. 

The  sterilization  of  the  hands  of  the  surgeon  and  his 
assistants,  and  the  sterilization  of  the  field  of  operation  on  the 
patient,  have    been    by    various    methods,  including    rubber 


1901  A   Factor  in    IVotmd  Disturbance.  579 

gloves,  so  practically  if  not  bacteriologically  accomplished 
that,  with  the  proper  care  and  attention  which  is  imperative, 
experience  has  shown  them  to  be  adequate.  Infection  from 
the  air  does  not,  in  the  opinion  of  surgeons  and  experience 
generally,  play  a  serious  part  in  direct  wound  infection. 

In  support  of  all  this  I  can,  as  can  others,  testify  to  having 
seen  continuous  months  of  a  hospital  service  pass  without  a 
trace  of  suppuration  in  cases  not  infected  previous  to  oper- 
ation, where  all  the  wounds  in  clean  cases  healed  by  first  in- 
tention and  were  absolutely  dry,  and  when  all  the  cases, 
infected  and  clean  alike,  were  operated  upon  in  the  same 
operating  room.  How  the  staphylococcus  epidermis  albus, 
which  may  be  found  in  the  deep  layers  of  the  epidermis  of 
the  patient,  can  exercise  a  serious  practical  influence  in 
wound  disturbance  is  not  evident  to  me,  for  in  no  one  of  these 
cases  was  any  attempt  made  to  disinfect  the  skin  wound  after 
it  was  made,  and  the  same  knife  and  instruments,  used  in 
cutting  through  the  skin  were  used  in  the  subsequent  steps 
of  the  operation. 

There  are  cases  now  and  then,  however,  where  all  the  de- 
tails of  aseptic  operating  have  been  undoubtedly  faithfully 
carried  out,  that  do  develop  pus,  and  it  is  for  a  consideration 
of  what  I  believe  to  be  a  common  cause  of  such  infection 
that  this  paper  is  presented. 

We  all  know  that  there  are  certain  regions  of  the  body 
where  wounds  can  be  made  without  much  danger  of  suppur- 
ation occurring,  even  when  all  the  details  of  aseptic  operating 
are  not  observed.  Such  regions  are,  for  instance,  the  scalp, 
face,  lips  and  cervix,  while  it  is  certainly  not  very  rare  to  see 
slight  suppuration  in  an  abdominal  wound,  after  a  hernia 
operation,  or  in  an  amputation  stump,  after  every  detail  in 
operative  asepsis  has  been  presumably  carried  out  faith- 
fully. 

I  have  frequently  seen,  in  operations  for  suppurating  ap- 
pendicitis, the  abdominal  wound  bathed  in  foul  smelling  pus, 
and  yet  heal  by  first  intention  where  it  was  approximated  by 


58o  The  New  England  Medical  Gazette,  Dec, 

sutures,  and  under  a  dressing  saturated  with  discharges 
through  the  opening  left  for  drainage. 

There  is  no  doubt  that  healthy  wounded  tissues,  properly 
approximated,  can  resist  a  certain  amount  of  dangerous  in- 
fectious material  and  yet  heal  by  first  intention  and  without 
suppuration. 

It  is  not  a  new  suggestion  and  it  has  long  been  recognized 
that  where  blind  spaces  are  left  in  the  suturing  of  wounds, 
blood  and  serum  may  collect  and  break  down  into  pus,  but  I 
do  not  believe  that  the  extent  of  this  is  as  fully  appreciated 
or  that  care  is  as  generally  taken  to  avoid  such  collection, 
however  minute,  as  is  demanded  by  the  facts. 

Some  years  ago,  during  a  period  of  great  freedom  from 
wound  infection,  I  removed  a  fatty  tumor  from  the  abdominal 
wall  of  a  woman  at  the  Hospital.  The  wound  was  closed 
with  a  few  interrupted  silk-worm  gut  and  a  continuous  catgut 
suture.  In  a  few  days  she  had  pain  and  fever.  I  looked  at 
the  wound  and  was  more  pained  than  she  to  find  swelling  of 
the  area  with  redness  at  one  end.  An  opening  was  made 
and  some  thin,  bloody,  purulent  fluid  evacuated.  The  rest 
of  the  wound  did  not  break,  but  healing  was  greatly  delayed 
by  this  considerable  area  having  gradually  to  close  from  the 
bottom.  Here  I  had  put  on  good  pressure  but  in  spite  of  it 
serum  had  been  thrown  out.  The  wound  itself  healed,  but 
the  serum,  being  a  good  culture  medium  and  plenty  of  germs 
being  present  from  the  handling  and  exposure  of  the  tissues 
to  the  atmosphere  in  operating,  had  become  infected,  and  the 
result  was  a  septic  condition  after  an  aseptic  operation. 
This  is  a  very  simple  case,  but  I  have  every  reason  to  believe 
from  many  similar  cases  upon  which  I  have  since  operated, 
that,  had  I  put  in  a  small  tube  or  even  a  silk-worm  gut  drain, 
the  serum  poured  out  in  the  first  few  hours  would  have  soaked 
into  the  dressing  and  there  dried,  that  the  walls  of  the  space 
would  have  come  together,  and  all  would  have  united  by  first 
intention  throughout.     Figs  i  and  2. 

In  the  common  operation  for  removal  of  the  breast  and 


igoi 


A   Factor  in    Wound  Disturbance, 


S8i 


clearing  out  of  the  axillary  space,  very  large  areas  of  wounded 
surfaces  are  brought  into  apposition.  Here,  with  a  drainage 
tube  in  the  axilla  and  a  firm  pressure  bandage,  healing 
throughout  by  first  intention  is  almost  the  invariable  rule. 
A  large  amount  of  bloody  serum  is  usually  discharged  by  the 


Fig.  I. 
Bed  of  fatty  tumor  filled  with  bloody  serum. 

drainage  tube  during  the  first  two  days,  the  drain  is  then  re- 
moved, and  the  case  is  then  practically  finished.  Yet,  in 
spite  of  the  firm  chest  wall  forming  a  most  excellent  base 
upon  which  to  apply  pressure,  I  have  several  times  seen  ex- 
tensive suppuration  occur  in  cases  where  drainage  of  the 
axilla  was  not  used.  This,  I  believe,  was  due  purely  to  not 
providing  for  the  discharge  of  serum. 

In  operations  upon  the  scrotum  and  its  contents,  where  th^ 


FlC.    2. 

Same  as  Fig.  i,  with  serum  discharged  through  drain. 

tissue  is  perhaps  the  most  lax  in  the  body,  and  where  it  is 
very  difficult  to  apply  even  and  firm  pressure,  first  intention 
is  almost  invariable,  even  when  a  large  cavity  is  left,  where 
drainage  is  used,  and  it  is  a  portion  of  the  body  very  apt  to 
swell  and  suppurate  if  drainage  is  not  used. 


582  The  New  England  Medical  Gazette.  Dec, 

In  wounds  where  the  tissue  is  firm  and  can  be  accurately 
approximated  by  sutures,  such  as  the  scalp,  face,  and  cervix, 
there  is  little  chance  of  blind  spaces  being  left  for  the  accum- 
ulation  of  serum,  and  these  are  the  portions  of  the  body 
where  first  intention  in  wounds  is  the  common  rule,  even 
under  adverse  conditions. 

Abdominal  wounds  are  the  most  important  and  the  most 
interesting  wounds  with  which  a  surgeon  has  to  deal.  First 
intention  in  abdominal  wounds  is  especially  desirable,  for,  if 
suppuration  occurs  here,  healing  results  with  the  formation 
of  more  or  less  increased  scar  tissue.  Scar  tissue  is  a  fibrous 
tissue  which  is  apt  gradually  to  stretch  and  give  under  strain, 
so  that  a  hernia  is  far  more  likely  to  result  from  a  wound 
which  has  suppurated  than  from  one  which  has  not. 

The  abdominal  wall  is  composed  of  several  planes.  Below, 
over  the  bowels,  is  the  peritoneum  and  transversalis  fascia, 
then  comes  a  layer  of  muscle,  over  this  is  a  strong  aponeur- 
osis or  aponeuroses,  and  over  this  the  skin.  There  are  dif- 
ferent methods  of  suturing  the  abdominal  wall  in  vogue. 
One  is  by  interrupted  through  and  through  sutures,  another 
by  approximation  of  each  layer  separately,  another  by  a  com- 
bination of  the  two  in  which  the  stay  sutures  generally  pass 
through  all  the  layers  of  skin,  aponeurosis  and  muscle,  but 
not  the  peritoneum. 

It  can  readily  be  seen  in  diagram  that  spaces  may  easily 
be  left  in  which  serum  may  collect,  and  I  believe  the  fact  of 
such  collections  frequently  to  be.  the  cause  of  a  great  deal  of 
the  suppuration  in  abdominal  wounds  that  is  often  attributed 
to  errors  in  technique.     Figs.  3  and  4. 

Pressure  cannot  be  applied  over  the  abdominal  wall  as 
advantageously  as  it  can  upon  the  firm,  unyielding  chest  or 
head,  and  dependence  must  necessarily  be  put  upon  suturing 
almost  entirely.  In  using  the  through  and  through  stay 
sutures,  some  vessel  in  the  muscular  layer  is  not  infrequently 
pricked.  This  causes  some  blood  to  flow  into  the  wound. 
Tying  the   stitch  usually  arrests  this  readily,  but  it  never- 


I90I 


A  Factor  in   Wound  Disturbance. 


583 


theless  is  a  not  infrequent  source,  I  believe,  of  blood  being 
left  in  the  wound.  It  is  a  very  fortunate  fact  that,  when  an 
abdominal  wound  does  suppurate,  instead  of  the  pus  making 
its  way  into  the  abdominal  cavity,  it  seeks  a  vent  outwards 
either   along   a  stay  suture  or  out  through  a  layer.     The 


Fig.  3. 
Abdominal  wound  sutured  in  layers,  showing  spaces   over  aponeurosis 
under  skin,  and  over  transversalis  fascia  under  muscle,  where  serum  may 
collect. 

"  Stitch  hole  abscess "  about  a  stay  suture  is  undoubtedly 
usually  the  result  of  a  collection .  in  a  space  below,  which 
seeks  a  vent  along  the  suture  and  is  not  to  be  attributed  to 
the  suture  itself. 

During  the  Spring  term  at  the  Hospital  last  year,  several 
abdominal  wounds  suppurated,  and  Dr.  Bell  determined  to 


ly^ftiM  tt^mm^^  ^m^^^tm  ^arm^^m^tmm^  prf»Mwri«rtMi  Midi» 


Fig.  4. 
A  common  way  of  suturing  abdominal  wounds  in  layers,  with  stay  sutures 
embracing  skin,  aponeurosis  and  muscle,  but  not  transversalis  fascia  and  per- 
itoneum.    Shows  space  under  muscle  where  serum  may  collect. 

give  a  vent  to  this  serum  which  he  suspected  might  be  the 
cause  of  the  trouble.  He  therefore  introduced  a  drain  of 
silk-worm  gut  strands  into  the  bottom  of  such  wounds  and  an 
immediate  change  took  place.    A  good  deal  of  serum  was  dis- 


584 


The  New  England  Medical  Gazette. 


Dec, 


charged  into  the  dressing,  the  drain  was  removed  in  thirty- 
six  to  forty-eight  hours,  and  healing  by  first  intention  again 
became  the  rule.     Fig  5. 

*  Another  method,  and  I  believe  the  best,  is  to  pass  the  stay- 
sutures  rather  close  together  through  the  wall,  including  the 


Fig.  5. 
Same  as  Fig.  4,  with  serum  discharged  through  drain. 

peritoneum,  and  to  approximate  the  layers  with  catgut.  The 
stay  sutures  are  held  taught  while  the  layers  are  being 
sewn,  in  order  that  no  gut  or  omentum  be  caught  in  them 
when  they  are  tied.  In  this  way  close  approximation  is  ob- 
tained and  the  spaces  obliterated,  with  excellent  results. 
Fig  6. 

Any  sterile  culture  medium,  such  as  bouillon,  if  left  exposed 
to  the  air  of  any  operating  room,  will  decompose  because  it  will 


3 


*r  *i    '■  ■><*■    %i     <      »     H-^ — ^ 


H   H  'I 


U 


Fig.  6. 
Tight  wound  with  no  spaces.     Layers  sutured  with  catgut.     Silk-worm 
gut  stay  sutures  passed  through  entire  abdominal  wall  including  peritoneum. 

be  attacked  by  the  germs  contained  in  the  air.  Bloody 
serum  collecting  in  blind  spaces  in  a  wound  is  an  excellent 
culture  medium.  It  is  liquid  and  lies  in  a  warm  bed — con- 
ditions most  favorable  for  germ  life  and  culture.  The  tissues 
in  which  it  lies  have  been  exposed  to  the  air  and  to  the  man- 


1 90 1  An  Involuntary  Proving  of  A ntimony,  585 

ipulation  of  the  operator,  and  it  is  easy  to  suppose  that  this 
serum  can  gain  from  the  tissues  which  have  been  thus  ex- 
posed, germs  in  plenty  to  set  up  changes  in  it.  While  living 
tissues  can  resist  the  little  infectious  material  met  with 
during  an  operation,  and  heal  by  first  intention  when  properly 
approximated,  bloody  serum,  lying  in  blind  spaces  in  a 
wound,  is  apt  to  become  infected,  and  lead  to  infection  and 
breaking  of  the  wound. 

Bloody  serum  lying  in  the  peritoneal  cavity  is  under  en- 
tirely different  conditions.  It  has  been  repeatedly  demon- 
strated that  the  peritoneum  can  take  up  a  large  amount  of 
bloody  serum,  and  absorb  it  very  rapidly.  In  an  ordinary 
wound  the  process  of  absorption  is  very  slow,  and  time  is 
given  fbr  changes  to  take  place  which  are  set  up  by  micro- 
organisms. 

With  all  the  details  of  surgical  asepsis  faithfully  carried 
out,  with  careful  stopping  of  all  bleeding,  with  the  obliteration 
of  blind  spaces  where  serum  might  collect,  either  by  means 
of  pressure  or  close  suturing,  and  with  the  draining  of  blind 
spaces  that  can  not  be  surely  obliterated,  wounds  in  clean 
cases  ought  to  heal  readily.  I  feel  confident  from  what  I 
have  seen,  that  the  presence  of  even  very  small  quantities  of 
bloody  serum  collecting  in  not  readily  absorbing  tissues  is  a 
potent  factor  in  wound  disturbance,  even  when  aseptic  details 
have  been  carried  out  fully. 


AN  INVOLUNTARY  PROVING  OF  ANTIHONY. 

BY    KRKDFKICK    IJ.  "I'KRCV,    M.  D. 

It  has  always  been  a  mooted  question  whether  a  voluntary 
or  an  involuntary  proving  of  a  drug  was  productive  of  more 
valuable  information.  Whichever  horn  of  the  dilemma  you 
accept,  you  must  admit  that  the  following  proving  is  both 
interesting  and  instructive.  It  certainly  subscribes  to  four 
fundamental  rules  for  a  proving,  namely,  that  the  drug  shall 


586  The  New  England  Medical  Gazette,  Dec, 

be  pure  and  in  varying  conditions.  Second,  that  the  prover 
shall  be  in  ordinarily  good  health.  Third,  that  there  shall  be 
as  few  changes  as  possible  in  the  mode  of  life.  Fourth,  that 
there  shall  be  intelligent  observation  and  interpretation  of 
the  effects. 

One  unique  feature  of  the  proving  lies  in  the  fact  that  all 
the  pathogenetic  effects  were  elicited  through  skin  absorption 
of  the  drug.  It  may  not  be  amiss  to  recite  to  you  the 
reasons  for  this  proving  coming  into  my  possession. 

Some  years  ago  a  well-known  chemist  came  under  my  care 
for  temporary  indisposition.  His  recovery  was  rapid  and  un- 
eventful, but  a  pleasant  friendship  resulted.  Many  years 
after  we  met  again,  and  then  it  was  that  he  told  me  of  a 
recent  illness  from  which  he  was  only  then  recovering.  At 
my  instigation  he  committed  the  facts  to  writing,  and  I  sub- 
mit to  you  his  letter  : 

"  Dear  Dr.  Percy, 

The  following  is  an  account  of  the  case  of  Antimony 
poisoning  as  nearly  as  a  layman  can  describe  it.  I  was  en- 
gaged in  the  manufacture  of  the  double  lactate  of  antimony 
and  soda  for  dyers*  use.  This  is  made  by  dissolving  pow- 
dered regular  or  metallic  antimony  in  a  mixture  of  lactic  and 
nitric  acids.  The  nitric  acid  is  simply  to  convert  the  metal 
into  an  oxide  soluble  in  lactic  acid.  When  the  nitric  acid  is 
used  up,  one  half  the  remaining  lactic  acid  is  neutralized  with 
soda. 

"  The  double  lactate  of  antimony  and  soda  is  a  hygroscopic 
non-crystalizable  salt,  which  is  absorbed  through  the  skin 
with  great  readiness.  Shortly  after  beginning  the  manu- 
facture of  this,  I  noticed  a  decided  lowering  of  the  general 
health  and  great  sensitiveness  to  cold.  I  was  only  comfort- 
able in  a  room  at  80^  to  85^,  and  was  obliged  to  give  up 
cold  baths,  to  which  I  was  regularly  accustomed  up  to  this 
time.  There  was  also  great  digestive  disturbance,  much  gas 
in  the  intestines,  watery  and  mucous  discharges  from  the  in- 


igoi  An  Involuntary  Proving  of  Antimony,  587 

testines  but  no  pain,  a  nasty  coated  tongue,  torpid  liver,  and 
yellow  skin.  The  whites  of  the  eyes  showed  yellow  as  well. 
The  heart,  which  had  always  been  quick  but  strong,  became 
most  erratic,  jumping  from  fifty-six  to  a  hundred  and  fifty 
beats  per  minute,  and  from'  weak  to  strong  and  vice  versa. 
The  mental  disturbance  was  more  pronounced  than  the 
physical.  An  extreme  listlessness  was  accompanied  with  the 
most  extreme  melancholia.  The  thing  which  finally  led  me 
to  the  cause  of  the  trouble  was  the  breaking  out  of  watery 
pustules  on  the  wrists  and  arms,  principally  an  intense 
itching  of  the  inflamed  parts.  The  pustules  resembled  ivy 
poisoning. 

**  A  physician  prescribed  soda  and  a  tonic  without  relief. 
Then  iodide  of  potassium  solution,  one  to  one,  five  drops  three 
times  a  day,  were  administered  with  immediate  relief.  The 
iodine  showed  in  the  urine  and  saliva.  For  the  liver  ergot, 
and  for  the  heart  strychnine  and  nitro-glycerine  were  given. 
After  five  months  I  am  nearly  in  a  normal  condition,  but 
have  never  been  able  to  resume  the  cold  baths  and  am  more 
or  less  dependent  on  the  nitro-glycerine.  Hoping  this  com- 
plete, I  am, 

Sincerely  yours, 


That  we  may  better  appreciate  the  remarkable  confirm- 
ation of  the  generally  accepted  symptoms  of  Antimonium 
crudum,  I  beg  that  you  will  follow  me  as  I  give  you  these 
symptoms  in  parallel  columns : 

HOMCEOPATHIC 
PROVING. 

INDICATIONS. 

Decided  lowering  of  the  gen-     Depressed    vitality     of     the 
eral  health.  mucous    membranes    with 

mal-assimilation. 
Great  sensitiveness  to  cold  in     Cold     baths    aggravates    or 
the  prover.     Only  comfort-         causes  trouble.     Child  al- 
able  in  a  room  80^  to  85^.  ways     worse     from     cold 

bath. 


588 


The  New  England  Medical  Gazette, 


Dec, 


Obliged  to  give  up  cold  baths 
to  which  I  was  regularly 
accustomed. 

Nasty,  coaced  tongue. 

Great  digestive  disturbances. 

Much  gas  in  intestines. 
Watery  and  mucous  discharges 

from  the  intestines. 


Heart,  which  had  always  been 
quick  and  strong,  became 
most  erratic,  jumping  from 
56  to  150  per  minute,  from 
quick  to  strong  and  vice 
versa. 

Mental  symptoms :  Most  ex- 
treme melancholia. 

Watery  pustules  on  the  wrists 
and  arms ;  pustules  resem- 
ble ivy  poisoning.  Intense 
itching  of  the  inflamed  parts. 


Disagreeable  feeling  of  in- 
ternal chilliness,  so  he  can- 
not get  warm. 

Tongue  thickly  coated,  white, 
very  white,  white  as  milk. 

Chronic  loss  of  appetite,  eruc- 
tations, tasting  of  ingesta. 

Stools  partly  solid  and  partly 
fluid,  alternate  constipa- 
tion and  diarrhoea,  con- 
stant discharge  of  yellow- 
ish slime  from  anus. 

Violent  palpitation  of  the 
heart.  Pulse,  sometimes  a 
a  few  quick  beats,  then 
three  or  four  slow  ones. 


Great  sadness  and  woful 
moods.  Child  cannot  bear 
to  be  touched  or  looked  at. 

Pimples,  pustuules,  furuncu- 
lar  elevations,  with  prick- 
ing itching  of  the  skin. 


Could  stronger  proof  of  the  law  of  similars  be  offered  than 
these  parallel  columns  give  ?  *'  Few  drugs  have  made  as 
much  noise  in  the  medical  world  as  Antimony.  It  was  known 
in  the  remotest  antiquity.  Hippocrates,  Galenus,  Plinius  and 
Dioscorides  mention  it.  From  the  arcana  of  Paracelsus  it 
was  afterwards  transferred  into  common  use  as  an  almost  uni- 
versal panacea,  and  during  the  fifteenth  and  sixteenth  centuries 
became  the  object  of  such  violent  disputes  among  doctors  that 
Parliament  was  obliged  to  interfere  and  to  interdict  the  use 
of  this  drujx-      This  interdiction  remained  in  force  from  the 


igoi  Aseptic  Vaccination.  589 

year  1566  until  the  1 6th  of  April,  1666,  when  it  was  revoked 
at  the  instance  of  the  medical  faculty  of  Paris,  one  hundred 
and  two  members  of  which  at  last  united  to  give  their  assent 
to  the  use  of  antimonial  preparations," 

The  modern  school  of  medicine  has  abandoned  the  use  of 
crude  antimony  almost  entirely,  but  our  study  of  the  drug 
has  always  led  us  to  place  almost  implicit  confidence  in  its 
usefulness  for  chronic  catarrhal  conditions  which  are  attended 
with  a  depressed  vitality  of  the  mucous  membranes  and  an 
unhealthy  condition  of  the  skin.  Its  strongest  analogies  are 
bryonia  and  pulsatilla,  but  it  has  a  sphere  of  usefulness  of  its 
own  which,  though  not  wide  reaching,  is  none  the  less  im- 
portant. We  can  therefore,  I  think,  claim  for  this  drug  that 
any  part  it  may  have  played  in  medicine  in  the  past  centuries 
or  will  play  in  time  to  come  can  be  interpreted  only  in  ac- 
cordance with  the  law  of  medicine  to  which  we  subscribe. 

October  8,  1901. 


ASEPTIC   VACCINATION. 

BY    H.    H.    POWERS,    M.  D. 
[Read  before  Mass.  Horn.  Society.] 

In  this  good  city  of  Boston,  in  the  first  nine  months  of  the 
current  year,  there  have  been  reported  to  the  Board  of  Health 
fifty-five  cases  of  smallpox.  I  say  reported,  for  I  believe  that 
there  have  been  a  number  of  cases  unreported  and  probably 
unrecognized,  since  the  source  of  infection  has  not  been 
found  in  a  number  of  instances.  This  is  more  than  we  have 
had  for  a  number  of  years  previously,  but  is  probably  not 
more  than  we  may  have  in  the  coming  years,  and  I  believe 
this  for  several  reasons.  The  most  important  reason  is  the 
fact  of  the  mild  character  of  the  disease  as  it  presents  itself 
throughout  the  United  States.  In  the  past  two  years  there 
have  been  cases  in  every  part  of  our  country  and  the  total 
number  of  cases  has  been  large,  but  the  mortality  has  been 
small  and  in  several  cities  there  have  been  heated  discussions 


590  The  New  England  Medical  Gazette,  Dec, 

as  to  the  diagnosis  of  cases  Which  were  presented  in  the  epi- 
demics. As  to  the  reasons  for  the  mildness  of  the  epidemic 
I  have  nothing  to  say  here,  since  it  has  no  relation  to  the 
present  topic.  Another  reason  is  that  we  have  a  generation 
of  physicians  who  have  seen  few,  if  any,  cases  of  smallpox  and 
hence  they  are  unable  to  maVe  prompt  and  accurate  diag- 
noses. This  is  still  further  the  fact  from  the  general  lack  of 
knowledge  of  skin  eruptions,  and  it  is  commonly  said  of  the 
general  practitioner  that  he  knows  everything  in  medicine 
better  than  dermatology. 

But  you  may  be  asking,  what  has  this  to  do  with  vaccina- 
tion except  indirectly,  and  yet  it  is  to  emphasize  the  import- 
ance of  vaccination  that  I  have  thus  referred  to  smallpox.  It 
is  probable  that  the  one  thing  that  a  medical  student  thinks  he 
knows  is  how  to  properly  vaccinate.  It  is  so  simple  and 
easy  that  off-hand  he  can  do  it  with  credit  and  profit  to  him- 
self. .  My  first  knowledge  of  vaccination  came  when  as  a 
child,  a  young  man,  a  neighbor  and  a  medical  student,  came 
to  my  father's  house,  and  vaccinated  my  sister  and  myself, 
and  from  then  till  now  medical  students  have  done  much  of 
the  vaccination  with  which  I  have  been  personally  connected, 
and  the  medical  student  usually  becomes  the  physician,  and 
commonly  he  carries  with  him  his  knowledge  of  vaccination. 
To  say  that  any  physician  does  not  know  how  to  vaccinate  is 
to  place  yourself  outside  the  pale  of  brotherhood  of  that 
member  of  the  profession.  Hence,  rather  than  criticize,  I 
simply  suggest  what  to  my  mind  is  the  ideal  method,  hoping 
that  others  may  criticize  and  through  courteous  discussion 
we  may  gain  the  whole  truth  concerning  this  topic.  Now 
how,  when  and  where  shall  we  vaccinate }  First,  how  shaU 
we  vaccinate }  The  surface  which  is  to  be  inoculated  should 
be  cleansed  with  soap  and  water,  preferably  green  soap,  and 
this  followed  by  washing  with  alcohol  or  ether,  so  as  to  make 
clean  and  aseptic  the  area  for  scarification.  Then  with  a 
clean  scalpel,  needle  or  metal  scarifier,  remove  the  scarf  skin 
from  a  square  not  larger  than  a  fourth  of  an  inch,  down  to 
the  papillae,  so  that  there  is  the  slightest  oozing  of  the  blood 


I  go  I  Aseptic  V^accination,  591 

or  blood  serum.  Now,  from  a  tube  of  glycerinated  vaccine 
lymph  apply  a  drop  of  its  contents  and  rub  it  well  into  the 
scarified  patch.  Allow  it  to  remain  uncovered  for  fifteen 
minutes  or  until  the  lymph  has  dried,  then  cover  with  an 
aseptic  dressing  and  this  dressing  continued  till  the  crust  has 
formed  and  fallen  from  the  skin,  leaving  a  non-absorbing 
surface.  The  time  to  vaccinate  is,  as  I  believe,  in  the  cooler 
weather,  avoiding  the  extremes  of  heat  and  cold,  and  the 
primary  vaccination  should  occur  before  three  years  of  age 
unless  there  is  some  proper  contra-indication,  and  re-vaccina- 
tion should  occur  before  twenty,  and  again  and  again  if  an 
epidemic  of  smallpox  appears.  The  point  of  election  for  vac- 
cination is  at"  the  insertion  of  the  deltoid  muscle  of  the  left 
arm  and  rarely  should  vaccination  be  performed  on  the  leg  or 
thigh. 

And  now  a  tew  of  the  reasons  for  the  suggested  method 
and  I  will  close.  And  first  I  wish  to  emphatically  record 
myself  as  in  favor  of  glycerinated  lymph  in  preference  to  the 
dry  points,  and  for  the  following  reasons.  The  vaccine  point 
practically  always  carries  staphylococci  arid  streptococci,  but 
lymph  subjected  to  the  action  of  glycerine  becomes,  after  a 
little,  aseptic.  It  preserves  the  vitality  of  the  lymph  much 
longer  than  points,  unless  they  have  been  especially  dried, 
exhausting  all  the  moisture.  This  gives  a  chance  to  test  the 
lymph,  so  that  any  which  will  not  conform  to  the  highest 
standard  may  be  discarded.  In  addition  to  the  germs  which 
all  points  carry,  there  are  a  certain  number  of  blood  cor- 
puscles which  ihay  decay  and  by  the  poison  thus  formed 
cause  irritation  of  the  wound,  I  was  as  skeptical  as  any  one 
as  to  the  advantage  of  this  form  of  lymph,  but  years  of  ex- 
perience have  shown  that  the  number  of  "bad  arms"  is  only 
a  fraction  of  what  occurs  when  points  are  employed.  An  ob- 
jection has  been  made  that  the  glycerinated  lymph  has  more 
failures  to  take  than  points,  but  that  is  on  account  of  lack  of 
knowledge  of  how  it  should  be  applied.  The  action  of  the 
glycerine  when  first  applied  is  to  draw  the  serum  from  the 
arm,  and  it  is  longer  before  it  is  absorbed  than  if  the  gly* 


592  The  New  England  Medical  Gazette,  Dec, 

cerine  had  not  been  added.  Still  further  the  lymph  is  diluted 
by  the  glycerine,  and  a  fair  amount  of  glycerinated  lymph 
must  be  applied  and  rubbed  in  to  insure  success. 

One  word  about  shields.  Many  of  them  are  a  delusion  and 
a  snare,  and  an  aseptic  dressing  of  cotton  and  gauze  has 
proved  to  be  very  successful  in  protecting  the  vaccinated 
arm. 

This,  then,  is  my  idea  of  vaccination.  Thus  performed 
there  is  very  slight  local  and  constitutional  disturbance  and 
the  dangers  are  insignificant  and  infinitesimal.  My  hope  is 
that  this  paper  may  elicit  enough  discussion  to  clear  away 
some  of  the  fog  which  hangs  over  the  medical  and  lay  mind 
in  regard  to  this  very  important  topic. 


Recovery  from  Leprosy.  Mr.  Jonathan  Hutchinson,  in 
the  Indian  Medical  Record  of  October  31,  1900,  reports  two 
cases  of  anaesthetic  leprosy  which  recovered  after  an  extended 
treatment  which  consisted  only  in  small  doses  of  arsenic,  a 
liberal  diet,  and  al)stinence  from  fish.  Of  late  years,  says 
Mr.  Hutchinson,  it  has  been  shown  that  in  not  a  few  cases  of 
leprosy  recovery  occurs.  They  have  been  chiefly  observed 
in  countries  where  the  disease  is  not  epidemic,  and  in  patients 
who  migrated  from  the  place  where  the  disease  was  acquired 
and  lived  under  wholly  altered  conditions.  In  former  times 
the  leper  had  no  chance,  but  now  the  disease  is  looked  upon 
much  more  hopefully.  The  essentials  to  recovery  are  a  lib- 
eral diet,  external  comforts,  and  entire  absence  from  uncooked 
fish.  In  olden  times  the  leper  was  an  outcast,  condemned  to 
poverty  and  the  poorest  food.  If  he  got  access  to  a  leper 
asylum,  he  would  very  probably  be  fed  on  fish.  To  a  consid- 
erable extent  this  is  changed.  The  leper  establishments  now 
allow  a  more  judicious  and  liberal  diet,  and  from  one,  that  of 
Robben  Island,  where  recoveries  have  been  chiefly  claimed, 
fish  i's  wholly  excluded.  The  best  examples  of  cure  have 
come,  however,  not  from  asylums,  but  from  private  practice 
and  from  cases  in  which,  as  in  the  United  States,  the  patient 
has  migrated  to  a  non-leprosy  district  and  has  been  able  to 
secure  plenty  of  non-leprosic  and  anti-bacillary  food. 


igoi  Editorial.  593 


EDITORIAL. 

CoatributioQs  of  original  articles,  correspoadence,  etc.,  should  be  sent  to  the  publishers,  Otis 
Clapp  &  Son,  Boston,  Mass.  Articles  accepted  with  the  understanding  that  they  appear  only  in 
the  Giisftit.  They  should  be  typewritten  if  possible.  To  obtain  insertion  the  following  month, 
reports  of  societies  and  personal  items  mutt  bg  rectivedby  th*  t^tk  of  ike  month  preceding. 


PUBLISHERS'  ANNOUNCEriENT. 

The  publishers  of  the  Nezv  England  Medical  Gazette  wish 
to  call  the  attention  of  the  profession  to  certain  changes  in 
the  policy  of  that  journal  which  will  be  inaugurated  with  the 
commencement  in  January  of  the  thirty-seventh  volume.  A 
specialized  and  earnest  attempt  is  to  be  made  to  bring  each 
of  this  journal's  several  departments  to  a  high  degree  of  effi- 
ciency, and  to  render  the  physician  the  greatest  possible  as- 
sistance in  his  efforts  to  keep  abreast  of  medical  progress. 

Thus  the  pithiest  and  most  practical  contributions  only  will 
be  published,  the  most  pertinent  abstracts  from  the  literature 
of  the  day,  the  best  obtainable  reports  of  society  meetings 
and  individual  researches. 

The  Gazette  will  take  special  notice  of  the  extension  and 
advancement  of  homoeopathy  all  over  the  world  and  endeavor 
to  chronicle  the  changes  and  improvements  in  our  therapeu- 
tical resources,  such  as  provings  and  reprovings,  the  intro- 
duction of  new  adjuvants,  etc.  At  the  same  time  not  neglect- 
ing to  give  adequate  space  to  matter  dealing  with  the  import- 
ant specialties  into  which  professional  work  is  being  more 
and  more  resolved,  such  as  surgery,  gynecology,  obstetrics, 
pediatrics,  diseases  of  the  nervous  system,  of  the  genito- 
urinary system,  of  the  eye,  ear,  nose,  throat,  chest,  and  skin, 
syphilis  and  kindred  disorders. 

A  most  interesting  field,  now  being  rapidly  developed,  is 
that  of  experimental  research  in  the  laboratory.  The  Gazette 
will  endeavor  to  give  trustworthy  accounts  of  the  results  of 
these  investigations,  especially  of  those  which  promise  to  be 
of  direct  and  immediate  value  in  the  prevention  and  limitation 
of  infectious  and  contagious  diseases. 


594  ^^^  New  England  Medical  Gazette,  Dec, 

It  is  hoped  that  very  many  items  of  general  interest  may 
appear  from  time  to  time,  relating  to  the  work  of  sanitariums, 
hospitals  and  colleges. 

All  the  newest  medical  works  and  books  on  related  sub- 
jects will  be  impartially  noticed  at  length,  so  that  the  physi- 
cian may  be  better  able  to  determine  what  he  wishes  to  read 
and  to  add  to  his  library.  Other  publications  and  journals  of 
general  interest  and  merit  will  be  grouped  under  the  follow- 
ing headings:  Editorially  Speaking;  Original  Communica- 
tions ;  Society  Reports ;  Abstracts  from  Books  and  Journals  ; 
College,  Hospital  and  Laboratory  Notes ;  Books  and  Read- 
ing ;  Personal  and  General  Items. 

As  co-editor  with  Dr.  John  L.  Coffin  of  Boston,  who  has 
been  for  some  years  editor  of  the  Gazette^  the  publishers  have 
secured  the  services  of  Dr.  A.  Temple  Lovering,  also  of  Bos- 
ton, a  journalist  of  experience,  and  well  known  through  sev- 
eral successful  books  on  medical  and  other  subjects. 

It  is  greatly  hoped  that  the  members  of  the  homoeopathic 
school  of  medicine  will  individually  feel  themselves  invited  to 
contribute  brief  original  papers  dealing  with  their  personal 
experiences  in  the  practice  of  medicine  and  surgery.  The 
profession  will  confer  a  favor  by  sending  items  of  general  and 
personal  interest,  announcements  of  removals,  appointments, 
and  the  like. 

All  contributions,  exchanges,  publications  for  review,  sub- 
scriptions and  all  business  and  other  communications  should 
be  sent  directly  to  the  care  of  the  publishers,  lO  Park  Square, 
Boston. 

The  publishers  feel  justified  in  asking  every  physician  who 
reads  this  announcement  to  respond  with  a  year's  subscription, 
which  will  be  liberally  returned  to  him  in  the  form  of  twelve 
numbers  of  the  Gazette^  issued  promptly  monthly  and  replete 
with  everything  which  will  materially  assist  him  in  his  work. 

Otis  Clapp  &  Son,  Publishers, 

10  Park  Square,  Boston,  Mass. 


igoi  Editorial.  595 

CONNECTICUT    HOnCEOPATHIC    MEDICAL     SOCIETY— 
SEni-CENTENNIAL  CELEBRATION. 

On  the  17th  and  i8th  inst,,  the  Connecticut  Homoeopathic 
Medical  Society  observed  their  fiftieth  anniversary.  Judging 
from  the  extended  report  in  the  Hartford  Courant  for  Nov. 
19  and  20,  the  celebration  was  in  every  way  a  success.  The 
exercises  began  on  Monday  afternoon  at  3  o'clock  with  a  bus- 
iness meeting,  over  which  Dr.  Charles  E.  Sanford,  of  Bridge- 
port, as  president,  presided.  A  detailed  and  interesting 
history  of  the  Society  was  read  by  Dr.  A.W.  Phillips,  of  Derby, 
Conn.  Dr.  Bradford,  of  Philadelphia,  Pa,,  presented  an  ad- 
dress on  *' Homoeopathy  in  the  United  States  from  185 1  to 
1901."  Dr.  J.  P.  Sutherland,  of  Boston,  spoke  in  his  charac- 
teristic and  interesting  manner  upon  "The  Homoeopathic 
Materia  Medica."  The  afternoon  exercises  closed  with  an 
address  upon  **  Medical  Colleges  and  Medical  Education,*'  by 
Dr.  Pemberton  Dudley,  of  Philadelphia. 

Monday  evening  was  devoted  to  a  public  meeting,  at  which 
there  were  several  musical  selections,  an  address  by  Dr.  J.  B. 
Rand,  of  Monson,  Mass.,  on  "The  Relation  of  the  Physician 
to  the  Patient,"  and  an  address  by  Prof.  F.  S.  Luther,  of 
Trinity  College,  on  **  The  Relation  of  the  Patient  to  the  Phy- 
sician." Prof.  Luther,  after  speaking  of  the  helplessness  of 
the  sick  and  their  absolute  dependence  on  the  physician,  goes 
on  to  speak  of  and  to  deplore  the  difference  of  opinion  of  the 
physicians.     He  says  in  part : 

"  Within  the  memory  of  most  of  us,  all  men,  sick  and  well 
alike,  have  become  your  patients.  We  are  demanding  not  so 
much  that  you  shall  cure  us  when  we  are  sick  as  that  you 
shall  prevent  us  from  getting  sick.  Now  it  is  in  this  larger 
range  that  the  relation  of  patient  to  physician  is  least  satis- 
factory. I  venture  to  say  that  we,  the  patients,  have  some 
fault  to  find  with  you,  the  physicians.  You  are  in  many  re- 
spects altogether  too  much  like  other  people,  too  much  like 
the  rest  of  us.  There  is  a  good  deal  more  disagreement 
among  our  doctors  than  we  patients  like  to  see.  We  have 
our  lawyers,  our  soldiers,  our  delegates  to  the  constitutional 


59^  The  New  England  Medical  Gazette,  Dec, 

convention,  to  do  our  quarrelling.  For  our  doctors  and  our 
ministers  we  want  harmony  and  unity.  And  I  think  that  the 
clergy  are  to-day  further  advanced  toward  agreement  than  the 
doctors  are.  The  clergy  at  least  deplore  their  differences  and 
show  traces  of  a  desire  to  work  together.  Indeed,  they  do 
largely  work  together  in  the  most  essential  and  the  most 
profitable  of  their  activities.  They  unite  in  all  sorts  of  asso- 
ciations for  the  exchange  of  views  and  for  the  conduct  of 
enterprises  looking  to  the  betterment  of  mankind.  They  are 
doing  this  because  they  are  coming  to  understand  that  their 
knowledge  is  but  a  small  thing  when  compared  with  their  ig- 
norance and  that  the  common  end  avowedly  sought  by  all 
will  be  quickest  attained  by  coroperation  of  all.  So  far  they 
set  most  physicians  a  good  example  and  the  spectacle  should 
stir  your  emulation.  We  patients  are  unable  to  comprehend 
a  professionalism  that  has  a  barb  wire  fence  around  it.  We 
laugh,  if  we  are  not  sick  ourselves,  when  we  see  that  a  doctor, 
feeling  himself  at  a  loss,  will  decline  to  consult  save  with 
those  most  likely  to  think  his  own  thoughts  and  follow  hi.s 
own  methods. 

"I  suppose  I  ought  not  to  be  saying  this  just  here  and 
now,  especially  as  I  have  had  some  experience  in  the  same 
line.  Some  years  ago  I  addressed  a  company  of  physicians 
and  ventured  upon  a  few  remarks  which  I  feared  would  not 
be  received  with  perfect  cordiality.  Well,  they  weren't. 
They  produced  a  coldness  such  that  the  price  of  coal  was 
raised  twenty-five  cents  a  ton  the  next  day.  Yet  mark  the 
sequel.  Every  one  of  the  several  doctors  in  the  room  whom 
I  chanced  to  know  personally  took  early  occasion  to  say  to  me 
privately  that  for  himself  he  deemed  my  opinions  thoroughly 
sound,  but  that  probably  he  was  the  only  doctor  in  the  room 
who  agreed  with  me.  Well,  when  loyalty  to  a  sect,  whether 
the  sect  be  religious  or  scientific — when  loyalty  to  a  sect 
dulls  the  perceptions,  cripples  earnest  effort,  and  sours  sweet 
charity,  then  treason  to  the  sect  becomes  the  highest  virtue. 

Moreover,  it  is  the  apparent  hostility  of  physicians  to  each 
other  that  is  partly  responsible  for  whatever  of  public  distrust 


190 1  EditoriaL  597 

causes  you  annoyance.  I  am  speaking  now  of  your  patients 
with  that  broad  inclusiveness  which  looks  upon  all  civilized 
peoples  as  in  the  hands  of  the  physicians.  Before  this  vast 
clientage,  disagreements  look  like  confessions  of  meager 
knowledge.  They  shake  confidence.  They  bring  into  prom- 
inence and  exaggerate  the  uncertainties  of  medical  science. 
In  every  science  it  is  the  borderland  of  the  unknown  that  is 
the  battlefield.  For  the  physicist,  the  chemist,  and  of  late 
years  for  the  biologist,  there  is  a  great  and  growing  body  of 
theory  that  is  accepted  by  all  and  depended  upon  by  every- 
body with  absolute  confidence.  Yet  there  have  been,  in  each 
of  these  lines  of  thought,  revolutions  as  great  as  any  that 
have  taken  place,  or  been  attempted,  in  medicine.  If  the  ex- 
tent of  indisputable  acquirement  in  medical  science  is  less 
than  in  some  other  sciences,  less  than  we  could  wish,  as  it 
probably  is,  then  that  is  all  the  more  reason  for  frank  public 
union  as  to  all  that  has  been  gained ;  all  the  more  reason  for 
abandoning  any  differences  that  are  merely  artificial,  con- 
ventional, sectarian.  We,  your  patients  in  the  broad  sense, 
want  to  see  our  doctors  get  together,  acknowledge  their  lim- 
itations, maintain  their  varying  opinions  as.  to  doubtful 
matters  stoutly,  yet  in  the  spirit  of  earnest  seekers  after 
truth." 

Dr.  T.  Y.  Kinne,  of  Patterson,  N.  J.,  gave  an  address  on 
**  Samuel  Hahnemann  " 

Tuesday  morning  the  business  session  was  occupied  by  the 
most  interesting  papers.  The  Hon.  Charles  E.  Gross,  of 
Hartford,  gave  an  extended  and  most  interesting  "  History  of 
Medical  Legislation."  Other  addresses  were  :  "  Progress  of 
Medicine  in  Fifty  Years,"  by  Dr.  George  F.  Laidlaw,  of  New 
York  City ;  "  Progress  of  Surgery  in  Fifty  Years,"  by  Dr. 
George  W.  Roberts,  of  New  York  City ;  and  Dr.  Horace 
Packard  on  "The  Hospital  in  1851  and  1901." 

On  Tuesday  evening  the  Society  and  its  invited  guests 
closed  its  celebration  with  a  banquet  at  the  Allyn  House. 
Dr.  Ed.  Beecher  Hooker  acted  as  toast-master.  The  toasts 
were  responded  to  by  the  Rev.  George  W.  Smith,  President 


598  The  New  England  Medical  Gazette.  Dec, 

of  Trinity  College;  Louis  E.  Stratton,  Esq.,  of  Hartford; 
Col.  Norris  G.  Osborn,  of  New  Haven,  Editor  of  the  New 
Haven  Register;  Dr.  Jos.  E.  Root,  Secretary  of  the  Hartford 
Medical  Society  (Allopathic)  ;  and  Joseph  T.  Greenleaf,  of 
Owego,  N.  Y.,  President  of  the  New  York  State  Homoeo- 
pathic Society. 

Our  friends  in  Connecticut  are  to  be  heartily  congratu- 
lated upon  the  enthusiasm  manifested  and  the  success  of  the 
occasion. 


The  Comparative  Germicidal  Action  of  Some  Dis- 
infectants. The  following  antiseptic  solutions  were  tested 
by  the  author :  Biniodide  of  mercury,  perchloride  of  mercury, 
chlorinated  lime,  formaldehyde,  lysol,  carbolic  acid,  izal,  med- 
ical izal,  Jeyes'  sanitary  fluid,  Walker's  I.  X.  L.  disinfectant 
fluid,  Condy's  fluid,  "  sanitas  *'  fluid,  and  boric  acid. 

Several  platinum  loops  of  bacillus  coli  communis  in  pure 
culture  on  potato  were  transferred  to  sterile  peptone  bouillon. 
In  this  emulsion  pieces  of  finely-plaited  sterilized  silk,  an  inch 
long,  were  immersed  for  ten  minutes,  and  then  transferred 
with  sterile  forceps  to  Petri  dishes  for  three  hours.  Next 
they  were  put  in  the  disinfecting  solutions  for  the  required 
times,  and  then  placed  in  sterilized  peptone  bouillon,  after 
they  had  been  thoroughly  washed  in  sterile  water.  A  growth 
was  then  looked  for  during  the  ten  days  following.  If  no 
growth  appeared  during  this  time  the  tubes  were  inoculated 
from  an  emulsion  of  the  bacilli  as  prepared  above.  In  every 
such  case  a  growth  was  found  at  the  end  of  twelve  hours, 
proving  that  the  bouillon  in  these  tubes  was  a  suitable  me- 
dium.—  Arthur  H.  Burgess,  The  Lancet^  June  23,  1900. 


1 90 1  Societies.  5  99 

SOCIETY  REPORTS. 


BOSTON   HOMCEOPATHIC   MEDICAL  SOCIETY. 

An  adjourned  meeting  of  the  society  was  held  at  the  Bos- 
ton University  School  of  Medicine,  Thursday  evening,  Sept. 
17,  1901,  at  eight  o'clock,  the  President,  T.  Morris  Strong, 
M.  D.,  in  the  chair. 

Report  of  the  Section  on  Electro-Therapeutics. 

T.  R.  Griffith,  M.  D.,  Chairman. 
Lucy  Barnby-Hall,  M.  D.,  Secretary.  C.  Y.  Wkntworth,  M.  D.,  Treasurer. 

Subject  for  the  Evening. 

"Treatment  of  Neuralgia,  Neuritis  and  Rheumatism  by 
Electricity.*'  Two  papers  by  Eliza  T.  Ransom,  M.  D.,  and 
George  E.  Percy,  M.  D.  Discussion  by  Dr.  Frank  C.  Rich- 
ardson, Dr.  Edward  P.  Colby,  Dr.  Clara  E.  Gary,  Dr.  Martha 
E.  Mann,  Dr.  A.  Howard  Powers,  and  Dr.  Nelson  M.  Wood. 

The  papers  were  interesting  and  heard  with  attention  ; 
Dr.  Ransom  treated  the  scientific  aspect  of  the  subject. 

Discussion. 

Dr.  Frank  C.  Richardson :  I  regret  that  I  have  not  heard 
Dr.  Percy's  paper,  except  the  last  of  it,  and,  therefore,  I  will 
not  attempt  to  say  anything  in  regard  to  it. 

Any  attempt  to  place  the  application  of  electricity  upon  a 
scientific  basis  is  of  great  interest.  Up  to  the  present  time 
that  has  been  the  great  drawback  to  the  therapeutic  applica- 
tion of  electricity.  No  doubt  you  have  all  heard  reports  of 
cures  of  similar  cases  by  very  different  methods  of  applica- 
tion. This  has  been  so  much  the  case  as  to  lead  to  the  accu- 
sation that  the  principal  effect  were  psychical.  Dr.  Ransom's 
paper  has  certainly  attempted  to  put  it  upon  a  scientific  basis. 
I  do  not  attempt  to  criticize  it,  because  I  do  not  know  enough 
about  it.  Theoretically,  it  seems  correct,  and  I  have  learned 
a  great  deal  from  her  paper  in  regard  to  the  reason  for  se- 


6oo  The  New  England  Medical  Gazette,  Dec, 

lection  of  currents,  some  of  which  I  have  selected  with  impu- 
nity. I  am  convinced  of  the  benefit  to  be  derived  from  a 
limited  and  somewhat  psychical  effect. 

There  has  been  one  point  in  Dr.  Percy's  paper  in  regard 
to  neuritis.  I  think  he  did  not  speak  as  enthusiastically  as 
he  might.  I  believe  that  there  are  some  cases  of  degener- 
ation which  never  can  be  cured,  a  regeneration  can  never 
take  place,  but  I  do  think  those  cases  are  rare  and  that  in 
the  majority  of  cases  one  does  well  to  persist  in  the  use  of 
electricity  long  after  it  seems  reasonable  to  give  it  up.  Sev- 
eral cases  have  responded  when  I  have  almost  lost  hope. 

Dr.  E.  P.  Colby  :  This  is  one  of  those  instances  in  which  a 
former  pupil  has  got  a  little  ahead  of  her  former  instructor. 
There  are  some  points  in  connection  with  her  paper  which 
show  the  advance  of  science  and  my  own  lack  of  reading  as  I 
should. 

With  regard  to  the  pathology.  I  am  pleased,  more  than 
ordinarily  pleased,  to  hear  the  pathology  of  neuritis  introduced 
in  the  way  that  it  has  been  and  carried  out  on  strictly  scien- 
tific principles.  It  is  true  pathology  that  we  can  abide  by, 
and  in  that  lies  our  picture  of  the  diseased  conditions,  the 
conditions  to  be  overcome.  Years  ago  I  began  treating  neu- 
ritis according  to  advice  published  by  Dr.  Weir  Mitchell,  in 
which  there  was  recommended  a  very  strong  primary  current. 
I  soon  found  that  in  order  to  use  this  current  with  benefit 
and  without  injury  to  my  patient,  I  must  wait  until  the  acute 
stage  was  past.  After  that  the  static  machine  came  into  use 
and  I  had  opportunity  to  test  it,  and  I  found  that  the  high 
frequency  of  the  current  and  the  greater  electro-motive  force, 
and  consequent  less  potential,  gave  us  a  new  agent  by  which 
we  could  relieve  pain  and  not  do  the  damage  of  the  high  cur- 
rent of  the  primary  coil.  Then  from  that  I  have  for  over  a 
year  past  been  using  this  current,  which  Dr.  Ransom  calls 
convective,  one  pole,  usually  the  negative,  grounded,  the  pos- 
itive connected  with  the  patient  and  the  poles  very  near  to- 
gether, with  rather  rapid    sparks,  what  Morton   terms   the 


190 1  Societies.  601 

vibratory  current  of  extreme  high  frequency.  An  important 
point  is  that  it  does  good,  it  meets  the  requirements  of  the 
case  and  patients  get  well,  they  get  better,  and  that  is  what 
I  like  to  have  them  do,  because  they  tell  their  friends.  They 
recover  in  a  fairly  satisfactory  way,  and  I  think  with  much 
less  inconvenience  to  them  and  certainly  much  less  pain  than 
with  the  old  method.  I  employ  electricity  as  an  agent  as  we 
do  nux  vomica,  belladonna  and  other  good  remedies.  I  have 
not  provided  myself  with  all  the  instruments  that,  perhaps,  I 
ought.  Of  coure,  there  are  some  things  to-day  done  in  a 
chemical  way  that  can  be  done  with  the  old  galvanic  current. 
I  think  that  is  of  very  great  value.  There  is  more  done,  I 
think,  in  a  way  that  has  not  been  so  much  thought  of  with 
the  high  frequency  Current,  in  continually  sending  shocks  or 
impulses,  creating  nerve  impulses,  and  some  one,  whom  I  do 
not  remember,  said  some  time  ago  that  those  impulses,  being 
established  by  electricity,  act  as  a  bombardment  against  the 
barriers  of  diseased  tissues.  We  know  that  nerve  tracks, 
that  passage  way  for  nerve  areas,  can  be  increased,  can  be 
developed.  I  would  not  say  that  inefficient  cells  can  be  de- 
veloped by  education  into  efficient  cells  by  causing  impulses 
to  pass  over  those  imperfect  tracks.  Nature  herself  is  after 
all  a  curative  agent.  Nature  herself  is  doing  the  cure  when 
we  seem  to  be  doing  it,  and  the  best  physician  after  all  is  he 
who  recognizes  that  fact  and  directs  his  every  aid  not  to  force 
but  to  aid  nature  in  her  natural  process  and  normal  direction, 
and  I  believe  that  electricity  does  this. 

One  very  important  class  of  inflammatory  process  has  not, 
perhaps,  had  here  that  attention  that  it  deserves  by  the  gen- 
eral practitioner.  I  refer  to  multiple  neuritis.  It  is  a  con- 
dition which  depends  upon  some  toxic  condition  in  the  blood. 
It  is  bi-lateral.  It  affects  usually  more  than  one  member, 
referable  to  more  than  one  segment  of  the  spinal  cord  Now, 
there  are  other  forms  of  neuritis  that  are  not  bi-lateral,  which, 
for  some  unknown  cause,  become  local.  Among  these  I 
would  include  acute  neuritis. 


6o2  The  New  England  Medical  Gazette,  Dec, 

Rheumatism  is  not  probably  a  uric  acid  disease.  I  do  not 
know  what  rheumatism  is,  but  I  do  believe  more  and  more 
every  year  that  it  is  a  condition  due  to  a  toxic  condition  which 
cannot  be  expressed  in  chemical  terms.  There  are  peculiar 
cases  of  gout  and  multiple  neuritis  which  are  affected  by 
electricity,  but  never  cured,  and  we  must  not  forget  constitu- 
tional treatment,  according  to  rules  laid  down,  by  properly 
selected  remedies.  I  believe  that  in  neuritis  and  multiple 
neuritis,  electricity  will  act  more  beneficially  by  removing 
the  other  symptoms  making  up  the  totality  of  the  disease. 
I  think  you  will  find  anaemia  present  in  neuralgia  by  making 
examination  of  the  blood.  We  know  we  have  hysterical 
neuralgia  which  is  cortical  in  its  origin  and  which,  when  the 
mental  perturbation  is  removed,  recovers  in  a  very  short 
time,  particularly  if  attention  is  given  to  nourishment. 

Dr.  A.  H.  Powers  :  I  am  rather  at  a  loss  to  know  why  I 
am  asked  to  discuss  the  paper  as  I  am  not  a  neurologist.  I 
have  had  neuralgia  once  or  twice  in  my  life,  which  is  about 
as  far  as  my  experience  goes.  Incidentally,  it  has  been  my 
experience  or  observation  that  coming  under  my  care  there 
have  been  a  good  many  cases  roughly  called  rheumatism  or 
neuralgia,  which,  on  careful  examination,  have  proved  to  be 
neuritis.  I  never  could  understand  why  a  neuritic  patient 
should  come  to  the  surgeon  at  the  Dispensary.  They  have 
been  pleasant  cases  in  some  respects.  I  prescribe  proper 
remedies  and  do  not  see  them  again  and  presume  they  get 
well.  I  remember  a  case  of  a  woman  who  had  suffered  for 
a  long  time.  A  practitioner  known  throughout  the  State  as 
a  good  prescriber,  called  the  case  rheumatism.  There  was 
no  improvement,  the  patient  became  dissatisfied  and  incident- 
ally came  under  my  care.  On  careful  examination  I  found 
the  diagnosis  proved  it  to  be  neuritis  beyond  any  doubt.  My 
use  of  electricity  has  been  very  meagre  and  I  have  nothing  to 
say  about  its  practical  use. 

I  was  going  to  say  that  some  practitioners  call  everything 
neuralgia,  but   I  certainly  believe  that  the  average   practit- 


190 1  Societies,  603 

ioner,  who  is  seeing  cases  and  caring  for  them,  fails  to  recog- 
nize the  disease,  overlooks  the  cause,  not  but  that  most  of  us 
make  mistakes  along  certain  lines.  I  would  urge  the  careful 
discrimination  as  to  neuritis  and  rheumatism,  and  have  the 
electric  current  scientifically  applied  as  suggested  this  eve- 
ning. I  have  observed  the  improvement  from  the  use  of 
electricity,  and  I  am  a  believer  in  its  use  when  applied  by 
some  one  who  knows  a  good  deal  more  than  I  do  about  it. 

Dr.  Frederick  F.  Strong :  I  am  interested  in  the  discus- 
sion of  this  subject.  I  was  impressed  with  what  Dr.  Colby 
said,  and  I  think  every  one  must  be  who  is  dealing  with  dis- 
ease and  observing  it  every  day,  that  it  is  a  fact  that  we  can- 
not hope  to  cure  disease  by  medical  or  other  means,  that 
nature  cures  and  we  only  assist.  In  looking  over  the  litera- 
ture of  electro-therapeutics,  I  have  always  been  impressed 
with  this  fact,  the  great  diversity  of  opinions  regarding  the 
use  of  the  electrical  current  and  the  multiplicity  of  details 
given  in  text-books.  My  experience  in  the  use  of  electricity 
has  been  that  there  are  practically  a  very  few  effects  resulting 
from  the  different  currents.  While  we  have  various  forces 
and  different  currents,  which  will  produce  different  effects 
and  modifications  of  effects,  I  think  we  can  limit  the  action 
of  each  current  accurately,  and  find  there  is  a  certain  definite 
field  for  the  use  of  each  one.  It  has  been  my  experience  in 
this  line  of  work  that  electricity  acts  principally  in  the  line  of 
high  potency,  acts  principally  as  nutrition,  bringing  about  a 
repair  of  tissues  on  the  verge  of  degeneration.  It  was  my 
privilege  to  say  something  on  the  use  of  the  high  frequency 
currents  a  year  ago  and  I  am  still  interested  in  their  use.  I 
think  these  currents  differ  noticeably  in  their  action. 

About  the  bombardment.  It  is  an  electrical  massage,  a 
bombardment  of  the  nerve  cells,  which  results  in  an  increased 
chemical  action  of  the  cell  itself.  The  diseased  condition  of 
the  cell  is  probably  the  result  of  toxic  conditions,  the  princi- 
pal one,  and  the  one  which  has  been  considered  to  the 
greatest  extent,  is  uric  acid.     We  may  assume  that  it  has 


6o4  The  New  England  Medical  Gazette.  Dec., 

something  to  do  with  these  conditions,  for  it  is  certain  that  if 
uric  acid,  or  the  tendency  to  uric  acid,  is  eliminated  the 
symptoms  disappear.  The  effect  of  the  high  frequency  cur- 
rent is  to  increase  the  cellular  combustion,  to  burn  up  their 
waste  products  so  that  the  result  is  urea.  The  analysis  of 
the  urine  in  cases  of  rheumatic  or  gouty  character  shows  in 
the  first  part  of  the  treatment  an  increased  elimination.  Uric 
acid  already  in  the  system  seems  to  be  eliminated  more  rap- 
idly as  the  action  of  the  current  is  increased.  This  is  ac- 
counted for  by  electrical  massage.  The  uric  acid  between 
the  tissues  and  interstices  of  the  body  is  jostled  into  the  main 
channels  and  passes  out  of  the  body.  The  comparison  of 
urea  and  uric  acid  show's  that  the  former  is  increased  and  the 
latter  decreased. 

Lithium  salts  and  salicylic  acid  are  the  two  mainstays  of 
old  school  physicians  in  the  treatment  of  gout  and  rheuma- 
tism. They  act  by  their  solvent  action  on  the  uratic  de- 
posits, forming  respectively  soluble  lithium  urate  and  salicyl- 
uric acid  (the  salts  of  the  latter  being  quite  soluble).  In 
order  to  get  the  solvent  effect  on  a  gouty  deposit,  it  is  neces- 
sary to  saturate  the  entire  system  with  the  drug,  if  it  be 
given  in  the  usual  manner.  I  have  employed  a  solution  of 
lithium  salicylate  on  gouty  joints,  either  immersing  the  part 
in  a  solution  of  the  salt,  or  using  the  latter  on  a  sponge  elec- 
trode. Using  the  positive  pole  over  the  joint  the  salt  is  de- 
composed, lithium  being  driven  into  the  tissues.  After  from 
ten  to  thirty  minutes  the  poles  are  reversed,  making  the  elec- 
trode over  the  joint  the  negative.  The  current  is  made  as 
strong  as  the  patient  can  bear  with  comfort  through  both 
stages  of  the  treatment.  When  the  negative  pole  is  over  the 
joint,  salicylic  acid  is  driven  into  the  tissues,  so  that  at  the 
end  of  the  operation  both  lithium  and  salicylic  acid  have  been 
driven  directly  into  the  part  without  affecting  the  rest  of  the 
body,  as  is  often  the  case  when  the  drugs  are  given  by  mouth. 
As  far  as  I  know,  this  double  method  of  electrical  osmosis 
has  never  been  employed  elsewhere  up  to  the  present  time- 


1 90 1  Societies.  605 

I  have  had  gouty  joints  which  responded  nicely  to  this 
treatment,  though  my  experience  has  not  been  sufficient  to 
give  results.  I  should  like  to  see  it  carried  out  by  those  who 
have  opportunity  for  larger  clinical  experience.  I  would  like 
to  say  that  I  speak  of  the  high  frequency  current  because  I 
have  made  a  special  study  of  it.  It  will  take  the  place  al- 
most entirely  of  the  static,  also  the  galvanic. 

Dr.  Percy :  I  am  very  grateful  to  Dr.  Ransom  for  her 
paper,  and  the  discussion  it  has  elicited  has  been  very 
interesting. 

There  is  one  thing  I  should  like  to  say  and  that  is  in  rela- 
tion to  the  constitutional  condition  arising  in  rheumatism. 
I  do  not  suppose  any  of  us  know  the  cause,  but  if  there  is 
anything  in  logic  or  scientific  fact  we  must  accept  the  uric 
acid  theory  as  laid  down  by  Dr.  Hamilton. 

Dr.  Ransom  :  I  desire  to  say  that  in  my  paper  on  rheum- 
atism and  neuralgia,  I  have  said  nothing  of  the  treatment  by 
other  methods.  I  was  very  glad  to  hear  what  Dr.  Strong 
had  to  say,  and  desire  to  emphasize  one  point,  that  electricity 
should  never  be  applied  unless  the  person  using  it  knows 
how  and  why  it  is  being  used. 

Adjourned  at  9.40. 

Edward  D.  Allen, 

Secretary, 


ANNOUNCEMENT. 

Cleveland,  Ohio,  Nov.  i,  1901. 

To  THE  Members  of  the  American  Institute  of  Hom- 
oeopathy : 

The  American  Institute  of  Homoeopathy,  in  session  at 
Richfield  Springs,  N.  Y.,  empowered  the  newly  elected  exec- 
utive committee  to  select  the  place  for  the  Institute's  fifty- 
eighth  meeting. 

The  Committee  has  made  choice  of  the  city  of  Cleveland, 
Ohio,  for  the  meeting  of  the  Institute  in  the  month  of  June, 


6o6  The  New  England  Medical  Gazette,  Dec, 

1902.  We  feel  assured  that  after  the  meeting  has  taken 
place,  the  members  will  agree  that  the  Committee's  decision 
is  the  wisest  one  that  could  have  been  made.  In  1899  the 
Institute  made  Cleveland  its  first  choice  for  the  next  suc- 
ceeding meeting,  thus  recognizing  its  eminent  fitness.  The 
local  profession  now  desires  the  meeting.  Cleveland  has  the 
advantage  of  being  easily  accessible  by  many  lines  of  road 
from  all  parts  of  the  United  States.  This  is  looked  upon  as 
being  of  the  greatest  importance  in  insuring  a  large  attend- 
ance. The  place  of  meeting  must  be  accessible.  The  month 
of  June  in  Cleveland  is  one  of  the  most  delightful  of  the  year 
and  weather  conditions  are  likely  to  be  of  the  pleasantest. 
The  Hollenden  House,  which  will  be  headquarters,  is  one  of 
the  best  hotels  in  any  city  in  the  country.  It  has  made  many 
concessions  in  the  interests  of  its  expected  guests.  The  Hol- 
lenden has  five  hundred  rooms  and  will  take  splendid  care  of 
a  large  number.  There  are  other  first-class  hotels  near  by. 
All  can  be  suited  and  all  can  be  accommodated. 

There  is  a  very  large  number  of  homoeopathic  physicians 
in  the  part  of  the  country  tributary  to  Cleveland,  making  it  a 
most  favorable  point  for  the  accession  of  new  members.  It 
is  many  years  since  the  Institute  met  in  Ohio,  an  additional 
reason  in  favor  of  the  choice  that  the  Committee  has 
made. 

It  is  proper  to  state  that  the  Executive  Committee  is  well 
aware  of  the  fact  that  there  is  a  strong  and  wide-spread  senti- 
ment in  favor  of  a  quiet  "resort"  for  the  Institute  meetings. 
Each  member  of  the  Executive  Committee  shares  in  this 
feeling.  With  this  in  view  an  earnest  effort  was  made  to  find 
a  suitable  place  of  the  character.  The  only  one  that  pre- 
sented itself  was  Put-in-Bay  island  in  Lake  Erie,  After  a 
thorough  investigation  the  Committee  felt  compelled  to  aban- 
don further  thought  of  this  place,  for  the  main  reason,  among 
others,  that  it  is  very  inaccessible.  Boats  do  not  always 
make  proper  connection  with  trains,  often  causing  long  delay. 
Should  the  Lake  chance  to  be  rough,  the  trip  is  very  object- 
ionable to  many  people.     Therefore,  because  of  its  inaccess- 


igoi  Reviews  and  Notices  of  Books.  607 

ibility,  the  Committee  became  convinced  that  it  was  unde- 
sirable to  make  choice  of  the  Lake  Erie  island  resort. 

In  making  the  above  announcement  of  its  final  choice,  the 
Executive  Committee  entertains  the  confident  assurance  that 
the  meeting  of  the  Institute  to  be  held  at  Cleveland,  June 
17-21,  1902,  will  take  its  place  among  those  that  have  been 
the  most  successful,  the  most  profitable,  and  the  most  largely 
attended. 

James  C.  Wood,  M.  D.,  President-elect, 
Charles  Gatchell,  M.  D.,  Secretary-elect. 


REVIEWS  AND  NOTICES  OF  BOOKS. 


Elfxtricity  in    Medicine    and    Surgery,  inci.uding   the  X-Ray. 

By  William  Harvey  King,  M.  D.,  Editor  of  1\\q  Journal  of  Electro- 

Therapeutics,     New    York:    Boericke    &    Runyon    Co.,    1901. 

pp.  296.     Price,  I3.50. 

In  the  above-mentioned  work  we  seem  to  have  one  that  is  com- 
prehensive and  carefully  written,  embodying  the  latest  knowledge  of 
the  subjects  treated.  All  the  conditions  to  which  electricity  is 
remedially  applicable  are  enumerated  and  the  indications  outlined. 
The  contents  of  this  work  are  presented  in  two  parts,  the  first  inclu- 
ding sections  on  electro-physics*  the  X-ray,  motor  points,  electro- 
diagnosis,  organic  electrology,  all  very  fully  illustrated.  The  second 
part  comprises  sections  on  general  electro-therapeutics,  diseases  of 
the  nervous  system,  gynecology  and  obstetrics,  diseases  of  the  ali- 
mentary tract,  genito-urinary,  the  treatment  of  hypertrophy  of  the 
prostate  gland  by  the  galvano-caustic  method  after  i  ottini,  diseases 
of  the  nose  and  throat,  diseases  of  the  skin,  general  diseases,  and 
diseases  not  otherwise  classified.  Diseases  of  the  eye  and  ear  and 
the  therapeutic  action  of  the  electric  light  have  been  omitted,  but 
these  are  not  omissions  which  lessen  the  value  of  this  treatise  as  a 
whole.  We  think  it  peculiarly  adapted  to  serve  as  a  general  text- 
book in  and  out  of  college.  The  explanations  and  instructions  are 
clearly  put  and  thoroughly  practical.  Professor  King  is  a  man  of 
large  experience  and  is  an  authority  upon  the  therapeutic  uses  of 


6o8  The  New  England  Medical  Gazette,  Dec, 

electricity,  while  his  coadjutors  are  fully  competent  to  collaborate  in 
the  preparation  of  such  a  work.  The  drawings,  which  have  been 
specially  prepared,  will  be  of  great  assistance  in  memorizing  the 
accompanying  text  and  in  determining  motor  points. 

Manual  of  the  Essentials  of  Diseases  of  the  Eye  and  Ear. 
By  J.  H.  Buffum,  M.  D.,  Professor  of  Ophthalmology  and  Otology 
in  the  Chicago  Homoeopathic  Medical  College,  etc.  Illustrated. 
Chicago:   Halsey  Bros.  Co.,  1901. 

The  subject  matter  of  this  book  is  arranged  in  the  form  of  ques- 
tions and  answers.  This  admits  of  frequent  paragraphing  and  would 
have  permitted  with  advantage,  we  think,  such  divisions  as  would 
properly  have  appeared  under  chapter  headings.  There  is,  however, 
nothing  of  this  kind  and  consequently  no  table  of  contents.  The 
index  is  sufficiently  complete  and  the  scope  of  the  book  not  so  ex- 
tensive as  to  create  confusion  in  the  search  for  a  given  subject. 
The  principal  diagnostic  and  therapeutic  points  of  the  various  dis- 
eases of  the  eye  and  ear  are  concisely  given,  preceded  by  the  anat- 
omy, physiology  and  pathology.  Many  of  the  illustrations  are 
chromo- lithographs  of  considerable  merit.  The  inclusion  of  homoe- 
opathic remedies  will  be  much  appreciated.  We  commend  the 
spring-back  binding  and  wide  margins  but  deplore  the  cheap  paper. 

Essentials  or  Obstetrics.    By  Charles  Jewett,  A.  M.,  M.  D.,  Sc.  D., 
Professor  of  Obstetrics  and  Gynecology  in  the  Long  Island  Col 
lege  Hospital,  etc.     Assisted  by  Harold  F.  Jewett,  M.  D.     Illus- 
trated.    New  York  and  Philadelphia :  Lea  Brothers  &  Co.,  1901. 
pp.  386.     Price,  J2.25  net, 

A  manual  such  as  the  above  furnishes  an  admirable  introduction 
to  larger  and  more  comprehensive  works  on  obstetrics.  It  serves 
as  an  accompaniment  to  and  a  commentary  upon  the  didactic  and 
clinical  teaching  of  the  college  course.  It  belongs  to  the  popular 
class  of  treatises  which  stand  between  the  quiz-compend  and  text- 
book proper. 

The  author  is  accustomed  to  write  for  students  and,  as  a  teacher, 
understands  and  appreciates  their  needs.  These  "Essentials"  will 
be  found  practical  and  helpful.  The  book  has  many  and  excellent 
illustrations,  is  well  printed  and  attractively  bound. 


190 1  Reviews  and  Notices  of  Books,  609 

The  Medical  News  Visiting  List  for  1902.  Weekly  (dated,  for 
30  patients) ;  Monthly  (undated,  for  120  patients  per  month)  -, 
Perpetual  (undated,  for  30  patients  weekly  per  year)  ;  and  Per- 
petual (undated,  for  60  patients  weekly  per  year).  The  first 
three  styles  contain  32  pages  of  data  and  160  pages  of  blanks. 
The  60- patient  Perpetual  consists  of  256  pages  of  blanks.  Each 
style  in  one  wallet- shaped  book,  with  pocket,  pencil  and  rubber. 
Seal  Grain  Leather,  II1.25.  Thumb-letter  Index,  25  cents  extra. 
Philadelphia  and  New  York  :  Lea  Brothers  &  Co.,  Publishers. 

A  visiting  list  is  a  necessity  for  every  physician.  Among  the  va- 
rious ones  which  are  annually  put  forth,  the  Medical  News  Visiting 
List  seems  to  fill  the  bill  as  well  as  any.  It  has  several  useful  tables 
in  the  beginning,  such  as  "  Doses,"  "  Examination  of  Urine," 
"Artificial  Respiration,*'  ** Diagnostic  Table  of  Eruptive  Fevers," 
etc.  As  seen  above,  it  is  issued  in  four  styles,  and  the  work  is  up 
to  the  standard  usually  maintained  by  Lea  Brothers  &  Co. 

Saunders'  Question  Compends.  Essentials  of  the  Diseases  of 
Children.  By  William  M.  Powell,  M.  D.  Third  Edition. 
Thoroughly  Revised  by  Alfred  Hand,  Jr.,  M.  D.,  Dispensary 
Physician  and  Pathologist  to  the  Children's  Hospital,  Philadelphia. 
1 2 mo.,  259  pages.  Philadelphia  and  London:  W.  B.  Saunders 
&  Company.     Price,  ^i.oo  net. 

In  this  third  edition  we  find  an  unusually  clear  consideration  of 
the  essential  features  of  all  the  ordinary  diseases  of  children,  together 
with  a  like  careful  survey  of  some  of  the  rarer  affections. 

The  feature  of  the  book  calling  for  especial  commendation  is  the 
judicious  stress  put  upon  the  matter  of  diet  throughout,  but  partic- 
ularly emphasized  in  relation  to  the  disorders  of  the  gastro-intestinal 
tract.  The  introduction,  under  which  is  included  medical  examina- 
tion, fecal  evacuations,  the  pulse,  the  temperature,  and  drugs,  would 
prove  instructive  reading  for  any  practitioner.  Everything  is  re- 
vised to  date.  A.  E.  p.  R. 

Saunders'  Medical  Hand-Atlases.  Atlas  and  Epiix^me  of  the 
Nervous  System  and  its  Diseases.  By  Professor  Dr.  Chr. 
Jakob,  of  Erlangen.  From  the  Second  Revised  German  Edition, 
Edited  by  Edward  D.  Fisher,  M.  D.,  Professor  of  Diseases  of  the 


6jo  The  New  England  Medical  Gazette.  Dec, 

Nervous  System,  University  and  Belleview  Medical  College,  New 
York.  With  83  plates  and  copious  text.  Philadelphia  and  Lon- 
don :  W.  B.  Saunders  &  Co.,  1901.     Cloth,  ^3.50  net. 

To  those  of  us  who  have  shrunk  from  the  critical  study  and 
precise  interpretation  of  the  pathological  processes  underlying  the 
various  diseases  of  the  nervous  system,  this  book  comes  as  a  revel- 
ation. 

Even  those  members  of  the  medical  profession  who  have  not 
enjoyed  the  elaborate  pathological  training  of  these  latter  days  will, 
without  great  difficulty,  soon  find  themselves  at  home  in  its  pages. 
To  the  neurologist  it  is  a  veritable  mine  of  information.  The  trained 
histologist,  realizing,  as  he  does,  the  great  skill  and  untiring  energy 
involved  in  carrying  tissue  through  the  various  steps  from  the  post- 
mortem table  to  the  multi-colored  lithograph,  is  simply  overcome 
upon  inspecting  this  work.  The  debt  which  we  owe  Dr.  Jakob  and 
his  coadjutors,  including  those  concerned  in  the  production  of  ihe 
mechanical  features  of  the  book,  is  one  that  it  will  be  difficult  to 
repay. 

The  text  includes  a  concise  and  marvellously  clear  consideration 
of  the  Morphology  of  the  Nervous  System  ;  Development,  Structure 
and  Histology  of  the  Nervous  System ;  Anatomy  and  Physiology  of 
the  More  Important  Nervous  Pathways ;  General  Pathology  and 
Treatment  of  the  Diseares  of  the  Nervous  System ;  Special  Path- 
ology and  Treatment ;  each  section,  as  indicated,  being  accompanied 
by  profuse  and  well- described  illustrations.  It  is  difficult  to  con- 
ceive anything  more  complete.  a.  e.  p.  r. 

A  Practical  Treatise  on  Diseases  of  the  Skin.  By  John  V. 
Shoemaker,  M.  D.,  LL.  D.,  Professer  of  Skin  and  Venereal  Dis- 
eases in  the  Medico- Chirurgical  College  and  Hospital  qf  Phila- 
delphia, Physician  to  the  Philadelphia  Hospital  for  Diseases  of 
the  Skin,  etc.  Fourth  Edition^  enlarged  and  revised,  D. 
Appleton  &  Co.,  1901.     Cloth,  $5.00;  Sheep,  J6.00.     8vo. 

This  is  essentially  the  practitioners'  and  students'  hand-book  of 
diseases  of  the  skin. 

Part  I  is  devoted  to  general  considerations  and  includes  the  Anat- 
omy, Physiology,  Function,  and  Hygiene  of  the  Skin  and  its  Append- 
ages. 


1 90 1  Personal  and  News  Items,  61 1 

In  Part  II  the  nine  heads  under  which  the  diseases  of  the  skin 
and  their  treatment  are  considered  are  as  follows :  i,  Disorders  of 
Secretion  and  Excretion;  2,  Hyperaemias;  3,  Haemorrhages;  4, 
Exudations;  5,  Hypertrophies;  6,  Atrophies;  7,  Tumors;  8,  Neu- 
roses ;  9,  Parasites. 

A  valuable  formulary  of  one  hundred  pages  completes  the  book. 

A  careful  inspection  of  the  work  reveals  the  fact  that  all  the  im- 
portant features  that  have  marked  the  most  creditable  advance  made 
in  dermatology  during  the  past  few  years  have  been  faithfully  noted. 

This  book  is  especially  valuable  because  of  the  admirable  classifi- 
cation and  arrangement  of  the  material,  the  simplicity  of  the  text, 
and  the  detailed  attention  which  the  subject  of  treatment  receives 
throughout. 

A.   E.   p.  R. 


PERSONAL  AND   NEWS   ITEMS. 


Dr.  J.  S.  Shaw  has  removed  from  552  Tremont  St.  to  2 
Commonwealth  Ave.  He  will  have  office  hours  from  12  m. 
to  3  p.  M. 

Dr.  Frederick  William  Payne  has  removed  from  the  Stein- 
ert  Building  to  Colonial  Theatre  Building,  100  Boylston  St. 
Office  hours  from  1 1  a,  m.  to  i  p.  m.,  and  from  2  to  5  p.  m. 

Dr.  Frederick  W.  Colburn  has  removed  to  1 16  Newbury 
St.,  near  Dartmouth.  His  office  hours  are  from  2  to  4  p.  m  : 
Sundays  excepted. 

Dr.  H.  E.  Fernald,  of  Cohasset,  has  removed  to  the  resi- 
dence formerly  owned  by  the  late  Edward  E.  Ellms,  on 
South  St. 

Dr.  Alice  E.  Rowe,  of  Springfield,  Mass.,  returned  from 
Germany  on  Nov.  12,  where  she  had  spent  three  months  in 
the  study  of  gynaecology  in  the  German  hospitals. 


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