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r
THE
NEW ENGLAND
MEDICAL GAZETTE
gl (mon<§C^ gouvnaC
HOMCEOPATHIC MEDICINE.
'^Dic viildc Mac lit ist grassy
VOLUME XXXVI.
BOSTON :
OTIS CLAPP tSc SON, lo PARK S(,)UARE.
1901.
MAY 13 1902 ^^
INDEX.
COMMUNICATIONS.
Acate Ivaryngitis. By N. H. Houghtoni M.D io6
Address Delivered Before Graduating Class of 1901 of Boston Uni-
versity Medical School. By Prof. E. P. Colby, M.D. . 517
An Involuntary Proving of Antimony. By Fred'k B. Percy, M.D. 585
Annual Address by President of Boston Homoeopathic Medical
Society. By Fred. M. Halsey, M.D. 73
Annual Address by President of Massachusetts Momoeopathic
Medical Society. By John L. Coffin, M.D 270
Aseptic Vaccination. By H. H. Powers, M.D 589
Brief Study of Temperature in Certain Serious Puerperal Compli-
cations, A. By Sarah S. Windsor, M.D 481
Case of Chronic Suppurative Otitis Media, A. By F. W. Colburn,
M.D • ; ^ • ,- • 436
Catarrhal Children. By.Edwari Beech er looker, M.D. . 532
Chest Diseases in 1800 and looo. By HY^^-.Glapp, M.D. . . 350
Complicated Fracture, A. SyNafhani^l W. Emerson, M.D. 565
Diagnosis and Treatment of Gall Stoae Cases, The. By Horace
Packard, M.D. 169,336
Eye Strain Notwithstanding Acute Vision. By D. W. Wells, M.D. 85
Factor in Wound Disturbance, A. By Wm. F. Wesselhoeft, M.D. 578
Four Cases of Pernicious Anaemia in Insane Subjects. By S. C.
Fuller, M.D 441
Letter From Germany, A. By Horace Packard, M.D. . 421, 469
Local Use of Arsenic in Malignant Ulceration, The. By George
L. Van Deursen, M.D. 96
Maternity Department of the Massachusetts Homoeopathic Hospi-
tal, The Services of Walter Wesselhoeft, M.D. By J. Emmons
Briggs, M.D 428
Medical Registration. By Fred A. Davis, M.D i
Modern Aids to Accurate Diagnosis. By J. P. Rand, M.D. . 380
Modern Idea of the Use of Drugs as Medicines, The. By C. Wes-
selhoeft, M.D 325
Modern Surgical Technique. By J. Emmons Briggs, M.D. 176, 243
Modern Surgical Technique. By George H. Earle, M.D. . 454
Notes on the Waters of Gastein. By Walter Wesselhoeft, M.D. . 571
Onosmodium Virginianum in Headache from Eye Strain. By A.
B. Norton, M.D 121
On the Faith in the Efficacies of Remedies. C. Wesselhoeft, M.D. 476
4 The New England Medical Gazette.
On the Therapeutics of Catarrhal and Neurotic Gastric and Intes-
tinal Diseases. By C. Wesselhoeft, M.D 13
Report of a Case of Smallpox. By H. H. Amsden» M.D. . 522
Report of Cases Illustrative of the Association of Crime and In-
sanity 191
Report of the Surgical Service of the Massachusetts Homoeopathic
Hospital, January i to April i, 1901. By Nathaniel W. Emer-
son, M.D 490
Report of the Surgical Service of the Massachusetts Homoeopathic
Hospital, July i to October i, 1900. By Winfield Smith, M.D. 285
Scleroderma. By John H. Urich, M.D 133 -
Second Annual Report of the Rutland Sanatorium. By H. C.
Clapp, M.D. 26
Serum-Therapy, and the Animal Extracts. By John P. Suther-
land, M.D 339
Some Experiences With Bubonic Plague. By W. H. Watters, M.D. 527
Some Preventable Causes of Mental Diseases. By Ellen L.
Keith, M.D 183
Some Reminiscences of the Study of Materia Medica. By N. R.
Perkins, M.D 139
Some Throat Symptoms of Lachesis. By Maurice W. Turner, M.D. 229
Spinal Anaesthesia by the Tuffier Method. By William G. Wil-
cox, M.D 22
Surgical Treatment of Tubercular Joint Disease. By Ceorge W.
Roberts, M.D 373
Temperature in Puerperal Cases. By Lena H. Diemar, M.D. . 505
Teratoma of the Parotid Gland. By T. M. Strong, A.M., M.D. . 221
Treatment of Epithelioma Other Than by the Knife. By John ly.
Coffin, M.D. 226
Treatment of Rheumatism, Neuritis, and Neuralgia by Electricity,
The. By George E. Percy, M.D 540
Treatment of Tubercular Peritonitis by Abdominal Section and
Drainage. By William T. Hopkins, M.D 104
Tuberculosis and the Great Southwest. By Dr. Merrill -391
Uterine Fibroids from the Practitioner's View Point. By G. For-
est Martin, M.D. 125
What is Peritonitis? By Horace Packard, M.D 279
EDITORIAL.
dazaar for the Benefit of the Medical School 205
Case of the Late President, The 507
Cephalic Hypertrophy 398
Connecticut Homoeopathic Medical Society Semi-Centennial Cel-
ebration 595
Dr. Packard's Letter 458
^
Index. S
Hahnemann A,9SOciation, The no
Institute Meeting, The 148
Legislation 207
Meeting of the Hahnemann Monument Committee of the Ameri-
can Institute of Homoeopathy 253
Pending Legislation 145
Present Danger, The 549
Publishers' Announcement 593
Reproving of the Materia Medica, The 249
^ Resolution, Western New York Homceopathic Medical Society . 209
Subject of Over-Study in Our Public Schools, The ... 32
j. ■ Word to Graduates, A 296
\
EDITORIAL NOTES AND COMMENTS.
Hampden Homoeopathic Hospital 400
Medical Curiosity, A 38
New Site for Detroit Homoeopathic Hospital 458
Opening of the New Homoeopathic Hospital at the University of
Michigan 36
Reproving Drugs 298
>«-
SOCIETIES.
American Institute of Homoeopathy .... 258, 266, 316
Boston Homoeopathic Medical Society 46. 151, 161, 2(3, 301, 310, 361,
401, 555, 599-
Massachusetts Homoeopathic Medical Society 254, 553
. 408
. 315
• 557
41 » 370
Massachusetts Surgical and Gynecological Society
Rhode Island Homoeopathic Medical Society .
Texas Homoeopathic State Society . . . .
Worcester County Homoeopathic Medical Society .
OBITUARY.
Dr. Galen Allen 113
Dr. Wm. D. Anderson 252
Dr. Henry F. Batchelder 149
Dr. L. Louise Brigham 252
Dr. Jane K. Culver 296
Dr. Erastus E. Marcy 113
Dr. Max Pettenkoper 358
Dr. Sarah E. Sherman 35
Dr. Anna F. Smith 298
Dr. Henry M. Smith 208
6 The New England Medical Gazette,
Notes on Pathology 55 210
Reviews and Notices of Books 59. 115, 165, 215, 261, 318, 372, 409, 467,
515,558,607-611,
Reprints and Monographs Received . . . ^ . 322, 561
Items of Interest 67, 459, 509, 562, 598
Personal and News Items 71, 120, 167, 218, 265, 323, 372, 420, 468, 516,
563, 611.
r
2 The New England Medical Gazette, Jan.,
Medical Association : " The matter of medical legislation is
a delicate one from a professional standpoint. The passage
of medical practice acts has been urged by the medical pro-
fession, and we have been distinctly misunderstood in our
attitude toward legislation. There is a feeling in the com-
munity and on the part of legislators that in some way the
medical profession wishes to put a fence around the practice
of medicine, in order that those who are on the inside may
fatten. It is persistently charged that we wish to create a
medical oligarchy, to which only the few shall be eligible.
For selfish, reasons it is said that we desire to limit the num-
ber of medical men, to the end that we alone may occupy
the chosen field. To the credit of the better elements in the
community it must be said that such charges largely eminate
from those whose interests are identical with the diploma
mills and the various forms of quackery. The profession
urges medical legislation, not from selfish and interested
motives, but in the interest of the public health.' At no
time has it desired legislation which shall limit the number
of medical men, but it has insisted that those who pose as
practitioners of the healing art should be in effect what they
claim — masters of medical science.
The government licenses pilots and engineers in the in-
terests of the public. We merely point out that the same
precautions should be taken in protecting the individual life,
that are taken for the many. It is the duty of government
to ascertain the qualifications of medical men who pose as
qualified practitioners. This is the attitude of the medical
profession upon this question, and so far as we are personally
concerned, we would rather there were no medical practice
acts, because they are not necessary for our protection, but
simply for the protection of the public."
Another objection which has always been urged with great
force is that it restricts the liberty of the individual. Any
person has absolute right to select any method of treatment
in a supposed or real illness that he sees fit, or to choose any
igoi Medical Registration, 3
person to attend him that he pleases, and so far as the indi-
vidual is concerned this may be right, but as far as the com-
munity is concerned it is essentially wrong ; for the reason
that no individual has the right to endanger the life of his
neighbor or the community in which he lives by the failure
of the medical attendant, whom he chooses to employ, to
recognize diseases dangerous to the public health.
We have also heard an objection raised, that you cannot
by legislation educate people to the necessity of recognizing
those who have ability and those who have none. That is
very true, and for that reason registration is necessary. You
cannot legislate people to be honest, therefore laws are
passed to punish theft. You cannot legislate people to be
moral, therefore laws are passed to protect the community
from immorality. You cannot legislate people against sud-
den rage or a spirit of vengeance, consequently laws are
passed against murder and violence. And although you can-
not by law enact as to what physician, or what class of
physicians, or what means of skill, medical or otherwise,
people may choose to employ for the cure of their ailments,
it is right and proper that registration should be passed,
protecting the community from the deplorable consequences
of ignorance in all matters pertaining to the cure of the sick.
As one of, the many instances where this lack of sufficient
knowledge has worked irremediable harm, resulting in the
death of the individual, I cite from the New York Medical
Journal of March 10, 1900, with editorial comments thereon :
" A case recorded in the Western Medical Review for De-
cember 15th, comes, if accurately stated, clearly within the
limits of criminality. A professing Christian Science Healer
of Fort Dodge, Iowa, undertook the sole charge of the case
of a child suffering from post-pharyngeal abscess. The bur-
rowing nature of this disease is well known, and the impor-
tance of providing an outlet for the pus is beyond question.
This was not done, and the consequence was that the child
died from asphyxia. Mr. Lincoln, the healer in question
4 Ihe New England Medical Gazette, Jan.,
signed the certificate as the * attendant nurse,' giving the
cause of death as * spasms.* Many of the cases where
death ensues under Christian Science treatment are those of
incurable disease, concerning which, while it is probable that
proper skilled aid would have ameliorated suffering if not
prolonged life, it is yet impossible to assert positively that
such would have been the case, and still more impossible to
state that Christian Science was in any sense a cause of
death. But the case now recorded is one in which proper
treatment would undoubtedly have saved life, and death was
directly due to its being withheld. Although we believe
that Iowa is one of the states that have legalized this pestif-
erous and unscrupulous charlatanry, there should still be a
remedy in firm application of the law of malpractice." Also,
in the same issue of the New York Medical Journal^ I cite
an editorial entitled " Faith Healing and the Law." " Ac-
cording to the New York Tribune for March 5 th, the aid of
the law is to be invoked to rescue a young woman in Chicago
from the criminal folly of the faith healing community. The
young woman is said to be suffering from * brain fever,'
which from the reference to her screams of agony we take to
be tuberculous meningitis, and these wiseacres, led by a
former * regular physician,' are attempting to cure her by
casting out devils, anointing the head with oil, and other
methods." The Humane Society and the health department
having no legal ground to interfere, a judge has been ap-
pealed to for an order to commit her to the Detention Hos-
pital for treatment. The absurd blasphemy of these people
is exemplified in the following statement, which purports to
have eminated from one of the before mentioned physician's
disciples : * Miss Bettison's illness is due to the rapidity of
her spiritual experience. It is due to the struggle between
the Holy Ghost and whatever of evil there is in her for mas-
tery. The Holy Ghost seems to have come to her all at
once, and it is more than her body can stand. We feel
sure she will be well in a few days if we are only left alone
I go I Medical Registration, 5
and allowed to care for her as Dr. Gentry says/ We are
no advocate for any undue interference with the personal
liberty of the individual adult, in full possession of his facul
ties, to get his treatment in disease done for him as he gets
his laundry — anywhere and by any method that pleases him.
But children, who are incompetent to take care of them-
selves, and adults who are mentally incapacitated, either per
manently or temporarily, have a right to protection from the
vagaries of fanatics," As to the right and interest of the
community to enact laws for sufficient protection in this
respect, I cannot do better than repeat the words of Mr.
Justice Field, of the Supreme Court of the United States,
in the case of Dent vs. West Virginia, in delivering the
opinion, he said : " The power of the state to provide for
the general welfare of its people authorizes it to prescribe all
such regulations, as in its judgment will secure, or tend to
secure them against the consequences of ignorance and inca-
pacity, as well as of deception and fraud. Few professions
require more careful preparation by one who seeks to enter
it than medicine. It has to deal with all those subtle and
mysterious influences upon which health and life depend,
and requires not only a knowledge of the properties of vege-
table and mineral substances, but of the human body in all
its complicated parts, and their relation to each other, as
well as their influence on the mind. The physician must be
able to detect readily the presence of disease, and prescribe
appropriate remedies for its removal. Every one may have
occasion to consult him, but comparatively few can judge of
the qualifications of learning and skill which he possesses.
Reliance must be placed upon the assurance given by his
license, issued by an authority competent to judge in that
respect, that he possesses the requisite qualifications. Due
consideration, therefore, for the protection of society may
well induce the state to exclude from practice those who
have not such a license, or who are found upon examination
not to be fully qualified. No one has a right to practice
6 The New England Medical Gazette, Jan.,
medicine without having the necessary qualifications of learn-
ing and skill ; and the statutes only require that whoever
assumes, by offering to the community his services as a
physician, that he possesses such learning and skill, shall
present evidence of it by a certificate or license from a body
designated by the state as competent to judge of his qualifi-
cations.*'
The general recognition of the necessity for registration is
evidenced by the fact that of all the civilized countries, China
and Japan are about the only ones without any special law.
From an article of Julius Schwabe, editor of the Diietsche
Medicinische Wochenschrift^ we learn that the following
countries have regulations governing the practice of medi-
cine: "No special laws. i. China and Japan. 2. The
requirement of a diploma or certificate authorizing the holder
to practice in his own community — many states in the
United States and some states in Africa. 3. The passage
of a state examination — some states in the United States,
Austria and Turkey. 4. The passing of a state examina-
tion, with some concessions as to preliminary examinations
— Argentina, Denmark, France, The Netherlands, Spain,
Sweden. 5. Regular courses in the community's own
schools — Belgium, Greece, Italy and Portugal. 6. The
same, with evidence of preliminary education — Germany,
Russia and Switzerland. 7. Denial of all foreigners of the
right to practice — Luxemborg and Servia." The earliest
legislation of which we have any record, as far as I have
been able to learn, was passed by the legislature of Virginia
in 1639, in regard to regulating fees. Out of thirteen colo-
nies there were only two where laws were enacted in regard
to defining the qualifications of a physician. In 1 840 laws
were enacted by nearly all the legislatures of the United
States to protect the citizens from the imposition of quacks.
Between 1840 and 1850, however, the cry of monopoly was
raised, and most of these laws were repealed or lapsed into
"innocuous desuetude." In 1859 North Carolina passed a
190 1 Medical Registration, 7
law creating a State Board of Medical Examiners, and in
1874 Kentucky enacted a law creating district examining
boards, but this soon became a dead letter. In 1875 Nevada,
and in 1876 California and Texas legislated upon the sub-
ject. In 1877 Alabama established a State Board of Medi-
cal Examiners, and Illinois passed a Medical-Practice act,
the execution of which devolved upon a State Board of
Health, created by a separate enactment. Within the next
two years only two other states took action — Kansas in
1879 (repealed in 1 881) and New York in 1880. In 1881
nine states and one territory enacted medical practice laws,
viz. : Arizona, Arkansas, Colorado, Connecticut, Florida,
Georgia, Nebraska, New Jersey, Pennsylvania and Wis-
consin; in 1882 Louisiana, Mississippi, New Hampshire,
New Mexico, South Carolina, West Virginia and Wyoming ;
in 1883 Delaware, Michigan, Minnesota, Missouri; in 1884
Dakota and Virginia.
Thirty-two of the states now require an examination before
permission to practice is obtained, the mere holding of the
medical diploma not conferring the right to practice. Many
efforts have been made from time to time to enact legisla-
tion in our own state, but not until 1 894 was definite legisla*
tion enacted. This law, at present, as you all know, renders
an examination before the State Board of Medical Registra-
tion requisite for a permission to practice medicine, but the
law does not prescribe definitely any preliminary education.
In some states a diploma from a chartered medical school is
accepted as sufficient evidence of ability. This is not so in
this state, and a perusal of the reports of the various exam-
inations, to which we shall refer later, shows that this pro-
vision is a wise one. The practical working of the law in
this state, however, is essentially handicapped by the exemp-
tion of all • clairvoyants, hypnotists, magnetic healers, mas-
seurs. Christian scientists, osteopaths, or any other method of
healing,' so long as they do not advertise themselves as
physicians. While nominally forbidding this class of people
8 The New England Medical Gazette. Jan.,
to practice medicine, it practically leaves a wide open door
for an imposition upon the public to a full extent of all forms
of charlatanry.
What is essential to any law is not only that such people
should not have the right to use the title of doctor, but that
they should be obliged to give evidence of sufficient knowl-
edge of disease to enable them to recognize diseased condi-
tions dangerous to the public health.
As the law stands at present, should a physician from
neglect or any other cause, fail to report to the proper
authorities a disease dangerous to the public health, he is
subject to a penalty ; while similar failures on the part of the
clairvoyant, Christian scientist, etc., etc., is subject to no
penalty whatever. That is, we have a law for protection
which does not protect. The modifications of our present
state law for the remedying of this condition of affairs, is
absolutely and immediately imperative.
An examination of the various reports of our present State'
Board, and especially the results of the examinations hereto-
fore held, showing as they do a large per cent, of applicants
who have been refused permission to practice, illustrates one
of two things — either that a large proportion of those who
apply are not graduates of a medical school, or that the
standard of the requirements for graduation from our medi-
cal schools is not sufficiently high or else not rigidly en-
forced. As evidence of this, permit me to give briefly a few
results of various examinations held within the past four
years: In 1897 there were 492 applicants and 152 rejec-
tions, an average of 31 per cent, rejected. In 1898 total
number of applicants 489, 1 34 rejected, making an average
of 25 per cent, rejected. In 1899 the applicants numbered
480 and 141 were rejected, an average of nearly 26 per cent,
rejected. In 1900, out of 428 applicants, 136 were rejected,
an average of 3 1 per cent. Thus, in the past four years, of
1889 applicants, 563 have been rejected who would otherwise
be practicing medicine today.
IQOI Medical Registration. 9
It may also interest you to hear a brief sample of some of
the questions and answers, showing if these are a fair sample
of the papers excluded, the examination ks by no means too
rigid. These questions and answers are taken from the
report of the State Board of Registration of Massachusetts
for 1899 and 1900. They are in every case taken from the
papers presented by graduates of medical schools, and each
answer is exact as to spelling, punctuation, capitalization and
phraseology, and no one student is quoted more than one : —
Q. Acute iritis, — diagnosis and treatment ?
A. With this trouble there is trouble in the sight owing
to the inflamation which causes a blur of the sight the
treatment would be to treat the system internally and then
send to an optician and have the eyes fitted with proper
glasses.
Q. In the second stage of labor what conditions would
require the application of forceps ?
A. I think a transverse position would require the use of
forceps.
Q. Differentiate infanticide from foeticide ?
A. The first is an instance in which the mother kills the
new born, the next is an instance in which the child is born
alive, but immediately upon birth dies as a result of its own
strange conduct.
Q. Describe operation and after treatment for amputation
of the leg at any point of election }
A. In operating the leg at the middle of the thibia I will
first put my rubber band little below the knee, made a cir-
cular incision to cut the skin, made my flap, saw the thibia
and ulna attach the thibial and ulnal arteries, stop the others
little hemorrhages by compression and made an antiseptic
dressing with iodform gauze.
Q. Describe a thrombus and tell how it is produced ?
A. A thrombus is a foreign substance detached from
some remote organ carried through the circulation, occluding
lO The New England Medical Gazette, Jan.,
the lumen of the vessel. It may be a detached piece of the
valvular structure of the heart.
Q. Of what value is sugar as a food ?
A. The sugar by the glycocenic function of the bile is
transformed in glucose and is the principle component of the
blood.
Q. Describe the two main cavities of the body and
name the organs contained in each }
A. The body is formed by two cavities the thorax and
abdomen. The thorax is a cavity surrounded in front by the
sternum and behind the spine laterally the ribs external is
covered by the epidermis connective and interstitial tissues is
divided by the abdomen by the diaphram.
The organs which contains is the heart, lungs, stomach.
The abdomen is a cavity composed externally by epidermis
and internally by a membrane called the omentum."
Comments upon such results of medical education are
unnecessary.
The recent lengthening of the course of study from three
to four years in all the best medical schools of the country
is undoubtedly a move in the right direction, but improve-
ment should not stop here. More attention should be paid
to the preparation for entrance to a medical school.
The Johns Hopkins Medical School demands not only the
diploma of the Bachelor of Arts degree, but also evidence of
ability to read French and German, and of laboratory train-
ing in physics, chemistry and biology.
The Harvard Medical School accepts the A. B. diploma as
evidence of fitness to pursue professional studies, requiring
only that the holder shall possess an adequate knowledge of
inorganic chemistry. It also provides for the admission, by
a vote of the faculty, of young men not holders of an A. B.
degree, who may furnish satisfactory evidence that they have
obtained an equivalent education, and that they are conse-
quently able to profit by the instruction which the school has
to offer. Collegiate training as a preparation for a profes-
190 1 Medical Registration, 11
sional career, is undoubtedly of great value, but nevertheless,
a properly conducted examination for admission is a better
test of fitness to pursue the study of medicine than the pos-
session of a diploma, the value of which varies so much
according to the college bestowing it and the mental capacity
of the holder of the diploma. Many young men who are
unable to bear the expense of a literary college course, by
close application to private study, prepare themselves for a
professional career better than many holders of the A. B.
degree.
Usually the first year of a medical college course is spent
in a course of study which should have been taken before
entering the college. On the other hand, a great many of
the holders of the A. B. diplomas are young men who have
simply frittered their time away during their college course,
and who are graduated more because they have gone through
the prescribed course than from any special effort upon their
part to thoroughly discipline their minds.
I have chosen the medical departments of the Johns Hop-
kins and Harvard Universities as being the two institutions
generally recognized as the leaders in medical education in
this country.
But to return briefly to the subject of registration, an
examination of the reports of the various state examining
boards shows a marked discrepancy, both in the means
required and in the results obtained. Thus, many states
requiring an examination in a large range of subjects, often-
times show a smaller percentage of rejections than other
states nominally requiring much less. Consequently, under
the present condition of affairs, reciprocity between the dif-
ferent states is hardly practicable.
So far as the practical working of the present registration
law in our own state is concerned, we believe it to be one of
the best. The question of favoritism in any individual case,
or discrimination in favor or against any institution, is abso-
lutely out of the question, as is evidenced from the fact that
12 The New Etigland Medical Gazette, Jan.,
no applicant is known at the time of the examination or dur-
ing the criticism of his paper, by the individual members of
the examining board, as he is simply known by his number.
The essential difficulty with our law is not in its practical
application, but the fault is inherent in the law itself.
To summarize briefly, the following facts are deduced :
That there is a general wide-spread recognition of the neces-
sity of a law governing the practice of medicine ; and that
there is some law in existence in every state in the Union
governing medical registration. That the laws in different
states vary to such a degree in the standard required, that
it makes reciprocity between the states, under this condition
of inequality, an impossibility. That the beneficent results
of the impartial and rigorous application of the law in our
own state is evidenced by the abolition of several fake med-
ical schools. By the fact that since the operation of the law
more than 2000 persons have been compelled to drop the
title of Dr., and also by the rejection of 563 unfit applicants
since 1897.
The inherent defects in the law itself seem to be, first,
that it does not define the practice of medicine ; secondly,
that it does not require every person who undertakes the
cure or healing of disease to show by proper examination
before the board, sufficient medical knowledge to protect his
patients from imposition and the community from the spread
of contagious diseases.
I would demand that every clairvoyant, faith curist. Chris-
tian scientist, osteopath, and every other fake, be compelled
to pass an examination before the State Board which should
show that he has sufficient knowledge to diagnose diseased
conditions in the individuals submitting themselves to his
care, and thereby protect the patient and the public, and
they should be subject to the same laws and penalties as
regards the reporting of contagious diseases to the proper
authorities, as members of the regular profession. Person-
ally, I believe that no one is more cognizant of defects in the
IQOI Catarrhal^ Gastric and Intestinal Diseases. 13
present law than the present board of registration ; no one
is more desirous of its improvement or more zealous in their
efforts to bring it about. But it cannot be done by them
alone. They must receive the full support and hearty co-op-
eration of every member in all branches of the profession.
Each and every physician, among his clieritelle and the com-
munity in which he lives, must constantly use his influence
to educate the people to this necessity. It is a duty which
every physician owes to himself and the public, and a duty
which he cannot in safety neglect.
THE BROTHERHOOD OF MAN.
" No man is born unto himself alone.
Who lives unto himself, he lives to none.
The World's a body, each man a member is
To add some measure to the public bliss.
Where much is given, there much shall be required ;
Where little, less." — Francis Quarles.
ON THE THERAPEUTICS OF CATARRHAL AND NEU-
ROTIC GASTRIC AND INTESTINAL DISEASES.
C. WESSELHOEFT, M. D.
[Read before Boston Horn. Med. Society, Nov. i, 1900.]
I feel very much tempted to say a good deal about the
diseases of the digestive organs, but I wish only to devote a
short paper to the homoeopathic therapeutics of those affec-
tions. Diseases are not so easily recognized as would appear
from text books. I desire to repeat this here and suggest
that inflammation of the oesophagus, acute catarrh of the
stomach, phlegmonous gastritis, ulcer, cancer of the stomach,
are all distinguished well enough in books, but that they are
not so readily differentiated in actual practice from those
forms of so-called dyspepsia which present themselves there
very often — I may say every day — while the acute cases
occur rarely compared with the ordinary chronic dyspeptic
cases.
It is the neurotic dyspeptic to whom I refer ; he is always
14 The New England Medical Gazette, Jan.,
in evidence ; in the office of the general practitioner, or the
specialist of the eye, the throat, or of any other organ, and
the patient of this kind is governed in the choice of his
specialist or general practitioner entirely by the notion or
theory which that patient has formed in his own mind. If
he fancies that his* eyes are affected he will seek relief at the
hands of the proper specialist ; if he thinks that his stomach
or liver is out of order, he goes to a stomach or liver spec-
ialist, if there is any, or as very often happens to the general
practitioner, who in these days might as well call himself a
stomach specialist, or specialist for dyspepsia, so numerous
are the patients of that kind.
Now, in all these cases it is of vital importance always to
make very sure of whether we are dealing with an actual
inflammatory or degenerative disease of the stomach, or
whether we are dealing with a neurosis more or less deep
seated, not in the stomach, but in the brain or in the great
sympathetic itself.
It will now be understood why I think differentiation of
ga.stric disorders difficult, and why it is very difficult to con-
vey to students the real relationship of these disorders.
Of the actual acute forms, the treatment by diet and medi-
cine suggests itself more readily than it does in the neurotic
forms, (but I will say first that in the December number of
1890, of the North American Journal of Homoeopathy will
be found an article entitled " Observations on the Pathology
and Therapeutics of certain cases of Dyspepsia,'' comprising
observations gathered from thirty-two tabulated cases.* ).
This paper is only intended to supplement some points of
the paper just mentioned, chiefly concerning homoeopathic
remedies. In considering the acute forms of gastritis, catar-
rhal, phlegmonous, and the catarrhal symptoms induced by
ulceration and cancer, there is one remedy to which I would
draw your attention and that is Rhus,
* See also articles on " Habitual and Neurotic Constipation," Am. Journal
of Homoeopathy, Sept., 1895, and Oct., 1896.
IQOI Catarrhal y Gastric and Intestinal Diseases. 1 5
In ''Hughes' Cyclopaedia" we find the following gastric
symptoms caused by Rhus radicans and Toxicodendron^ con-
sidered identical. Soreness of the throat, with intense burn-
ing extending to the stomach. Irritation extends to the
mucous membranes, redness and swelling of the throat,
. . . great thirst, irritable cough, nausea and vomiting,
. . . colicky pains throughout abdomen, especially dur-
ing the nights and aggravated by eating and drinking.
Diarrhoea frequently comes with tenesmus and the stools are
often bloody.
These observations are fully corroborated by other provers
named in the cyclopaedia. Although each prover of case of
poisoning adds some minor features to the gastric symptoms
of Rhus, it is evident not only from these, but also from the
violent form of inflammation which Rhus excites on the skin,
that it ought to promise relief if applied according to the
homoeopathic maxim in various forms of inflammation of the
stomach, and so it does.
I have used it frequently in acute gastritis of children and
adults where arsenic is usually given without result because
it is not indicated. Rhus suits best where there is loss of
appetite, bitter taste gradually increasing to nausea and
vomiting with pressure in the stomach, nocturnal colic, diar-
rhoea, etc., as we have seen.
Rhus is not usually selected as a remedy for gastric
diseases because it is not fashion. But where it seems to
tne to promise much would be in those rare forms of phleg-
monous gastritis. Nor is it necessary to wait for simple
catarrhal inflammation, for the very symptoms I have enum-
erated above also occur in cancer, as well as in ulceration
(ulcusrotundum, etc.) of the stomach. "It is best to use it
not lower than 3x, or even above to the fifth.
Among the other remedies such as Pulsatilla^ Nnx vom-
icay Arsenic y there is another which fashion has very much
overlooked in cases of acute gastritis and that is Cantharis.
This, like many other toxic substances, is supposed to act
1 6 The New England Medical Gazette. Jan.,
only upon the bladder and kidneys, and is under the ban of
fashion. A fashion once set will endure for a long time.
Some one will say that Calendula cures all soreness (I
believe it is said to be indicated in incised wounds) ; it has
become the fashion ; its tincture is sold by the gallon, I
presume it is grown in fields and harvested with the mowing-
machine, while if its pathogeny be referred to, there is noth-
ing to account for its popularity.* So it is with Baptisia, our
commonest pasture weed, once said to be good for typhoid,
is now regularly given and sworn by ; when neither its
pathogeny nor proving indicate any activity of that drug at
all, its symptoms bearing on typhoid being the result of the
alcohol of the tincture (See N. E. Med. Jour, of Feb., 1891.)
Such is fashion ; while medicines whose pathogeny is
quite indicative of useful results are left out of sight. Thus
Cantharis is one of the remedies which should not be over-
looked in certain forms of acute gastritis. For among the
effects of Cantharis there appear cutting pains in the
stomach and umbilical region and epigastrium ; burning
pain in the throat and stomach — (usually associated with
irritation of genital organs) nausea, vertigo, burning in mouth
and throat, violent retching and vomiting — ardent thirst
(the kidneys and bladder always primarily affected.) I have
found Cantharis most useful in violent attacks of acute gas-
tritis and have, therefore, called attention to this very incisive
remedy. It should be given not lower than the 3 and will
act high as the fifth and beyond.
I will not say that either of these medicines will supersede
Nux vomica. This is always indicated in obstinate retching
and vomiting of a cramp-like nature, when the inflammatory
process is not so marked as the nervous irritation, chiefly
marked by empty ineffectual retching, little or no thirst.
This powerful and most useful polychrest is so well known
* One prover Franz ; no information as to dose and repetition, and un-
corroborated by others. Hughes, Vol. IV., p. 730.
190 1 Catarrhal, Gastric and Intestinal Diseases, 17
that I omit its details for the present but shall refer to it
again if I have time.
I will not take up too much of your time with acute cases,
which are comparatively easy to reach and usually of short
duration, but I wish to emphasize the axiom once for all,
that no medicinal application is of the slightest value unless
the diet is regulated by proper restrictions in the first place.
To say this metaphorically, dieting in acute gastritis means
to rest the stomach, just as you would rest a broken limb, the
least use of which prevents union. In acute digestive dis-
turbances abstain from food as much as possible and return
to it slowly.
I still wish to say something about our friends, the chronic
dyspeptic. They will be our friends if we can give them
relief. If I describe one of them you will recognize them as
a class. This patient is generally above middle age, gener-
ally somewhat anaemic, anxiously scanning you to see if in
your face he can detect the right doctor, whom as yet he has
n^ver found. If asked how long he or she has been ailing,
the answer will be several months if not years. All food
distresses ; it seems to lie heavy in the stomach ; there are
uncomfortable sensations which pass from epigastrium to the
back ; there may or there may not be nausea, generally there
is none ; but the symptom the patient dwells most on is
"wind or gas in the stomach.'* The tongue is often not
coated and the bowels are usually regular enough. What
the patient wants is to get rid of that gas, and he will often
proceed to give you an exhibition of the quantity of it in his
stomach by a process of eructation (known in horses as a bad
habit called cribbing, which they show by a noise they make
in their throats while trotting and also in the stalls.) It con-
sists of swallowing air into the stomach and then ejecting it
by eructation. Examination shows the patient's stomach
not to be distended at all.
There is no doubt that he has many bad feelings, oftien
very voluminous ; but when we come to the disentanglement
1 8 The New England Medical Gazette. Jan.,
of the whole case we find that the patient has no dyspepsia
at all. What food he takes is properly digested, as indicated
by the fecal discharges ; his appetite is good but he does not
dare to eat for fear that the food will hurt him and cause the
gas to bloat him.
If in such cases we find constipation, it is simply absence
of regular stools from insufficient food which the patient
fears. But the stools indicate digested food, and when that
is the case, dyspepsia is not present.
The whole condition is caused first by a hereditary predis-
position traceable to a hypochondria of a parent or two. If
not this, to overwork, mental anxiety and business and family
cares. I do not know which are the most difficult to treat.
First comes the question of diet ; the patient must be per-
suaded to eat, and not abstain too long from food. " But it
will hurt me and cause gas," will be his reply. It is now
that the doctor must resort to argument adapted to the
patient's understanding, to the effect that he must put up
with a certain degree of pain, for there is every evidence
that the food digests ; that he must not allow his stomach to
dominate, but give it the work to do, by taking moderate
quantities of food rather oftener than three times a day.
After regulating this matter, comes the selection of the
appropriate medicine. I need not look far in my note book
to find a case. October 24, J. A. was here two years ago
for headache, gas, etc., was benefitted and wants to be again.
His case now is : Gas after eating. Headache in the morn-
ing, dull, heavy, does not want to rise ; bad taste in mouth ;
sedentary work, no exercise. Last time Nux vomica 3x
cured him ; he has the same again with strict injunction to
saw wood, or ride a wheel, or walk an hour every day.
October 23d, Th., Mrs. — 30 : Neurasthenic and hypo-
chondriacal to prostration ; could write page after page of
distressing symptoms most of which she refers to abdomen ;
claims to have terrible distress there from diarrhoea. Feels
as if her head, her eyes, her heart were all affected ; spends
190 1 Catarrhal, Gastric and Intestinal Diseases. 19
most of her time in bed, fearing diarrhoea. This is the only
positive symptom she has, and amounts to two or three
rather loose stools a day, with some tenesmus and mucous
discharge. She has had Mercurius v., 3x, one tablet every
three hours, and is now much better of her bowel trouble^
but quite as disconsolate as before. She continues Mercu-
rius v., but has to be much encouraged and made hopeful.
I will not weary you with cases of this kind, but refer
briefly to a few remedies which, after encouragement, are
applicable in neurotic cases. There are three species of
neurosis which are very often associated with what the
patient calls dyspepsia — flatulence, pressure, fear of food,
while stools, etc., show digestion to go on properly. These
forms are Hypochondria, Hysteria and Neurasthenia. The
hypochondriacal man or woman dwells on his or her disease ;
thinks of it, tries to find its cause ; is sometimes melancholic
but usually dyspeptic. Hysteria is characterized by lack of
self control ; Neurasthenia by want of muscular and mental
endurance, tiredness..
These forms are often associated with each other. The
hypochondriacal woman is generally neurasthenic ; men some-
times but rarely ; or she is apt also to be hysterical ; but all
these forms, combined or uncombined are in a majority of
cases associated with neurotic dyspepsia, but our remedy
should be directed mostly toward the symptoms presented
by the nervous system, of which the semblance of dyspepsia
is only a part. It is in our case the most prominent part,
and the most prominent symptom which should guide us in
seeking for its remedy.
In an article written six years ago * I have endeavored to
point out the class of remedies to choose from in cases of
neurasthenia, including hypochondria and hysteria, without
reference to dyspepsia. Now the same class of remedies has
a very strong bearing on cases of neurotic dyspepsia.
In this as in my former lectures on the study of the
* Therapeutics of Neurasthenia, N. E. Med. Jour., Dec, 1894.
20 The New England Medical Gazette. Jan.,
materia medica, I still adhere to the principle that medicines
should be studied according to their botanical and chemical
groups, which resembling each other in this respect, will also
resemble each other toxicologically.
At the head of the list stand Nnx vomica and Ignatia
(belonging to the order of Loganiaceae). It is certainly
unnecessary to enumerate the indications for either, espec-
ially for the former. 1 can only briefly give the indications
upon which I prescribe Nux vomica : Great worry about
patient's condition ; he is anxious and wants to know the
cause of this or that sensation ; ascribes it all to his stomach
which feels to him as if " bloated with gas," thinks he can't
digest his food because the gas in his stomach causes so
much pressure. He eats little, and has irregular stools. So
in addition there is nausea, costiveness, headache in the
morning with coated tongue, why, then, the case is clear
enough.
Conium Macnlatum is strongly indicated in the symptom
of gas in the .stomach where there is no gas ; but where the
patient has loud and long eructations often cultivated by
habit, and the mental conjecture that he must get rid of that
gas. Constipation associated with hypochondriacal intro.spec-
tion, or hysterical loss of self control and nervous palpitation.
The relationship of Conium to certain forms of nervous
dyspepsia might lead us to think that Cicuta would also be
indicated here ; but this is so .strongly related to the spasm-
producing drugs, decided epileptic form attacks being fre-
quent among its effects, that we find no place for it in
nervous dyspepsia.
Helleborus comes very near to it (in the class of Hellebo-
rineae). It is a remedy to which I owe much gratitude. Its
.severe cerebral symptom .s, approaching actual meningitis,
point out its sphere of action, not only in its relation to the
cerebral membranes, but to the cerebrum itself. I use it in
cases where there is melancholic depression, dullness of the
senses ; where patients complain of great pressure upon the
190 1 Catarrhal^ Gastric and Intestinal Diseases > 21
vertex ; vertigo, flickering, qualmishness, nausea, empty eruc-
tations, burning pain in stomach, prostration.
If these symptoms are the result of actual acute cerebral
irritation, Helleborus is undoubtedly indicated ; and when
they arise from a general neurotic condition simulating acute
disease, Helleb. relieves very well indeed. In fact it appears
to me as if a deep-seated hypochondriacal condition, with
melancholic tendency were pathologically due to a chronic
meningeal inflammation which sooner or later might end in
actual degenerative disease, and I do not hesitate to give
that remedy when these cases are ushered in by or take the
form of chronic dyspepsia, always bearing in mind that I
must distinguish between the purely neurotic and the actual
catarrhal form. I am inclined to think that Helleborus is
related more to the former than to the latter.
Hydrastis Canadensis is commonly used only in catarrhal
affections of the fauces and bronchial tubes, but it has a
much wider range than that, its sphere extending to the
digestive tract producing cutting pains in the bowels, con-
stant dull aching in the stomach, umbilical pains and stool,
along with obstruction of the nose and coryza. Scattered
throughout its provings are many neurotic symptoms, which
should point to that remedy in cases of neurotic digestive dis-
turbances associated with catarrh of the fauces, larynx and
bronchia.
Cimicifuga Racemosa (or Actaea r.) is much more far-
reaching than Hydrastis. The neurotic element largely pre-
vails among its effects, together with digestive disturbances.
The dull pain in the vertex appears quite often in its provings,
faintness in epigastrium and nervous uneasiness ; often with
neuralgic pain in the eyeballs. Abdominal fullness ; excruci-
ating pain in the bowels, much rumbling of wind. Thin,
dark, offensive stools. With these go mental depression and
suicidal tendency ; internal tremors in stomach ; cannot fix
attention ; nervous uneasiness, interpreted by compilers (see
Bering) to mean that the prover " declares she will go
22 The New England Medical Gazette, Jan.,
crazy." I can find no such expressions in authentic prov-
ings, and think that it means nothing serious, and only that
the prover has got into a nervous state. But it is just this
nervous condition combined with the digestive disturbances
which suggests the use of Cimicifuga in neurotic dyspepsia.
If I have not used it often I ought to have done so, and
think that in that case I should be able to report favorable
results derived from that medicine.
There are many others. Pulsatilla is well known, but it
needs supplanting by other medicines where thus far it has
been expected to do most of the work alone.
I must also add Cocculus and Agaricus to the list ; the
latter with its derivative muscarine^ is a very far-reaching
poison producing great nervous weakness and exhaustion with
manifold digestive disturbances, whence it should be used in
neurasthenia and neurotic dyspepsia.
This does not exhaust the list nor the subject. I could do
little more than to point out a few of the overlooked remedies
which can help us out in those tedious and distracting cases,
and have preferred to do it in this way instead of detailing
clinical cases from my practice.
SPINAL ANAESTHESIAS BY THE TUFFIER METHOD.
Buffalo, N. Y., Nov. 19, 1900.
Editor of The New England Medical Gazette^ Boston^ Mass :
Dear Doctor, — As the profession generally is quite in-
terested in the results of Medullary Narcosis (Spinal Cocain-
ization) I take the liberty of sending you (as well as other of
our journals) a report of my first case, (the first I understand
to be reported from Buffalo.) Mr. Curtiss, a patient of
Dr. Chadwick's, sixty years, entered the Homoeopathic Hos-
pital November 9, for a removal of a tumor of the thigh.
Being the attending surgeon he came under my care. He
1 go I Spinal AncBsthesias, 23
had suffered a slight apoplectic stroke one year ago, leaving
his speech affected slightly, but not impairing in any way his
tactile sense. Height, five feet, eight inches ; weight, one
hundred pounds ; general condition, good ; previous narcosis,
none ; respiratory and circulatory system, normal ; tempera-
ture on morning of operation, 99.2 ; pulse 100; urine, slight
trace of albumen ; knee terk exaggerated ; pupillary reac
tion normal.
The method of injecting the cocaine into the sub-dural
space was practically the same as that recommended by
Tuffier. Patient sat on the edge of the operating table, back
to the light. The articulation of the fourth and fifth verte-
brae was located by drawing a line from one illiac crest to
the other ; such line crossing slightly above the articulation.
The needle used was such as belongs to the ordinary aspirat-
ing syringe, about two and one-half inches long and of a
calibre three tirne that of an ordinary hypodermic needle.
The long bevel had been filed down reducing the bevel
length one-half. Dr. Critchlow, pathologist to the hospital,
had in charge the preparation of the cocaine solution. It
was intended to have used a freshly prepared solution, made
by first boiling the water in a test tube, then adding three-
tenths of a grain of the cocaine crystals to fifteen minims of
this sterile water, but owing to the absence of the crystals a
2 per cent, drug store preparation of indefinite age was
rendered sterile, and fifteen minims of this was drawn into a
sterile syringe. The point selected for the insertion of the
needle was three-eighths of an inch to the right of the
median line and midway in the interspace, caused by the
fourth and fifth vertebrae being pulled apart when the patient
bent forward. The needle having been rendered thoroughly
sterile, and the back of the patient being well scrubbed, he
was directed to bend forward in the " scorcher's position."
The needle detached from the syringe was inserted at the
point mentioned, being directed upward and inward, passing
slowly through the structures. It pas.sed two and one-half
24 The New England Medical Gazette. Jan.,
inches without the escape of the spinal fluid. The patient
being thin, I felt confident a needle of that length was suf-
ficiently long. No fluid appearing, the needle was with-
drawn and inserted on the left side at a corresponding
distance and angle ; no fluid escaped. The space between
the fifth vertebra and sacrum was then selected, but the
needle could not be inserted more than one and one-half
inches. Selecting a point not more than one-fourth inch
from the median line and between the fourth and fifth verte-
brae, the needle was inserted at a very slight angle to the
spine; in fact, were the patient sitting straight upright, the
needle would be at a right angle with the spine and but
slightly directed from without inward. Again it was pushed
in slowly, and at a depth of two and one-fourth inches the
spinal fluid escaped. Two drops of clear fluid showing un-
questionably that the sub-dural space was reached. The
syringe was then attached (all instruments having been ren-
dered sterile) and fifteen minims of a 2 per cent, solution
was slowly injected, allowing forty seconds for this pro-
cedure ; the needle was then withdrawn and puncture, sealed
with collodion.
Patient was placed on his back on the operating table, and
close observations were taken by Drs. Groesbeck and Critch-
low every few minutes. The following is their report : —
Administration of cocaine 12 o'clock, 32 minutes, 30 seconds.
12.30 P.M. (before injection), pulse it6, temperature 992-5;
12.36 P.M., pulse 126; 12.43 P.M., pulse 134; 12.48 p.m., pulse
78 ; 12.51 p. m., pulse 68 ; 12.55 p« m-» pulse 86 ; i p. m., pulse 90 ;
1.05 p. M., pulse 97 ; 1.07 p. m., operation completed.
Partial anesthesia first appeared in thigh 12.36, six min-
utes after the injection ; sensation still present in the feet ;
slight tremors through the legs. 12.43, anesthesia complete
below the lumbar puncture. Operation begun.
12.46, when asked if felt pain, said, felt some pulling at
seat of operation. 12.50, anterior crural nerve exposed, and
when pinched or pricked with knife patient complained of
I go I Spinal A nasthesias. 2 $
sharp pain ; otherwise he complained of no sensation what-
soever during the entire operation.
The operation consumed thirty-two minutes from the first
incision until the complete closure of the wound. The anes-
thesia lasted from 12.38, when dullness to pin prick was
first noticed in the thigh until 1.15, when it had almost en-
tirely passed away. A total of thirty-seven minutes. The
operation consisted in making an incision down the thigh
from the ranus of the pubes for a distance of five inches.
The tumor was encapsulated and embedded beneath the
rectus and adductor longus muscles and attached to the
pubes. Branches of the anterior crural nerve were cut, as
well as a number of small blood vessels.
During the operation the patient talked freely and said he
felt very comfortable, not complaining of nausea once ;
although he looked pale throughout the operation. He had
regained complete sensation in his feet within two hours
after the operation. He passed a comfortable night and felt
the next morning like getting up, no nausea or vomiting fol-
lowing. He has continued to do well (now the fourth day)
since the operation.
Some points to be gained from even this one case are, first,
that although the patient was susceptible to cocainization, yet
he took it well and rallied quickly from its effects, unusually
so in fact, as the majority of cases reported where they have
been influenced at all by fifteen minims of two per cent, solu-
tion have remained under its effects from forty to seventy
minutes. Second, the difficulty of reaching the canal by fol-
lowing the carefully worded instructions of Tuffier ; I was
unable to reach the medullary space by three repeated punc-
tures, but when I started the needle nearer the spinal process
and directed it more nearly at a right angle with the length
of the spine and but slightly from without inward, I secured
the fluid at once. Third, that had the operation required an
hour or more, I should, in his case, have been obliged to repeat
26 The New England Medical Gazette, Jan.,
the cocaine injection or resort to chloroform because the
effects lasted less than forty minutes.
Just what this method is going to do for us both in sur-
gery and obstetrics remains to be seen, but it promises suf-
ficient to induce us to make the most practical investigation
concerning its employment.
Dr. Wm. G. Wilcox,
Buffalo, N. Y.
SECOND ANNUAL REPORT OF DR. H. C. CLAPP,
OF RUTLAND SANATORIUM.
Sept. 30, 1900.
To the Trustees of the Massachusetts State Sanatorium :
Gentlemen, — My first annual report was made to end on
Oct. 10, 1899, because that date was exactly one year from
the day when the Sanatorium (then called Hospital) refceived
its first patients.
To conform, however, to the other reports, my second
annual is made to end on Sept. 30, 1900, which makes the
period to be covered, and now under consideration, less than
a full year by about ten days.
During this time there have been admitted to the Sanato-
rium under my care 143 patients. These, with the TJ
remaining at the time of my last report, Oct. 10, 1899, make
a total of 220 patients treated during the year. Out of this
number 144 (69 males and 75 females) have been discharged.
Of these discharged patients 1 2 had remained in the Sana-
torium, for one reason or another, less than one month, which
was, of course, too short a time to warrant deductions as to
the efficacy of treatment, although some of them manifestly
improved. Of these 1 2 one entered the Sanatorium in prac-
tically a moribund condition, and died in a very few days.
She had been accepted on examination three or four weeks
I go I Annual Repqrt of Dr. H, C, Clapp, 27
previously, but did not come to Rutland when requested to
do so, because, as she afterwards explained, she was suddenly
taken sick at home. At last she forced herself to take the
journey, but on reaching the Sanatorium, was too much ex-
hausted by the acute miliary tuberculosis (which had mean-
time complicated her disease) to allow of her being sent
home. A regulation has since been adopted requiring a
second examination of "passed" applicants, who do not
enter for two or three weeks or more.
Leaving out of consideration these 12, we have 132 dis-
charged patients, whose cases will be considered statistically
in this report. Of these cases 82 on admission were incipi-
ent, 40 were moderately advanced, and 10 were far advanced,
according to the definition of these stages given in my report
of one year ago.
By incipient cases are meant those which present evidence
of a small tubercular deposit in one or both lungs, but with-
out very decided constitutional disturbances. By moderately
advanced cases are meant those where the tubercular deposits
are larger and are beginning to soften, and the constitutional
disturbances are prominent ; or where, without an extensive
infiltration; the pronounced rational symptoms indicate a
greater susceptibility of the system to the poison. Far ad-
vanced cases require no definition.
The average length of stay of these patients was six
months and six days. Only 14 remained longer than one
year.
The results of treatment are clearly shown by the follow-
ing tabular view, not only for the 82 incipient cases, but also
for the 40 moderately advanced and the 10 far advanced
cases, under the headings of Apparently Cured or Arrested,
Improved, Not Improved and Died. The reasons for the
selection of these headings were given in my last report.
Finally, the results for all stages of the disease combined
appear under the same headings.
28
The New England Medical Gazette,
Jan.,
In the latter line, of the 49 improved, 28 were certainly
very much improved.
132 patients who remained for i month to 19 2-3 months.
Condition on Admiuion. Apparently Cured or Arrested. Improved. Not Improved. Died.
82 Incipient cases • • 53 28 i o
40 Moderately advanced cases, 6 18 15 i
10 Far advanced cases .0 361
Total (132.) 59 49 22 2
From these tables the following very favorable percentages
may be obtained : —
Of the Incipient Casks There Were
Apparently cured or arrested ....
Improved (including also greatly improved) .
Not improved (worse)
Of the Moderately Advanced Cases
Apparently cured or arrested
Improved (including also greatly improved) .
Not improved (including worse) . . : .
Died
Of the Far Advanced Cases.
Improved ........
Not Improved (worse) ......
Died
Of All the Cases in Mv Service
Apparently cured or arrested ....
Improved (including much improved)
Not improved (including worse) ....
Died
Per Cent.
64 >i
34-1-
i-l-
15
45
37 J4
2>^
30
60
45
37
As in my last report, the expression apparently cured
indicates cases in which the phthisical cough, fever, etc., are
practically gone, no tubercle bacilli being found in the
sputum (or there being no expectoration), and the physical
signs either having entirely disappeared, or if any remain,
indicating a healed lesion.
igoi Annual Report of Dr. H. C. Clapp. 29
Tubercle bacilli were found in the expectoration of 1 1 7 of
my patients and were not found in 1 5 cases. The sputum
from the whole of the Sanatorium has been sent indiscrimi-
nately to the pathological laboratories of the Boston Uni-
versity and of the Harvard University Medical Schools,
sometimes to one and sometimes to the other, just as it hap-
pened. Of the 1 5 cases in which no tubercle bacilli were
found, seven had no sputum to examine. Of these seven,
three had had hemorrhages, one had a tubercular knee (which
has since been operated on at one of our hospitals in Boston),
two had decided physical signs, and the last had constitu-
tional symptoms which made it at least very suspicious.
Of the 8 cases where sputum existed, but contained no
bacilli, three had had hemorrhages, one was so far advanced
that the patient died at the CuUis Consumptives' Home
within a few weeks after leaving the Sanatorium ; one was
an old and well-marked case of fibroid phthisis, and the
other three were incipient cases with physical signs and
symptoms fairly well marked if not absolutely conclusive.
The greatest weight gained by any one patient discharged
during the year was 49 pounds. Of the 132 patients, 127
gained weight during their stay, and the average gain was
1 3 2-3 pounds. Five lost weight, and the average loss was
4 pounds. This is certainly a very satisfactory showing.
The better results obtained this year, as compared with
last, are undoubtedly owing, to a great extent, to the fact
that more applications for admission having been received a
more judicious selection of patients, as to physical condition,
could be made. Still more satisfactory work could be done
if the applications were so numerous that only incipient
cases could be admitted. One practical difficulty now in the
way of our admitting only such cases is to be found in the
fact that very frequently persons in the early stages of con-
sumption are either unaware of their condition, or on being
informed, are very reluctant to believe it, and persistently
refuse to do the right thing, because they deem it unneces-
30 The New England Medical Gazette, Jan.,
sary, or else because they feel that they cannot afiford to
give up work in order to attend to themselves. When, how-
ever, they have pursued this policy long enough to become
incurable, they are willing enough and anxious enough to do
anything, whether it be in their power or not. The large
number of such applicants, many of whom have exhausted
all, or nearly all, of their resources, is. exceedingly distressing
and pitiable indeed, and constantly calls attention to the
great need which exists for some suitable provision for this
unfortunate class of advanced consumptives, to be made
either by our commonwealth, or perhaps better by districts,,
counties, cities or towns.
An erroneous idea prevails ^to some extent among certain *
physicians in Massachusetts, that our rejection of an appli-
cant necessarily means incurability. This is far from being
the case. We endeavor to select from among the applicants
those who seem most likely to improve, and that to the
greatest extent and in the shortest time, so that the beds can
be occupied by as many patients as possible in succession,
and can thus do the most good to the greatest number. The
standard of admission may vary somewhat from time to time,
according to the number and physical condition of the
appHcants.
An effort has lately been made to ascertain, as far as pos-
sible, the present condition of the 29 patients who were
reported as apparently cured or arrested in my first year of
service, and who are now more or less widely scattered. A
carefully drawn up letter, with numerous questions designed
to elicit information as to the presence or absence of import-
ant symptoms, the ability to work, etc., was printed and sent
to these former patients, and all but one replied. To my
great gratification, the answers indicated that 24 or 25 out of
the 29 still remained up to that time in pretty good condi-
tion, in spite of the fact that in some cases it was impossible *
for them to avoid unhygienic surroundings. Of about one-
IQOI Annual Report of Dr. H. C. Clapp, 31
third of these patients I was able to make a physical exam-
ination which corroborated these conclusions.
Very likely some allowance is to be made for optimism in
the report of those not thus examined ; but not, I think,
sufficient to influence the results very materially.
As if to compensate for these relapses, four of those who
had been reported only .as improved when discharged in the
first, year, were found to have advanced in health, as a result
of a careful outside continuance of the treatment initiated at
at our Sanatorium, sufficiently to warrant the change of
designation to apparently cured or arrested.
It may not be out of place to add that your physicians are
eagerly looking forward to the erection of the hall for recrea-
tion, religious services, and other public gatherings, which is
sorely needed, as well as the administration building, with
proper examination and waiting rooms, laboratory, throat
room, etc., also the new dining hall, all- of which will be valu-
able additions to the equipment of the institution.
I desire to record here my continued satisfaction with the
work of my assistant. Dr. D. P. Butler, Jr., who has been
very faithful in the performance of all his duties. The
nurses, too, as last year, have been very efficient.
Respectfully submitted,
Herbert C. Clapp, M. D.
32 The New England Medical Gazette. Jan.,
EDITORIAL.
Contributions of original articles, correspondence, etc., should be sent to the publishers, (^tis
Clapp & Son, Boston, Mass. Articles accepted with the understanding that they appear only in
the Gazttte. They should be tyjiewritten if possible. To obtain insertion the following month,
reports of societies and personal items must b* rtc*iv*dby the 15th c/ the month preceding.
The subject of overstudy in our public schools, and more
particularly the damage done children by the night study
necessitated thereby, has again come somewhat prominently
to the front. It is a subject in which every physician is
interested, and therefore we feel we are justified in quoting
from the opinions of two of our representative physicians,
one of each school, as recently published in a Boston daily
paper.
Dr. Geo. L. Walton, one of, if not the leading, neurologist
among the old school in Boston, says : —
** I should think that average children of 12 or 1 3 years
could stand a certain amount of home work, unless occupied
with other outside duties, as music, dancing lessons, or house-
hold cares beyond their years, or in attending parties and
entertainments. The more such sources of exhaustions are
added the less the ability to stand the school work either in
or out of regular hours.
" With regard to evening work, the question is largely one
of artificial light, and with children, as well as with adults,
great care should be taken, not only that proper light be
used, but also that glasses be worn when needed, for eye
strain is often a potent factor in brain fatigue.
" I have not been able to satisfy myself that nervous ex-
haustion as a result of school work is prevalent among chil-
dren in this vicinity, and should be inclined to think that
inability to keep up the work occurs largely among children
either exceptionally delicate or occupied by other wearying
pursuits than those connected with the school."
I go I Editorial, 33
As one who deservedly commands attention among profes-
sional men of our own faith, Dr. Sutherland, the Dean of
Boston University School of Medicine, says : —
" The question of home study is one to which I have given
serious thought, and I have come to the conclusion that
there should be no night study for children under 14 years
of age. I will go farther, and will say under 16 or 17 years
of age. Then it should be confined to one or two hours.
After a student enters college it is a different matter. The
body has then attained its growth, and systematized study
will do no harm.
" It is a grave fault in modern education that growing chil-
dren are so crammed with study that their minds are forced
to the detriment of the body. Better results would be ac-
complished with a strong, healthy body and a well regulated,
not an overtaxed, brain.
" Not only should there be no study at night for growing
girls and boys, but there should be a proper amount of fresh
air and physical exercise in the afternoon as well. If this
and home study cannot both be accomplished, the work
should be sacrificed for the salvation of the body. Let such
children learn what they can in the school room, and let the
rest go rather than have them grow up to find themselves
with wrecked constitutions when they are called upon to per-
form the strenuous work of life.
" Why is it that men are stronger than women as a rule }
There is a prevalent opinion that they are healthier by
nature. Such is not the case. Women are weaker than
men because of their bringing up. While the boys are
turned out to romp, to play, in short to become athletes,
their sisters have their duties about the house ; they are
taught to sew, to sing, to play, to dance, in order that they
may be graceful. But wouldn't it be better to be strong
first }
" It is considered necessary for a girl to have so many
accomplishments. To the cultivation of these her education
1
34 The New England Medical Gazette, Jan.,
is turned. She sits at the piano and practises, while her
brothers, shouting over their game of ball or whatever it
may be, are building up hardy, robust bodies. That is why,
when they come to maturity, their constitutions can stand
the strain of life work better than the average woman can.
" So much for children when they are growing. When
they enter college and become men and women the face of
the matter changes. Night work must be done then, and
can be done without injury. In the post graduate courses in
the scientific schools, the law schools and the medical schools,
there are from 24 to 36 hours of lecture work a week, with a
proportionate amount of outside study. In my own depart-
ment in the Boston University the students have from 32 to
36 hours a week in the lecture rooms and laboratories. Be-
yond this they must find the time to study and perform the
required outside work.
" Is is imperative that they should devote to their profes-
sion many hours of the night, yet my experience has been
that these men and women are in a better physical condition
when they complete than when they commence their four
years* course. Their bodies have reached maturity, however,
and can stand the strain of night work. There is the
difference."
Although there seems to be some difference of opinion
here expressed, we are inclined to think it is more apparent
than real. The fact is both are right. ' Dr. Walton says if
outside matters, such as dancing parties, music, etc., are not
indulged in, the study does no harm ; and Dr. Sutherland
says these things do harm, largely because the girl especially
must have, in addition to studies, accomplishments acquired
at the expense of time which should be given to the building
up and strengthening of the body. The question is a com-
plex one. Many elements such as individual abilities and
idiosyncrasies, hereditary tendencies, home influences and
atmosphere must be taken into account, and these vary to
such a great extent that absolute conclusions are impossible.
190 1 Editor iaL 35
Each physician's opinion must be largely based on the chil-
dren with whom he comes most in contact and whose physi-
cal welfare he has had much to do with. For this reason
we believe that the well founded opinion of a conscientious
and observant general practitioner is of more value than that
of the speciajist. From our own observation, made during
several years in general practice, during a part of which we
had to do somewhat with school management, we certainly
were convinced that children from the years of 12 to 16
were often over taxed by their school work, in addition to
what was demanded of them in other directions ; in other
words the attainment of accomplishments. One or the other
should certainly be modified, and we should not attempt any
longer to make a girl of 18 or 20 an educated ( ? ) and
accomplished young lady.
Again the courses of study are altogether too diffusive.
We believe it taxes the mind during the developmental
period much more to be constantly diverted from one topic
to another than if it was held more continuously to one line
or branch of study until it was thoroughly mastered. Every-
body cannot know everything. It would be better if our
public school system turned out somebody who knew some-
thing and knew it thoroughly.
OBITUARY.
Dr. Sarah E. Sherman, of Salem, died recently. She was
bom in Fayton, Vt., April 28, 1845. After graduating from
school, Miss Sherman taught school for a while. Later she
began to study for the practice of medicine, and was gradu-
ated at Boston University Medical School in 1876.
In the fall of that year she went to Salem and began to
practise, being the first woman physician in Salem. For
many years she had a large practice. She was a member of
36 The New England Medical Gazette. Jan,,
the school board for several years, and one of the originators
of the Salem Woman's Club, and its first president. Miss
Sherman was a member of the American Institute of Hom-
oeopathy, and at the time of her death lecturer on anatomy
at the Emerson College of Oratory. She was a trustee of
that institution and of Boston University.
EDITORIAL NOTES AND COMMENTS.
The exercises in connection with the opening of the new
Homoeopathic Hospital at the University of Michigan began
Thursday, December 6, and continued through Saturday,
December 8. The detailed programme was. as follows : —
THURSOAV AFTERNOON.
Operative clinic, surgical amphitheatre. Dr. Claudius B.
Kinyon, professor of obstetrics and gynaecology in the hom-
oeopathic department of the University.
THURSDAY EVENING.
Exercises in Sarah Caswell Angell Hall, Women's Gym-
nasium.
Prayer, Prof. Martin L. D'Ooge, LL.D., professor of
Greek in the University.
Introductory, presenting James B. Angell, Lt.D., presi-
dent of the University, who presided, Prof. Wilbert B. Hins-
dale, M. D., dean of the homoeopathic department.
Remarks, President James B. Angell, LL.D.
Address, Prof. Charles E. Walton, M. D., Cincinnati, O.,
president of the American Institute of Homoeopathy.
Address, the Hon. Henry S. Dean, Ann Arbor, chairman
of homoeopathic committee of the Board of Regents of the
the University of Michigan.
190 1 Editorial Notes and Comments, 37
Address, Malcolm C. Sinclair, M. D., Grand Rapids, presi-
dent of the state board of registration in medicine.
Address, Prof. Charles Gatchell, M. D., Chicago, formerly
professor of theory and practice in the homoeopathic depart-
ment.
Address, Rolin C. Olin, M. D., Detroit, member of the
first graduating class of the homoeopathic department.
Address, Prof. Royal S. Copeland, M. D., Ann Arbor,
president State Homoeopathic Medical Society.
Reception by the ladies of the faculty of homoeopathic
department in the women's gymnasium, for the speakers of
the evening, alumni and friends of the department.
FRIDAY FORENOON.
Lecture in medical lecture room, Willis A. Dewey, M. D.,
professor of materia medica and therapeutics in homoeopathic
department.
Surgical clinic, surgical amphitheatre. Perry W. Cornue,
M. D., acting professor of surgery and clinical surgery.
FRIDAY AFTERNOON.
The new hospital will be open to the public for general
inspection.
FRIDAY EVENING.
Commencement of the Training School for Nurses, hos-
pital lecture room, address by DeWitt G. Wilcox, M. D.,
Buffalo. Reception in new nurses' home.
SATURDAY FORENOON.
Lecture, medical lecture room, Prof. Wilbert B. Hinsdale,
M. D., dean of the homoeopathic department and professor
of the theory and practice of medicine and clinical medicine.
SATURDAY AFTERNOON.
The hospital will be open for public inspection — Xew
Michigan News.
38 The New England Medical Gazette, Jan.,
A riEDICAL CURIOSITY.
The following *' antique " may be of interest to some of
our readers : —
West Medway, Mass., Oct. 31, 1900.
Dr. John L. Coffin, Editor New England Medical
Gazette, Boston, Mass :
Dear Doctor, — I have a little old book (just how old I
don't know) that I send you an extract from. I thought it
would interest some other doctor as it has interested me.
The capitals, punctuation aiid spelling are the same as in
the book. Many of the s's are printed life f's. I have tried
to write them in that way. Italics are underlined.
The cover is of wood, leather covered, about 4x6 inches
in size. Is entitled '^the Englifh Phyfitian Enlarged." Has
285 pages. No date of publication or name of author, but
on the first page is written with pen, a name, and then fol-
lowing it, " Ejes Libor AD 1781
The Englifh physitian
Enlarged
By
Nicholos Culpeper M D.
I think it was published in the last part of 1600 or the
early part of 1700, as I have seen somewhere in the book a
reference to some other book of his writing in 168 1. If you
wish to use this extract at any time it is yours.
Alvin Boyce.
Henrane.
Defcription
Our common Henbane hath very large, thick, foft, wooly Leaves
lying upon the ground, much cut in or torn on the edges, of a dark
ill grayifh green colour, among which arife up divers thick and
fhort ftalks two or three foot high, fpread into divers fmaller
branches with leffer Leaves on them, and many hollow Flowers
190 1 Editorial Notes and Comments, 39
fcarce appearing above the Husks & ufually torn on the one fide,
ending in fine round points growing one above another, of a dead-
ish yellow colour, fomewhat paler towards the edges, with many
purplifh veins therein, & of a dark yellowish purple in the bottom
of the flowers with a fmall pointel of the fame colour in the middle*
each of them ftanding in a hard clofe husk, which after the Flower
is paft, gtoweth very like the Husk of Afarabacca, and fomewhat
fharp at the top points, wherein is contained much fmall feed very
like the Poppy feed, but of a duskie grayish color. The root is
great, while & thick, branching forth divers ways underground so
like a Parfnip Root (but that is not fo white) that it hath deceived
divers. The whole Plant more than the Root hath a heavy ill
foporiferous fmell fomewhat ofTenfive.
Place, It commonly groweth by the way fides, and under hedge
fides and Walls.
Time, It flowreth in July^ and fpringeth again yearly of its own
Seed.
I doubt my Authors miftook/z^/y ior /u?ie, if not for May,
Government aiid Virtues, I wonder in my heart, now Aftrologus
could take on them to make this an Herb of Jupiter^ and yet
MizalduSy a man of a penettrating Brain, was alfo of that Opinion
as well as the reft : the Herb is indeed under the Dominion of
Saturn^ and I prove it by this Argument. All the Herbs which
delight moft to grow in Saturnine places, are Saturnine Herbs.
But Henbane delights most to grow in Saturnine places, and whole
Cart- Loads of it may be found near the places where they empty
the common Jakes, and fcarce a Ditch to be found without it grow-
ing by it. Ergo 'tis an Herb of Saturn.
The Leaves of Henbane do cool all hot Inflam- Infla^nma-
mations in the Eyes, or any other part of tne //^,^
Body ; and are good to affwage all manner of Cods
fwellings of the Cods or Womens Breafts, or elfe- 1 Wojuens
where if they be boiled in Wine, and either applied I Breafts
themfelves or the Fomentation warm ; it alfo ass- I (Joiit
wageth the pain of the Gout, the Sciatica, and all Sciatica,
other pains in the joynts which arife from an hot | foyyits.
Cause, And applied with Vinegar to the Forehead I
and Temples, helpeth the Head-ache and want of ,
40
The New England Medical Gazette.
Jan.,
fleep in hot Feavers, The juyce of the herb or ! Deafnefs
feed, or the Oil drawn from the Seed doth the like. Noise in the
The Oil of the Seed is helpful for the Deafnefs, Ear,
Noise, and Worms in the Ears, being dropped
therein; the juyce of the herb or root doth the
the fame. The Decotion of the Herb or Seed or
both killith Lice in- man and beaft. The fume of
the dried Herb, Stalks and Seed, burned quickly
healeth Swellings, Chilblains, or Kibes in the Hands
or Feet by holding them in the fumes thereof. The Remedy to
help thofe that have taken Henbane, is to drink Goats Milk,
honeyed Water, or Pine Kernels, with fweet Wine : Or in the
abfence of thefe Fennel feed. Nettle feed, the feed of Creffes, Muf-
tard, or Raddish, as also Onions of Garlick taken in Wine, do all
help to free them from danger, and reftore them to their due
temper again.
Take notice, that this Herb might never be taken inwardly ; out-
wardly, an Oyl, Oyntment, or Plaifter of it, is most admirable for the
Gout, to cool the Veneral heat of the Reins in the | French
French Pox, to ftop the Tooth-ach being applied to \ Pox
the aking fide, to allay all Inflammations, and to
help the Difeafes before premifed.
Tooths
ach
Galvanism in Pelvic Inflammatory Lesions. — Galvan-
ism properly applied offers to the conservative gynecologist
the very best means of allaying pelvic inflammations. Electro-
therapy is worthy of all the study you can give it ; but recol-
lect that the possession of a hammer and anvil does not make
a blacksmith, nor an amputating case, a surgeon ; and do not
think because you have the most approved electrical appara-
tus in your office, it will make you an electro-therapeutist.
Study its physiological and polar effects, prove it as you would
any of your remedies, and you will find, as others have, that
it has the widest range of all. — Dr. C. S. ]^eiswangerin Min-
neapolis Iloniceopathic Magazine,
igoi Societies. 41
SOCIETY REPORTS.
WORCESTER COUNTY SOCIETY.
The Thirty-fourth Annual Meeting of the Worcester
County Homoeopathic Medical Society was held at Worces-
ter, Nov. 14, I goo, at the Y. W. C. A. Rooms, Chatham St.
The meeting was called to order promptly at 10 A. m, by the
President, Dr. Amanda C. Bray. The records of the pre-
vious meeting were read and accepted ; the annual report of
the treasurer was read and ordered placed upon the records
of the society. The following applications for membership
were presented, and by vote of the society, referred to the
board of censors : Albert E. Cross and Edwin Roy Leib, of
Worcester ; George Van Deusen, of Lowell ; David P. But-
ler, of Rutland, and David W. Wells, of Boston.
The election of officers resulted as follows : President,
Dr. J. F. Luscombe, Fitchburg ; Vice-President, A. J. At-
wood, Townsend ; 2nd Vice-President, Dr. G. H. Wilkins,
Palmer ; Secretary and Treasurer, F. R. Warren, Worcester ;
Librarian, A. E. P. Rockwell, Worcester; Censors, E. A.
Fisher, . Worcester ; Amanda C. Bray, Worcester, and Dr.
R. G. Reed, Woonsocket, R. I.
The business session concluded, the meeting was placed in
charge of the Bureau of Clinical Medicine and Pathology,
Dr. Carl Crisand presiding. The first paper was read by
Dr. H. A. Gibbs, and was entitled, " What shall we do with
the Drunkard ^ '* The writer believed that institutional
treatment, especially for the confirmed inebriate, was essen-
tial for a complete cure. He also believed most thoroughly
in mental suggestion in treating these cases ; in restoration
of the bodily functions and in the promotion of sleep and
entire rest of the nervous system. For remedies he would
suggest nitrate of strychnia and the salt of sodium and gold
chloride. He uses apomorphia in doses of from 1-30 to i-io
42 The New England Medical Gazette, Jan.,
of a grain, for its physiological effect and also for its relaxing
effect upon the nervous and circulatory system.
Dr. G. G. Shelton, of New York, was unable to be present
and his paper, " Typhoid Fever, its dietetic and therapeutic
treatment," was read by title. This subject, however, was
the topic for a very interesting discussion, opened by Dr.
Frederick B. Percy, of Brookline. Dr. Percy spoke of the
different methods of feeding in typhoid. These methods
embraced : i, an abstemious diet ; 2, a modified milk diet ; 3,
a diet of meat broths, with or without the addition of barley,
sago, etc. ; 4, a liberal diet, such as rice, eggs, farina, arrow-
root, cocoa, etc. His method is to use the modified milk
diet in most cases ; in some cases, however, he believes a
more liberal diet can safely be allowed, and that it often
shortens convalescence. He mentioned the different thera-
peutic methods employed in typhoid, including the Brandt
method, the antiseptic treatment of Woodbridge and Hom-
oeopathic medication. He believes fully in the hydro-thera-
peutic measures. For remedies, he has used with most suc-
cess, Bapt. Tine, Mer. Dulc, and Cupras Arsen 2x.
Dr. C. L. Nichols believes in milk diet, and at the end of
second week usually gives some beef preparation and
whiskey, in addition to the milk.
Dr. De Witt G. Wilcox believes that that most dread com-
plication of typhoid — intestinal perforation, with resulting
hemorrhage and inflammation, should be treated by surgical
means.
Dr. E. A. Fisher reported a fatal case of typhoid fever, in
which, at the autopsy, large and numerous perforations were
present, yet there had been no evidence of blood in the
stools.
The next paper on the program was by Dr. Wm. Morris
Butler, of Brooklyn, N. Y., and entitled " Puerperal Insanity
and its Homoeopathic Treatment." This paper dealt with
the etiology symptoms and homoeopathic medication of this
form of mental derangement. He believes that a large per
cent, of the mental troubles of women arise from mental
IQOI . Societies. 43
derangement during the puerperal state. In the treatment
of this, condition, the writer mentioned as essential, a com-
petent nurse, pleasant and well-ventilated apartments, plenty
of healthy exercise and bathing. For remedies he advises
the use of belladonna, hyoscyamus, platina, strychnia, stramo-
nium, ignatia, etc.
Dr. Frank C. Richardson, of Boston, in opening the dis-
cussion, said that he believed the cause of the trouble must
be removed before a cure could be expected. An examina-
tion of the blood or of the gastric secretion often revealed a
cause of trouble which must be corrected before the patient
could improve. Dr. De Ette Brownell had in some pro-
longed cases, where the tendency was toward dementia, used,
with good success. Thyroid Extract. It seemed to exert a
beneficial influence upon the mental condition of the patient.
The next paper was by Dr. De Witt G. Wilcox, of Buffalo,
N. Y., entited "Pelvic Inflammation." Dr. Wilcox spoke of
the necessity of an early recognition of the causes which
may lead to a pelvic inflammation, and of the responsibility
of the family physician to whom these cases nearly always
come in the begmning. An apparently slight inflammation
of the meatus urinarius or of the vagina, will, if let alone, in
an incredibly short time, extend to the uterus, tubes and
peritoneum ; hence, the quicker the primary cause is cor-
rected and removed, the less damage will result to the gen-
eral pelvic peritoneum. The treatment must be according to
the extent of the disease. If a specific vaginitis only is
present, the patient should be given a hot vaginal douche,
followed by an application of a r per cent, argonine or pro
tagol solution. She should then be put to bed and a
bi-chloride douche given every three hours.
If the disease has extended a little farther and an endo-
cervicitis is present^ the same vigorous treatment must be
pursued. The bi-chloride solution must be freely used and
the cervical canal thoroughly cleansed. Finally, the canal
should be painted with tr. of iodine by means of an applicator.
Under no circumstances should a probe be passed through
44 ^/'^ New England Medical Gazette. Jan.,
such a canal, for fear of infecting a healthy uterine mucous
membrane. If the disease has progressed still farther and
an endometritis is present, we must resort to surgical meas-
ures. The patient should be anaesthetised, the uterine canal
dilated and sterilized. This should be followed by a
thorough curretage and intra-uterine douching. If the
disease has extended to the pelvic peritoneum, in addition to
the treatment of the endometritis present, the writer advised
irrigation and drainage of the pelvic cavity through an
incision in the posterior cul de sac.
Dr. Solomon C. Fuller presented an interesting paper on
" A case of Uretastic Carcinoma of the Liver," illustrating
his remarks with macroscopic and microscopic specimens of
the growth.
Dr. J. M. Barton presented a clinical report of a case of
"Carcinoma of the Lungs," and Dr. E. A. Murdock of a
case of *' Diphtheritic Paralysis."
A paper entitled " Prevention and Cure of Renal Calculi,"
by A. M. Cushing, was read by Dr. Crisand, in Dr. Cushing's
absence. The author gave his experience with this condi-
tion and advocated the use of appocynum andros, which he
had found to be almost .04 specific.
This paper closed the scientific session, and the society
adjourned to Hotel Newton where fraternal greetings and
dinner occupied the members and their guests, to the num*
ber of fifty-five, until 2.30 p. m. Dinner over, the toast-
master, Dr. G. Forrest Martin, of Lowell, called for order,
and for nearly three hours there was *'a feast of reason and
a flow of soul," such as the society has seldom been privi-
leged to enjoy.
In his opening remarks, Dr. Martin spoke of a tendency
among young graduates of homoeopathic institutions to grow
rather ashamed of their chosen school .of medicine, seeming
to lack reasons for their belief and arguments in defense of
it. This tendency is lamentable, and young physicians were
urged to stand strong in their faith, knowing well the firm
principles which they advocate.
190 1 Societies. 45
Dn Bray, the retiring president, in her address, urged upon
physicians the importance of realizing their .responsibilities
as educators, and cited many cases in which a conscientious
physician might have large influence for right solution of
many every day problems.
Dn Wm. M. Butler, of Brooklyn, gave a most interesting
address on "The Homoeopathic Institutions in the State of
New York," showing the great success which has followed
the long years of hard work necessary to found these institu-
tions.
Dr. John L. Coffin, of Boston, compared Homoeopathy of
today with its standing thirty years ago, showing the wonder-
ful progress and success of "the new school."
Dr, F. B. Percy gave as an ideal example of "The Family
Physician," one with principles of truth, love, patience,
honesty of purpose and true living, strong and well-defined.
Dr. Wilcox, of Buffalo, treated his subject, "The Scalpel,"
with a wit as keen and sharp as that instrument itself, con-
stantly amusing his listeners by his clever puns, bright sallies
and apt illustrations. In more serious vein. Dr. Wilcox em-
phasized the importance of only true-hearted, strong-pur-
posed men using "the scalpel" in difficult surgery — men
who thoroughly understand their work, and who operate for
the good of mankind rather than for the pleasures of scien-
tific and surgical study.
The topic " Nerves," was of necessity very briefly treated
by Dr Richardson, as time had passed rapidly, and he, with
other guests from the eastern part of the state, were obliged
to leave at this point in the session.
Remarks were made* by Dr. Rockwell on "The Micro,
scope," and by Dr. Rand on "The Country Doctor." The
meeting was adjourned after a unanimous vote of the society
that the Thirty-fourth Annual Meeting had been one of the
most profitable and enjoyable ever held.
F. R. Warren, Secretary.
46 The New England Medical Gazette, Jan.,
HEDICAL SOCIETY OF THE 5TATE OF NEW YORK.
The Ninety-fifth Annual Session of the Medical Society of
the State of New York will be held in Albany, Jan. 29, 30,
31, 1901.
The meetings of the Society have always been replete in
scientific work as becomes the representative society of the
medical profession of the Empire State — and it is con-
fidently expected that this meeting will equal those which
have preceded it.
This circular letter is sent to every member of the Society
with the request that those who desire to read papers will
communicate at once with the Chairman of the Business
Committee, Dr. Frank Van Fleet, 63 East 79th Street, New
York City, or with the President, Dr. A. M. Phelps, 62 East
34th Street, giving the title of the paper and such other
information as the author desires.
As there will be a great many papers offered, and the
time necessarily limited, it is suggested that papers be con-
densed as much as possible in reading, as they can be pub-
lished more fully in the transactions. Arrangements for
reduced fares can be made when purchasing railroad tickets.
A. M. Phelps, A. M., M. D.,
62 East 34th St., New York.
BOSTON HOMOEOPATHIC SOCIETY.
BUSINESS SESSION.
The regular meeting of the society was held at the Boston
University School of Medicine, Thursday evening, Dec. 6,.
1900, at 8 o'clock, the President, F. W. Halsey, M. D., in the
chair.
The records of the last meeting were read and accepted.
The following physicians were proposed for membership :
C. C. Morrison, 1740 Beacon St., Brookline; John F. Wor-
igoi Societies, 47
cester, 405 Washington St., Dorchester ; David P. Butler, Jr.,
State Sanatorium, Rutland, Mass. ; Robert W. Southgate, 2
Commonwealth Ave., Bpston ; Walter J. Graves^ yy King
St., Dorchester ; Bertha L. Hoskins, 97 Francis St., Brook-
line.
The Resolution providing for the appointment of a Stand-
ing Committee on Legislation was taken from the table, and,
in its revised form, was adopted. The Resolution, as adopted,
reads as follows : —
STANDING COMMITTEE ON LEGISLATION.
Resolved, the President shall appoint a committee of
four, one member to serve one year, one for two years, one
for three years, and one for four years. After the year 190O
one member shall be appointed each year, by the President,
to serve four years. The President shall be chairman of this
committee, ex-officio^ and said committee shall have in charge
all legislation or other interests which may affect the prac-
tice of homoeopathy in Boston,
The Committee appointed to draw up resolutions on the
death of Dr. Benj. H. West, reported as follows : —
Whereas, our Nestor, Dr. Benj. H, West, has been re-
moved from us by death at the ripe age of four score and six,
therefore,
Resolved, that in his death homoeopathy has lost one of
its earliest exponents in this part of the country, as well as
one of its most earnest advocates.
Resolved, that although he has been in retirement from
active practice for about thirty years, yet he has never on
this account lost his interest in the cause, but has always
been eager to attend our meetings, to lend his assistance
when its interests seemed to be assailed or when aggressive
action seemed to be needed. At such times, although his
venerable appearance and long flowing white hair and beard
picturesquely suggested the dignified patriarch, yet the fiery
impetuosity of his speech and his sustained eloquence were
convincing proof that in spirit he kept as young as the
48 The New England Medical Gazette, Jan.,
youngest. A man of the highest character and of kindly
disposition, he will long be missed.
H. C. Clapp,
C. Wesselhoeft,
H. B. Cross,
Com^nittce,
The resignation of Dr. Henry F. Batchelder, of Danvers,
was accepted.
The following committees were appointed by the Presi-
dent : —
To nominate officers of the society for the ensuing year :
Drs. John L. Coffin, Herbert C. Clapp and Emma J. Peasley.
Sjtanding Committee on Legislation : Drs. S. H. Calder-
wood, four years; John L. Coffin, three years; T. Morris
Strong, two years, and Frederick A. Davis, one year.
SCIENTIFIC SESSION.
Dr. Horace Packard exhibited a beetle 3-4 inch long and
1-2 inch wide, which he had extracted from a man*s ear. Its
presence had caused intense pain due to the front legs
scratching the tympanic membrane.
Dr. H. P. Bellows exhibited a number of instruments which
he had obtained in Florence, Vienna, and other European
cities, while abroad last summer. A cap made of tape, to
be used in binding down the ears when they project in
infancy. A neat, compact box for utilizing the Edison cur-
rent, which can be easily moved and placed anywhere, in
clinics, could be put on the wall and furnishes a brilliant
light for illuminating the field of operation. A strictly
aseptic syringe, which can be perfectly cleansed, and works
admirably. Three mirrors for examining the attic. A for-
eign body extractor. Two new instruments for the extrac-
tion of the anvil. A vibrating fork for producing low tones.
A new instrument to assist the hearing, made of aluminum,
can be attached to the ear or can be used for conversation.
1 90 1 Societies. 49
Report of the Section of Ophthalmology, Otology,
AND Laryngology.
N. H. Houghton, M. D., Chairman.
Eliza B. Cahill, M. D., Secretary. L. H. Kimball, M. D.. Treasurer.
The President appointed Drs. M. E. Mann, L. D. Miller
and F. P. Batchelder, a committee to nominate sectional
officers for the ensuing year. The committee reported as
follows : Chairman, T. Morris Strong, M. D. ; Secretary,
G. A. SufFa, M. D., and Treasurer, Emma J. Peasley, M.D.
programme.
1. Eye Strain, Notwithstanding Acute Vision. David W.
Wells, M. D. Discussion by G. A. Suffa, M. D., and L. H.
Kimball, M. D.
2. Tumor of the Parotid Gland (a case). T. M. Strong,
M. D. Discussion by George B. Rice, M.D.
3. A Case of Chronic Suppurative Otitis Media. Fred-
erick W. Colbum, M. D. Discussion by Howard P.' Bellows,
M.D.
4. A Differentiation (Eye). J. M. Hinson, M. D. Discus-
sion by John H. Payne, M, D.
DISCUSSION.
I. Dr. Wells stated that 75 per cent, of all headaches were
due to eye strain, though this did not preclude there being
other factors, the correction of any one of which would re-
lieve the difficulty, and that it would be a great help to the
general practitioner if he had the means of discovering cases
of eye strain.
Dr. SufFa : Dr. Wells, in his most interesting paper, has
brought out in a clear manner important facts in regard to
eye strain and its early recognition and correction, most of
which I heartily endorse, and even desire to enlarge upon
the advice that not only all backward children and those
showing some well recognized evidence of eye strain merit
examination, but that all children at the time of first enter-
50 The New England Medical Gazette, Jan.,
ing school (if not previously examined) have their eyes care-
fully tested so as to be sure that they are not handicapped
at the beginning of their career, often to a permanent
detriment.
It is a well recognized fact that practically all children are
born hyperopic, and that it is a normal evolution to outgrow
this hyperopia during the growing period. Also that the
accommodative power and the associated muscular action
convergence are controllfid--%y--thL§ third nerve, and that
nerve stimulation (A\X!^^^ fUnetidpiN^nd the centres of
action are intimat6p related to eacnryo^er, so that when
accommodation rdceive^AN/envo ifAm^seTt^ focus rays from
an object at a givqp distance that th^^oSn verging muscles
receive a corresponding amount ^ n^e force, but on
account of the 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
I
I
I
10
2
I
2
I
I
3
2
22
I
2
4
3
I
I
I
I
I
I
I
I
6
5
I
2
2
4
I
I
4
2
I
I
I
23
I
I
12
8
3t
II
9
32
5
43
8
2
I
7
5
I
I
TlmeofOp'n
Septic Clean
23
344
64
o
I
6
3
3
I
I
10
2
I
I
3
2
13
I
I
SubeeQ. course
Septic Clean
21
23
8
31
II
9
32
5
'I
2
I
7
5
I
I
280
3
2
'5
I
I
3
2
I
I
I
2
I I
I 4
I I
4
j 2
I X
I I
I 12
I 8
I 3^
II
! 9
I 2
I I
7
5
I
I
55
J89
Total number of operations 344
Septic at time of operation '64
Clean at time of operation 280
Aseptic healing after operation 289
Septic development after operation in cases previously clean ... 4
Septic at time of operation but rendered aseptic by the use of formalin 13
IQOI Modern Surgical Technique. 247
haps a teaspoonful of pus escaped. The discharge continued
for four or five days and tfcen subsided.
• In this case it is clear to my mind that infection -did not
occur at the time of operation, but later as a result from
septic urine.
Case 2. — Mrs. S., age 42, was operated upon Dec. 9,
1 898, for inguinal hernia. Kangaroo tendon was employed
in closing the wound. On the tenth day the wound began
to redden and in two or three days thereafter began to dis-
charge bloody serum, and later pus. The knots of Kanga-
roo tendon were expelled one by one, and then the wound
closed. I have always attributed the infection in this case
to Kangaroo tendon.
Case 3. — It is difficult for me to know how this case
should be classified. There is little doubt in my mind but
that the case was septic when operated upon, as it was not
recognized as such, being treated as a clean case, it seems
only fair to classify it among clean cases which developed a
septic condition following operation.
Mrs. B, age 30, was operated upon Nov. 29, 1899, for a
cyst of the left ovary. After removing it with the tube, the
exploration of the right side was undertaken. Here strong
adhesions were encountered, which were broken up with dif-
ficulty. The right tube was found much distended and as
large as my thumb, the fimbriated extremity of the Fallopian
tube being completely sealed. This ovary was apparently
healthy. Gauze mops were adjusted preparatory to remov-
ing it, when it ruptured and a clear, transparent fluid es-
caped. The condition was thought to be hydro-salpinx, and
a suitable case for conservative treatment. The sealed end
of the tube was excised, and the mucous membane of the
interior of the tube stitched to the serous membrane, and the
abdominal wound closed.
On the second day symptoms of septic peritonitis began
to appear, and the patient died on the sixth day. A post
mortem examination revealed a general, purulent septic peri-
248 The New England Medical Gazette, May,
tonitis, which apparently originated in the right tube which
was found gangrenous, and almost completely destroyed. It
resembled a slough of the appendix veriformis.
It is the operator's opinion that the tube contained a septic
accumulation which was liberated by the conservative treat-
ment adopted, and had this right tube and ovary been re-
moved a better result might have been obtained.
Case 4. — Mrs. J. (colored), age 41, was operated upon
Oct. 18, 1899, for a tumor in the abdominal wall. The
operation was simply an incision into the tumor, for the pur-
pose of exploration, and to obtain tissue for microscopical
examination. The knife entered tissue very hard and glis-
tening, like a fibroid of the womb. No bleeding occurred
from the cut surface. A piece of tissue was removed and
the wound closed. The pathologist reported "keloid." The
suppuration following the operation was very slight, but
persisted for about a week.
Matriculate at a Leading College Only. — To no other
class of professional men does the stability and permanence
of his alma mater mean so much as to the physician. The
clergyman having entered his profession, cannot be debarred
from preaching so long as he can obtain an audience, no mat-
ter what becomes of the college from which he received his
diploma ; the lawyer cannot be debarred from practice so
long as he finds a client, and observes the amenities of his
guild, no matter where he may locate, or what changes take
place in the college in which he received his instruction ; but
the physician whose diploma is from a new college, a defunct
college, or a college whose assets give no guarantee of pro-
longed life, is always an object of suspicion ; he is liable to be
bliged to prove the character of the institution from which
e graduated, and may actually be debarred from practice if
is alma mater fails to be included, as time passes, among the
eputable colleges of the land ; or if, at the the time of its de-
ease, it had not met the requirements of some state board.
190 1 Editorial. 249
EDITORIAL.
Contributions of original articles, correspondence, etc., should be sent to the publishers, Otis
Clapp & Son, Boston, Mass. Articles accepted with the understanding that they appear only in
the Gnsttt*. They should be typewritten if possible. To obuin insertion the following month,
reports of societies and personal items must bt rteahtdby tk$ istk »/ihg m^nth prtctding.
THE REPROVING OF THE MATERIA MEDICA.
After some years of agitation it is good to know that the
reproving of one drug, as a test, along lines more in accord-
ance with scientific methods than ever before is beginning.
In his annual address before the American Homoeopathic
O. O. and L. Society, the President, Dr. H. P. Bellows, of
Boston, presented a perfected plan for this work, a plan
more comprehensive in detail than any yet suggested. The
plan, as briefly summarized in the conclusion of his address,
is as follows : —
'* To summarize, in closing, I should say, therefore, that,
from the standpoint of a specialist, the reproving of the
Homoeopathic Materia Medica requires that such work be
done either in our large cities or in close connection with our
medical colleges ; that it be conducted by organized clubs or
boards of physicians which shall be presided over by a
master or director of provings ; that this director shall him-
self be a general practitioner of the largest possible experi-
ence and the broadest knowledge and grasp of materia
medica, or that he be a specialist who has previously had
such general experience in medicine ; that he shall have
associated with him two or three other general practitioners
for the division of labor and a body of specialists for the
examination of special conditions and testing of special
organs, and that these shall cover the mind and nervous sys-
tem, the eye, the ear, the nose and throat, the chest, the
genito-urinary system and the skin ; that arrangements shall
250 The New England Medical Gazette. May,
be made for the assistance at all times of laboratory experts
for chemical, microscopical, bacteriological and physiological
tests ; that the provers shall receive some adequate compen-
sation for their time and services, the means to come from
private sources, from funds administered by our medical
colleges, or from the treasuries of our State societies ; that
the provers shall be subjected to careful preliminary organic
and functional tests ; that they shall receive the drug to be
proven at the hands of the director of the proving so guarded
by blanks and counter-tests that they shall not know the
nature of the drug taken or when the actual administration
begins ; that the examiners themselves shall not know what
drug is being proven or when it is being administered, but
may receive special hints or practical suggestions from the
director at his discretion ; that the prover shall keep a daily
record of his own condition and symptoms in a book provided
for this purpose and shall submit this written record every
day to the director of the proving ; that after careful ques-
tioning the director shall each day send the prover to such
specialists as may seem desirable for the further testing and
verification of special symptoms or conditions which may
arise, the visit to be made during the specialist's office hours
or at such other convenient seasons as may be specified in
advance or arranged at the time by telephone ; and that,
finally, the results of the proving as a whole shall be sum-
marized and arranged for publication in scientific form by
the director with such aid from any or all of his associates
as he may desire."
The suggestions were accepted by the Society, Dr. Bellows
invited to take the position of general director, and com-
mittees have already been appointed in New York, Brooklyn,
Chicago, Philadelphia, St. Louis, Boston, Baltimore, Cincin-
nati, Buffalo, Cleveland, Detroit, Washington and San Fran-
cisco.
In Brooklyn the committee has organized, money has been
raised and the work practically begun.
I go I Editorial. 2 5 1
In Boston the committee has been organized with Dr. E. P.
Colby as director of provings, and a better selection could
not have been made.
This work initiates the most important movement in the
homoeopathic school for many years, and it should receive
the most enthusiastic and cordial support of every member
of the profession.
Everybody can help in some way, but the best and only
way that will give results will be to respond to the calls of
the committee.
Necessarily work of this scope and character must be done
in the large cities where laboratory facilities are at command,
but some money must be raised, and this can be contributed
by everybody, so everybody must help with what he can, be
it ever so little. The committee has not yet cajled for funds
but when they do, let everybody respond, respond gladly and
generously.
American Medicine.
The above is the title of the new journal edited by Dr.
George M. Gould* and a large staff of collaborators. It is
"founded, owned and controlled by the medical profession
of America," and its aim is to publish a journal which shall
be absolutely free from "commercialism," as understood in
its application to professional matters. Anybody who has
ever had anything to do with medical journalism knows how
very difficult it is to do this and attempt to financially sup-
port the journal, and realize what a difficult task Dr. Gould
and his assistants have undertaken, but it is in the right ;
the only way a journal should be conducted, and we are sure
it will receive the endorsement and cordial support of those
who place profession above pocket-book. We cordially wish
American Medicine a long and useful existence.
2 52 The New England Medical Gazette, May,
OBITUARY.
Dr. W. D. Anderson.
Dr. Wm. Dexter Anderson, of New Haven, Conn., died in
March, 1901, at Grace Hospital, after operation for intesti-
nal obstruction.
Dr. Anderson was born in Londonderry, N. H., in 1841.
When he was very young his parents removed to Boston.
Here his father became a prosperous merchant. In 1858,
Mr. Anderson, then in his 17th year, entered Yale College
as a student in the academic department. He was very suc-
cessful at his studies and an unusually popular man, receiv-
ing an election to Scroll and Keys in May of his junior year.
He graduated in 1862, then spent three years in the medical
school, from which he graduated with a high standing in
1865.
For a time after graduating he practiced with Dr. Paul C.
Skiff, but after the death of Dr. Arthur Foote, which oc-
curred about the year 1869, Dr. Anderson purchased his
home and practice.
Dr. Anderson joined the Connecticut Homoeopathic Medi-
cal Society in 1869, and was its president in 1879 and 1880.
Dr. L. Louise Brigham.
Dr. L. Louise Brigham, of Hartford, Ct., died April 2, 1901.
She was a graduate of the Boston. University School of Medi-
cine in 1843; practised in Hartford for seventeen years,
building up a large business. She was quite an active mem-
ber of the State society, and also belonged to the Dunham
Medical Club of this city.
I go I Editorial, 253
New York, April 3, 1901.
Meeting of the Hahnemann Monument Committee of
THE American Institute of Hom(Eopathv.
Held at the residence of Dr. \Vm. Tod Helmuth, 504
Fifth Avenue.
Dr. J. H. McClelland in the chair.
Drs. J. H. McClelland,. J. B. Gregg Custis and \Vm. Tod
Helmuth, the latter appointed Secretary /r^ tern.
The President stated that the meeting had been called to
consider the death of Dr. Henry H. Smith, the Secretary
and Treasurer, and to take the necesary legal steps to fill the
vacancy occasioned thereby.
On motion of Dr. Helmuth, Dr. J. B. Gregg Custis, of
Washington, D. C, was nominated for Secretary and Treas-
urer of the Committee ; carried.
On motion the following preamble and resolutions were
unanimously adopted.
Whereas, through the death of Dr. Henry H. Smith, this
Committee has lost one of its most active and efficient mem-
bers, and
Whereas, through the untiring energy and perseverence
of Dr. Smith much of the successful workings of this Com-
mittee can be attributed, therefore
Resolved, that the Hahnemann Monument Committee of
the American Institute of Homoeopathy has sustained an
irreparable loss in the demise of Dr. Smith, and offers this
resolution as a tribute to his perseverence and self-sacrifice
in assisting to secure a lasting monument to the founder of
Homoeopathy in the United States of America.
Resolved, also, that copy of this preamble and resolu-
tions be presented to the American Institute of Homoeopathy
at its next meeting in June and to the family of Dr. Smith.
Wm. Tod Helmuth,
Secretary Pro tern.
254 T^^^^ iWze; England Medical Gazette. May,
SOCIETY REPORTS.
MASSACHUSETTS HOMCEOPATHIC MEDICAL SOCIETY.
The sixty-first annual meeting of the Society was held at
Pilgrim Hall, Boston, Tuesday evening, April 9, and Wednes-
day, April 10, 1 90 1.
EVENING SESSION.
The meeting was called to order by the President, John L.
Coffin, M. D., and placed in charge of Dr. Fred B. Percy,
Chairman of the Committee on Diseases of Children, who
presented the following program : —
1. "Antitoxin in the Treatment of Diphtheria." W. C.
Goodno, M. D., Philadelphia, Penn. Discussion opened by
Geo. B. Rice, M. D.
2. "A Method of Infant Feeding." Wm. F. Wesselhoeft,
M. D.
3. "Some Interesting Cases of Tuberculosis in Children."
D. P. Butler, Jr., M. D.
4. " Experiences with Marasmus at the Sea Side Hospital.''
Carroll C. Burpee, M. D.
5. "A Leaf from the Children's Ward at the Massachu-
setts Homoeopathic Hospital." A. S. Boomhower. M. D.
6. "A Contribution to the Study of the Treatment of
Pertussis." F. L. Babcock, M. D.
Dr. Goodno's paper brought out a great deal of discussion,
but it was almost universally conceded that we should use
antitoxin in every case of diptheria. A vote of thanks was
extended to Dr. Goodno for his exceedingly interesting and
up-to-date discourse.
Wednesday, April 10, 1901.
The meeting was called to order by the President, John L.
Coffin, M. D., and the records of the semi-annual meeting,
also the records of the Executive Committee's quarterly meet-
190 1 Societies. 255
ings were read and approved. The reports of the Treasurer
and Auditor were received and accepted. The report of the
Necrologist, F. A. Warner, M. D., was read and referred to
the Committee on Publication. Following is the list of
deceased members during the past year : —
Luther M. Lee, M. D., Benjamin H. West, M. D., Sarah E.
Sherman, M. D., Charles L. Farwell, M. D., Henry F. Batch-
elder, M. D.
The report of the Committee on Amendments of By-
Laws was received and voted upon. Dr. Moore offered an
amendment to the By-Laws, which was referred to the same
committee.
The following candidates were elected to membership : —
Solon Abbot, M. D., 10 Dean Ave., Franklin ; Jeanie O.
Arnold, M.D., loi Brown St., Providence, R. I. ; Thomas E.
Chandler, M. D., 670 Massachusetts Ave,, Boston; Marion
Coon, M. D., Hotel Ilkley, Boston ; Charles T. Cutting, M.D.,
66 Highland Ave., Newtonville ; Charles J. Douglas, M. D.,
524 Warren St., Roxbury ; Mary R. Farnum, M. D., 45 Water
St., Penacook, N. H.; H. E. Fernald, M. D., Elm St , Cohas-
set ; Walter J. Graves, M. D., Peabody Sq., New Dorchester;
Fred'k De F. Lambert, M. D., 33 Summer Street, Salem;
Edwin R. Leib, M. D., 45 Pleasant St., Worcester; Francis
H. MacCarthy, M. D., 39 Hancock St., Boston; Edward R.
Miller, M. D., 63 Merriam Ave , Leominster ; Lillian B.
Neale, M. D., 138 Marlboro St., Boston; Elizabeth B. New-
man, MrD., Belmont; Helen F. Pierce, M.D., 13 Pleasant
St., Plymouth ; Julia M. Plummer, M. D., 160 Huntington
Ave., Boston ; William H. Watters, M. D„ 26 So. Common
St., Lynn ; Henry A. Whitmarsh, M. D., 64 Jackson St.,
Providence, R. I. ; Ralph C. Wiggin, M.D., 26 Puritan Ave.,
Dorchester.
Dr. F. P. Batchelder, Chairman of the Committee on Reg-
istration and Statistics, made a very interesting report which
was referred to the Committee on Publication.
256 The New England Medical Gazette, May,
Report of Committee on Obstetrics.
Gborgb H. Earl, M. D., Chairman.
General Subject : Temperature after Delivery.
1. **A Brief Study of Temperature in Certain Serious
Puerperal Complications, with Cases." Sarah S. Windsor,
M. D.
2. "Dispensary Cases and Statistics." Lena H. Diemar,
M.D.
3. "Two Cases." Nelson M. Wood, M. D.
4. "The Common Cause, with Cases." George H. Earl,
M.D.
After luncheon the meeting was called to order by the
President, John L. Coffin, M. D., and the report of the
Election Committee was received as follows : —
President, George S. Adams, M. D.
Vice-Presidents, Winfield Smith, M. D., George E. Percy,
M.D.
Recording Secretary, Frederick L. Emerson, M. D.
Corresponding Secretary, Frederick P. Batchelder, M. D.
Treasurer, Winslow B. French, M. D.
Librarian, J. Wilkinson Clapp, M, D.
Censors, John L. Coffin, M. D., Edward P. Colby, M. D.,
Fred B. Percy, M. D., Nathaniel W. P2merson, M. D., Frank
C. Richardson, M, D.
Report of Committee on Clinical Medicine.
Elmer H. Copeland. M. D., Chairman.
1. "The Modern Idea of the Use of Drugs as Medicines,"
Conrad Wesselhoeft, M. D.
2. ** Diseases of the Chest in iSooand 1900." Herbert C.
Clapp, M. D.
3. "Serum Therapy and the Animal Extracts." J P.
Sutherland, M. D.
4. " Modern Aids to Accurate Diagnosis." John P. Rand,
M.D.
IQOI Societies. 257
Report of Committee on Insanity and Nervous Diseases,
Eli.bn L. KxiTH, M. t)., Chairman.
1. "The Influence of Manual Education upon the De-
velopment of the Speech Centres." Illustrative Case.
Frank C. Richardson, M.D.
2. "The General Practitioner and the Insane." Clara
Barrus, M. D., Physician at the Middletown State Hospital,
New York.
3. "Suicidal Tendencies of the Insane." Edward H.
Wiswall, M. D.
4. "The Report of Four Cases of Pernicious Anaemia in
Insanie Subjects with a Consideration of the Nervous Sequelae
of the Disease." Solomon C. Fuller, M.D.
The meeting adjourned at 5.15 p.m. to meet at Young's
Hotel, where dinner was served to one hundred and sixty-five
members, and at eight o'clock the annual address of the
President was delivered and very much enjoyed by all
present.
The papers and discussions will be found in full in the
transactions.
Frederick L. Emerson, M. D.,
Secretary,
Teaching Hygiene in Somerville, Mass. — The Som-
erville, Mass., School Board, according to an item appearing
in the public press March 26, passed the following order :
" That in the primary and grammar schools instruction in
physiology and hygiene be entirely oral, and that hereafter a
single desk book be furnished for the use of teachers only ;
and it is hereby also ordered that instruction be regarding
the proper care of the body, rather than the structural
formation."
The order that should be passed by every school board is
that such teaching should be given by, and at the discretion
of, a properly qualified and appointed physician. Not less,
but more teaching of the right kind is needed.
258 The New England Medical Gazette. May,
AMERICAN INSTITUTE ANNOUNCEMENT.
The Executive Committee beg to announce to the mem-
bers of the Institute, and the profession generally, the follow-
ing important notice as to the railroad arrangements and the
program of entertainment offered to the Institute and its
guests by the citizens of Richfield Springs.
The usual fare and one-third rate for the round trip, on
the certificate plan, has been granted by all the roads.
Arrangements have also been made whereby all members
coming from the Western Country via Buffalo can stop over
at the Pan-American Exposition for ten days on any kind or
character of ticket, providing said ticket is deposited with
joint agent. No. 50 Exchange Street, Buffalo, and the pay-
ment of $1 made.
For those who come from the Eastern Country, The New
York Central, West Shore and Lackawanna will make amic-
able arrangement that will grant our members a suflRcient
stop over at Binghamton or Utica, at which points they can
procure regular excursion tickets to Buffalo and return.
This will allow members from the East to attend the exposi-
tion at a very slight additional expense.
Through parlor cars will be run direct to Richfield Springs
from both the East and the West. The Delaware and
Lackawanna Road will put on its summer schedule of trains
for the session of the Institute, which provides close connec-
tions at both Utica and Binghamton.
The Entertainment Committee and the citizens of Rich-
field Springs offer the following unusually fine social pro-
gram which has been so arranged as not to interfere with the
work of the Institute.
Saturday, June 15. — Open Air Concert, Richfield Springs
Military Band, 3.30 p. m.
Sunday, June 16. — Sacred Vocal and Instrumental Con-
cert in the EarHngton Hotel parlors, 8.30 p. m.
190 1 Societies. 259
Monday, June 17. — Open Air Concert, Richfield Springs
Military Band, 3.30 p. m.
Tuesday, June 18. — Open Air Concert, Richfield Springs
Military Band, 3.30 p.m. Grand Ball, Hotel Earlington,
tendered to the Institute and its guests by Messrs. E. M.
Earle & Son, 10 p.m. Supper, 12 m.
Wednesday, June 19. — Drive over magnificent mountain
roads to Lake Otsego, the famous ** Glimmerglass," of Ytm-
more Cooper, sail over the lake to Cooperstown, his home ;
Luncheon in Cooperstown, drive home to Richfield along the
shores of Lake Otsego, reaching Hotel Earlington about 5
p.m.
N. B. — Each day the ladies of the Institute are invited by
the Citizens of Richfield Springs to take this delightful ex-
cursion to Cooperstown and return.
Music in the parlors Hotel Earlington, 11 a. m. Open Air
Concert in Earlington Park, 4 p. m. Reception at the
Waiontha Golf Club, 4 to 6 p. m., by the president, Mr. T. R.
Proctor. Progressive P^uchre Party, tendered by Messrs.
Earle & Son in the Earlington parlors.
Thursday, June 20. — Drive to Cooperstown and return
(same as Wednesday), 10 a. m., 5 p. m. Music in the parlors
Earlington, 1 1 a. m. Open Air Concert, 4 p. m. Musicale
in the parlors of Hotel Earlington, 9.30 p. m.
Friday, June 21. — Drive to Cooperstown and return (same
as Wednesday), 10 a.m., 5 p.m. Music in parlors Earling-
ton, II A. M. Open Air Concert, 4 p. m. Grand Compli-
mentary Vaudeville PLntertainment, tendered to the Institute
and their guests, by the Entertainment Committee and Citi-
zens of Richfield Springs. (It will be the endeavor of the
Committee in charge of this entertainment to procure in
New York City for this performance only the very best
available talent, and no expense will be spared to make this
vaudeville performance one of the highest class.
Saturday, June 22. — Music in Hotel Earlington parlors.
36o New England Medical Gazette. May,
1 1 A. M. At 2 p. M. at the Lake House, on Canadargo Lake,
a Clambake tendered by the Entertainment Committee and
the Citizens of Richfield Springs. Music by the Richfield
Springs Military Band.
The Citizens of Richfield Springs announce it as their
purpose to make every member of the Institute pleased with
their visit. They do this as an advertisement of their health
resort, and the Committee feel assured that the session of
1 90 1, will be the most pleasant one in the history of the
Institute.
A. B. Norton, M. D., President,
E. H. Porter, M. A., M. D., Secretary.
Infection through Modelling Clay. — Mr. M. O.
Leighton, health inspector of Montclair, N. J., in a paper
read before the American Society of Bacteriologists at its
recent meeting in Baltimore, made the following statements :
" In the ordinary schools such clay, after having been
used by one student, is returned to the stockbox and subse-
quently used again. Study of clay thus obtained from
schools showed bacteria to be tolerably abundant in the clay.
The species of bacteria identified were those which ordinarily
occur in pus formations, thus showing that clay may be capa-
ble of distributing these organisms. An attempt to sterilize
clay showed that the only efllcient means of accomplishing
this purpose is by the use of superheated steam under the
pressure of 1 5-20 pounds for forty-five minutes.
" Next, an attempt was made to determine how long cer-
tain pathogenic bacteria could remain alive in the clay.
Sterilized clay was inoculated, under proper precautions,
with the bacilli of typhoid, diphtheria and tuberculosis. The
clay was then kept moist and warm, and studied periodically
for the presence of these organisms. The results were,
briefly, as follows : B. typhi abdominalis grew vigorously
after having been enclosed in the clay for thirty-two days.
After that no colonics were found. B. diphtheria grew after
having been enclosed in the clay for eighteen days. B.
tuberculosis was alive after eighteen days."
190 1 Reviews and Notices of Books, 261
REVIEWS AND NOTICES OF BOOKS.
Obstetric and Gynecologic Nursing. By Edward P. Davis, A. M.,
M. D., Professor of Obstetrics m the Jefferson Medical College,
Philadelphia, and in the Philadelphia Polyclinic, etc. Philadel-
phia and London: W. B. Saunders & Co. 1901. pp. 402*
Price, $1.75 net.
The above is one of the most valuable of the recent contribuions
to medicar literature for nurses. It is exceptionally thorough and
comprehensive, and in a plain, straightforward, practical way gives
all the teaching required by a nurse engaged in obstetrical and
gynecological work.
In Part I., Obstetric Nursing, an outline of the anatomy and
physiology of pregnancy is followed by instruction in nursing in
complicated and uncomplicated cases. Chapters are devoted to
preparations for confinement, nurse's duties during and after labor,
care of the child, obstetric surgery, complications during and follow-
ing labor, feeding and weaning, disorders of infancy, etc.
Under Part II., the examination and management of patients,
local treatment, douches, preparation for and assistance during
operations, post-operative nursing, and care in special cases are
treated at length, and many additional directions are given in
regard to the preparation of surgical supplies, selection of foods
and aseptic precautions to be observed.
There are many good full page illustrations, and carefully a pre-
pared index.
Transactions of thp: Ho.vkeopathic Medical Society of the State
OF New York for the Year 1900. Vol. XXXV. Edited by
the Secretary, De Witt G, Wilcox, M. D., Buffalo, N. Y, pp. 410.
The present volume is a record of the forty-eighth annual meet-
ing of this society, held at Albany, N. Y., Feb. 13 and 14, 1900, and
of the thirty-fourth semi-annual meeting held at Brooklyn, N. Y.,
Oct. 3 and 4, 1900.
It contains a large number of short suggestive papers, which are
well supplemented by the discussions they evoked. Transactions
like these are interesting reading, and form excellent books of
262 The New England Medical Gazette, May, •
reference, inexpensive to society mcinbers, and serviceable to all
who would keep in touch with what is being thought and done
along medical lines.
We are pleased to note that Drs. N. W. Emerson and Horace
Packard, of Boston, have been elected honorary members of this
society.
A Text-Book on Practical Obstetrics. By Egbert H. Grandin,
M. D., with the collaboration of George W. Jarman, M. D. Third
edition, revised and enlarged- Illus. Philadelphia : F. A. Davis
Co. 1900. pp. 511. Price, cloth, {4 net; sheep, J5 net.
As a standard work on obstetrics Grandin and Jarman's occupies
a decidedly leading position. If it is less voluminous than certain
contemporary treatises which might be mentioned, it is not the less
instructive and reliable on the subject of essentials. The schema
of the work, which for the most part relegates instruction in
anatomy, physiology, embryology and pathology to other and earlier
chairs, admits of a considerable omission and condensation of
matter ordinarily included. We think this a reasonable and advan-
tageous plan to pursue, and that little is gained by diffuseness and
repetition if the student comes to obstetrical work well grounded in
preliminary branches.
We also commend the omission of many of those antiquated wood
cuts, whose introduction to the pages of books on midwifery ante-
dates the memory of the oldest practitioner. There are still 21 few,
notably those illustrating the structure of the genital organs, which
we hope to see superceded by far better ones in a subsequent edi-
tion. There are numerous excellent plates, photogravures from
nature, in the present volume.
We have always liked this book, and continue to think it well
and conscientiously written. It is clear and practical, not over
burdened with theory, statistics or literary references which do not
help a man out appreciably in a difficult case, and which often
confuse a student.
Students and practitioners need more than one text book on
obstetrics, and the one under discussion may well be among the
nuTiber selected.
We quote one or two of the many sensible sayings concerning
j 1 90 1 Reviews and Notices of Books. 263
I precautions, to prevent infecting the lying- woman : * • These precau-
tions take but little time, and the man who is not willing to give
I this time to safeguard a human life had better decline obstetrical
\ work altogether.'*
I Again, "The vaseline-pot should, once and for all, be banished
from the lying-in chamber.'*
Concerning the time for instrumental delivery, " It is a question
of conditions, and not minutes or hours."
i
I Nursing Ethics for Hospital and Private Use. By Isabel
I Hampton Robb, Graduate of the New York Training School for
' Nurses, Bellevue Hospital, etc. Cleveland: J. B. Savage. 1901.
Price, $1.50.
The qualifications of a young woman who wishes to become a
professional nurse are summed up by the author as being good
physical health, education and culture. To these must be added a
sense of personal responsibility which shall ensure the conscientious
discharge of her obligations.
The author very carefully presents the ethical side of a nurse's
service as probationer, junior, senior and head nurse while in the
hospital, and the relations she should bear to patient, doctor and
family when practicing her profession outside.
It is unfortunate so much important and well expressed advice
and instruction should be dissociated from a text- book on nursing,
as joined with the technical teaching, a larger circle of readers
might be reached.
The Medical Adviser; or How to Treat the Sick and the
Injured. By O. Edward Janney, M. D., Professor of the Practice
of Medicine in the Southern Homoeopathic Medical College.
Baltimore: Maryland Homoeopathic Pharmacy Co. 1901.
pp. 72.
Designed primarily for the use of patients temporarily out of
reach of a physician, this monograph is also recommended by the
author to readers at large. The best things it contains are the sug-
gestions on diet in common diseases, but the text throughout is too
sketchy to be otherwise than frequently misleading to the laity.
This is especially noticeable in the section on Remedies and Reme-
264 Th^ New England Medical Gazette, May,
dial Measures. The subject of dysentery, for instance, is dismissed
as follows : " Mercurius corr. 3X one tablet every hour or two."
There are several good receipts for the preparation of food for
the sick.
Infant- Feeding in Its Relation to Health and Disease. By
Louis Fischer, M. D., Attending Physician to the Children's
Service of the New York German Poliklinik, etc. Illus. Phila-
delphia: F. A. Davis Co. 1901. pp. 368. Price, cloth, $1.50
net.
We have no hesitation in predicting that Fischer's Infant- Feed-
ing, will at once command the appreciative attention of the profes-
sion. It is the work of an educated man and a clinician who has
thoroughly mastered his subject.
The plan of the book embraces a description of the digestive
organs of the infant, verified actual capacity of the stomach at dif-
ferent ages, properties and action of the digestive juices, intestinal
bacteria, constituents of breast and cow's milk and their value,
feeding of milk, diet of mother, wet-nursing, care of nipples, impor-
tance of record of infant's weight, properties of human and cow's
milk, modification of milk, how good milk may be secured, sterili-
zation, pasteurization, modification,* mixtures, infant foods with
analyses ! and deductions, condensed milk, Gsertner's '* mother-
milk," chemical and clinical reports on same, infant stools, appro-
priate feeding of infants in various diseases, rectal feeding and
feeding in intubation cases, dietary.
When breast milk is not available. Dr. Fischer favors the feeding
to healthy infants of raw milk obtained under conditions of perfect
cleanliness. He points out its superiority over sterilized or pasteur-
ized milk, and gives rules for its modification at home. The use of
modified or laboratory milk is not recommended. He notes that it
causes constipation, retards development, and may occasion or
predispose to intestinal disorders and scurvy.
It is impossible to call attention to all the good points of this
book which will not only supplement, but supercede much of the
present teaching of infant-feeding.
igoi
Personal and News Items.
265
PERSONAL AND NEWS ITEMS.
Emergency Hospital at Pan-American Exposition.
The above cut represents the Emergency Hospital which
has been erected on the Pan-American Hxposition Grounds
at Buffalo. It is equipped with all the approved medical and
surgical appliances necessary for emergency work. A
unique feature consists of two electrical ambulances, and also
another automobile ambulance to run either by gasoline or
steam. The hospital has accomodations for from twenty-five
to thirty patients at one time. Physicians visiting the expo-
sition will doubtless find much to interest them in the ar-
rangements and appliances of the hospital, all of which are
of the most modern style.
At the next meeting of the American Homoeopathic Oph-
thalmological, Otological and Laryngological Society, which
will open its session in the parlors of the Hotel Earlington,
Richfield Springs, New York, on Saturday, June 15, at 2.30
p. M., and have sessions on Monday and Tuesday, June 17,
and 18, it has been arranged to have Mr. M. R. Hutchison,
266 The New England Medical Gazette, May,
E. E., exhibit and explain his recently perfected akouphone
and akoulalion, mycro- telephonic instruments so constructed
as to reproduce and intensify sounds and still preserve their
quailty.
AMERICAN INSTITUTE OF HOMCEOPATHY.
president's office.
New York, March 29, 1901.
To THE Members of the Amer. Inst, of Homceopathy :
Having appointed Dr. A. C. Cowperthwaite to the office
of Necrologist, in place of Dr. H. M. Smith, deceased, I
would respectfully urge upon the members of the Institute
that they forward to him at once all the data within their
possession as to the death of any member of the Institute
during the past year.
Fraternally yours,
A. B. Norton,
President,
Dr. Given's Sanitarium at Stamford, Conn., is pleasantly
situated on a hill overlooking the city of Stamford and Long
Island Sound, and is easy of access from New York and all
New England States.
It is a well known fact that certain climatic conditions are
beneficial in certain nervous and mental disorders, and the
invigorating (coast) air of this locality, charged with ozone, is
a sedative in itself.
During the past year another cottage has been added, and
the recreation hall has been enlarged, thus improving upon
the already excellent accommodations offered for patients
desiring special treatment.
All modern means are employed for the treatment of
nervous and mental disorders. A separate department is
devoted to the treatment of drug habits.
190 1 Personal and News Items, 267
Dr. Kraft, editor of the American Homosopathisty 57
Bell Ave., Cleveland, Ohio, is collecting a small but select
party of ladies and gentlemen for a fifty days' summer tour
in Ireland, Fnence, Italy, Switzerland, Austria, Germany,
Holland and Belgium. Terms moderate. Apply early.
For Sale. — A $2,000 country practice in Massachusetts.
Terms very reasonable. Collections over 90 per cent. Ad-
dress "Y," Care Otis Clapp & Son, 10 Park Sq., Boston,
Mass.
The town of Norfolk, Connecticut, is in need of a homoeo-
pathic physician, and it is said to be a good opening for one.
For information regarding the place, address Dr. B. A. Saw-
telle, Southington, Conn.
Dr. Thos. H. McClintock, class of '98, B. U. S. of M.,
has removed from Hillsboro Bridge, New Hampshire, to No.
56 Buckingham St., Hartford, Conn.
268 Ihe New E?igland Medical Gazette. May.
Death Rate of Six Large Cities.— It may be of inter-
est to glance at the death rates of six of the large cities dur-
ing the past five years :
189s 1896 1897 1898 1899
London . . .
19.8
18.6
18.2
1 8.7
19.8
Paris . . . .
21.3
19.0
18.6
19.7
20.2
Berlin . . . .
19.4
17.9
17.7
17-3
18.7
Vienna . . .
23- 1
22.3
20.9
20.1
20.6
St. Petefsburgh
28.8
30.9
29.0
25.8
25.2
New York . .
23.2
21.8
20.0
20.5
19.8
The death rates for New York given here are for the bor-
oughs of Manhattan and the Bronx, and are calculated from
the results of the United States census of 1900, It is seen
by this table that there has been a tendency to a lower death
rate during the past few years. This may be accounted for
by a lessening of the virulence of influenza, by better paving
of streets, and by a more careful oversight of water and milk
supply. Much can still be done by physicians and sanitarians
and municipal governments in these relations. — New York
Medical Journal.
A Useful Dragon Fly. — The United States Government
has been experimenting with the savage looking but harmless
dragon fly. Experimenters saw one fly eat up 800 mosquitos
in an hour, and it is now proposed to breed the " darning
needle " on a large scale to see if they cannot be made suffi-
ciently numerous to kill the mosquitoes that infest some parts
of the country. ... A recent report of a commission of
surgeons of the United States Army, prepared by Dr. Walter
Reed, is of interest in this connection. The conclusion
reached by this commission is that the mosquito serves as the
intermediate host for the parasite of yellow fever and it is
highly probable that the disease is propagated through the
bite of this insect. — Exchange.
THE NEW ENGLAND
MEDICAL GAZETTE
No. 6. JUNE, XQOx. Vol. XXXVI.
COMMUNICATIONS.
PRESIDENTIAL ADDRESS.
BY JOHN L. COFFIN, M.D.
[Delivered before Mass. Horn. Med. Society, April lo, 1901.]
Ladies and Gentlemen^ Members of the Society:
Since last we met, the last year of a century has closed,
and with its demise the nineteenth century has passed into
history. Not the history that is written but the history that
is. The history that is written at best gives only the salient
points, the remarkable things that have been done, the nota-
ble or notorious people that have lived, and from the perusal
and comtemplation of these recorded facts we endeavor to
construct an idea of the genius of the ages past. Not so
with the remarkable century just gone. We are not yet so
remote that it is necessary to summon our imagination to
help in forming our estimate.
The blood is hardly yet cold in our veins that fought at
Lexington or froze at Valley Forge. Our ears still tingle
and our hearts throb at the voice of Patrick Henry, and
Jefferson, and We'bster, and Calhoun, and Clay. The story
is still told in the flesh of Bull Run, of Fredericksburg, of
the Wilderness, of Gettesburg, and Antietam. The trying
days of the reconstruction period are yet a reality to many of
270 The New England Medical Gazette, June
us and the solution of the race problem is still with us today
in all its complexity. We no longer drag our weary way
over the hot and dusty road in the stage-coach, but travel on
the wings of the wind surrounded by all the luxuries of an
up-to-date hotel. We talk almost, if not quite, all around the
globe. Distance and space are annihilated. These are facts
well known to us and these are the things that will be
known to the future, emblazoned as they will be on the
pages of the written book.
But of more importance far than all this is the fact that
we still know and feel all those tremendous, subtle, silent
forces of humanity which have made these achievements pos-
sible. We know the denial and self-sacrifice of the parents
that the children might be educated, and the earnest struggle
and endeavor of the children that they might be worthy of
the sacrifice. We remember that early and wholesome dis-
cipline at home and in school, resulting in that intelligent
obedience which enables the American citizen-soldier to
walk unflinchingly into the hell of battle and to stay there
till he wins. We feel the honest struggle of the New Eng-
land conscience with dogma and tradition, that everlasting
reaching out after truth which resulted in a religious eman-
cipation, and rendered possible an Emerson, a Channing, a
Theodore Parker and a Phillips Brooks. We are yet an
integral part of that living, breathing, resistless, onward-striv-
ing humanity, which under Divine guidance has made the
nineteenth century the best the world has yet seen. Never,
I believe, has the intelligence of the great mass of people
been so well developed as today, never has the laborer been
so well-housed and well-fed both physically and mentally,
never to so great a degree has the possession of great wealth
been so much regarded as a sacred trust to be used for the
benefit of mankind, and therefore it is that at the dawn of a
new century we stand fully conscious of the debt we owe the
past, fully appreciative of the responsibilities thereby entailed
upon us, but at the same time proud of our forebears and
190 1 Presidential Address, 271
their work, strong in our ability to do the duty of today, and
filled with courage and determination for the future.
So has it been with our chosen profession. As we look
over the past hundred years we are dazed at the names and
deeds that stand out in bold relief. The names of Jenner,
Claude Bernard, Rasori, Brussais, Couvelhier, Andral, Ma-
gandie, Rokitansky, Vichow, Lister, Cooper, Lagenbeck,
Hutchinson, Paget, Spencer Wells, McDowell, Sims, War-
ren, Dunglison, Austin Flint, Mott, Hamilton, Gross, Bige-
low, Meigs, Agnew, and many others. And in our own
special school the names of Hahnemann, Stapf, Gresselich,
Fleishman, Quin, Jahr, Gram, Pope, Hughes, Drysdale,
Lippe, Dunham and Talbot.
When we recall the discovery of the homoeopathic law, of
anaesthetics, of the principles of asepsis and antisepsis, when
we contemplate the advance made in surgery and the perfec-
tion of the various instruments to assist us in diagnosis, we
stand almost aghast. But of far greater moment to human-
ity is the fact that, guided by the brilliant and indefatigable
labors of these noble men, the whole body of medical men
and women have steadily and persistently added their mite
to the work until the ordinary, every-day, average practi-
tioner today, has more knowledge of the human body in
health and disease that is accurate and true, than ever before
since the world began. This is a condition of affairs, of which,
we, each and every one of us is a living part, a condition of
which we may justly be proud and which should constantly
stimulate us to add what we may, be it ever so little, to the
sum total of medical knowledge.
Fascinating as is the temptation to dwell in the glorious
past, we must live in the prosaic present. It was wisely or
otherwisely, ordained by our founders, that the society should
twice each year be benefitted, or bored, by an oration and
presidential address.
As we opine that the object of the oration was to give
such members as might be selected, full license to choose
272 The New England Medical Gazette, June
their pet subject and display their elocutionary and oratorical
powers through all gradations from a Booth to a Barn-
stormer, so we conceive that the object of the presidential
address was to consider more especially those things of vital
interest to the society itself, a sort of annual stock-taking.
We are the representative society of our chosen faith in the
State and as such our interests are two-fold ; first as regards
those matters of general interest to the whole profession, and
second those pertaining more especially to homoeopathy.
Not for some years have there been before the legislature
matters of such importance to our profession. The first
matter to come up was a bill to give the College of Physio-
logical Optics permission to grant the degree of Doctor of
Physiological Optics. The general character of the scheme
may be judged from the fact that of sixteen students enrolled,
the names of four appeared in the application for a charter-
and the names of eight of the sixteen appear as trustees of
the institution. Through the efforts of the leading oculists
of the city, backed by the profession generally, we are happy
to say the bill was practically killed in committee. The com-
mittee reporting '* reference to next general court ". Of far
greater import and danger to the welfare of both the public
and the profession, was a petition of one Dr. Emanuel Pfeif-
fer, praying for some modification of the existing laws gov-
erning the Board of Registration whereby the fees for
examination should be reduced and graduates of legally char-
tered medical schools should be granted licenses without an
examination. This was a very crafty and plausible attempt
to cripple absolutely the Board of Registration by cutting of
its resources and its principal power. The petitioner as well
as remonstrants were represented by able legal counsel.
There were present at the hearings among the remonstrants
the president of the Massachusetts Medical Society, the
president and vice-president of the Massachusetts Homoeo-
pathic Society, the president and legislative committee of
the Boston Homoeopathic Society, and many others. Com-
1 90 1 Presidential A ddress, 273
munications were read by the deans of Harvard, Boston
University and Tufts Medical School. As a result of their
work the committee unanimously reported "leave to with-
draw," which was accepted by the House a few days after
without debate.
The third legislative matter of interest was a petition
afterwards incorporated with the report of the Board of
Registration, including under the rules and laws of the
Board, osteopaths, mental healers, clairvoyants and Chris-
tian scientists, who heretofore have been exempt. This
matter is still under consideration, and the influence of this
as well as of other societies is being used to further the
recommendation. The point I wish to emphasize is that the
above pernicious legislation has been defeated, largely be-
cause there has been harmonious and concerted action by
the medical fraternity, brought about very largely by the
interest and activity of the committees on legislation of the
various societies, more especially by that of the Boston
Homoeopathic Society, headed by its able president, Dr.
Strong, whose labors were unceasing and invaluable.
All these matters but tend to show that there is no reason
why, under proper management and well-organized co-opera-
tion, we cannot have here in Massachusetts as satisfactory
laws regulating the practice of medicine as in any State in
the union.
I have not touched upon the question of vivi-and anti-vivi-
section because that is perennial. We can examine that at
any time. So far as I know, no injurious legislation has
been enacted and the cat-loving old maids of both sexes
have had the pleasure of doing what they consider their duty.
Next to these matters of general interest to us as medical
men and women, comes those of special interest to us as
homoeopaths. Our Massachusetts homoeopathic institutions
should always be the especial interest of this society, for
either directly or indirectly we are held accountable and are
accountable for their success. Our State hospital has
274 The New England Medical Gazette, June
throughout the year fully maintained its well established
reputation for good work. The staff has been materially
enlarged by the appointment of second assistant physicians
and surgeons. What to my mind is more a cause of con-
gratulation is the fact that never before has the medical side
of the hospital been so continually occupied. This certainly
shows that the appreciation of our methods of practice is
constantly growing with the public. Our Hampden County
members are to be cordially congratulated on the opening of
the new Hampden County Hospital, and treading close upon
the heels of this fact comes the good news that undoubtedly
the name of Essex County Homoeopathic Hospital of Salem,
will before long be added to our list. Of one thing this
society may be sure, and that is, that if Essex County has
started to have a homoeopathic hospital she will have it, for
since the foundation of the world, the New World, I mean,
Essex County has generally accomplished what she set out
to do, whether it be to catch fish or burn witches.
Of the State Insane Hospital at Westboro, I can say that
we still cure a larger per cent, of cases admitted that are
classed as curable than any other State hospital ; our accom-
modations have been over-crowded during the entire year,
and the legislature will undoubtedly appropriate means for
additional buildings during the present session. What is
true of our hospitals is equally applicable to our dispensaries.
At the college dispensary on Harrison Avenue the clinics are
constantly increasing in size, and more room or the opening
of the building for afternoon hours is imperative.
Under the auspices of a committee appointed by the so-
ciety in 1873, there was established a medical school. What
has the society as a society done for it since ? Search the
records as I may I fail to find a single mention. Appar-
ently it gave birth and then deserted its off -spring. But the
child fell into good hands, was well tended and well nour-
ished, and today has arrived at healthy maturity.
The attitude of the society toward the college has for the
1 90 1 Presidential A ddress. 275
most part been one of indifference. This is not as it should
be. The college should always have the cordial support of
the society, and the faculty should always feel that in their
labors they have back of them the friendly support and the
influence of this representative body. The society in no
small degree is dependent upop the college, for the last
census shows that out of our published list of members, num-
bering 329, 224 are graduates. If, then, the society desires
that the new additions to its membership shall be well-
equipped men and women, capable of becoming useful,
active workers and ornaments to the profession, it certainly
is for its interest to encourage and support by all means in
its power the college from the graduates of which the society
largely recruits its members. There are many ways in
which this body might be helpful to the college. At the
present time the trend all along the line is toward a marked
advance in the requirements for admission to the study of
medicine. Some advance has already been made, but much
more is necessary and so far the faculty has hesitated to
take so radical a step. One advance to the standard already
set by the leading institutions is, in my judgment, much less
pernicious than a series of slight advances, and were the
faculty assured by united action that such a move was
desired and endorsed by this society, I am sure the faculty
would feel encouraged and sustained in such action. The
immediate result of such a change is loss of students ; the
ultimate result will be an increase in members and quality.
Loss of students means loss of income, a most serious matter
for any institution dependent almost entirely upori fees for
its maintenance. For a time then during the transition
period, there is grave danger of the institution becoming finan-
cially embarrassed. Here, again, this society can be of great
practical assistance, not by the direct contribution of mpney,
but by their influence with those who have means and are
seeking worthy channels in which to dispose of it It was this
influence that built our hospital and endowed it so hand-
276 The New England Medical Gazette. June,
somely. It will do it for the medical school if the society
will only use its individual and united efforts in that direc-
tion. I would earnestly recommend, therefore, that this
society appoint a standing committee, no member of which |
shall be a member of the faculty, to confer with that body as
to ways and means in which and by which the society may
be of practical assistance to the medical school.
Finally I wish to speak somewhat of the relation of the
members to society and the work of the society as a whole.
The attitude of each and every member should be one of
loyal and enthusiastic support, with a cheerful willingness to
work. It has been my experience in the past on more than
one occasion to have heard a member say, " O, yes, I belong j
to the State Society, but I don't get much out of it. I pay I
my fee every year and get a dinner and hear a few papers |
read, but I can't say I get much out of it." Such a spirit is
unworthy of the age in which we live. Not what do I get
out of it, but what can I put into it for the benefit and help
of my fellow members, should be the motto of every man I
and woman worthy to meet in this body. A more recent
criticism, and one not entirely without reason, is that too
many of the papers are presented by the specialists, and so
are not of a character to be most helpful to the general body
of general practitioners. The best answer to this criticism
is, that the critics themselves should do more work.
The specialists more frequently prepare papers because
they are undoubtedly more frequently urged by the commit-
tees of the various bureaus, they are more frequently invited
no doubt, because giving as they do all their time and study
to the perfection of a single department, they are the more
conversant with the most recent advance along their partic-
ular line, because they have more time for literary work and
because they are oftentimes more accustomed to express the
results of their investigations and experiences on the written
page. Nevertheless there is always the danger strive against
it as one may, of the specialist studying the case too much
igoi Presidential Address, 277
from his particular point of view, and therefore it is, that
there is no paper more valuable and more acceptable than
that carefully prepared from the rich store of clinical experi-
ence, which is the possession of every conscientious general
practitioner. The more they write, the less will the specialists
be called upon.
To one who has watched the general character of the
work of the society for the past fifteen or twenty years, the
improvement is marked and gratifying. The papers cover
a wider range of subjects, show evidence of more study,
and extended research and conclusions are more frequently
drawn from the consideration of a collection of recorded clin-
ical cases than from the single case as formerly. But in one
respect the society has not made satisfactory advance, that is
along the line of the study and development of our materia
medica, a department vital to our existence as a distinctive
school. I do not know that the society should be blamed,
indeed I do not feel that the society should be criticised for
this. There are many good and sufficient reasons for it, but
I do believe the time is ripe for work on this most important
subject. It is very gratifying to know that in some direction
this work has been begun along satisfactory lines.
At the last meeting of the O. O. & L. Society, the Presi-
dent, Dr. Bellows, of Boston, presented a definite plan for
the revision of the materia medica. The provers should be
hired, they should be examined by a general practitioner, and
by the various specialists, to note their normal condition.
During the proving, under the care of a director of provings,
the prover from day to day is to undergo physical examina-
tion and any deviation from normal noted. Such in brief
are the gross outlines of the plan. The committee on presi-
dential address reported that the suggestion contained therein
should be put to the practical test and committees should be
appointed in the various cities to prove a single drug. The
committee consists of a director, two general practitioners,
and one practitioner in each branch of special work.
278 The New England Medical Gazette, June,
In Brooklyn, New York, the necessary money has been
raised, the committee appointed, and the work begun. Here
in our own city the committee has been appointed with
Dr. E. P. Colby as director. Dr. Bellows is general director
over all committees. This is the right and scientific way in
which to prove a drug, where the narrative of the prover
is supported by the physical, chemical and pathological
examination.
I sincerely trust that this society will see its way to do
something to encourage persistent, steadfast work in materia
medica, and with this end in view would recommend that the
society offer annually or biennially a prize for the best paper
on materia medica, and that the contest be open to the
members of the senior class of the Boston University Medical
School.
The danger in the present attitude of the old school to-
ward us, which may be summed up as one of tolerant indif-
ference, the apparent tendency of some few of the newer
members of our faith to long after the flesh-pots of allopathy,
the possibility of the official recognition of our school in the
army and navy, are all themes worthy of our consideration at
this time, but I fear I have already taxed your patience far
beyond the bounds of courtesy.
Tonight upon the threshold of a new century, gaze as far
as we may, there is to be seen only encouragement. We
have an established medical faith. It has been accepted by
many and that many increasing every day. It has been
established by one hundred years of indomitable perserver-
ing work by noble men and women who had that greatest of
all courage, the courage of their convictions. It is for us
who know that their convictions were true and right to see
to it that their labors have not been in vain. True, are we
yet a minority in the medical world, but in all great reforms
that ever have been or ever will be, it is necessarily the
minority that is right. Whenever I meditate on minorities,
I am always reminded of a story of the late Dr. Bartol. The
I go I IV/mt is Peritonitis f 279
reverend doctor had invited a young friend to assist him in a
service in the old church at the west end. The two rever-
end gentlemen sat in the pulpit while the congregation as-
sembled. There were not many, and as the time approached
for the service to begin, the young man remarked upon the
few people present. The elder divine peeked around the
desk, surveyed the congregation, and then quietly remarked,
" Yes, yes, there are but few sjich people."
WHAT IS PERITONITIS?
BY HORACE PACKARD, M.I).
[Read before Boston Horn. Med. Society.]
The subject, which I have selected tonight, is perhaps
couched in somewhat peculiar terms. Modern bacteriolog-
ical research has materially changed former theories regard-
iug inflammation, and has established beyond any question
what is peritonitis. All who have giyen heed to facts, which
have been evolved of the relation which microbic life bears
to the human body, can be but profoundly impressed with
the importance of the subject. Much light has been thrown
upon many hitherto obscure pathological problems.
Inflammations of the peritoneum have been, and are now,
among the most perplexing affections which menace human
life. Without premonitory symptoms, pain arises in the
abdomen, quickly followed by local or general tenderness,
reflex nausea and vomiting, gradually increasing distension,
loose movements, collapse and death may be, within four or
five days from the beginning of the attack, and without any
inkling whatever on the part of the family or physician of
what the cause has been of such a calamitous illness.
Since it has become known that the appendix vermiformis
figures so largely in inflammatory abdominal affections, it is
natural that in cases of persistent pain and tenderness, sus-
28o The New England Medical Gazette, June,
picion should be aroused of its complicity. Excluding these,
however, as well as cases of peritonitis, which are a sequela
to tubal disease in the female, there are still a not inconsid-
erable number which are obscure in their origin, fatal in
their effects, and exhibit on exploratory incision, or autopsy,
no physical explanation of their cause.
What I have to say to you is based largely upon matters
which have come to my notice in the course of examination
of cases of abdominal infection. The cases quoted are some
out of the ordinary run which have come to my knowledge.
Case I. — Mrs. C, age 62, was seen in consultation with
her family physician late in the evening of Dec. 10, 1898.
She had for two years or more been troubled with intestinal
indigestion. The day prior to my visit she had vomited at
noon, which was accompanied by pain in the abdomen of
indefinite character. Saturday, the day of my visit, the pain
had become very severe, with recurrence of vomiting and
loose stools. Her temperature was 101.8®, pulse 112. Pal-
pation disclosed great tenderness in right hypochondrium,
occupying the whole space between the costal cartilage and
crest of ileum. N6 tumor demonstrable. My notes, written
at the time, read " Obscure case, may be appendicitis, possi-
bly gall stones. Exploratory incision advised."
The patient was immediately taken to the hospital and the
abdomen opened. The appendix was sought first and found
normal. The gall bladder was next explored and found also
normal. The pelvic organs were also without pathological
change. The intestines were then inspected, and, after
going carefully over their whole length, the upper part of the
ileum, at about its junction with the duodenum, was found,
for a distance of about fifteen inches, dark livid red, infected,
but not nodular, thick and inflexible as compared with nor-
mal intestine. There was no plastic deposit on the perito-
neum, no pus, no feculent fluid, no perforation. The wound
was closed without drainage, and ice bags applied to the
abdomen. But little pain was suffered thereafter. The
igoi WAat is Peritonitis f 281
patient gradually improved and finally recovered from the
operation and lived about ten months. No tumor ever de-
veloped in the abdomen, and she had no recurrence of the
acute symptoms. The appearance of the part of the gut
affected was of acute inflammatory infiltration.
Was this a case of localized enteritis, caused by invasion
of the intestinal walls with bacteria from the interior of the
intestine ?
Case 2. — Miss W., age 25, was prostrated Oct. 15, 1899,
with obscure abdominal pain. In spite of treatment, it con-
tinued increasing in severity with elevation of temperature
and pulse.
I saw her in consultation with Dr. Wm. G. Hanson, the
evening of October 18. At that time the abdomen was
exceedingly tender, without localization ; pain was contin-
uous and diffuse; temperature 102 2-5°, pulse 118. I could
neither confirm or refute a diagnosis of appendicitis, but in
view of the obscurity and menace, advised an exploratory
incision. She was hurriedly .removed to the hospital, and an
incision made over the appendix, which, on exposure, was
found unperforated and apparently was not the source of the
trouble. On inspection of neighboring loops of intestines,
they were found covered with patches of exudate, were dark
red and distended. Another incision was made in the me-
dian line to facilitate wider exposure. The same yellowish
exudate was found over nearly all the intestinal peritoneum
and the pelvic organs. Intense inflammatory redness was
apparent everywhere. All parts were carefully cleaned by
gently rubbing with mops of soft gauze under a stream of
sterile water. Lastly the abdomen was irrigated with saline
solution and the wounds closed without drainage. Ice bags
were packed over the abdomen. The patient gradually
improved and recovered.
In this case there was no visible gate-way open for infec-
tion of the peritoneal cavity. The appendix was not at fault.
The appendages were normal. There was no perforation of
282 The New England Medical Gazette. June,
the intestine. What was the cause and source of the peri-
tonitis ?
Case 3. — Mrs. C, age 38. Two children. General health
good up to present illness. Friday, Feb. 23, 1900, suffered
pain in the abdomen during night, accompanied by loose
movement of bowels. Had been taking anti-fat pills for a
few weeks, which produced some diarrhoea. Was seen by
her physician. Dr. Hodgdon, Saturday afternoon. Tempera-
ture then 103®, pulse 130 ; pain diffuse over the whole abdo-
men, much distension. I saw the case March i, and found
distension still present and diffuse tenderness ; temperature
1022-5°, pulse 120. No further movements had occurred.
The patient had vomited the preceding Monday. Here was
another obscure case. I could make out no localization of
pain or tenderness, no tumor. Again, in view of the ob-
scurity and menace, exploration was advised. Incision in
the median line showed the intestine covered with a plastic
exudate, foul fluid in the pelvis, but appendix and append-
ages normal. Further exploration along the small intestine
disclosed a segment, about a foot long, greatly thickened, in-
tensely red, with small areas of gray necrotic patches scat-
tered over it. It was much like Case i only a more intense
degree of involvement. The same treatment was adopted
as in the preceding case, except that gauze drainage was
adjusted. The patient succumbed in a few hours.
Was this again a case of penetration of the intestinal wall
by the bacteria which inhabit the intestinal canal, and if* so,
what condition made such a dire disaster possible .-^
Case 4. — Mrs. M., age 6^^ of Irish birth and strong con*
stitution. Was prostrated Saturday, December 29, with
feeling of sickness all over. Sunday morning vomited and
had pain in the bowel, which became sore and tender all
over. She felt hot and feverish. Took castor oil, and had
four or five free movements. Her physician was summoned
Monday. Temperature was then loi 4-5®, pulse 104.
Tenderness seemed localized toward the right side. Tues-
igoi W/tat is Peritonitis f 283
day was more comfortable, temperature 99 2-5®, less tender-
ness. I saw her Wednesday, and was summoned because
the bowels were more tender, painful and sore, and had
become distended and .vomiting had supervened. In this
case appendicitis was suspected, but final diagnosis was held
in abeyance, because of obscurity of symptoms. Exploratory
incision was advised and accepted. The appendix was found
normal, but the whole peritoneum was inflamed, covered
with yellowish white deposit, and there was much foul puru-
lent fluid in the pelvis and lumbar fossae. No focus of in-
flammation nor defective area could be found. The abdo-
men was thoroughly flushed, mopped and irrigated and gauze
drainage established. The patient lived about eighteen
hours. A culture was made of the fluid found in the abdo-
men and an infection of pneumococci found. This latter,
while it gives no hint of value for guidance in future cases,
demonstrates that a fatal peritonitis may be established with-
out physical lesion of the abdominal viscera, and from other
source than the intestinal contents.
GENERALIZATION.
Cases I and 3 demonstrate fairly satisfactorily that peri-
tonitis may be produced by direct penetration, through the
intestinal wall, of pathogenic bacteria, which at all times
inhabit the intestinal canal.
Cases 2 and 4 demonstrate that peritonitis may exist with-
out evidence of such penetration and irrespective of the
intestinal contents, 1. ^., it probably occasionally becomes in-
fected directly through the blood current. In the last case,
there was a recent history of some kind of a pneumonia or
bronchial attack of mild character from which the patient
was convalescent when the abdominal trouble came on.
This was probably the source of the pneumococci.
We come back to the question, what is peritonitis }
Modern pathological research has changed the views of all
who have given the matter careful consideration. The time
284 The New England Medical Gazette, June,
has been when any disease which was characterized hy pain
and tenderness in the peritoneal cavity was called peritonitis.
It was a very common thing to speak of fibroid tumors as
causing peritonitis. As bacteriological science has come to
be more widely known, the question arises whether it is
proper to call any inflammatory development, or anything
that suggests inflammation, peritonitis, unless there are bac-
teria in the abdomen, or some bacteriological process is
going on. ' There are many microbic organisms, which are
capable, if they reach the peritoneal cavity, of producing a
train of symptoms that we call peritonitis. Experiments have
been made of injecting into the animal, bacteria which have
been sterilized. They act as poisons, producing diarrhoea,
but the animal will get well. But let pathological living
bacteria be injected in the same quantity, and in the resist-
ance of the animal there will be more or less fatal sequelae.
It is interesting to look at the peritoneum as an anatomical
structure. I would call your attention to the peritoneal
tissue. It is something over one-third of the area of the
anatomical covering of the body. It is provided on the
upper portion, about the region of the middle tendon of the
diaphragm, with little openings varying from 3-16 to 5-16 of
an inch in diameter, and these connect with the lymphatics.
To one dealing with the abdominal organs, and operating on
them, flushing them, according to the modem method of
using saline transfusion, it is of interest to note how quickly
the peritoneum will absorb. It seems but a few minutes
after the injection is given, when it is absorbed and taken
over the system, for the pulse, which has been weak, will
improve in a very short time.
It is said that the peritoneum is very inactive in resistance
of bacterial organisms. There is usually a strong effort
early on the pait of nature to ward off all infection by throw-
ing out plastic exudate over the intestine, and cutting it off
from the other portions of the cavity. This is nature's safe-
guard, and if she cannot do it, here comes the great menace
i
IQOI Service at Mass, Homoeopathic Hospital, 285
to the system. This will indicate to you my views of peri-
tonitis, that it is a derangement of the peritoneum itself and
a subsequent invasion of toxines. It is evident from clinical
evidence that a great many cases of local peritonitis take
care of themselves. The peritoneum is relieved by nature
and absorption occurs and repair takes place. We can reach
but one conclusion, that the earlier the abdomen is opened
and the material washed out and drainage established, the
better the patient is prepared to withstand the attack. The
use of copious solutions of poisonous substances has been
given up and clear water is not used. Instead copious injec-
tions of saline solution are given to facilitate the washing
away, through the drainage that has been established, and
the drawing out of millions of bacteria, and rendering their
toxines inert.
This is the history of cases of peritonitis that have come
to my notice. They usually die, the mortality, in spite of all
modem methods, is not very encouraging. Cases that come
to the surgeon are almost always far advanced, after the in-
flammation is general, the abdomen is distended, and the
patient septic through and through. Under these circum-
stances death is pretty likely to occur.
REPORT OF THE SURGICAL SERVICE OF THE MASSA-
CHUSETTS HOnCEOPATHIC HOSPITAL FOR JULY.
AUGUST AND SEPTEHBER, 1900.
BY WINFIELD SMITH, M. D.
It is a great temptation in reporting a service at the
Homoeopathic Hospital to make a complete list of all the
cases which have come under the supervision of the attend-
ing surgeon, and to add such a list to the general report, but
as this unduly complicates the description of the more impor-
tant cases occurring in the service, I shall refrain from such
286 The New England Medical Gazette, June,
an indulgence and separate the cases into groups which,
though somewhat unusual, are sufficiently descriptive to over-
come the bad features of such classification. It is perhaps
unnecessary to add that a surgical service, such as we have
at our hospital, is characterized by many so-called "general **
cases, and that the multiplicity of the phenomena and the
growth of the service from one year to another, only adds to
the general interest and makes the specific cases more num-
erous. The number of surgical cases coming under our
observation last summer was 235, and of these, 212 were
subjected to operation of greater or less severity according
to the case. The difference between the 212 and 235 is
represented by the cases of actual operation on the one
h^nd, and those of anaesthetization on the other; but 23
cases of simple anaesthesia comprise some which were ether-
ized for the purpose of examination and were found inopera-
ble or inexpedient, together with -several which were sub-
jected to removal of a piece of tissue from a cervix for
instance, or in one case from the clavicle, for the purpose of
microscopic examination and determination of the character
of the disease. It may be said, however, that all the 235
mentioned were subjected to ether or chloroform, and hence
come in legitimately to such a report as we are endeavoring
to make. In ^6 cases the abdomen was opened, and there-
fore they have been placed under the head of "abdominal."
39 cases, comprising all classes of operations done through
the vagina, with the exception of vaginal hysterectomy, are
put in the class called "vaginal." 10 cases, exclusive of
those of carcinoma or sarcoma requiring abdominal opera-
tion, are cited under the head of "malignant," and consist of
such cases, for example, as carcinoma of the breast and of
the penis, and of the superior maxilla, with epithelioma of
the lip and tongue, and sarcoma of the clavicle. 1 2 cases,
including haemorrhoids, fistula in ano, and fissura ani, come
under the head of "rectal." While 16 cases, such as strict-
ure of the urethra, hydrocele, tubercular testicle, varicocele.
igoi Service at Mass. Homceopathic Hospital, • 287
hypospadias, phimosis, paraphimosis and cyst of the scrotum,
come under the head of " genito-urinary." " Fractures " in-
clude Potts, fracture of the bones of the foot and of the fore-
arm, intracapsular, 'fracture of the hip, several fractures of
the clavicle, and one each of the patella, femur at its middle,
shaft of the humerus, of the external condyle of the humerus,
and a depression of the skull calling for trephining. Under
"dislocations and diseases of the osseous structures'* are
included dislocation of the elbow joint, which is somewhat
rare, floating cartilage of the knee, chronic osteitis of the
tibia, necrosis of a rib and tuberculosis of the knee. 19
cases are grouped under the head of "abscesses," subnamed
ischio-rectal, labial, post-auricular, inguinal, etc. Under
"foreign bodies," cases of needle in the foot and in the
finger are included. While under "miscellaneous," are
placed empyema, streptococcus infection of the legs and
arm, cyst of the gluteal region and of the forehead, sinuses
of the cheek, keloid, lipomata, haematoma of the thigh, trau-
matism of the nose and contraction of the fingers following
burn.
A general examination of the list may be interesting.
As appendicitis is now exciting the interest and the inge-
nuity of surgeons the world over, it may be well to speak of
28 cases which occurred in this term, several of which
seemed of a hopeless character. They all recovered. Two
cases paid the price for their lives in sustaining a faecal fistula,
which, however, in each case was repaired with success in a
subsequent service. Of one of these cases I shall speak
more fully later on.
In many cases of abdominal section for other causes than
appendicitis, the appendix was removed on account of un-
doubted signs of previous inflammation, and in fact it may
be said at this time that I invariably inspect the vermiform
appendix and, when feasible, the gall bladder when the
abdomen is opened for any purpose whatsoever. In the
cases in which the appendix was removed in addition to
288 The New England Medical Gazette, June,
some other operation in the abdomen, I cannot see that it
complicated the recovery in any way, and it certainly left the
patient with a very considerable menace for the future
removed.
The interesting cases in such a list are, of course, num-
erous, and it is impossible in a paper of this kind to even
enumerate them, so I shall content myself with giving atten-
tion to the failures only, thinking that in that line most may
be learned for the future. Six of the patients of this list
died. One case of appendicitis, operated on several days
before, came from the previous term in a semi-moribund
condition on the first day of the service and the wound was
further opened to permit better drainage. This patient
scarcely survived the operation.
The six cases dying from operations performed during the
service were, one of double pyosalpingitis, an abscess of the
left tube having ruptured into the abdominal cavity several
days before the patient was brought into the hospital ; one
of carcinoma of the ovaries, a rare disease, in which the
operation was done to add to the comfort of the patient
whose abdomen was filled with a serous effusion from the
peritoneum ; one of recurrent carcinoma of the breast ; one
of deep cervical abscess, tubercular in character, situated
over the middle of the right clavicle and undoubtedly con-
nected with a large abscess cavity in the upper lobe of the
right lung ; and lastly, one of streptococcus infection in both
legs, which I will describe a little later in the report.
Taking the cases in detail : that of double pyosalpingitis
was one from which the patient had suffered for a long time
from inflammation of the uterine appendages, and if I re-
member rightly had been previously advised to have an
operation for relief of the symptoms. Neglecting this oppor-
tunity, pus formed in considerable amount on the left side
particularly, and finally ruptured into the abdominal cavity.
General peritonitis supervened, and while the patient made
a strong fight for life she suddenly sank a few days after the
operation and died.
IQOI Service at Mass, Homceopathic Hospital, 289
The second case, carcinoma of the ovaries, presented con-
ditions which I have never met before or since in these
organs. The abdomen was filled with a dark colored serum
to such a degree as to interfere by pressure with respiration,
and the ovaries presented a curious deposit of carcinoma
which caused enlargement of each organ to, on the right
side, a mass three inches in diameter, and on the left, a very
hard adherent body at least five inches through its narrowest
part. The disease was diagnosed as a probable malignant
case. The abdomen was opened more for the purpose of
relieving the discomfort from which the patient suffered
than from hope of doing any lasting good. When the
ovaries were inspected, however, it seemed that there might
be a possibility of achieving a better result than at first
thought. There was no unusual complication in the removal
of these carcinomatous organs, although the adhesions men
tioned above were many and strong, but the disease had
already evidently sapped the patient's strength as she died
the following day.
The case of recurrent carcinoma of the breast was one
' which I never had the opportunity of seeing, as the patient
was in the last stages of cancer and was sent to the hospital
by her family as a last resort. Her condition was so septic
and foul that one of the assistants took exclusive charge of
the case until her death, as it did not seem right to subject
other patients to even the possibility of infection from one
for whom we could do nothing.
The next case was one of prostatic disease in which it had
not been diflScult to introduce a catheter and keep the
bladder clean and comparatively asceptic. The kidneys
were undoubtedly incompetent as he suddenly sank into a
comatose condition from no local reason which we could
discover, and died of uremia in a few hours.
The case of tubercular abscess of the neck died on the
medical side to which he had been removed for general treat-
ment sometime after the operation had been performed.
290 The New England Medical Gazette, June,
From the symptoms it was evident that another abscess had
formed in the lung which had ruptured into the trachea and
caused death from suffocation.
The last case of streptococcus infection of the legs also
died on the medical side, but comes in our list on account of
the operation which we made in order to evacuate the pus
which formed in large quantities. This case was unique.
The woman came into the hospital supposedly suffering from
rheumatism confined to the knees and to the parts below
them. There was sweUing in each leg below the knee and
this continued to increase for several days, until through the
courtesy of Dr. Walter Wesselhoeft, who was on service on
the medical side, I was invited to examine the case with a
view to operation, as Dr. Wesselhoeft had found evidence of
pus on each side. The patient rapidly grew worse, and
operation was called for at once. An incision was made in
each leg from a point just below the outer part of the knee
opposite the lower portion of the head of the fibula down the
outer side of the leg and well along the dorsum of the foot.
This disclosed an enormous pus cavity due to streptococci,
according to microscopic examination, and showed a condi-
tion of the muscles and intermuscular tissue such as I have
never seen. The muscles were dissected out by pus and
sloughing masses of cellular tissue as well as one could do it
with a scalpel and forceps, and the foul character and exces-
sive secretion of the discharge continued until some time
after the operation when the patient succumbed undoubtedly
to general infection. On investigation it was found that the
probable entrance of the streptococcus was through the
uterus, as the patient gave a history of uterine and adnexal
disease which had existed for a considerable time. Why the
deposit should be confined to both legs and should affect no
other part of the body during the first stages of the disease,
is a question which we have not as yet been able to answer.
If it had occurred on one side of the body only, it might be
supposed that infection was deposited in that one place, but
190 1 Service at Mass, Homoeopathic Hospital. 291
having it in similar places on both sides at the same time
complicates the case to such a degree that it has been impos-
sible up to this time to arrive at a satisfactory solution of the
problem.
There are, of course, many cases in a service list such as
this which might be of interest, but it is impossible to even
outline them in the space and time at our command. There
are two, however, which are of such unusual character, that
I have thought it well to go into them somewhat fully for
reasons which will appear, I think, in the recital of their
histories.
The first case was one of double inguinal hernia with
chronic appendicitis in a Swedish girl of apparently robust
constitution. The herniae were repaired and the appendix
was removed in the typical manner, a Dawbarn suture being
applied to the stump of the appendix which was turned
toward the bowel in the usual way. The morning following
the operation I was informed by telephone that the patient
was doing badly, in fact that she was almost in a condition of
collapse. Advising at once an intravenous injection of saline
solution, I went immediately to the hospital and found the
patient suffering from symptoms of internal hemorrhage.
Opening the abdominal wound as soon as possible, the peri-
toneal cavity appeared clean and showed no evidence of
hemorrhage, or anything to account for the very serious con-
dition of the patient. Being convinced, however, that hem-
orrhage from the stump was the cause of the collapse, and
noticing that the caecum was partially filled with a soft mass
which might be blood, I immediately removed the sutures
and turning out the stump for inspection, found a tiny vessel
ejecting, synchronously with the heart beat, a small stream
of arterial blood which was evidently the source of all the
hemorrhage and the cause of the serious symptoms present,
and this was definitely determined by the fact that sewing
over the vessel with a small catgut suture, controlled the
hemorrhage. Another Dawbarn suture was applied, the
292 The New England Medical Gazette, June,
stump turned again toward the bowel and the ordinary Lem-
bert suture placed over the site of the appendix. The abdo-
men was closed as previously, and barring the natural weak-
ness incident to the loss of considerable blood, the patient
thereafter made an uneventful recovery. In talking with
my colleagues about this case later, it seemed impossible
that after the application of a Dawbarn suture hemorrhage
from the stump can result, but this is the second one with
which I have come in contact within a year, the first one
being at the Leonard Morse Hospital at Natick, the patient
being a young robust boy of eighteen years. There was no
complication from the hemorrhage which was comparatively
slight, only showing in the stools the morning after the ap-
pendix was removed. In this first patient the hemorrhage
was evidently spontaneously controlled, but it was a hint
which was undoubtedly of use in the second case. Since
the Natick experience it has been my habit to put the sepa-
rate stitches of the Dawbarn suture close together and in-
clude a great deal of tissue under each stitch. For this
reason it cannot be said that the hemorrhage was caused by
insufficiently deep sutures, and while I think the patient was
inclined to be a " bleeder," there was not sufficient evidence
to establish that idea as a fact. In one way, at least, this
case has been of practical benefit, as each appendix stump is
now subjected to very careful scrutiny, and small bleeding
points are ligatured or sutured to prevent such accidents as
the ones cited.
The next case which I wish to report is one which has
been and is somewhat of a mystery. The patient fifty years
of age, long past the climacteric, entered the hospital suffer-
ing from prolapsus uteri of such a degree that the womb
protruded from the vaginal orifice. Slight pressure only was
necessary to keep it in position, and ventral suspension was
decided upon as a remedy. The operation was complicated
in no way, nor was there anything to cause apprehension for
several days after, but on the fifth day the temperature rose,
IQOI Service at Mass, Homceopathic Hospital, 293
the pulse became rapid, there was soreness through the
wound, but not sufficient evidence of pus to warrant one
thinking that the symptoms were due to sepsis. On the
sixth day after the operation the condition became alarming.
The abdomen was reopened through the old wound to deter-
mine, if possible, the cause of the difficulty. When the
bowels were exposed, a portion of the small intestines about
sixteen centimetres long was found to be congested and
thickened to such a degree as to interfere with the move-
ments of the contents of the bowel. About the middle of
the outer surface of this inflamed area, a scratch or slight
fissure was noticed, and this was folded in and a Lembert
suture of catgut applied over it. The site of the uterine
suspension was perfectly clean and showed no evidence of
any inflammation. The wound was partially closed and
drainage was inserted to guard against infection. The
patient continued to have a slight temperature and pulse for
two or three days, but the symptoms gradually subsided and
recovery occurred. No satisfactory explanation has as yet
been offered for this case except the possibility of having
pricked the intestine during the first operation, but one
would think that the symptoms would have appeared before
they did, and that the second operation would have been
called for long before it was necessary. Intra intestinal
complications would hardly have been relieved by the sec-
ondary operation, and as convalescence began directly after
the abdomen was opened the second time, the covering in of
the slight fissure of the intestine was undoubtedly curative
in its effects.
A few general remarks in closing may not be out of place.
Regarding suppuration it may be said that this was practi-
cally a " clean " service. The appearance of pus in a case
which was aseptic at the time of operation was practically,
although not quite, unknown. It must be remembered that
the presence of a fraction of a drop of pus in or about a
wound stamps the case as " suppurative," although the con-
294 '^he New England Medical Gazette. June,
valescence of the patient may be in no way retarded and the
wound may thereafter heal, as though no complication what-
ever had appeared. It is worth something to be able to say
that in no "clean" case was there any menace to the
patient's recovery from infection by pus, and that nothing
"septic" was introduced into the wounds from the hands,
the instruments, the atmosphere or the dressings which en-
dangered the life or even the well-being of the patients who
came under our treatment during this service. On examin-
ing the list it will be seen that no " surgical " death occurred
and that patients died despite, rather than because of,
surgical interference.
Regarding rubber gloves I have only to say that my
opinion has in no way been influenced in their favor by any
experience which I have .had during the past year. They
are still to me more of a complication than an assistance, and
should be worn only when one is operating on septic cases
in order to avoid bringing the hands in contact with material
which may make it impossible to get them clean for subse-
quent operations. To the surgeon personally they are un-
doubtedly of some use as a protective against infection,
although not as universally useful in this way as the rubber
glove enthusiast would have us believe. Needle pricks are
still a menace, and while gloves may cover a contused or an
incised wound and thus avoid personal infection, a surgeon
having his hands in such a condition should avoid operating
until the menacing spots are healed, unless they are found
on the fingers, when a sterilized finger-cot may be used to set
aside the necessity of covering the entire hands and fingers
with a material which undoubtedly interferes, in some degree
at least, with fine manipulations.
There is no better time than this to mention the excel-
lence of the Massachusetts Ilomceopathic Hospital as a place^
to do surgical work, and it is only fitting to say that no public
institution of which I have knowledge, which is subject to
the same conditions, has a lower death rate than this hospi-
I go I Energy in the Practice of Medicine, 295
tal in which we are all so much interested. That this is
due, in some measure, to the methods employed goes with-
out saying, but a large share of the credit must be given to
the assistants and nurses of the hospital who are indefatiga-
ble in their efforts and painstaking and conscientious in their
work from the time the patients enter the hospital until there
is nothing more to be done for their comfort* or recovery. I
wish thus publicly to thank them for the assistance given me,
not only during the term of service, but also on any occasion
when their services have been required.
Energy in the Practice of Medicine. — We know of no
profession or occupation which requires more vim and energy
than the practice of medicine. We know many brainy, well-
qualified men who have failed to possess the necessary "push"
to carry the load. It has always seemed to us that even if a
man lack natural energy, he might arouse sufficient artificial
voltage to carry him through.
The young man who begins in indolence will end in failure
in the practice of medicine. The older man who acquires the
habit will fall in the same ditch. Be thorough ; be energetic ;
be prompt ; nothing else will do. — Charlotte Medical JoumaL
Bubonic Plague. — The rat has generally been described
as a potential means of distributing the disease, but according
to Dr. Cantlie's investigations, it is the insect parasites that
infest its coat. When the rat has been killed, these parasites
forsake the animal and seek refuge upon any persons in the
vicinity. Immunity from attack by these pestiferous para-
sites can only be assured by careful personal cleanliness,
since it has been conclusively proved in the hospitals that the
disease cannot thrive where strict hygiene is maintained.
— Modem Medical Science,
296 The New England Medical Gazette. June,
EDITORIAL.
Contributions of original articles, correspondence, etc., should be sent to the publtsbers, Otis
Clapp & Son, Boston, Mass. Articles accepted with the understanding that they appear only in
the GatetU. They should be typewritten if possible. To obtain insertion the following month,
reports of societies and personal items mutt bt rtceived by tht ijth 0/tke m»nth prtctding.
This is the month when many anxious students will be
made happy in receiving the diploma which will enable them
to begin their chosen work in life. Now is the time when
the temptation is great to give advice on various matters per-
taining to their professional life, but we shall resist the
temptation, and in place thereof extend to them the right
hand of fellowship, and cheerfully and gladly welcome them
to the active ranks of the noblest profession on earth.
Whatever may be their success professionally, they may be
sure of the good-will and support and co-operation of their
fellow-practitioners as long as they display those qualities of
mind and heart which make up the conscientious, honest and
upright man and woman.
OBITUARY.
Dr. Jane K. Culver.
Dr. Jane.Kendrick Culver, one of the most successful of
the women physicians of this city, died at her home No. 2
Commonwealth Avenue. Dr. Culver came of distinguished
ancestry. Her maternal grandfather was one of the Alexan-
der Hamilton family, and her mother was a Felton, a name
intimately associated with educational matters for many
years, one branch of the family having been a president of
Harvard College, while three others occupied the head posi-
tion in as many other educational institutions. Dr. Culver's
I go I Editorial. 297
father was Jacil Kendrick, of Enfield, Mass., near which
town the deceased was bom. She received her medical edu-
cation in the Boston Univ. Med. College, where she was
graduated in the class of '78, and for the past twenty-three
years has been an active practitioner in this city. Her hus-
band was William C. Culver, of Boston, who died ten years
ago. He will be recalled by many as superintending the
first borings made for the Hoosac Tunnel, as well as for his
prominence in local politics. For many years he held a high
position in the internal revenue department in this city.- His
uncle was Hon. David Culver, at one time lieutenant gov-
ernor of New Hampshire and for whom one of the Dart-
mouth College buildings is named through a bequest which
he made to that institution.
Dr. Culver was a member of many local organizations,
most of them closely allied to medicine. She was the oldest
living member of the Ladies' Physiological Institute, and was
at one time its vice-president ; also honorary vice-president
of the American Institute of Medicine ; vice-president of
the Massachusetts Gynecological Society ; a member of the
American Art Society, the Boston Medical Society, the Bos-
ton University Alumni, the Women's Educational and Indus-
trial Union, and many others. She also took a strong per-
sonal interest in the Society for the Prevention of Cruelty to
Children, as well as the other which takes the dumb animals
as the centre of its interests. She was at one time a candi-
date for the Boston School Board. Dr. Culver's death was
due to a complication of heart troubles, and she had been
seriously ill since the early part of March. She was a
woman of singularly strong personality which made for her
many friends, both in and out of her chosen profession ; and
as a proof of the kindly interest manifested during her ill-
ness, it is interesting to note that nearly eleven hundred
persons called at her home during the first eight weeks of
her illness to offer their personal sympathy. She leaves one
daughter, who reside in New York. — Boston Transcript,
298 The New England Medical Gazette. June,
Dr. Anna Furber Smith.
Dr. Anna Furber Smith, who died at Covington, Ky.,
March 31, 1901, was a daughter of the late John N. Furber,
who was for many years a prominent attorney of Covington.
She was graduated from the Boston University School of
Medicine in 1885, and for a number of years practised her
profession in Covington and Cincinnati. She afterward mar-
ried Dr. William H. Smith, an earnest worker in church and
benevolent work. She leaves two infant children.
EDITORIAL NOTES AND COMMENTS.
REPROVINQ DRUQ5.
The following letter from Dr. W. P. Roberts, of Janesville,
Wis., shows that the plan for reproving the materia medica
has already aroused attention and a desire for co-operation :
To THE Editor :
Recently, while waiting to have an order filled in Clapp's
Pharmacy in Park Square, Boston, I chanced to pick up the
May number of The New England Medical Gazette,
and on page 249 read the article " Reproving of the Materia
Medica." From reading that article I feel like exclaiming,
** What a grand undertaking ! '* If suggestions will be con-
sidered and recognized by the general directors of that move-
ment I will be glad indeed to cast in my mite to aid in the
glorious work.
Some twenty years since, while filling the position of
house physician in Hahnemann Hospital, Chicago, I con-
ceived a similar idea and was able to interest a few of the
graduating class of that year (1879) to set such a scheme on
foot by holding a meeting, and in an informal way organized
what we called the Scientific Chair of Hahnemann College,
IQOI Editorial Notes and Comments, 299
of Chicago, III. The design was for reproving homoeopathic
remedies by the aid of all modern scientific appliances. The
Chair was to get its funds from the graduates and friends of
that institution. After we held our meeting we consulted
with the faculty of the college who seemed to take a deep
interest in such a movement, and the leading members of
the faculty made fair promises to attend to it and see that
the graduates and profession at large be notified in their
next annual announcement of the college, also that they be
invited to take a part in the work. Thus we left the matter
in the hands of the faculty. The invitation did not appear,
and nothing ever came of the undertaking. Our plan,
briefly outlined, was through the annual announcement to
invite all the alumnus and interested profession to join in
helping to support such a scientific chair in that college, we
were to pledge ourselves to contribute not less than five
dollars each annually for five years toward the support of the
professor of that department, and the trustees of the college
were to give free tuition to a few worthy provers to induce
them to volunteer in the work. We expected if the chair
was established that future graduates would perpetuate the
work until the materia medica should become as reliable as
science could make it. We also hoped that our success
would induce other medical colleges to take up the work and
that every medical college in the land would establish such a
scientific chair, and that soon some agreement would be
entered into so that each college would take a certain num-
ber of drugs (no two colleges to prove the same drugs the
same year) and prove them, so that each year a score or
more drugs would be proven. As to method of proving, we
planned that our professor have full charge of provers for a
week prior to exhibiting the drug, and that careful examina-
tion be made of the prover while living on a wholesome diet,
and a strict account or record of condition be kept during
that time by examination of all excrements by aid of micro-
scopic, thermometer, chemical tests, etc. With this record
300 The New England Medical Gazette, June,
preceding the proving, and by keeping a careful daily record
of temperature, and chemical, and microscopical examina-
tions of urine fceces, etc., daily, while proving, any imagina-
tion of the prover would be obviated.
It has seemed to me strange that such a grand scientific
work has been so long delayed, and it now seems almost too
good to credit. I sincerely hope that every person whether
of this, that, or the other school of healing the sick, will be
interested enough to contribute in this new movement. I
feel sure that had the homoeopaths adopted such a scientific
proceedure twenty-five years ago, that there would not have
been so many charlatan methods come into existence, nor
would there now be such a desire on the part of half-breed
homoeopaths to uilite with the alopaths in declaring that
there is no difference in the two schools.
Huxley tells us that science is trained and organized com-
mon sense. Common sense should teach us that since
Hahnemann established the law of similars in curing disease
that the clinical thermometer, microscope and chemical ex-
aminations have come into the science of dealing with mor-
bid conditions of mankind. So now there is no excuse for
any person possessing common sense — whether he be of
one or the other pathy — in turning in to help science (com-
mon sense) to prove the effects of drugs on healthy human
beings. In my humble opinion, if the idea advanced in that
article can be promoted we will within ten years advance the
science, of drugs (medicine) more than it has been since the
founder of homoeopathy passed out of this life. " So mote
it be."
W. P. Roberts, M. D.,
Devereux Mansion, Marblehead, Mass.
May 17, 1901.
IQOI Societies, 301
SOCIETY REPORTS.
BOSTON HOiVKEOPATHIC HEDICAL SOCIETY.
BUSINESS SESSION.
The regular meeting of the society was held at the Boston
University School of Medicine, Thursday evening, April 4,
1901, at eight o'clock, the President, T, Morris Strong, M. D,,
in the chair.
The records of the last meeting were read and approved.
The following physicians were proposed for membership .
Robert M. Southgate, W. H. Waters and Alice H. Bassett,
all of Boston.
The committee appointed to draw up resolutions on the
death of Dr. Chas. L. Farwell, made the following report :
Whereas, the short life mission of our late colleague has
been prematurely ended, and.
Whereas, he was a man of good scholarly attainments,
genial disposition and open, generous character, therefore be
it
Resolved, that by his death the medical profession has
been deprived of a member who was, and gave promise to be,
a most valuable associate for many years.
Resolved, that these resolutions be spread upon our
records and a copy, properly engrossed, be sent to the widow
of the deceased.
- N. M. Wood,
a. f. boothby,
Percy G. Browne,
Committee.
On motion of Dr. Frank E. Allard it was voted that the
society, through the secretary, extend to Dn Jane K. Culver,
sympathy and hope for her recovery.
Dr. Strong made a brief report for the standing committee
on legislation, stating that the bill to give the New England
302 The New England Medical Gazette, June,
Optical Institute the right to grant degrees had gone into
the general court for the third reading, when it was. laid on
the table. By mutual agreement the bill went back to the
committee.
Advocates of the Pfeiffer bill were given leave to with-
draw.
The State Board of Registration in Medicine will be given
another hearing tomorrow (Friday) with the probability that
the committee will sustain the recommendations of the board,
i. e, it is the hope and supposition that they will do this.
This about ends the legislative matters for this session.
The vivisection bill was discussed pro and con^ and the
committee has as yet made no report.
SCIENTIFIC SESSION.
Dr. Boothby exhibited a specimen of a double uterus. The
case was diagnosed as a tumor of the abdomen. The patient
had a good many symptoms of sepsis, and she was thought
to be in a rather precarious condition when brought to him.
Pregnancy was thought to be present, though the uterus was
felt. The abdomen was opened and a double uterus found,
in one side of which was a foetus. The other side, as well as
the tube, was septic. The foetus was removed first and then
the uterus and appendages. Dr. Boothby had never seen a
double uterus in his practice before. Shortly after a case
was sent him from Hartford, where there was a double
vagina, with cervix distinct in each vagina, but the two
canals opened into one. Had had one child, but came very
near dying.
Dr. W. F. Wesselhoeft exhibited the largest appendix he
had ever seen, one he had recently removed at the hospital.
Report of the Section of Surgery.
Wm. F. Wksselhohft, M. D., Chairman.
Alice L. Pattkrson, M. D., Secretary. W. B. Frrnch, M. D., Treasurer.
The President appointed the following committee to nomi-
nate sectional officers for the ensuing year, Drs. F. W. Col-
burn, M. R. Lakeman and Alice C. Patterson. The commit-
IQOI Societies. 303
tee reported as follows : Chairman, A. H. Powers, M. P ;
Secretary, Chas. T. Howard, M. D. ; Treasurer, Augustus C.
Haub, M. D., who were duly elected.
PROC^RAM.
1. "Report of Surgical Service of the Massachusetts
Homoeopathic Hospital from Jan. i to April i, 1901." N. W.
Emerson, M. D. Discussion opened by Winfield Smith, M.D,
2. "What is Peritonitis .? " Horace Packard, M.D. Dis-
cussion opened by J. Emmons Briggs, M. D.
3. "The Modern Technique of Surgery." George H.
Earl, M. D. Discussion opened by Alonzo Boothby, M. D.
4. "A Factor in Wound Disturbance." William F. Wes-
selhoeft, M D. Discussion opened by J. B. Bell, M. D.
Dr. N. W, Emerson's " Report of Surgical Service of the
Massachusetts Homoeopathic Hospital from Jan, i to April
I, 1901," was omitted.
Dr. Horace Packard, not being present at this time. Dr.
Earl's paper on "The Modern Technique of Surgery" was
the first paper read.
He contrasted the means adopted by modern surgery to
prevent sepsis, with the lack of precaution fifteen or twenty
years ago, dexterity arid celerity being the aim of the sur-
geon. Cleanliness, he said, is the one thing we are all trying
for — great care in cleansing the hands, scrubbing them with
soap and water, also thoroughly cleansing the field of opera-
tion, and the least possible handling of delicate or bruised
tissues. When practicable using dry dressings, and then
letting everything severely alone, avoiding as far as possible
all poisonous antiseptics, justifies us in claiming that the
mild power is greater.
Dr. Boothby: It seems to be, perhaps, a worn out sub-
ject, and yet one which may be always interesting. One
point which may be considered as a part of this surgical
technique, an important point has been solved in a very
simple and direct way by our good chairman, Dr. Wessel-
hoeft, and I take great pleasure in saying that his method of
disinfecting the catgut is a thorough and absolutely perfect
304 The New England Medical Gazette, June,
one. The only objection has been that it was almost impos-
sible to get it aseptic. Now, with his apparatus, I believe it
is possible to completely disinfect the catgut. We have sent
specimens to the Massachusetts Institute of Technology to
be tested, and they have been returned as aseptic.
As to the surgeon wearing gloves, I believe in it just as
little as ever I did. I have my assistants wear gloves. I am
positive that no patient has had serious trouble from my
hands, though I admit they are not absolutely aseptic. I
cleanse the hands very thoroughly, the nails especially, scrub-
bing with a sterilized brush. I believe the assistant can
wear gloves, because he does not have the delicate work to
do that the surgeon has. I have very difficult work to do,
which I could not do with gloves. The point is, whether
the hands, sterilized as completely as possible, are dangerous
to the patient. I advocate bare hands for the operator, but
the assistants should wear gloves, and the surgeon should do
so in an infectious case, if he can. There has been a great
change, as Dr. Earl has said. Twenty-five or thirty years
ago, I used to go to the Massachusetts General Hospital to
see Dr. Bigelow operate, who was quite as skilful as any sur-
geon we have now, and he would put on a coat stiff with
blood, and physicians would come into the operating room
just as they had been visiting their patients, and if there
was anything of peculiar interest in the case, would put their
fingers into the wound.
Dr. Briggs : I would like to say just a word in regard to
peritonitis. We have the different kinds of inflammation,
which are the cause of the disease. We are familiar with
the different forms, and they are due to a form of bacteria
which caused the infection, that by the streptococci being
the most severe. The germ enters the system through the
blood serum of the interior wall, and the history of a case of
peritonitis is a rapidly progressive and fatal one, and the
only way to avoid death is by early and rapid operation. We
have a sort of clew to the germ which has caused the mis-
chief. If due to the streptococcus, the progress of the
igoi Societies. 305
disease is very rapid ; that due to the staphylococcus and
pneumococcus are a little less so. We also have peritoneal
infection due to gonorrhea attributable to previous disease of
the uterus and tubes, and spreading from contact
I recently had a case which illustrates the connection be-
tween some symptoms of the abdominal cavity, peritoneum
and lungs. A woman, 35 years of age, never had an attack
of peritonitis or appendicitis, was taken with severe pain in
the right side nearly over the appendix ; temperature 102^,
pulse 1 20. Made careful examination, the slightest pressure
on the appendix caused intense pain. It seemed to me there
was too high a temperature and too rapid a pulse for a case
of short standing, eighteen hours. It is rare in my experi-
ence to find such a high pulse in a short time. The patient
went to the hospital, and I was summoned to operate. The
temperature still high, but the patient was coughing, exam-
ined the lungs and found very marked case of pneumonia,
lower lobe of right lung involved. An illustration of pneu-
mococci infection. It may have developed in the lung, and
also at the same time in the peritoneum. I would like to
quote a case very briefly. It was a complicated type of the
peritoneal symptoms of peritonitis. A case of very severe
infection of the throat, so severe that I made a culture. The
Board of Health reported no diphtheria, but an abscess of
the throat developed. After a week or ten days some pain
developed in the abdomen. It was questioned whether to
operate. After four or five days the symptoms referrable to
the peritoneal cavity subsided and the patient is improving.
At one time I had an experience with a patient of Dr.
Wood, of Charlestown. The patient came to the hospital
with great pain in the abdomen, operated and found the
peritoneum of the intestines inflamed, but it was not peri-
tonitis. The patient developed typhoid fever, and made good
recovery.
There is one thing that has particularly interested me,
why are we having so many cases of peritonitis and located
over the appendix and upon operating find the appendix
normal } I have had three or four such cases.
3o6 The New England Medical Gazette, June,
Dr. Boothby : A patient of mine had a child who de-
veloped some abdominal symptoms. I could not quite make
out that it was appendicitis. Dr. Sutherland saw the case
also, but we could not decide that it was appendicitis. The
abdomen was very much distended and there was a diffuse
peritonitis. The father desired an exploratory incision, and
in this case the appendix was inflamed, as were other parts
of the abdomen. There were dark spots over the intestine,
which looked like infected blood serum between the coats of
the bowel. It seemed as thiough those patches were the
cause of the trouble. Patient died from the disease. I ques-
tion if it could not have been saved by an early incision
and cleansing. In some cases of typhoid fever the condition
has infected the peritoneal cavity, and it is a good plan to
operate under such circumstances.
Another patient I had with Dr. Spalding. The patient
had been sick only a short time; violent inflammation; abdo-
men opened and a long portion of the colon was inflamed,
and for a long distance there were pin holes clear through
the bowel, so many openings could not be sewed up and
patient died. I had another case of violent peritonitis, and
we considered it appendicitis. I opened the abdomen, and
immediately there came out quite a little quantity (2 oz.) of
reddish brown serous discharge. I found upon examination
appendix somewat inflamed, right ovary and tube were very
much involved. In this case the inflammation might have
come up to the tube, but was not in the tube originally. I
do not believe it was a gonorrheal infection. The patient
seemed to be relieved for three days, when the symptoms
returned as violent as ever, and the abdominal cavity was
washed out ; in three or four days the symptoms returned,
again the cavity was washed out with saline solution. Patient
gradually improved a little, left the hospital, but died within
a year. These cases were peritonitis, u e. there was an
infection of the peritoneum.
There are various kinds of peritonitis, a kind that produces
adhesion and those which do not. I agree with Dr. Pack-
1 90 1 Societies. 307
ard that we have diseases of the peritoneum which are not
from the appendix or the tubes, but come from the gall
section.
Dr. C. H. Thomas: I can recall one case, that of a
patient who was sent to the maternity with all symptoms of
eclampsia. She had persistent nausea, unable to take any
nourishment ; urine scanty, only 2 oz. or 5 oz. It became
necessary to produce labor. Saline solution was introduced
into the abdominal cavity. In twenty-four hours the quantity
of urine had increased to 33 oz., illustrating the power of
absorption of the peritoneum.
Dr. Wesselhoeft illustrated his method regarding "A
Factor in Wound Disturbance " by three diagrams, showing
different modes of suture ; the ordinary method of leaving a
blind space where serum can collect, causing suppuration,
and another method of providing for drainage of the wound.
Dr. Bell : It takes two to make a quarrel and it takes two
to make trouble in a wound — the seed and the soil. Some
of us can remember the early history of the whole question
of wound infection, that all stress was laid on the germ,
given the germ disease must follow. Now the soil has
become very important. It is not considered that all infected
with tuberculosis will die. This matter has not received its
due importance in surgical circles.
It seems to me of the greatest importance in closing the
wound that an exit should be provided for the serum ; other-
wise, upon pressing the wound the serum will run out, which
is prevented by the suture. Now in particular cases, where
there is a great deal of difficulty in securing stoppage of
hemorrhage, it is important to put in for 48 hours suitable
drainage, and on opening, the dressing will be found satu-
rated. In a case of cancer of the penis, there was difficulty
in making the wound perfectly dry, thought it would be dry
enough and closed without drainage. After a day or two
serum collected and I thought pus was there, but there was
no rise of temperature. I hoped that it would be absorbed,
but it was not, so a probe was used, and out gushed normal
3o8 The New England Medical Gazette. June,
serum. The wound had gathered infection. It is quite im-
portant to note Dr. Wesselhoeft's method of closing the
wound after operating on the appendix where drainage is
required. You close two-thirds with through and through
sutures and drain lower part, the first half will close by first
intention, because it has good drainage.
Germ and soil are both factors of infection.
Dr. Briggs: I have been very much interested in this
paper and the method of obliterating the sac or cavity which
may remain beneath. I want to say that Dr. Packard has
used strips of gutta-percha tissue in this last term of service
and one term previous, and it is astonishing how much serum
will pour out, saturate the dressings and relieve almost the
probability of infection.
Dr. Packard : It leaves one inference, that about every
wound we make suppurates. I believe that most wounds are
left clean, serum leaks out, but will not turn to pus, unless it
is infected. I have resorted to drainage of my wounds, not
because I had suppuration, but because I observed that by
leaving proper drainage there was a quantity of serum ab-
sorbed by the dressings. I do not want to have it go out
broadcast that the majority of our wounds are infected.
Dr. Wesselhoeft: I do not think there is any wound
made that has not possibility of infection.
Dr. Packard : The inference is that a good many of them
had suppurated, and you admit infection, so you had to resort
to something.
Dr. Earl : I do not know as it bears on this subject, but I
would like to mention the relation of this treatment to a
woman after labor. I think the plan which has been taught
in this school bears out exactly the point of the paper to-
night, the providing of drainage for the uterine cavity and
vaginal vault. There you have a cavity which not only
throws out serum but blood, the uterine cavity. The vagina,
which is more or less distended, and the old way of keeping
a patient on the back, provided the necessary reservoir. It
is better to get the patient into a position to allow drainage
after labor.
• igoi Societies. 309
Dr. Sutherland : The diagram explains something in my
experience. Because of suppuration some of the perfect suc-
cess in operation has been lacking. I remember the case of
a young boy operated upon for appendicitis at the hospital.
Four or five days after leaving the hospital a deep hole two
or three inches in length was' found in the abdominal wall.
A collection of serum had occurred in the wall between the
peritoneum and the muscle. The abdominal cavity was not
opened. Apparently the peritoneum had healed previously*
but something was wrong with the tissues. The diagrams
tonight throw a little light upon the case.
Adjourned at 10.10.
Edward E. Allen,
Secretary.
Concentrated Sunlight. — With concentrated sunlight
I have removed facial blemishes, such as moles, warts and
sebaceous tumors, with excellent results. I find though that
it is liable to burn too deep if not carefully watched. In a
stubborn case of acne pustulata, I tried the experiment of
cauterizing a particularly stubborn pustule with sunlight,
effectually destroying the pustule, but burning so deeply into
the skin as to leave a scar after healing was accomplished.
— Dr, H, 7! Webster in Southern Progressiva Med. Journal.
Olive Oil as a Food. — The use of pure olive oil as a
food, with the meals, should be used, by both the mentally
depressed and the abnormally excitable. It helps nutrition
and gives a gentle aid to elimination. If it cannot be taken
with food preparation, a teaspoonful or two can be taken
regularly at the close of each meal. — Medical Sentinel,
Personal Influence. — The life of every man is freighted
with good, which he leaves along the way he goes to bless
and beautify, or with evil, which he unloads upon his fellows.
— Exchange.
3IO The New England Medical Case tie, June,-
BOSTON HOMCEOPATHIC MEDICAL SOCIETY.
A special meeting of the society was held at the Boston
University" School of Medicine, April i8, 1901, at eight
o'clock, the President, T. Morris Strong, M. D., in the chain
The reading of the records of the last meeting was omitted.
SCIENTIFIC SESSION.
Dr. Horace Packard exhibited a fibroid tumor removed
from a woman that morning. The patient had known of the
tumor for some years. She was first seen by Dr. Packard
three or four years ago, the tumor at that time being small
and non-interference was advised. Growth was slow and she
was advised to see him again, but put off doing so until
Tuesday. The last three or four months the tumor had
grown rapidly, causing much pain, and two menstrual periods
had been passed The cervix was very soft, suggesting the
possibility of pregnancy, as did also the absence of the men-
strual periods. In view of these facts operation was per-
formed, and a very large fibroid tumor removed, which, upon
dissection, was found to contain a three month foetus. If
the operation had not been performed, abortion would have
occurred.
Another pathological specimen exhibited by Dr. Packard
was an ovarian tumor removed by him six months ago.
Nothing different appeared exteriorly, but the cyst wall was
exceedingly black. At first it seemed like a strangulated
ovarian cyst, but on looking very closely he found it was not
strangulated. Examination of the peritoneum showed that it
was black too. Careful investigation showed the discolora-
tion to be due to blood pigments, which probably resulted
from sub-peritoneal hemorrhages.
Dr. Jos. Chase, Jr., gave an account of a peculiar case
which came to his notice last February. He received a call
to come immediately to the electric light works, one of the
workmen had broken his ribs. He found the man lying on
190 1 Societies, * 311
the floor, groaning and unable to move ; pulse very slow, 56,
with cold perspiration. Pressure caused pain. Under the
scapula there protruded about four inches of what seemed to
be a piece of bone from a rib. After an anaesthetic had
been given Dr. Chase cut through the side of the thorax but
did not find any periostium, instead found a piece of wood.
He immediately cut down a little further and pulled out a
pointed piece of wood gi inches in length, from a revolving
shafting pulley, which had struck the workman's jumper and
passed through his clothing into his side.
Report of the Section of Anatomy and Physiology.,
Wbslky T. Lrb, M. D., Chairman.
D. W. Wblls, M. D., Secretary. Marion Coon, M. D., Treasurer.
The President appointed the following committee to nomi-
nate sectional officers for the ensuing year : Drs. Howard,
Spalding and Lewis. The committee reported as follows :
Chairman, David W. Wells, M. D. ; Secretary, Edward E.
Allen, M. D. ; Treasurer, Helen S. Childs, M. D., who were
duly elected.
1. " Hypnosis a Physiological Condition." Demonstration
on one or more subjects. F. E. Schubmehl, M. D. Discus-
sion opened by F. C. Richardson, M. D.
2. "Why We Grow Old." John P. Sutherland, M.D. Dis-
cussion opened by A. H. Ppwers, M. D.
3. "Studies in Respiration and Cardiac Activity." Demon-
stration of the use of the Stethograph, Chest Pantograph
Cardiograph. Physiological Department of Boston Univers-
ity School of Medicine. Discussion opened by F. E. Allard,
M. D., and H. C. Clapp, M. D.
Dr. Schubmehl said that the cataleptic state is due usually
to suggestion, and the subject remains in the attitude in
which he is placed without any effort on his part. He also
stated that Mr. Curtis, the subject to be hypnotized, was not
feeble-minded, but in good health and interested in athletics.
He was, apparently, perfectly under control, unable to move
without permission, and his insensibility to the prick of a
312 The New lEngland Medical Gazette, June
needle, proved how connpletely he was under the influence of
the anaesthetic.
Dr. Richardson was not present to open the discussion.
Dr. Suffa : I hoped to see some demonstration that wouKl
convince me that the hypnotic state is a physiological condi-
tion. I myself do not believe that to be a fact. I cannot
conceive how a person in a hypnotic state, where the brain
power is inhibited, also all intelligences of the brain senses
are in abeyance, can be called a physiological condition.
Also how it is of therapeutic value. We know it is possible
to make them do anything they are told to do. It seems to
me a very dangerous thing. It is claimed by some a patient
must be susceptible, or hysterical, and it seems to me, if not,
they are a class of patients w'ho are ill-balanced. If this
treatment is carried out, and it is much easier to make a sort
of cumulative and lasting effort, would it not produce an un-
balanced mind t If not a medical, it has a legal aspect.
Unless it can be shown that it is of therapeutic value, which
it has not, it ought to be under control.
Dr. Klein : In Germany, in 1886, it was shown how easily
persons with deranged minds can be influenced. A young
lady, a patient from an insane asylum, when hypnotized, could
be placed in any position. It was shown that the greatest
harm could come to such patients, if hypnotism was produced
more than once it would leave them in a more dangerous
condition to the community and the asylum. Magnetic
power produces no influence upon patients under hypnotism.
I consider it very dangerous to fool with hypnotism. I have
used it in operations upon the eye, but I would not do it
again. I found it left patients in a worse condition than if
they had not been hypnotized. I prefer ether or chloroform.
I think the medical profession ought to oppose such means,
as great harm can be done. It has a great demoralizing
effect, not only on the patient but on the whole community.
The medical profession should not encourage it.
Dr. Earl : I agree somewhat with Dr. Suffa and Dr. Klein.
It may not be out of place to relate an instance which
I go I Societies, 313
occurred not many years ago. A woman was in the second
stage of labor, hemorrhage from placenta praevia had nearly
cost her life, and she -was in a pretty desperate condition.
Dr. Schubmehl was present and two or three students.. It
seemed wise to deliver her with forceps, as we were without
an anaesthetic and there was no time to get one. She was
n)uch frightened and apprehensive. Dr. Schubmehl tried
suggestion, she laid still, and was pretty soon delivered. I
feel, if we had delayed to procure an anaesthetic, or to give
it, the woman's life would have been endangered.
Dr. Sutherland : The facts are very interesting and more
convincing than theories. I had some experience in the hos-
pital five or six years ago.* A case of aphonia. The patient
could not speak, only whisper, could not utter a note. Ex-
amined for laryngitis, but the larynx was in perfect condition.
Electricity and medicine were tried without cure. Then it
was decided to try suggestive therapeutics, which might pro-
duce some effect. She was told that tomorrow is Christmas,
and we want you to wake up and say to your nurse, " Merry
Christmas." In the morning she awoke, and said, " Mrs.
Wright, I wish you a merry Christmas." She returned home
and after a year had had no return of the aphonia. She was
in an abnormal state, and was restored to a normal one.
Dr. Wells : The good or ill effects of hypnotijsm depend
upon the nature of the suggestion made. There are plenty
of records of the benefit of suggestion at the reformatory
Dr. Quackenbush, of New York, states that many boys have
been reformed by suggestion.
The French authority referred to (Charcot) represents one
school in the treatment of this subject, and his experiments
have been made almost entirely upon hysterical subjects.
Bernheim, however, has experimented on non- hysterical sub-
jects, and he has developed entirely different phenomena. It
is well to say to the subject, "You will not be subject to
another suggestion against your will." Cures have undoubt-
edly been performed by Christian scientists, layers on of
hands, and during pilgrimages, to shrines, and we ought to
314 The New England Medical Gazette. June,
examine what the element of truth is in these different kinds
of cures. What do these cures consist in ? Is it in the hyp-
notic power ? We ought to inform ourselves of the elements
of truth in these various fads.
Dr, Powers : My knowledge of hypnotism is not exten-
sive. I had a case where there was a needle lost in the hand
and operation made for finding it, and the hand came under
my care for treatment. It was sensitive, and the patient of a
very nervous temperament. At that time I was interested
in hypnotism, and I suggested that if she would let me try
hypnotism, the pain would be lessened. I did so. and while
the hand would be drawn away a little, I could dress the
wound with comparatively little piiin. A dentist, doing a
good business, who would not be called hysterical or feeble-
minded, was a sufferer from headaches, which were relieved
by hypnotism. I have seen patients entirely insensible after
three or four long breaths of ether, and operation could be
performed with less than a drachm of the anaesthetic.
Dr. Haskell: I have known Mr. Curtis well all this
winter, and I consider him far from being hysterical. I have
found him a young man of original thought and he has made
original suggestions.
In regard to the ill effects. I would like to ask Dr. Schub-
mehl if it has not got something to do with the last sugges-
tion that the operator gives the patient. If he tells him he
is going to feel better and will be all right, when he awakes,
it will do away with all ill effects.
Dr. Schubmehl : I told him he would be all right. I
think all ill effects are due to neglect in making the sugges-
tion at the last that the patient will be all right. All bad
effects are due to the operator.
Dr. Suffa : Do not French authorities say it is dangerous.^
Dr. Schubmehl : Arsenic is poisonous, yet we all use it.
Dr. Packard : I have very little evidence that I can pre-
sent to you upon this subject. I do use suggestion a great
deal without thinking of using hypnotism, especially in
convalescence. I do not think I have used hypnotism as an
I go I Societies, 315
anaesthetic, it is too uncertain. In the convalescence of
patients, I often experience very gratifying results from sug-
gestion. With patients that are apprehensive and hysterical,
or anticipating an uncomfortable night, the suggestion that
they will have a good night, or will go to sleep at nine
o'clock, often produces most beneficial results. Sometimes
after a simple powder given by the nurse, the patient will go
to sleep and have a quiet night.
Dr. Sutherland's scholarly paper, " Why We Grow Old,"
was heard with much interest.
He emphasized the importance of an external stimulating
power and nutrition from within for the life and preservation
of protoplasms.
Mr. Wyesse, of the physiological laboratory, with the as-
sistance of members of his class, demonstrated the use of the
stethograph, chest pantograph and cardiograph.
Adjourned at 10 10 o'clock.
Edward E. Allen, Secretary,
RHODE ISLAND HOHCEOPATHIC SOCIETY.
The regular monthly meeting of the Rhode Island Homoeo-
pathic Society was held at Hotel Newman, Providence, R. I.,
on Friday, May 10.
The President, Dr. John H. Bennett, of Pawtucket, pre-
sided, and there was a large attendance of members.
The society placed itself on record as in favor of a uni-
versal State law, if possible, for the regulation of the practice
of medicine. The new law, compelling an examination for
every new practitioner, was also spoken of, and the constitu-
tionality of the law has been proven in this State. One new
name for membership was presented.
THE BUREAU OF OBSTETRICS.
Dr. H. M. Sanger, reported, i. "Treatment of Septic
Wounds of the Uterus." W. Louis Chapman, M. D, This
3i6 The New England Medical Gazette, June,
was a very interesting and instructive paper and special stress
was laid upon the value of antistreptococcic serum in the
treatment of apparently hopeless cases. Dr. A. H. Wood
opened the discussion of the paper, and also reported a rare
case of deciduoma malign um.
2. "A Case of Malpractice." C. J. Hashouck, M. D.
This paper was the report of a case of apparent blackmail,
which the doctor has successfully fought and obtained judg-
ment in the Supreme Court.
Owing to the lateness of the hour the paper by Dr. Jeannie
O. Arnold was postponed to the next meeting, and the
society adjourned to the dining-room where a lunch was
seryed.
List of Officers — President, John H. Bennett, M. D., of
Pawtucket, R. I. (Boston University, 1891); Vice-president,
H. M. Sanger, M. D., Providence, R. I. ; Secretary, Martin
Budlong, M. D., Providence, R. I. ; Treasurer, H. Clinton
Crocker, M. D., Providence, R. I. (Boston University, 1893).
Board of Censors. — H. A. Whitmarsh, M, D., Providence,
R. I. ; George F. Allison, M. D., East Providence, R. I. (Bos-
ton University, 1891); Mary D. Moss, M. D., Providence,
R. I. (Boston University).
THE AHERICAN INSTITUTE OF HOHCEOPATHY.
The Executive Committee desire to state as a final an-
nouncement, that the program submitted by the chairmen
of the various committees indicates an exceptionally valuable
series of papers and discussions for the forthcoming meeting.
The citizens of Richfield Springs have subscribed $2,cxx)
to entertain the Institute. The social feature of this year's
session will in consequence be of unusual attractiveness.
The entertainments, which have all been arranged so as
not to conflict with the work of the Institute, will make the
week a particularly pleasant one, especially for the ladies.
1 90 1 Societies, 3 1 7
There will not be a dull moment for any one at Richfield
Springs, for between riding, driving, wheeling, boating, fish-
ing and golfing every one may find recreation in the intervals
of work.
We are also assured that at all hotels every effort is to be
made to make each member of the Institute a friend of
Richfield. They look upon a convention of physicians as an
opportunity to advertise the merits of their health resort
rather than, as we are usually looked upon, the legitimate
prey of the landlord.
The railroads have made the customary fare and one-third
rate for the round trip, and in addition have made special
arrangements so that every one desiring to attend the Pan-
American Exposition at Buffalo, may do so without forfeit-
ing the special reduced rate. Through cars to Richfield will
be put on, and special connections made so that Richfield
will prove easy to reach from all points.
In all parts of the country unusual efforts are being made
to secure a long list of new members for this session, and
from reports already received there should be a greater acces-
sion to our membership than ever before. As the cause of
homoeopathy depends upon the strength of our national
organization, we appeal to every member of the Institute to
make this most important work for the welfare of the school
a personal obligation. Let every loyal homoeopath secure
one new member to the Institute this year.
Lastly we call upon every homoeopathic physician, be he a
member of the Institute or not, to be present at this meet-
ing ; our visitors will be as warmly welcomed as our mem-
bers, and we promise to one and all a most profitable and
enjoyable meeting.
A. B. Norton, M. D., Presideiit.
E. H. Porter, M. A., M. D., Secretary.
3 1 8 The Neiv^ England Medical Gazette, June,
REVIEWS AND NOTICES OF BOOKS.
Mental Diseases and Their Modern Treatment. By Selden
Haines Talcott, A. M., M. D., Ph.D., Medical Superintendent of
the Middletown State Homoeopathic Hospital in Middletown,
N. Y., etc. New York: Boericke & Runyon Co. 1901. pp.
352. Price, cloth, $2.50.
For twenty- five years Dr. Talcott has been brought in close con-
tact with the insane, and enjoyed exceptional advantages for
observation and study. In a work from his pen, therefore, we
should expect to find embodied the results of his great experience,
in a form calculated to appreciably assist in elucidating many prob-
lems connected with the causation, pathological changes, and symp-
tomatology of insanity, and the treatment and care of the insane.
It is with a certain sense of disappointment, therefore, that while
conscious of many excellencies in this work, we find it more in-
teresting and readable than original and scientific.
It is true, the author disavows any thought of offering his book
as an " exhaustive treatise " upon insanity, but we will venture to
ask, why this omission to make it such in the interests, not only of
his own reputation as an alienist, but also of the prestige of the
homoeopathic school? We feel that from such a man we might
rightfully expect a treatise which should compare favorably with the
writings of those of similarly extended experience in the old school.
Instead of this we have what more nearly approaches a series of
coversational papers on mental hygiene, the views of the ancients
interspersed with poetical quotations, and accepted definitions,
symptoms and pathological findmgs of different forms of mental
disorders.
The section, however, on hospital construction and methods is
helpful and instructive, and should certainly have been amplified.
While the pages given up to materia medica present nothing not
already familiar to the average student, they will prove a great con-
venience, as they group all the old stand-bys generally used in the
treatment of nervous disorders.
1 90 1 Societies. 3 1 9
A Text Book of Gynecology. Edited by Charles A. L. Reed,
A. M., M. D., President of the American Medical Association
(1900-1901), etc. Illus. New York : D. Appleton & Co. 1901.
pp. 900. Price, cloth, $5 ; sheep, $6.
Such a book as the above furnishes a certain embarrassment of
riches both from the number of its authors, and thp multiplicity of
the subjects included. While we doubt its supplanting any of the
standard and simpler text- books on gynecology, we are sure it will
prove a serviceable work of reference.
Many noted writers have contributed to its pages, each writing
upon the topic most familiar to him. Specialists, other than gyne-
cologists alone, have assisted in the preparation of this volume.
The pathologist, dermatologist and neurologist have each con-
tributed valuable material.
The work of contributors, instead of being bound together in the
form of distinct monographs, has been in some instances used only
as the basis of a chapter, all the subject matter being rendered con-
secutive, systematic and homogeneous by the editor. Under the
table of contents the different divisions of each chapter are men-
tioned in connection with the writers responsible for the text. This
arrangement, collaborative as well as individual, seems most satis-
factory in its results.
Some of the chapters attracting special attention are those on
diagnosis, sepsis and anti-sepsis, the pelvic floor and its injuries,
infections of the external genital organs, neoplasms of the uterus,
infections and inflammations of the fallopian tubes, the female
urinary apparatus and the rectum.
A special word should be said for the numerous illustrations
which are not only excellent, but also of uniform merit. The
mechanical work is a credit to the publishers.
A Manual of Practical Hygiene for Students, Physicians and
Medical Officers. By Charles Harrington, M. D., Assistant
Professor of Hygiene in the Medical School of Harvard University.
Illus, Philadelphia: Lea Brothers & Co. 1901. pp. 729.
Price, cloth, ^4.50.
In the seventeen chapters which comprise this book a wide range
of subjects is considered, viz. : foods, beverages, condiments, food
preservation, contamination of foods by metals; air; the soil;
320 The New England Medical Gazette, June,
water ; habitations, schools, ventilation, heating, plumbing \ disposal
of sewage, of garbage ; disinfectants and disinfection ; quarantine ;
military, naval and marine hygiene; tropical hygiene; hygiene of
occupation; vital statistics; personal hygiene; vaccination; dis-
posal of the dead.
Dr. Harrington has given us a most interesting and comprehen-
sive work, deserving better treatment at the hands of the binder
than it has met with, the margins being so narrow that the back
margin is encroached upon unduly, and the appearance of the page
is quite spoiled.
The text is very well arranged. The section on foods is supplied
with tables showing comparative composition and nutritive value.
Poisoning by animal foods is explained and illustrated by selected
cases. Adulterations, and their detection by suitable tests, occupy
several pages. In the section on air, the part air plays as a carrier
of infection is most instructive and important ; the same may be
said of the text relating to the carrying properties of the soil and
water. In connection with water the history of typhoid epidemics
and Asiatic cholera is reviewed. The chemical and bacteriological
examination of water is given at some length.
The other chapters in this book are equally good, those on quar-
antine and military hygiene being exceedingly interesting. Quaran-
tine regulations, home and foreign, are stated in detail together with
methods of inspection, disinfection, quarantine laws, etc. The
section on military hygiene is brought up- to date, recent wars hav-
ing furnished new and valuable data.
We commend this work on hygiene, not only to the profession,
but also to all thoughtful citizens.
The Curahilht of Tumors by Mkdicines. By J. Compton Lur-
nett, M. D. Second edition, revised. Philadelphia : Boericke
& Tafel. 1901. pp.345. Price, cloth, $1.25 ;«^/.
Those who find other of Dr. Burnett's books suggestive reading
will doubtless wish to add the present one to their collection. He
is certainly a prolific, if diffuse, writer. VV^e wish he used better
English, and knew how to condense what he has to say, but his
style, dcmbtless, does not offend buyers of his works.
The present volume is designed to aid practitioners in overcom-
ing that constitutional diathesis which predisposes certain persons
igoi Societies, 321
to develop benign or malignant tumors, and also to assist physicians
in selecting such remedies as will inhibit the enlargement of growths,
once they have appeared, or altogether dissipate and cure them.
Dr. Burnett explains in detail his understanding of pure homoe-
opathy applied to this class of cases, and cites numerous illustrations
in support of his views from his own practice. The book is neatly
gotten up with large, clear type, and a cheerful bright red binding.
The American Year- Book of Medicine and Surgery for 1901.
A Yearly Digest of Scientific Progress and Authoritative Opinion
in all branches of Medicine and Surgery, drawn from journals,
monographs and text-books of the leading American and foreign
authors and investigators. Arranged with critical editorial com-
ments by eminent American specialists. In two volumes — Vol, I,
including General Afcdicine^ Ovtavo, 681 pages, illustrated;
Vol. II, General Surgery y0ct2LV0f 610 pages, illustrated. Phila-
delphia and London : W. B. Saunders & Co. 1901. Per vol. :
Cloth, ^3 net; half morocco, ^3.75 net.
A year ago this work for the first time was issued in two volumes,
and the same plan has been followed in the Year- Book for 1901.
One volume is really not enough, or else becomes too bulky, while
two volumes can be and have been made both attractive and con-
venient in size. It is an advantage, also, to have the sections on
medicine and surgery distinct from each other ; they can be bought
and used separately or together, each being complete in itself.
Books of this class often fail to receive the recognition to which
they are fairly entitled. They represent the condensed views of a
large and representative number of leading writers, teachers and
practitioners. They furnish an explanatory index, as it were, to
countless journals of the day, new and authoritative text-books,
special papers, and other important contribution to medical science
that would otherwise be unavailable because so scattered. They
offer in compact form a means of following from year to year the
progress made in all the important departments of medicine and
surgery, and in time constitute a library of considerable historical
value.
In the work under consideration the contents of the volume on
Medicine are arranged under the following headings : General
Medicine ; Pediatrics ; Pat^nology and Bacteriology ; Nervous and
322 The New England Medical Gazette, June,
Mental Diseases ; Diseases of the Skin and Syphilis; Materia Med-
ica, Experimental Therapeutics and Pharmacology ; Physiology ;
Legal Medicine ; Public Hygiene and Preventive Medicine ; Physi-
ologic Chemistry. Contents of the volume on Surgery are grouped
under General Surgery; Obstetrics; Gynecology; Orthopedic
Surgery; Ophthalmology; Otology; Diseases of the Nose and
Larynx; Anatomy.
Among the leading contributors may be mentioned Da Costa,
Keen, Hirst, Duhring, Starr and Stengel. Both volumes are ade-
quately indexed, well bound, and printed on the high calendared
paper which we hope will eventually be altogether discarded.
The Pathology and Treatment of Sexual Impotence. By Victor
G. Vicki, M. D. From second German edition. W. B. Saunders.
189Q. Price, t2.
As the author states, not much that is new has occurred in this
line during the comparatively short time elapsing between the two
editions. The subjective matter is arranged in ten chapters, com-
prising Introductive Anatomy, Physiology of Sexual Act ; Etiology,
Diagnosis, Prognosis, and Treatment of Impotence.
The work is well written, thorough, and of value to any one
interested in this special subject.
We are inclined to feel, however, that one such book serves the
purpose intended for a considerable time.
REPRINTS AND MONOGRAPHS RECEIVED.
Treatment of Prostatic Hypertrophy. By Parker Syms, M. D.
Reprinted from ikit Journal of the American Medical Association ^
Jan. 12, 1901.
Some Remarks on the Present Status of the Physician in the
United States. By Emil Amberg, M. D. Reprinted from the Vir-
ginia Medical Semi' Monthly^ Feb. 8, 1901.
A Scientific Basis for Medicine. — Life and its Association with
Matter-Matter Not Vital but Absolutely Chemical. Two papers by
E. C, Hebbard, M. D. Reprinted from the Medical Times, Feb-
ruary and March, 1901,
1 90 1 Personal and News Items, 323
The Failure of the Consensus Judgment with Reference to
Tuberculosis. By Charles Denison, A. M., M. D. Reprinted from
the Medical News, Dec. 29, 1900.
Some Notes on the Treatment of Rheumatism. By Alfred
Stengel, M. D. Reprinted from the Medical News, Dec. 22, 1900.
Aneurism of the Arch of the Aorta, with Rupture into the Supe-
rior Vena Cava. By Alfred Stengel, M. D. Reprinted from the
American Journal 0^ the Medical Sciences, November, 1900.
A Review of the History of Cardiac Pathology. By Alfred
Stengel, M. D. Reprinted from the University Medical Magazine^
October apd November, 1 900.
Progressive Pernicious Anemia. By Alfred Stengel, M. D. Re-
printed from the Medical A^ews, Oct. 20, 1900.
Vaccination in the Light of the Royal British Commission. Ed-
ited by Montague R. Leverson, M. D. Reprinted from the Homcco-
pat hie Physician, 1900.
Fatty Degeneration of the Heart. By Thomas E. Satterthwaite,
M. D. Reprinted from the Medical Nexvs, Feb. 2, 1901.
Eye Strain Notwithstanding Acute Vision. By David Wells, M. D.
Reprinted from the New England Medical Gazette, February,
1901.
PERSONAL AND NEWS ITEMS.
Dr. James Krauss, of Maiden, expects to sail for Europe
on June 5, to return and resume his practice in November,
Wanted. — An assistant physician at Westboro Insane
Hospital. Address, Dr. G. S. Adams, Westboro, Mass.
For Sale. — A thriving practice. Present owner going
abroad. Rare opportunity. Address " W. G. B.," care Otis
Clapp & Son, 10 Park Square, Boston.
A graduate of B. U. S. of M., class of '99, located within
a few miles of Boston, would be glad to assist one or more
physicians by taking their practice a few hours every day or
by relieving them during vacations. Address "J. E. M.,"
care Otis Clapp & Son, 10 Park Square, Boston.
324 The New England Medical Gazette. June,
The Third Annual Meeting of the American Proctolngic
Society will be held at Hotel Aberdeen, St. Paul, Minn.,
June 4, and 5, 1901.
Order of Business. — Executive Meeting. Reports of Com-
mittees. Reading of Papers and discussion of same. Dem-
onstrations by Clinics and presentation of specimens.
Dr. Martin will present: (i) A Case of Naevus in the
Second Rectal Chamber. (2) Presentation of a Specimen
of Congenital Hyperplasia and Coarctation of the Rectal
Valve. Report of Committee on Progress of Proctologic
Literature during the past year. ^
President, Dr. James P. Tuttle, New York ; Vice-pfesident,
Dr. Thomas Charles Martin, Cleveland ; Secretary -Treasurer,
Dr. William M. Beach, Pittsburg. Executive Council, Dr.
Samuel T. Earle, Jr., Baltimore; Dr. A. Bennett Cooke,
Nashville ; Dr. J. Rawson Pennington, Chicago.
First Day 1.30 p. m. — Meeting of the Council. 2.00 p. m..
Executive Meeting ; Reading of Minutes ; Treasurer's Re-
port; Report of Council; Reports of Committees on other
than Scientific Subjects offered ; Unfinished Business ; New
Business. 3.00 p. m.. President's Address, Dr. James P. Tut-
tle, New York. 3.30 p. m., Reading of Papers. Primary
Tuberculosis of the Rectum and Anus with Report of Cases,
Dr. Leon Straus, St. Louis. Disease of the Sigmoid, Dr.
George B. Evans, Dayton, O. Report of Two Cases of
Valvotomy, Dr. Samuel T. Earle, Baltimore. Treatment of
Prolapse of the Rectum, Dr. J. Rawson Pennington, Chicago.
Foreign Bodies in the Rectum, with Report of a Case, Dr.
Lewis H. Adler, Jr., Philadelphia.
Second Day 1.30 p. m. — Reading of Papers. A Study of
Simple Ulceration of the Rectum from a Clinical Standpoint,
Dr. A. Bennett Cooke, Nashville. A New Method for the
Painless Removal of Hemorrhoids, Dr. Thomas Charles
Martin, Cleveland. Anal Pockets, Dr. Louis J. Krouse, Cin-
cinnati. The Treatment of Recto-Colitis, Dr. William M,
Beach, Pittsburg. Paper, Dr. George J. Cook, Indianapolis.
4.30 p. M., Executive Meeting, Reading of Minutes, Election
of Members and Officers, Miscellaneous Business, Adjourn-
ment.
THE NEW ENGLAND
MEDICAL GAZETTE
i
No. 7. JULY, 1901. Vol. XXXVI.
COMMUNICATIONS.
THE nODERN IDEA OF THE USE OF DRUGS AS
HEDICINES.
BY C. WESSELHOEFT, M. D.
[Read before Mass. Horn. Med. Society.]
This is the question upon which I have been requested to
write something. The time at my disposal will not permit
more than a brief allusion to some of the main points of the
problem which I have treated of more fully in a paper read
before the Medical Society County of New York, Feb. 9,
1888) see N. A. Jour, of Homoe., March and April, 1888).
To this I must refer to some extent. There I endeavored to
point out that what is called the history of medicine is only
very remotely and indirectly connected with medicine, being
mostly an exposition of philosophical dogmas concerning life
itself, while we search in vain for any direct knowledge or
principle governing the action of medicine proper. The
search for such a principle or such knoAvledge leads to many
interesting reflections, for everywhere there can be traced a
belief in the action of drugs to cure disease. "Simple ob-
servation of the bent of the popular mind to-day will show
us the root of the origin of the universal faith in drugs and
326 The New England Medical Gazette. July,
will assist us in understanding the nature of tradition. Look
about you where you please and you will be overwhelmed al-
most with this atmosphere of faith in medicine to accomplish
the miraculous. Every wall, every rock, is inscribed with it.
The landscape is disfigured and made uncanny. It pervades
society quite as much. It is proclaimed by cunfiing labels
of nostrums and by flaring announcements in the highways
and in whole sheets of the newspapers. This faith is shared
by the humblest squatter in the far West, as well as by the
highest dignitaries of the land." The present craze for medi-
cine is now even more widespread than in the so-called dark
ages, and "patent medicines " to-day show us just how materia
medica was collected and grew ages ago. Read only the
shrewdly worded labels on the bottles and packages, and com-
pare them with the pages of our old friend Pedanius Diosco-
rides, and the manner of the tradition will become apparent.
In Chap. II. of the book on ** poisonous animals and rabies
of dogs,'* he instructs us to burn crawfish with twigs of clem-
atis, and after having powdered the ashes, powder some gen-
tian root, mix with the ashes of crawfish in wine, make a
gruel of it and administer to the person bitten. It is better,
says our ancient friend, that some should suffer the medicine
in vain than to be led into danger for want of prompt action.
In another chapter selected at random (Cob. XXXII, Vol. II)
Dioscorides says : " In order to cure the swelling of the
breast, wash some dictam herb (Origanum dictamus) in the
cold, and bathe the breast with the water. If you doubt the
efficacy of this medicine and decide to test its power, anoint
with it the horns of a young goat, and they will cease to
grow."
Such was materia medica away back in the middle ages.
Pathological and physiological theories constituted the science
of medicine. At the time of Claudius Galenus the relation
between soul and body was that which interested physicians,
who thought then, as they do now, that deep insight into
anatomy and physiology would lead the way to the cure of
190 1 Modern Idea of the Use of Drugs as Medicines, 327
disease, while no effort was made to study the effects of
drugs and other therapeutic agencies. ** What we are search-
ing for is proof of positive curative power of drugs, — proof
based upon direct induction, not on conclusions drawn from
tradition." One question arises : Had the ancient traditions
and beliefs which they begot suddenly ceased to exist in the
beginning of this century ? No, they were present every-
where, and physicians shared them. The faith and belief
that medicines may and do cure, was an accepted axiom ; all
held fast to it, and none more so than Hahnemann himself.
Would Hahnemann have conceived of the principle (S. S. C.)
which he formulated if he had not been possessed of the time-
honored hereditary belief in medicine } His reformatory idea
was born of this belief. What did he demonstrate if he did not
seek the specific power inherent in medicines } Starting
from his China experiment, and supplementing it by anala-
gous data collected • from literature, he thereon founded his
system ; in his process of reasoning he never doubted the
faith that medicines cure, but only found a formula which
brought the ancient belief of the curative power of drugs
into rational relation with pathological conditions.
Before trying to define " the modern idea of the use of
drugs," let us consider for a moment what has been embraced
under the term of medicine hitherto. " For centuries every-
thing a physician had to learn has been included in that
term ; but it is time that we should distinguish more carefully,
especially now that the art of using drugs, and the art of
studying their most extended effects is receiving very little
attention in the great medical schools of the world. We
read with interest the advancement of pathology, the brilliant
classification and diagnostic distinction of disease, but when
we endeavor to find what ' medicine ' has to do with them,
we are greatly disappointed. . . . '*
Therapeutics embrace many things besides hydro-therapy,
antitoxines, electricity and even dietetics.
In the middle ages, law, theology, and what was called **medi-
328 The New England Medical Gazette, July,
cine" were all or could \i2N^ been contained in one of those
large pigskin covered volumes, • Now a large building could
not hold our medical literature. This comprises anatomy.
What that is you all know. There is nothing of medicine in
it. Physiology, teaching of the functions of organs, says
nothing about medicines or medicine. Chemistry deals with
a great many substances used in medicine, but chemistry
does not teach the art of using its productions as medicuies
any more than botany teaches the medicinal use of the plants
it describes. Neither is surgery medicine. It is now the
most popular way of dealing with diseased organs, but not
by the use of medicines, unless we can call the scalpel, the
needle and the ligature "medicine." Where surgeons use
medicines they do not claim to be practicing surgery ; when
they are employing the knife, or the ligature, or the needle,
they are not giving medicine. Not but that they have the
whole of the materia medica to draw upon ; when they make
use of it then only are they practicing medicine.
Pathology, that vast field occupying so many busy minds,
and leading us into the mysterious labyrinths of disease, is
not medicine any more than anatomy, physiology or chemis-
try. Indeed, it is often further from medicine than chemistry
or botany ; and those who, under the leadership of Virchow,
the greatest pathologist of the past century, hope that ad-
vancing pathology will lead us to the knowledge of curing
disease by medicine, hope in vain. It is only the knowledge
of disease, combined with the most comprehensive knowledge
of wTiat is curative in drugs and other agencies (see p. 3 of
the Organon) that will lead to the cure of disease.
Many other practices and methods of treating disease, such
as hydro-therapeutics, massage, immunization, electiicity,
while they are very indispensable branches of therapeutics,
do not deal with medicine or medicines proper, and in future
should not be considered under that name.
It belongs to the future to develop the knowledge of drug
power under a most comprehensive general law of cure, and
igoi Modern Idea of the Use of Drugs as Medicines, 329
this alone, from a somewhat exalted standpoint at present,
deserves the name of medicine. This by no means precludes
the other therapeutic branches which I have named. No
physician of the present or future will dare to claim that
medicine alone, or any other single branch of therapeutics,
will suffice to cover the ground of his usefulness; and the
time will surely come when physicians will make a distinction
between therapeutic methods, and will have their diplomas
define their position and knowledge accordingly, giving med-
icine its proper place among the methods of treating disease.
Before obtaining an idea of the modem use of medicines —
now that we have determined what is meant by this term — it
will be well to recall what that idea was one hundred years
ago. What the use of medicine was at that time none has
ever described better than Hahnemann in that inimitable
" Review of Physic '* contained in the Organon, from which
I condense : System had succeeded system. There were
theories of disease to which theories concerning the action of
drugs were applied. At one time the cry was, " Take care
and remove the cause." But they could not find it because
it has been and is yet undiscemible. An indigestible meal
or a foreign body are seen easily enough, but the actual arid
remote cause and essence of disease, no matter how carefully
and minutely searched for by microscopical examination of
histological elements, was then and is now still undiscovered.
There is still much to be looked for back of the microbe.
A hundred years ago a theoretically discovered cause of dis-
ease was sought to be removed by emetics, purging, venesec-
tion, for the removal of inflammation. This was obeying
" causal indications," and was called rational. The idea was
rational enough, but the method was based on fallaceous the-
ories in accordance with which they used what were called
repellants, as the exsiccation of ichorous ulcers was attempted
by means of astringents, cauterization, etc. '* To harmonize
with the theory of causal cures, physicians at that time pre-
supposed the existence of morbid mattqr, which they sought
330 The New England Medical Gazette, July,
J
to remove by acting upon the kidneys, the skin or the sali- I
vary glands." Salivation and diuretics as well as sudorifics
were invented ; classes of medicine were arranged for this
purpose without regard to the other deleterious effects those
sudorifics, salivates and diuretics puoduced. ' " On this afc-
count," says H., "scarcely anything is found in all works on
materia medica, from Dioscorides to those of the present
time, regarding individual remedies and the special proper
action of each."
CuUen, pretty much as Pedanius Dioscorides, was about the
only authority on materia medica as a specialty, anti-dating
Pliny and Galen ; so was William Cullen, the author of the
. principal text-book at the end of the eighteenth and the be-
ginning of the nineteenth century. He was as far in advance
of Dioscorides as Hahnemann was in advance of his contem-
poraries with regard to accurate knowledge of drug-effects
and the methods of obtaining them.
In order to get a glimpse, at least, of the idea of the use
of medicines a hundred years ago we find that, according to
Cullen, their effects were due to sensibility, and irritability,
of the nervous system exerting its influence on the contrac-
tile, chiefly the muscular fibres, of the body; this again va-
ried with the different temperaments; it was stronger in
youth and weaker in advancing age. The temperaments be-
ing dependent on five conditions, — on those of the simple
solids ; the fluids ; on the relation of solids to fluids ; on the
distribqtion of fluids ; and fifth, on the condition of nervous
force.
So far speculation was conservative and moved upon safe
ground, but it leaves that ground when we come to the con-
sideration of the uses of drugs. There we find they .^e di-
vided into twenty-three classes, such as astringents, tonics,
embracing all bitters ; emolients (water and poultices) ; sed-
atives; anti-spasmodics ; antacids; anti-alkaline remedies;
salivants ; emetics ; laxatives ; diuretics ; emmenagogues, etc.
In order to see how these theories work when applied in
igoi Modern Idea of the Use of Drugs as Medicines, 331
certain cases of disease, we find them floating in the air ;
thus CuUen is convinced that Peruvian bark cures intermit-
tents alone by its tonic quality dependent upon its bitter and
astringent effects upon the stomach, to which it imparts new
tone by strengthening* its fibres and, thence, imparting tone
to the rest of the system. ^ There is no use, says Cullen, in
attributing a specific effect to bark, when its eflFect is easily
explained by its tonicity.
How this was disposed of by Hahnemann we all know by
his historical footnote on p. 109, Vol. H of his translation of
Cullen's Materia Medica.
It is interesting to note how laxatives and purgatives were
regarded in those days, and that their effects and mode of
action were explained and made use of then precisely as they
are to-day. Their action was local and remote. Unloading
the intestines and acting as depletients, also as derivatives,
by lessening the blood pressure in certain parts where it was
supposed to be excessive. Some were considered more ac-
tive or stronger than others, but anything like a peculiar or
specific effect, or their effect upon other organs besides the
intestines, was not taken account of.
It is always interesting to seek for the explanation of tonics.
It is asserted that astringency and tonicity are not identical,
(Hahnemann's Trans., Vol. II, p. 64) and that there are tonic
medicines which have no astringent effect, but whose effect
is attributable to their bitterness alone ; but they unfortun-
ately (rften possess other qualities, narcotic, irritant, laxative,
or otherwise, which prevent their use as tonics unless we
select the "pure bitters" free from other objectionable
effects. They cure by " strengthening the tone of the mus-
cular fibres of the stomach." What a convenient idea this
was, applying with perfect elasticity to the cure of interrhit-
tents as well as dyspeptics. This idea has been handed
down to the present day, when not only in the popular mind
but that of medical men also, the stomach is often named as
the source of almost any complaint, and the popular cry is
332 The New England Medical Gazette. , July,
for "tonics/* with this difference that one hundred years ago
they meant some " bitters/' now they mean whiskey.
Straws show which way the wind blows. This sketch as-
suredly transgresses the time allowed me, therefore it is pos-
sible now only to sketch the most important points very
briefly. What remains to be said is what the idea of medi-
cine was fifty years ago, and what it is to-day.
In 1846, John Forbes, M. D., F. R. C, published an article
entitled, " Homoeopathy, Allopathy and Young Physic,"
which, (though a reply criticising William Henderson, M. D.^
of the University of Edinburg, who wrote "An Inquiry
into the Practice of Homoeopathy") is, next to Hahne-
mann's ** Review of Physic," the best essay on that subject
ever written. While it touches upon some alleged weal^
points in homoeopathic practice, it also most candidly exposes
those of allopathy, and furnishes some of the best material
for the comprehension of the idea of the use of drugs at that
time. I can only extract a few short passages to show the
prevalent idea. This was " heroic bleeding and mercuriali-
zation," compared with which the res.ults obtained by Dr.
Fleischmann and Henderson may indeed astonish our heroic
bleeders and mercurializers, or may even turn them, being
so full of faith in drugs, to the pole opposite to heroism —
homoeopathy itself. To the truth of Homoeopathy, Dr.
Forbes opposes much specious reasoning, claiming for its
cures the aid of the powers of nature only (940). In addition
to this. Dr. Forbes tells us (949) that a large proportion of
men of science " in the latter part of their career abandoned
much of the energetic and perturbing " medication of their
early practice and trusted greatly to the remedial powers of
nature. "But while we are thus exalting the powers of
nature at the expense of homoeopathy, are we not, at the
same time, laying bare the nakedness of our own cherished
allopathy .? . . . that the treatment of every disease on the
ordinary plan must, at the very best, be useless, while it in-
flicts on our patients some serious evils (that homoeopathy is
1
I go I Modern Idea of the Use of Drugs as Medicines, 333
free from), such as swallowing of disagreeable and expensive
drugs and the frequently painful and almost always unpleas-
ant effects produced by them during their operation ? " This
dilemma, by the way, Dr. Forbes manfully admits but does
not seem to escape from it when he says that " in a large
proportion of the cases treated by allopathic applications the
disease is cured by nature and not by them. ... In a
somewhat smaller proportion, the disease is cured in spite of
them, . . . consequently in a considerable proportion of
diseases it would fare as well or better ... if all remedies
. . . especi^ly drugs were abandoned.*'
The idea of the use of medicines fifty years ago is further
illustrated by a few passages which are here condensed : '* To
be satisfied on this point (the proportion of cures) we need
only refer to the history of one or two of our principal dis-
eases, as, for instance, fever, pneumonia, syphilis." " In
these, the author tells us, that antimony and blood letting are
being discredited (by Louis and others in Recherches sur les
Effets de la saignee^ Paris, 1835); likewise mercury in syph-
ilis. . . . Physicians of long experience adopting a mild
and tentative or expectant mode of practice. . » . We doubt,
therefore, if we should greatly, if at all, exceed the bounds of
truth if we said that the progress of Therapeutics, during the
centuries that have elapsed since the days of Hippocrates,
has been less than that achieved in the elementury science
of medicine during the last fifty years. The department of
medicine must, indeed, be regarded as yet in its infancy. . . .
that much of the practice of medicine," in as far as it exists in
the administration of drugs, is a system of traditional routine
and conventionalism, haphazard and guesswork."
This is the idea concerning medicine of one eminent phy-
sician and was soon voiced by another, dedicated to Dr. John
Forbes* in 1853.
In order to get the idea of another exponent of medicine
* Brief expositions of Rational Medicine in Modern Inquiries. By Jacob
Bigelow» M. D. Little, Brown & Co., 1867.
334 The New England Medical Gazette, July,
more than forty years ago, a few short passages must be cited
here.
"The artificial method of treatment is founded on the
assumption that disease can be removed by artificial means.
... It was only necessary to subdue the inflammation, to
expel the morbific matter, to regulate the secretions, to im-
prove nutrition and to restore strength, and the business was
at once accomplished. . . . The destructive tendencies of
disease, and the supposed pronenesS to deterioration of nature
herself, was opposed by copious and exhausting depletion,
followed by a shadowy array of alteratives, deobstruents and
tonics. Confinement by disease which might have terminated
in a few days was protracted to weeks and months. . . .
When carried to its * heroic ' extent, artificial medicine un-
dermined the strength, elicited new morbid manifestations,
and left more disease than it took away. The question raised
was not how much the patient had profited under his active
treatment, but how much more of the same he could
bear."
"A considerable amount," continues Dr. Bigelow, "of vio-
lent practice is still maintained (1858) by routine physicians.
Edged tools are brought into use as if they could never be
anything more than harmless playthings. It is thought
allowable to harass the patient with daily and opposite pre-
scriptions ; to try, to ab^don ; to re-enforce and to reverse ;
to blow hot and cold on successive days, but never to let the
patient alone nor to intrust his case to the quiet guidance of
nature. Consulting physicians frequently and painfully wit-
ness the gratuitous suffering, the continued nausea, the pros-
tration of strength, the prevention of appetite, the stupefac-
tion of the senses, the wearisome days and nights which would
never have occurred had there been no such thing as officious
medication. ..."
Enough of this idea of medicine a hundred years ago, and
forty years ago. The above words were strong and convinc-
ing, and it seems as if Hahnemann himself had written them.
I go I Modern Idea of the Use of Drugs as Medicines, 335
so closely do they compare with passages from his famous
" Review of Physic." Indeed, there is a strong probability
that that Review was carefully read by both Drs. Forbes and
Bigelow, who involuntarily fell into the spirit of it and
straightway quoted the sense if not the precise words. Such
is the contagiousness of vivid writing.
Notwithstanding this sketchy and almost garbled attempt
at a description of medicine in the past hundred years, it has
already overstepped ' the bounds of time allotted to it, and
still tKe idea of medicine of the present day remains to be
touched upon, also its comparison with the past. Omitting
for the present hydro and electro-therapeutics as well as im-
munization by toxines, we will glance at medicines and the
modem idea of medicines. We will at once draw for inspir-
ation upon one of the latest text-books of practical therapeu-
tics.* Here we read : "The definition of the word 'thera-
peutics ' in Billings* dictionary is : ' that ^ branch of medical
science which treats of the application of remedies to the cure
or alleviation of disease,' and, practically, the term is almost
universally used to signify the employment of drugs for such
purposes. ..." Again, " In the language of one of the
most progressive medical men of to-day in the United States,
the man who does not believe in the proper use of drugs for
the cure of disease must lack the very keystone of the arch
upon which all medical knowledge rests."
There we have it again — belief in the action of drugs, the
ancient belief which was handed down to Dioscorides, Pliny,
Galen, Paracelsus, Hahnemann. That part of it remains
to-day as it was hundreds of years ago. But the point for
the knower of things to decide is, how was it ever discovered
that medicines cured } Was fever questioned much } But
that attribute of drugs seems to have been taken for granted.
Hahnemann never doubted that cinchona cured fevers ; he
only maintained that it did so by virtue of its power to pro-
•A Text-Book of Practical Therapeutics. By Robert Amory Hare, M. D.
Lea Bros., 1894. •
336 The New England Medical Gazette. July,
duce similar fevers, and he gave the world-old axiom, rule or
law according to which medicines could be used. This is
also a modern idea of the use of drugs. It has stood the
test for a century. But there are other ideas of the use of
drugs and ideas regarding their mode of action. " Drugs,"
says our text-book, " act in two ways, which are sometimes
called near and remote, or direct and indirect. The near or
direct action of a drug is that influence which is felt by the
exercise of its effects directly upon the tissues with which it
comes in contact ; the indirect, or remote, influence is that
result which comes as a sequence of its primary effect. As
an illustration of this we may take the local use of cantha-
rides. The local, near, or direct effect of this is a blister ;
the remote or indirect effect is the absorption of exudations,
or the influencing of inflammatory processes. If pilocarpine
is used, its direct effect is the sweating which ensues, the
indirect effect is the relief of dropsy (sic) through the removal
of exudation by the increased action of the skin, salivary
glands and kidneys." So say the books.
Here we have Hahnemann's axiom of similia similibus
curantur, and also that of the dominant school. This, as ex-
pressed in Dr. Hare's book, is very disproportionate to the
2,400 odd medicines enumerated. Many of these evidently
cannot act according to the simple rule of direct and indirect
action ; and Dr. Hare does no injustice to the knowledge of
that school by seemingly making his explanation of the action
of drug apply to the whole list. Opium certainly does not
act in that way, neither does mercury, neither does digitalis,
whose great and specific actions are well known to depend
upon their primary and seconday tonic effects, which is a
very different matter than direct or indirect or simply irritant
effects, where usually the primary effect is the opposite of
the secondary effect.
We are able to derive a very correct idea of the present
use of drug or medicines when we take down any modern
I go I Modern J dea of the Use of Drugs as Medicines, 337
text- book on materia medica.* Here we learn incidentally
that, although' the principle of antagonism (allopathy) is de-
nied, it forms, as will be shown directly, the basis of modern
"regular" practice, and we also learn that this practice rests
on a rude classification of drugs arranged so as to make the
roughest toxic effects of a drug fit into a certain class, entire-
ly regardless of its other qualities and effects. A cathartic
is supposed to have no other effects ; a tonic simply strength-
ens regardless of other toxic effects'; an alterative simply
alters, etc. In nature there are no such classes.
In our idea of modem medicine we adhere to the maxim,
similia similibusy which, if not universal, certainly applies to
a great many drugs. The "regular school," on the other
hand, repudiates any law or principle, especially the term
allopathy^ etymologically well constructed to mean that the
Galenian principle of contraries still prevails, as can be plain-
ly demonstrated. Thus they classify their medicine into
about twenty-seven classes, most of which begin with "anti,"
and all the rest denote acceptance of antagonism, f or a con-
trary condition to that for which they are given. As such we
have " antacids," "anthelmintics," "antiseptics," "antiperi-
odics," "antipyretics," "counter-irritants," etc., and still
they claim that they have no such thing as an allopathic
principle.
They have numerous other classes, such as "alteratives"
and " tonics," and these names drag themselves along through
every text-book without a sign or an attempt to explain why
certain drugs are classified as tonics and others as altera-
tives ; why, for instance, colchicum and iodoform are altera-
tives, and cinchona, copper, nitric acid, etc., are tonics. Al-
though these names do not begin with "anti," these drugs
are plainly directed, according to the rule of contraries,
against the condition for which they are prescribed, and it
must be borne in mind that those conditions are mostly con-
ceived in the mind of the prescriber who h^s to invent a con-
*J3arthalow. fLect. VI., p. 84, etc.
338 The New England Medical Gazette. July,
dition to which his theoretical antagonist can be directed.
We diifer with them in this in that we aim to avoid all
suppositious states and theoretical actions of drugs ; we en-
deavor to elicit hard facts well and positively known signs
(symptoms) as indications to which we oppose equally well
known effects of drugs. It is also true that this opposition
of drug-effect to disease-effect involves a certain principle of
antagonism, although we select according to similars; the
curative action must be antagonistic in some way. This is
our idea of medicine.
There is one more modem idea of the use of medicine to
be considered just for a moment, although it requires more
time and space.
The usual text-books like the U. S. Dispensatory, often
allude to the drug effects as physiological,* only rudely to be
distinguished from their toxic effects, and these again from
their therapeutic uses. All this rests upon the same illogical
theory as their classification according to theoretical action.
We hold it easily demonstrable that there are no medi-
cines— as there are none in the U. S. Dispensatory — the
healing effects of which are not attributable to their patho-
genic, that is, to their sick-making power. (Lect. II, p. 24-6.)
This difference of opinion is due to the question as to what
is physiological and what is pathological or toxic. ... If
belladonna paralyzes the inhibitory nerves of the heart, that
is always toxic and pathological ; if Curare produces paralytic
inertia, it is toxic and pathological. If digitalis produces
slowness of the heart, or if alcohol increases its action and
excites the brain ; if opium produces somnolence and insensi-
bility to pain, these are never in any sense physiological
actions. This would mean normal, healthy, functional action,
while all those drug effects cause abnormal activity, differing
essentially from healthy functional activity.
To draw a true balance between physiological and toxic
effect, is simply impossible ; to call the mote uniyersal effects
*U. S. Dispensatory, p. 1272. Barthalow Mat. Med., p. 160, 179, 299.
1 90 1 Serum- Therapy and the A nimal Extracts, 339
after moderate doses physiological and the more dangerous
effects toxic is merely an arbitrary distinction without a prin-
ciple.
But enough of this. Here we are at the beginning of a
new century with the ideas of the uses of drugs but very par-
tially developed, our doctors divided into sects on matters of
opinion and belief, not on knowledge.
SERUn-THERAPY, AND THE ANIMAL EXTRACTS.
BY JOHN P. SUTHERLAND, M. D,, BOSTON, MASS.
[Read before Mau. Horn. Med. Society.]
If the title of my paper were to accurately index its con-
tents, it would read, "What I do not know about Serum-
Therapy." For of the knowledge born of actual experience
I have little or nothing to offer you. Yet I accepted our
chairman's flattering invitation to present a paper on " Serum-
Therapy and the Animal Extracts," soothing my conscience
with the reflection that I should acquire much valuable infor-
mation in the effort to prepare the paper, and the Society
would have a like privilege in listening to the discussion.
The term " Serum-Therapy " signifies the use of a blood
serum in the treatment of diseased conditions, although it
has been extended to include the use of a serum for the pur-
pose of rendering man or an animal immune to a certain dis
ease, or cause of disease. The theory itself is one of the
marked products of the last quarter of the last century. It is
the direct outcome of the modern laboratory, the result of
scientific experimentation, the lineal descendant of the "Germ
Doctrine." Its scientific basis is expressed in the axiom,
"Infectious diseases are caused by germs." Few now deny
the claim that micro-organisms are the exciting factors in the
production of many diseases, and it is useless, at this time,
to discuss the relative potency of micro-organisms and their
toxic products as exciting causes.
Recognition of the pathogenic power of microbes has led
340 The New England Medical Gazette, July,
to the improved technique of modern surgery, whereby re-
sults at once so brilliant and so beneficent have been made
possible. It has been said that at least two things are essen-
tial to the production of a crop, viz. : seed and soil. In the
case of the infectious diseases pathogenic bacteria are the
seed, the susceptible animal organism the soil.
With this idea as a basis efforts were made to explain
natural recovery from infectious diseases and the immunity
thereby acquired. A person who recovers from an infectious
disease is exempt from that disease for a certain time, which
may be short, perhaps a year, as in diphtheria, or life-long as
in the case of measles, scarlet fever, etc. Various theories
have been propounded to account for this immunity. Pasteur
supposed that during the multiplication of these pathogenic
micro-organisms in the animal body, they exhausted some
substance necessary for their maintenance and then ceased to
grow and the person or animal recovered, being consequently
immune, Chauveau, however, contended that in their growth
micro-organisms threw out some substance which accumulated
to such an extent in the animal as to further prevent their
development, and the animal recovered and was immune.
Metschnikoff supposed it was due to the action of the white
blood corpuscles, — in this connection called phagocytes.
But these and sundry other chemical and physiological theo-
ries have been found to be erroneous- The accepted theory
ijow is that there is produced in the recovered animal, by such
recovery, "anti" bodies or substances which are opposed to
the poisonous, or toxic, products thrown out by the growth
of germs in the body, and these substances are termed anti-
toxins.
I shall not occupy your time by discussing the value of the
chemical and physiological theories propounded in explana-
tion of recovery and immunity, but will summarize the
results of such discussions in the following statements :
A child who recovers from diphtheria has the antitoxin of
diphtheria in its blood as a result of such recovery ; and as
long as the antitoxin remains, the child will not take the
190 1 Serum-Tfierapy and the Animal Extracts, 341
disease again but will be immune. An anaimal that recov-
ers from the injection of the product of growth of a culture
of diphtheria also has the antitoxin of diphtheria in its blood.
A person or an animal recovered from tetanus has the anti-
toxin in the blood, and the presence of this antitoxin protects
against another attack. A person can have as many anti-
toxins in his blood at the same time as the number of infec-
tious diseases from which he has recovered. A person can
be immune from small pox by recovery and yellow fever by
recovery, and have at the same time antitoxins of both
diseases in his blood in preventive or immunizing amounts.
It was but a short step to assume that the blood of a per-
son or animal thus immunized against a certain disease, if
injected into the blood of a person or animal suffering from
that disease would neutralize the virus and prevent its action.
Bacteriological investigations were not slow in putting this
idea to the test and many experiments were made resulting
in what seems' to be proof that the blood-serum of animals
artificially immunized against certain diseases, contains a
something which is " germicidal " as to the micro-organisms
producing such diseases, or which antidotes the poisonous
product of these special micro-organisms.
It is a well-established fact that all kinds of germs do not
act in the same way, in producing disease. Some are strictly
parasitic, having a habatat in certain tissues or organs of the
body, and living at the expense of their host ; interfering
with the performance of the function of the part infested,
thus producing disease. Other kinds are pathogenic not by
direct action, but by the production of a poisonous some,
thing — (toxio.) — as the result of their life's activity. This
poisonous something — (toxin,) — need not be produced in
tlie living organism ; — it can be artificially made by cultivat-
ing the germ in a suitable culture-medium. The toxin thus
artificially produced is as virulent as the toxin produced in the
living organism : and its injection into a living organism is,
followed by the train of symptoms attributed to the germ it-
self. Very few, however, of the pathogenic germs produce
342 The New England Medical Gazette. July,
soluble toxins. Among those that do, the diphtheria and te-
tanus bacilli are peculiarly prominent from the fact that the
blood-serum of animals artificially immunized against diph-
theria and tetanus contains a true anti-toxin : and these anti-
toxins have been used very widely as therapeutic agents.
The diphtheria anti-toxin is the best known, from having
been the most universally used of the entire group of serums.
The specific bacillus of diphtheria was recognized by Klebs in
'83; cultivated and described by Loffler in '84; in '91 Beh-
ring commenced his experiments upon diphtheria immunity,
and almost immediately thereafter anti-diphtheritic serum
formed one of the most prominent subjects of discussion in
lay as well as medical literature. Such has been the influence
of newspaper and literary-magazine articles on the minds of
the laity, that now m the majority of cases a physician is
looked upon as culpable by the friends and relatives of the
patient if he fail to use "anti-toxin** as soon as the diagno-
sis "diphtheria** is made, and families readily submit to pro.
phylactic injections of the anti«-toxin, if any member be strick-
en with the disease. It did not require a decade to arouse
adverse criticism of the treatment, but the probability is that
such injury as has been traced to the use of the anti-toxin,
has been" due to the preservative used, the pure and unmedi-
cated anti-diphtheretic serum in common with other anti-toxic
serums being innocuous. " The anti-toxin treatment of diph-
theria** was the subject of a paper presented to the Society
yesterday evening, by Dr. Goodno, and thus requires no
further consideration at this time.
"Anti-tetanic serum*' is a true anti-toxic serum, prepared
in a similar way to the anti-diphtheritic serum. Tetanus^
however, is a comporatively rare disease, and experience in
its treatment is not sufficiently wide to enable one to authof.
itatively judge as to the efficacy of this serum. Theoretically
it must be of value, and the claim is made (Therapeutic Notes
for Feb., 190 1,) that anti-toxin therapy has reduced the mor.
tality in this disease from 90 per cent, to 40 per cent.
" Anti-streptococcic serum '* demands a moment's consider-
igoi Serum-Therapy and the Animal Extracts. 343
ation. Animals are immunized by the injection of living vir-
ulent streptococci, instead of by the use of gradually increas-
ing doses of attenuated virus, or toxin. It is called an anti-
mycotic, or anti-mycetic instead of anti-toxic serum, because
it arrests and prevents the growth of the germ rather than
antidotes its toxin. It is recommended as useful in scarlatina
erysipelas, chronic otitis media, puerperal septicaemia, pelvic
inflammations, post-operative sepsis, septic cellutitis and mixed
infections ; and several cases of cerebro-spinal meningitis, are
recorded as having been cured by it. Unfortunately, there
are several varieties of streptococci, and the serum of one'
variety is not protective against another variety. The serum
is therefore called " an experimental remedy, the exact value
of which remains to be determined." As to scarlet fever and
erysipelas the writer is justified by his experience in feeling
that he has reliable remedies to make use .of, but he acknowl-
edges the painful and lamentable fact that he has seen several
cases of various forms of meningitis and septic infection with-
in a few years which have proved fatal. And within three
months he has seen two fatal cases of meningitis, (one follow-
ing a pneumonia and the other following grippe) and a fatal
case of streptococcic infection, with multiple abscess, in which
he regrets not having used anti-streptococcic serum.
• "Bubonic plague serum " is said to be "mildly protective,
but not curative." " On this side of the water " it does not
attract the attention it did six months or a year ago, and may
be classed with antityphoid, anticancer, antirabic, antitubercle,
antipneumococcus, yellow fever and cholera serums, all of
which are under experimental investigation with more or less
promise of ultimately developing a degree of usefulness as
preventive or curative measures.
" Antivenomous serum" or " snake antitoxin " is to be
classed with the antitoxins of diphtheria and tetanus in point
of preparation and efficacy, if reports from India are reliable.
In New England snake-bite is not of as frequent occurence
as it is in some parts of our broad country, but this may be
due to the traditional potable and highly palatable prophylac-
344 2^^^ New England Medical Gazette, July,
tic which fishermen and sportsmen usually take with them in
liberal quantities on their expeditions and without which no
kit is complete.
It seems but yesterday that the whole world was excited
over the announcement that tuberculin or Koch's lymph
would cure tuberculosis. Many high hopes were ruthlessly
dashed to the ground by the failures which followed the trials
to which the lymph was subjected. From a state of hopeful
anticipation public and professional opinion swung to the
limit of pessimism and scepticism, and bacteriological inves-
tigators came near meeting a Waterloo, so that the later dis-
coveries along the line of serum therapy worked hard to ob.
tain a hearing. A point to bear in mind is that tuberculin
is a toxin, not an antitoxic serum, and its use at the present
time is chiefly for diagnostic, not therapeutic, purposes.
From the historical point of view ** vaccination " is a prac-
tice of too great importance to be overlooked in this connec-
tion, but the production of vaccina by the use of the lymph
of cow-pox vesicles is nothing more or less than prophylactic
inoculation, the descendent of the time-honored oriental cus-
tom of small-pox inoculations. And while the practice un-
questionably had great influence in determining the trend of
medical thought and laboratory investigations of the last
century it cannot claim attention as an instance of serum
therapy.
You are all familiar with the method of treating inoperable
malignant tumors by the hypodermatic use of ** Coley's Mix-
ture,**— but you may not all be familiar with the story of the
discovery and perfection of the method. Here we are dealing,
not with an inocuous anti-toxic serum, but, as in the case of
tuberculin, with a poisonous substance produced by germs —
a "toxin."
" A number of observers having noted improvements and
occasional cures in malignant tumors from an intercurrent
attack of erysipelas, Coley and others attempted to follow this
indication by inoculating erysipelas on to the region of the
tumor The method gave very promising results, but proved
190 1 Serum-Therapy and the Animal Extracts, 345
impracticable on account of the frequently fatal issue of the
erysipelas. In 1894 Coley proposed to modify the method by
using the toxins, the germs themselves having been removed."
Later he made use of unfiltered cultures containing the
dead germs, the germs having been destroyed by heating the
cultures to a temperature sufficient to render them sterile
(SS'' to 60** C). It was Coley who first tried a combination
of erysipelas streptococcus and bacillus prodigiosus, it hav-
ing been discovered that the bagillus prodigiosus, a non-
pathogenic organism^ possessed the power of increasing the
virulence of the erysipelas germ. After prolonged investiga-
tion and experience Coley's own conclusions are as follows :
"I. The mixed toxins of erysipelas and B. prodigiosus ex-
ercise an antagonistic and specific influence upon malignant
tumors, which influence, in a certain proportion of cases, may
be curative.
2. This influence is slight in most cases of carcinoma (in-
cluding epithelioma) ; most marked in sarcoma, but varies with
the different types, the spindle-celled form showing by far the
greatest influence.
3. The action of the toxins is not merely local in character
but systemic.
4. The toxins should be used only in clearly inoperable
cases, or after primary operation to prevent recurrence.
5. The results will vary greatly with the strength of the
preparation, the most virulent cultures giving the best re-
,sult." — Am. Journal of the Medical Sciences, Sept. '96, re-
printed by Parke, Davis & Co.
My experience with " Coley's mixture" has been limited to
one case of multiple sarcoma of the "spindle-celled" variety.
The use of "Animal Extracts" for one purpose or another
is as old as the human race. The aboriginal American ate
the hearts of brave men, when he could get them, to make
himself brave (to cure cowardice). Domestic medicine prizes
highly such remedies (simples) as snakes' skins, skunk's oil,
goose oil, etc. Two-hundred an^ fifty years ago blood pre-
pared in a certain manner was considered a remedy "of ex-
cellent virtue, which, being taken inwardly and applied out-
346 The New England Medical Gazette, Jiily»
wardly, easeth pains, and cureth most diseases/* "Elixir uf
Mummie" (man*s flesh hardened) was thought to be "a won-
derful prevention against all infections.'* The "Essence of
man's brains," made from the "brains of a young man, that
hath died a violent death, together with its membranes, arte-
ries, veins, nerves, and all the pith of the back-bone," was
looked upon as "a most infallable medicine against the Fall-
ing-sickness." A famous "Spirit of human sculls" was used
as "a kind of General Panacea!' "Oyl of Snakes and Ad-
ders" did "wonderful cures in recovering hearing in those
that be quite deaf." "Bears* Balsam," made from bears* feet
was looked upon as "an incomparable balsam to apply for
Stiffness, the Gout and Palsie.** The "Quintessence of
Snakes, Adders and Vipers,'* make from "the biggest and
fattest Snakes, Adders and Vipers" to be obtained in June
or July, was said to be " of extraordinary strength and virtue
for the purifying of the blood, the flesh, and the skin ; and
consequently cleanseth of all diseases therein. It cures also
the Falling-sickness, . . . and strengthens the Brain, Hear-
ing and Sight, and preserveth from gray-hairs ; reneweth the
old to Youth, preserveth Women young, cureth the Gout and
Consumption ; and it is good against Stings, Bites, and Pesti-
lential infections." Do not smile too incredulously at these
things. Have we not before our memories, as it were but
yesterday, the wild, enthusiastic rush that was made for*
Brown-S6quard's famous "Elixir.?" And have we not to-day^
in this our country of advanced civilization, an "American
Animal Theraph Association } " In the Journal of this Asso-
ciation we read much about a wonderful " Lymph Compound "
which contains the following ingredients, taken from seven,
months-old goats : "lymph, taken from the thoracic duct and
lymph glands ; extracts from lymphatic glands, and of the
gray matter of the cerebrum, medulla, cord and testicles.
Ingredients from bulls : . . . Semen, taken chiefly from
globus major and minor. The menstruum is composed of
blood serum, diluted with carbon water, and the entire com-
pound is preserved from coagulation by the addition of a very
I
I go I Serum-Therapy and the Animal Extracts, 347
small amount of chloride of gold and sodium, from which the
irritating properties have been taken." This is the powerful
modern "tonic to cell-function, and reconstructor of cell-struc-
ture." The list of diseases for which this newest lymph com- '
pound is confidently recommended, is far too long to quote.
It is suggested, merely, by the index of any work on patho-
logical conditions. Who says that the ancient alchemist died
without heirs } '
Truly the medical experiences of our generation, bears wit-
ness to the truth of the axiom that there is nothing new under
the sun !
The term " animal extracts," as used to-day, refers chiefly
to the thymus, thyroid and supra-renal glands, and the pre-
parations made from them. , Extract of thymus gland is said
to cure exophthalmic goitre. At all events it has been used
in the treatment of both simple and exophthalmic goitre with
some success. Suprarenal extract is said to be " the most
powerful astringent and haemostatic known." Congestion of
every organ to which it can be appjied, ** is relieved by the
external use of the extract. ... It benefits all forms of in-
flammation, in all parts of the body. . . . And it is the
strongest known stimulant to the heart." These facts we
learn from the Medica/ Age, April, 1900. The gland has
been used in the treatment of Addison's Disease, diabetes
mellitus, exophthalmic goitre, various forms of heart disease —
mitral and aortic, — and the following are some of the condi-
tions for the relief of which suprarenal extract has been suc-
cessfully employed as a local application : Urethral stricture*
intertrigo, hay fever, epistaxis, laryngitis, conjunctivitis, rhi-
nitis, acute catarrhal otitis, middle-ear congestions and gran-
ulations, and acute inflammation of the drum.
Not the least important application of suprarenal extract
has been for the blanching of the tissues prior to surgical op-
erations, such for example as the removal of polypi or spurs,
anterior turbinectomy, division of adhesions, buccal curettage,
tonsillotomy, etc. It makes a bloodless field ; and, although
some complaint has been made of secondary post-operative
348 The New England Medical Gazette. July,
hemorrhage, this can readily be avoided or controlled by re-
peating the suprarenal spray.
The most popular and extensively used animal extract is
obtained from the thyroid gland, of which there are several
preparations. It has a high reputation, in the cure of myx-
cedena. According to Osier, in his article on the subject.
" The results, as a rule, are most astounding : unparalleled by
anything in the whole range of, curative measures. Within
six weeks, a poor, feeble-minded, toad-like caricature of hu-
manity, may be restored to mental and bodily health." In
cretinism, it is claimed, the effect of thyroids is little less than
marvelous. In the treatment of insanity, Clouston says, "No
case should be allowed to become incurable, without trying a
course of thyroids." Obesity is said to be cured or improved
in a majority of cases, by the administration of thyroids. The
gland, or its extract, appears to be efficacious in chronic rheu-
matism, arterial schlerosis, schleroderma, prurigo, psoriasis,
ichthyosis, and lupus : in haemophilia, in pelvic hyperaemia,
fibroid tumor, disturbed lactation, and sundry gynecological
conditions. Its use has also been recommended in tetany,
paralysis agitans, acromegaly, acute suppurative tonsilitis, and
retarded consolidation of fractures.
" According to Serafine the treatment of simple goitre by
Thyroid gland is best adapted for the form known as struma
parenchymatosa. Definite cure is rarely observed, and only
in young subjects. The results are satisfactory in sixty-three
per cent, of cases, the goitre lessening in size. In thirty per
cent, of the cases .the treatment is absolutely valueless.
When goitre has undergone secondary degenerations, such as
colloid or cyst formation, the treatment is useless."
My own experience in cases of thyroid feeding has been in
cases of long-standing bronchocele in exophthalmic goitre
and in obesity; but I probably have made an unfortunate
selection of cases, for I have to report my results as wholly
negative.
Cerebrine I know only by name, but as it seems to me to
be nothing more nor less than a reincarnation of the "Essence
1 90 1 Serum- Therapy and the A nimal Extracts, 3 49
of Man's Brains " of three centuries ago, it may well be
allowed to remain a relic of the therapeutic past.
ProtonucUin is a preparation for which great claims are
made. I have used it in myelo-splenic leukaemia, in pernicious
anaemia, malignant growths, and in cases of marked nervous
exhaustion ; but I am unable to be at all certain that it exert-
ed any influence whatever, good or ill, on the progress of the
cases.
Camogen and Extract of Red Marrow are preparations
which cannot be excluded in a list of Animal Extracts. To
my mind they are to be classified simply as concentrated
foods. My experience with them has been of comparatively
moderate extent, but in some cases I have reason to think
they were distinctly useful. I have used them in three or
four cases of pernicious anaemia, one of which seems to have
been cured. Credit may be due to the red marrow in this
case, although other curative measures were also employed.
In a recent case of climacteric metrorrhagia, and in a few
cases of chlorosis, and marked debility with anaemia, I am in-
clined to credit camogen and red marrow with being of de-
monstrable service. In the category with the remedies just
discussed we must include the beef extracts and special food
preparations. Nor can we, without ingratitude, omit mention
of two articles which surely are ''animal extracts" in the
strictest sense of the term, and whose wide usefulness stands
undisputed. I refer to milk and eggs.
In concluding this brief and exceedingly inadequate review
of a large and highly important subject I would say that the
theory underlying the use of antitoxic serums appeals strongly
to the thinking mind as at least a plausible theory ; one which
promises much in alleviating suffering and in curing disease ;
one which should not lightly be set aside without intelligent
and exhaustive examination of its claims. My own experience
in this connection has not been extensive enough, however,
to tempt me to cast aside in favor of this or any other system
of cure the methods that I have made chief use of thus far in
my medical life.
350 l^he New England Medical Gazette. July,
If, as it has been claimed and partly demonstrated, the
anti-toxic serums are non-medicinal and innocuous, there
would seem no reason why they should not be extensively
experimented with along clinical lines. The toxins, like
tuberculin, and Coley's mixture, being poisonous substances,
should be used with the extremest caution, and only after
possessing the fullest attainable knowledge of their powers.
Thyroid and supra-renal preparations possess pathogenetic
properties of some power. One may feel justified in using
them along "physiological" lines. Why should the symp-
toms of "thyrodism," tachycardia, oppression, exophthalmos,
glycosuric, albuminuria, irritability, emaciation, vertigo, not
be made use of on the principle of similars } Has this ever
been attempted } This seems to me to be an interesting and
suggestive query.
CHEST DISEASES IN 1800 AND IN 1900.
BY HERBERT C. CLAPP, M. D., BOSTON.
[Delivered before Mass. Horn. Med. Society, April lo, 1900.]
The chairman of this bureau has asked me to write upon
this subject, thinking it an appropriate one for the first year |
of the new century. Since any essay approximating a com-
plete exposition of it would fill a book, I will merely ask you I
to take a few glances here and there, to look on this picture |
and then on that, and for the most part to draw your own \
conclusions.
In 1 8cxD a medical student coming up for examination on
the subject of heart disease must have had a very easy time,
after a "snap course." In fact, the works on practice, print- j
ed about that time, which I have consulted, contained little I
or nothing on the subject.
They did dwell on dropsy, which, as everybody knows, may
or may not be connected with some form of heart disease, but
no distinctions were made. A few words were said on the
pulse and circulation, but very little else that was practical.
I901 Chest Diseases in l8oo and in igoo. 351
Hippocrates and Celsus thought heart disease impossible,
as the heart was the centre of life, and disease of the heart
was incompatible with life itself. What we now consider
symptoms of heart disease were by the ancients interpreted
as symptoms of disease of the lungs, nerves, etc.
The first great advance was made .by Vesalius, when in
1543 he gave a clear description of the anatomy of the human
heart.
The next important step was taken by Harvey, who in 1628
described the circulation of the blood, although, queerly
enough, this great discovery had no effect upon the clinical
study of heart disease for very many years.
The real birth of the science of heart disease was possible
only after the discovery of auscultation and percussion, which
was made in the century which has just ended.
Although Auenbrugger had in 1761 published his little
book on percussion, this new invention at the time attracted
no attention whatever; and it was not until 181 1 that Corvi-
sart exhumed the book, translated it into French, and demon-
strated the importance of the subject, although the full value
of percussion was only appreciated by Piorri in 1840.
The greatest discovery of all, however, so far as heart dis-
eases are concerned, was that by the illustrious Laennec in
18 16, of auscultation, of which he was the originator, and
which he brought to a wonderful state of perfection.
Then, and then only, can it be said that the real science of
cardiac disease was born. And so, when asked what progress
we have made in this branch during the last century, we have
to Answer that there is no contrast at all. From nothing it
has grown to everything, especially in pathology, aetiology
and diagnosis. Although in the treatment of its advanced
stages our progress has shown little to boast of, yet our in-
creased knowledge now enables us to make the treatment in
the earlier stages and the preventive treatment of great im-
portance.
As to the development of knowledge regarding the lungs,
bronchi and plurae, the introduction of auscultation and per-
\
352 The New England Medical Gazette, July,
cussion in the early part of the nineteenth century was also
of great (although less) value.
Much was known about diseases of these structures before,
even from the earliest times. But, on the other hand, much
was a confused jumble of ideas waiting to be cleared up by a
nicer differentiation based on more exact methods of diagno-
sis. Pneumonia and pleurisy were often mistaken for each
other, phthisis and bronchitis, phthisis and empyema, phthisis
and asthma, to say nothing of the intermixture of outside
diseases, as asthma and heart disease, for example. Koch's
tubercle bacillus, announced in 1882, has afforded consider-
able help in differentiation, and the Roentgen rays a little.
Of more value than either has been the clinical thermometer.
A better diagnosis has naturally paved the way for a better
treatment.
By far the most effective agent in the nineteenth century
in improving the treatment of disease was homoeopathy, which
in i8cxD was not known in America, but was beginning to
make itself felt in Germany. Its value, as shown to the
world, has been both negative and positive ; negative, as
showing that patients could get well without the crude poly-
pharmacy, the bleedings, blisters and gigantic doses of drugs
given in 1800 ; and positive in showing that medicine given in
this way had real and true curative powers. Its negative
value, which alone was acknowledged to any extent by physi-
cians who were not its advocates, enabled the expectant
school to do far better work than the more zealous but
regular routine practitioners. Pneumonia is the disease be-
yond all others in which, undoubtedly, homoeopathy has proved
its greatest worth, and the contrast between the two schools
at the beginning of the nineteenth century was far greater
than at its end, on account of the change of base in the allo-
pathic school, induced to great extent by the revelation of the
powers of nature in curing disease afforded by homoeopathy.
Now let us take a few glances at the common treatment of
some of the diseases of the chest, as practised one -hundred
years ago, comparing them mentally with the present treat-
ment, with which we are all familiar.
IQOI Chest Diseases in l8oo and i^ igoo, 353
In a monograph on consumption published in London in
181 1 by Dr, Richard Reece, and dedicated to His Royal
Highness George Prince of Wales, who gave his name and
protection to a Phthisical Dispensary founded by Dr. Reece
in 1805, with William Wilberforce as President, and many
patrons among the nobility, the author advises, among other
remedies, blood-letting, sweating and mercury either by mouth
or by inunction. Purging he recommends, because " nothing
so much aggrevates the diseases as costiveness. In the first
stage of the malady a blister or a seton is a remedy indispen-
sably necessary. . . When the scrofulous diathesis runs
high and a sufficient discharge is not promoted from the
blister, a seton affords a more enlarged means of answering
the same intention. To most patients under the disease this
appears a severe remedy. It is, however, one of the first con-
sequence, if resorted to before the structure of the lungs has
received much violation. In this early period it keeps down
that fulness of vessels which favors the progress of suppura-
tion. It does powerfully correct the scrofulous diathesis. . .
When the system is quieted by the foregoing remedies, an
emetic of ipecacuanha I have found very beneficial. . . The
diet should be such as tends to allay irritation and to abate
the ignition of the system. Spirituous and vinous liquors
should be strictly prohibited, as well as animal food in solid
form."
Dr. William Buchan, in the twelfth edition of his work on
medicine, published in London in 1791, in speaking of the
treatment of consumption (which disease, he says, is seldom
cured), strongly recommends asses' milk, which he thinks
would produce extraordinary effects if taken early enough,
and in sufficiently large quantities. "But," he adds, naively,
" if it be delayed till an ulcer is f orm«d, which is generally
the case, how can it be expected to succeed V*
He next goes on to say : " Some extraordinary cures in
consumptive cases have been performed by women's milk.
Could this be obtained in sufficient quantity, we would recom-
mend it in preference to any other. It is better if the patient
354 ^'^^ Kew England Medical Gazette, ]^y^
can suck it from the breast, than to drink it afterwards. I
knew a man who was reduced to such a degree of weakness
in a consumption, as not to be able to turn himself in bed.
His wife was at that time giving suck, and the child happened
to die, he sucked her breasts, not with a view to reap any ad-
vantage from the milk, but to make her easy. Finding him-
self, however, greatly benefited by it, he continued to suck
her till he became perfectly well, and is at present a strong
and healthy man." At this day our comment on this story
might be, — Haecfabula docet that a kind act may sometimes
, prove a boomerang. The chapter ends thus: "Before we
quit this subject, we would earnestly recommend it to all, as
they wish to avoid consumptions, to take as much exercise
without doors as they can, to avoid unwholesome air and to
study sobriety. Consumptions owe their present increase
not a little to the fashion of sitting up late, eating hot sup-
pers and spending every evening over a bowl of hot punch or
other strong liquors. These liquors, when too freely used,
not only hurt the digestion and spoil the appetite, but heat
and inflame the blood and set the whole constitution on fire."
The disease empyema has been known for many years.
Indeed, even Hippocrates seems to have had about as much
knowledge of it as anybody down to the- time of the discovery
of auscultation and percussion, less than a hundred years ago.
The operation as performed to-day, if done at the right time,
saves a very large percentage of its victims ; whereas, on ac-
count of the difficulty of recognizing the disease in 1800, and
the crudity and bungling of the operation for letting out the
pus when discovered, empyema was a very fatal disease one
hundred years ago. So much so that Dr. R. Brookes, in his
Practice of Physic says that : " Sharp has no good opinion
of the operation, for he says he has opened several persons,
who have died of consumption of the lungs from an abscess
which had consumed a great part of the lungs, and he does
not remember to have found any pus lodged in the thorax.
** Besides," continues he. "it is evident that many who die
consumptive, die of the discharge they spit up from the
IQOI Chest Diseases in 1800 and in igoo, 355
lungs, and, therefore, we ought not to undertake any opera-
tion which promises so little success. There may, I own, be
abscesses formed between the lungs and the mediastinum
which may fall into the cavity of the thorax ; but then if the
pus is small in quantity, it may be absorbed by the lungs
themselves, and, if there is much, the operation will be of
little service. Besides, these cases are very rare, and the
symptoms of pus being fallen upon the diaphragm are very
equivocal, and, therefore, I think the operation should be
omitted, though the empyema is supposed to actually exist."
I have in my library, in the Latin language, Van Swieten's
Commentaries on the Aphorisms of the great Boerheave, the
learned Professor of Physics in the University of Leyden,
published in Paris in five large and handsome octavo volumes,
the last of which appeared in 1773, the publication of the
whole extending over five years. This was one of the great
classics and authoritative for the physicians of the year i8cxd.
In his essay " Of the Empyema " he says in one place :
'* But since it is necessary for the said mattfer in the breast to
be discharged by the paracentesis or incision, if it procures
not other passages for itself, therefore it is required of the
physician to know in which side of the thorax the matter
lies ; the fluctuation or rattling of which in the breast is some-
times perceived by the patient in turning around in the bed,
and even sometimes the collision of the matter is audible to
those who attend the patient.
"For determining this point, therefore, Hippocrates orders
the patient to be set fast in a chair ; that while one holds his
arms, the physician may shake him and, at the same time,
hearken, with his ear near to the side, in order to perceive
the collision or rattling of the matter collected in either
cavity of the breast. But then he also intimates, at the same
time, that the great thickness or excessive quantity of matter
may sometimes hinder any rattling of the matter from being
heard, when the breast is yet full of matter. . . When a
great rattling or noise of the matter is perceivable upon shak-
ing the shoulders of those who have an empyema of broken
356 The New England Medical Gazette, July,
suppuration in their breast, the quantity of said matter is less
than in those in whom it makes but little noise or fluctuation,
if, at the same time, they have also a more flushed color of
their countenance. But in such as have no rattling of the
matter, but only a violent difficulty of the breathing, with a
livid color of their nails, these are quite filled with matter and
in a deplorable condition."
What a contrast to the modern methods of diagnosis, and
how they did allow the golden opportunity for a successful
operation to slip by !
A few years ago a man in Canada, having a worthless eye,
was advised to have it enucleated ;^ but the operating oculist,
when the patient was anaesthetised, carelessly removed the
wrong eye. Our author, perhaps having a similar catostrophe
in view, goes on to say how it may be avoided in empyema :
" But since it is of such importance to the physician to know
for certain in which side of the thorax the matter is contained,
Hippocrates has, therefore, made it his business to collect to-
gether all the signs, and has attempted the practice of diverse
artifices by which a firm or sure diagnosis might be obtained.
Accordingly, he observes that the side of the thorax which
contains any considerable quantity of matter, so as often to
yield no rattling noise from the fulness, does thence appear
more enlarged or swelled than the other opposite side, which
is a circumstance confirmed after him by the observations of
modern surgeons."
The most curious diagnostic proceedure is this : " But be-
cause" the affected side grows hotter than the other, therefore
he advises the whole thorax to be wrapped up in thin linen
that has been dipped in liquid bole or red earth, dissolved and
rendered very fine and thin by trituration, and then directs
the incision or cauterization to be made in the place that ap-
pears the soonest dry ; or else he likewise advises the whole
naked chest to be anointed with the like red liquid, that the
place may appear where it is soonest dried up. But then he
prudently cautions that in this case several hands must be
employed to anoint the breast all over at once or in an instant,
I90I Sun Baths, 357
otherwise a mistake might arise from the part which was first
wetted appearing sooner dry than the rest."
Later he says that where it is not quite evident just where
the seat of the vomica is, some physicians are accustomed to
cauterize several outward parts of the thorax, thinking that
some one will hit the case, or to apply emollient poultices
with or without first cutting the skin, hoping to entice the
matter out at one of these spots after a while.
Much more of interest might be quoted from these old
books, but perhaps this will suffice.
HoMCEOPArHS Successful. — Every applicant for a license
to practice homoeopathy in the District of Columbia, during
the past year, was accepted,— Afedica/ Arena.
Nephrectomy for Floating Kidney. — In some in-
stances of floating kidney nephrectomy is indicated. This
is only where tubercular infection, marked degeneration from
renal calculus, or the presence of malignant disease is dis-
covered. Under no other circumstances, save with the pos-
sible exception of cases in which the ureter has become
obstructed and hydronephrosis has developed, is it warrant-
able to remove the kidney. — 5/. Louts Medical and Surgical
Review,
Sun Baths for Tuberculous Joints. — Some French
authors recommend local sun baths for tuberculous joints.
De Millioz, of Lyons, has the patient recline on a couch in a
sunny spot of a garden in suitable weather and under a sky-
light or in a window where several hours' exposure to the
sun's rays can be obtained. The diseased joint is freely
exposed and afterwards covered with wool and firmly band-
aged. He claims rather remarkable results in the early
stages, and decide^ improvement in the suppura,ting cases. —
Exchange,
358 The New England Medical Gazette. July,
EDITORIAL.
Contributions of original articles, correspondence, etc., should be sent to the publishers, Otis
Clapp & Son, Boston, Mass. Articles accepted with the understanding that they appear only in
the Gaattt*. They should be typewritten if possible. To obtain insertion the following month,
reports of societies and personal items mutt de rectivtd by tke isth 0ft1u month prtctding.
Dr. Max Pettenkoper.
To those among us who find themselves unable to accept
without question all the claims of dogmatic bacteriologists,
the life and labors of Prof. Pettenkoper, whose death occurred
last month in Munich, cannot be other than a subject of
deepest interest, and should not be allowed to pass without a
word of appreciation.
Although not a practicing physician few among his con-
temporaries in the profession have influenced more profound-
ly both the theory and practice of medicine. The first he
influenced in a marked degree by his methods of investiga-
tion; the second, by the results of these methods, for it is
not too much to claim that they have laid the firm foundation
for what we now know is modern sanitary science. How
great and far-reaching his work in this field has been is shown
by the fact that to-day this science is not only that of the
prevention of disease by the removal of available causes, but
also — and this is especially to be borne in mind — the science
of enhancing that vital energy within the individual organism
by means of which it is enabled both to resist the inroads of
disease and to insure the most perfect activity in its struggle
for exactness. As yet, it is true, the practical appreciation
of the results of his labors is far from perfect and universal,
but at the end of his long and laborious life Pettenkoper
could look back on the accomplishment of all that it was pos-
sible for a single individual to achieve in this direction.
I90I Editorial, 359
Bom in 181 8, he took his medical degree at the age of
twenty-five in Munich, where he then devoted himself under
Leberer, and, later, under Liebig, to the special study of
physiological chemistry. After having occupied the position
of assayer to the mint for a short time — a position he accept-
ed in part to secure the means of subsistence and in part to
perfect himself in the methods of exact chemical experimenta-
tion— ^he was cabled by his university to assist the chair of
dietetic chemistry, a subject which led him directly to the
systematic study of hygiene. In 1853 he was promoted to a
full professorship in this branch, which he at once strove to
raise and expand to that of hygienic science. In this he
finally succeeded in 1865 ; but it was not until 1875 that the
first Hygienic Institute was founded under his initiation and
direction. He remained at its head until 1 894, when he re-
tired, full of years and honors, from active work.
Throughout all his long and laborious career as investiga-
tor and teacher he had set himself the task of studying in all
directions and by the strictest methods all those physical and
chemical factors of the conditions of life which constitute the
environment of the human organism in its collection, as well
as its individual aspects. Above all others, his attention was
directed to the influence of dwellings and food on the growth,
development and working capacity of the human body. In
regard to the first it may be said that he and his followers
have succeeded in establishing data of the utmost practical
consequence. The questions of the Vitiation of air by respi-
ration and by the various occupations carried on in enclosed
spaces, of ventilation, heating, lighting, etc., have been
studied and in no small measure answered by his methods of
direct experimental inquiry. In the same way the allied
questions of converting the humidity of walls, cellars, floors
and air-spaces, porous ventilation, the penetratioli of gases of
the soil into houses, the character and origin of these gases,
and many other matters of like interest and importance, were
brought to definite conclusions in regard their bearing on
360 The New England Medical Gazette, July,
health, and the possibility of remedying their injurious effects.
The knowledge of all these subjects, which now place it
easily within the reach of the practical builder to meet the
requirements of scientific sanitary construction, was but
vaguely held or wholly neglected until fully elaborated by
him and his pupils.
When we now look complacently on the Hygienic Institute
everywhere flourishing and speak glibly of the modem de-
mands of hospital, tenement, office and other buildings de-
signed for the use of a great number of inmates, we are too
apt to forget the endless labor, care and thought bestowed on
these subjects by Max von Pettenkoper and those in all
countries whom he inspired to follow in the paths he first
pointed out. Walter Wesselhoeft.
Acute Pericarditis. — Primary rheumatic affections of
the pericardium were formerly thought to be idiopathic ;
Foureur and Banti, however, have found streptococci and
pneumococci in such cases. There is, however, no specific
bacterium that can be regarded as the sole cause of peri-
carditis.— Exchange.
Treatment of Chronic Prostatitis. — Chronic prosta-
titis and chronic seminal vesiculitis, unless of very long
standing, will be much benefited by hot rectal irrigations.
In addition they call for massage by means of the finger
introduced into the rectum. The irrigations may be prac-
ticed every day at first and later every three or four days
according to indications. The digital massage, however,
should not be repeated oftener than once in five to seven
days and should be discontinued altogether for a time if it
aggravate rather than relieve the condition. Such an aggra-
vation would mean that the inflammatory process in the
organs was too acute as yet to admit of massage. — Medical
Times.
1 90 1 Societies, 361
SOCIETY REPORTS.
BOSTON HOMOEOPATHIC MEDICAL SOCIETY.
BUSINESS SESSION.
The regular meeting of the Boston Homoeopathic Medical
Society was held at the Boston University School of Medicine
Thursday evening May 2, 190 1, at eight o'clock, the President,
T. Morris Strong, M. D., in the chair.
The records of meetings held in April were read and
accepted.
Charles W. Bush, M. D., 103 Court St., Newtonville, Mass.,
was proposed for membership.
Robert W. Southgate, M. D., W. H. Watters, M. D., and
Alice H. Bassett, M. D., all of Boston, were elected to mem-
bership.
Voted : To postpone the June meeting one week, because
of Commencement.
report of the
Section of Pathology and Therapeutics.
M. W. Tuknbk, M. D. Chairman.
S. C. FuLLBR, M. D., Secretary. Anna B. Davis, M. D., Treasurer.
The President appointed the following committee to nomi-
nate sectional officers for the ensuing year: Drs. C. H.
Thomas, F. W. Colburn and Ellen H. Gay. The committee
reported as follows : Chairman, S, C. Fuller, M. D. ; Secre-
tary, Thos. R. Griffith, M. D. ; Treasurer, W. B. French, M. D.,
who were duly elected.
PROGRAMME.
1. "Jamaica as a Health Resort." Anna B. Davis, M. D.
Discussion opened by Dr. Frank Albert Davis.
2. " Report of a Case of Small-Pox." Henry H. Amsden,
M. D. Discussion opened by Dr. Conrad Wesselhoeft.
362 The New England Medical Gazette. July,
3. " Report of Medical Cases Treated at the Massachusetts
Homceopathic Hospital from January i to April i, 1901."
Services of J. P. Sutherland, M.D., Edward E. Allen, M.D.
Discussion opened by F. B. Percy, M. D.
4. "Some Experiences with the Plague." William H.
Watters, M. D. Discussion opened by Dr. John P. Suther-
land.
I. Dr. Anna B. Davis gave an attractive description of
the Island of Jamaica, and considers it an ideal resort for
certain classes of invalids. Exercise should be taken early in
the morning and after three o'clock in the afternoon. There
is an abundance of fish, vegetables and fruits. The water is
efficacious in gout, rheumatism and kidney diseases ; also dys-
pepsia and liver troubles. Visitors should avoid the dew in
the morning and sun at noon. One-sixth of the native popu-
lation die of old age ; tuberculosis comes third, and diarrhoeal
diseases are not common. Nervous patients derive the most
benefit. The cure of insomnia is almost marvellous. Cases
of malaria and tuberculosis should remain at home.
Dr. Frank A. Davis : There is very little that I can say in
discussing this paper that will add interest to it. I can sim-
ply say that, from my knowledge in visiting Jamaica, I endorse
every word in the paper. It can be well called the garden of
the tropics, the land of perpetual summer and eternal beauty.
It is 1,600 miles from Boston, and the passage takes about
five days. Many people are very sick on the way ; and that
is not peculiar, because, as has already been said, most of the
passengers are those who seek Jamaica for their health. One
of the Bahama Islands is passed on the way, and for half a
day the steamer runs along the coast of Cuba. On landing,
one sees groups of natives, who seem to have nothing to do
but to laugh and be happy. The temperature is rarely above
90*^, usually from 78^ to 81*^. The roads, which are kept in
repair by the natives, are unsurpassed by any in the world.
The hospitals consist of one story, with open doors and win-
dows, and patients can be seen stretched on their cots, mostly
old people and paupers. I went to Jamaica myself for my
IQOI Societies, 363
health. I broke down during my college course, and tried
various expedients in Boston, growing worse. I was gone
three or four weeks, and came back well. Twelve invalids
were on the same boat. Jamaica is an excellent place for
tired business men. Last year I sent a young lady there who
had been very sick with insomnia and loss of appetite. She
slept most of the time in Jamaica, and can)e back absolutely
well. Another case went to Jamaica under my direction, a
man occupying a very prominent position, who was overworked
and had been rejected by several insurance companies because
of sugar in the urine ; he was also troubled with insomnia.
The first night out he slept and every night thereafter. In
four weeks was entirely recovered. Upon his return one of
the insurance companies, who had previously rejected him,
gave him a policy for i! 10,000.
In visiting Jamaica the things to be avoided are : alcohol,
wet clothing and the mid-day sun.
If any physician is tired out and wants to rest, there is no
better place than Jamaica. If he has any patients with ner-
vous troubles he should send them to Jamaica.
Dr. J. T. Sherman : I quite agree with all that has been
said about that beautiful place, Jamaica. I had, on one occa-
sion of my visit, a long talk with an English naval captain, '
who had been all over the world, and he knew of no more
beautiful place than this.
One point I would call attention to. I would advise inva-
lids visiting the Island not to go during the rainy season.
Late in November or last of January is the best time. Dr.
Davis spoke of abstaining from alcohol while there. I saw
more cases of delirium tremens than ever before. All use of
alcohol should be avoided. Some people seem to think they
must take alcohol upon arrival, but it is a great mistake.
Cases of alcoholism would lie in a comatose condition a day
or more before the excited stage came on. One of the physi-
cians there said it was very dangerous to take the vile stuff.
I think the voyage has a great deal to do with the benefit
derived. From July to October you are liable to strike a
364 . The New England Medical Gazette, July,
hurricane, but from the first of November to the first of July
there is absolutely no danger, and the only thing encountered
will be an occasional shower. I should certainly recommend
it for neurasthenics. The climate far surpasses that of Flo-
rida, which is so humid it is oppressive, and the air from the
Everglades is malarial. On the north side of the Island you
get the north-east trade winds in summer, and in December
the sun. At Kingston, the last time I was there, the thermo-
meter was 100^, and suffering more from heat than before, I
returned to Port Antonio, where the nights are usually cool,
and no particular change in the temperature at any time.
The Island itself is beautiful ; flowers and maiden-hair ferns
grow in profusion ; one mountain is covered with the fern.
I think fruits should bd avoided. If a patient will be careful
and keep out of the sun during the middle of the day and the
dew in the morning, taking off clothing as soon as damp, no
harm will result,
2. Dr. H. H. Amsden's paper reporting a case of small-
pox cured with tartar emetic, was listened to with marked
attention ; and the discussion which followed was full of pro-
fit, especially to the younger members present.
Dr. Conrad Wesselhoeft : In discussing this paper it is not
my object to criticize it, but, if possible, to add some experi-
ences of my own, I have not read up much upon it for some
time. I ought, perhaps, to have done so, but will give you
some of my own limited experience A physician may go
through several epidemical attacks of small-pox and see sev-
eral cases without getting much real experience of the disease.
This has been my case. I can remember four distinct epi-
demics. My first experience was in the '50s, when I saw two
or three cases, which I remember very distinctly. One case
was in a family in Dorchester, a young lady. The eruption
was slight, and certainly had not arrived at the point of pus-
tulation when I left the case one day, and the next day the
patient died. It was quite a shock, as there was every sign
of early recovery. That is all I can say about that case.
Very soon after that I saw another case, a child about four
I90I Societies, 365
years old, in an Irish tenement, who had the disease very
marked. It had passed from the vesicular stage to that of
pustulation ; but in none did I discover umbilication. I know
that point was impressed upon my mind. The child recov-
ered in a short time. The vesicles dried and the child was
well. I do not remember how long the convalescence lasted,
but it recovered very soon. During the Civil War, some
time in the '60s, I saw several cases ; I do not know how
many — not a great many. One was extremely severe. It
was termed confluent small-pox where the vesicles canie out
first very close together, and the pustules were as close to-
gether as cells in honeycomb. Another case was that of a
woman about fifty years old, who was fleshy, which made the
case all the worse. I went two or three times a day to dress
the case. Once the pustules broke, and the pus went all
over everything, — over the bed, over my hands, and I expected
in fourteen days to have the disease, but did not. The patient
went out of my hands, and died about a week later.
In '72-73, when we had quite a flurry of small-pox cases, I
had several cases (ten or twelve) which were all mild and
distinctly diarrhceal. Now about the distinction between the
cases of varioloid. There may be cases of varioloid which
are really small-pox, but much milder than cases of chicken
pox. The child with the marked vesicles, without pustula-
tion, was a violent case of chicken pox.
Another case : that of a young lady. She had some fever.
I advised her to stay at home, as she had a pimple on her fore-
head, though I was not sure it was small-pox. She went to a
dancing party,'and my first observation was the pimple; it
had developed into an umbilicated vesicle. I took her aside
and advised her to go home. The distinction is that in .
varioloid very few of the vesicles reach the stage of umbilica-
tion, while in the genuine, or more violent, the umbilicated
vesicles are always in the majority This is the distinction
between the two diseases as far as I am able to make it. The
distinction between the different forms of this disease and
scarlet fever is very easy, but not so with measles. When
366 The New England Medical Gazette, July,
they first break out, it is very difficult to say what they are
going to be, when there is headache and fever. Infants have
the measles lightly, but with older people the eruption
appears slowly, and the disease is apt to be severe. If an
isolated case, it is better to reserve judgment until it is known
what shape the primary pimples are going to take.
Now with regard to the treatment of these cases I have
very little to say. The greatest caution should be used to
keep patients quaranteed. Bathe with soap and water, adding,
perhaps, a little soda, and the utensils should be very care-
fully destroyed. In olden times this did not receive much
attention. Sterilized gauze and cotton should be burned after
using. Perhaps the use of a little vaseline, or any other
greasy substance on the parts, will prevent the spread of dis-
ease. Premonitory symptoms are sometimes the most violent
of all, and you think the patient is going to have some violent
disease, whether typhoid fever or small-pox it is often difficult
to say. One case I had where the symptoms were most dis-
tressingly violent. ' The patient was unconscions and deleri-
ous ; at last little pimples appeared in very small number, not
more than half a dozen, overall the body. They went through
^he course very lightly, dried up and dropped off, without
leaving any scars. You would have supposed the patient was
going to have some fatal disease. Unfortunately, it is impos-
sible always to say as to remedies. I shall mention only one
or two. Aconite and veratrum viride are certainly very ex-
cellent in premonitory stages of the disease. In the second-
ary fever stage, especially at the time of pustulation, it seemed
to me, if I can call it experience, rhus was the best indicated.
The appearance of small-pox is allied to that of erysipelas. I
cannot now remember whether I had any striking results. I
have seen no death, except what I have mentioned. When
the pustular stage is distinctly developed, I have used tartar
emetic in the third trituration, with the result that the pus-
tules would dry up before their time and would not run the
course that they would in other cases.
Dr. Sutherland: I would like to ask when patient's hus-
band was vaccinated }
igoi Societies, 367
Dr. Arasden : He was vaccinated about the third djy of
the disease.
Dr. Clapp : That was the work we tried to do in the epi-
demic of '72. It was done successfully. It was a race be-
tween the germs of the disease and the germs of the virus,
which should get there first. At that time nothing else was
talked about, the papers were full of it, and it was the talk of
the town. I saw a good many cases, I think there were at
least fifty, not only my own cases, but those I saw with older
physicians. I was enthusiastic and anxious to see as many
as possible for the experience. My ardor ought to have been
tempered by the recollection that the disease is, as a rule, an
extremely nasty one ; that is the only expression that occurs
'to my mind, especially as there were many severe cases at
that time. Nevertheless, I had no personal fear, because I
had supreme faith in vaccination. One thing was demon-
strated : that vaccination protects, but not unless it saturates
the system.
Dr. Amsden : With what did you vaccinate }
Dr. Clapp : From arm to arm, — from a healthy child.
Dr. Chase : Did you not use ivory points }
Dr. Clapp : Ivory points came in before. I never saw a
case of transmission of disease from one child to another, and
yet upon that Dr. Martin depended for the sale of his virus.
Dr. Sherman : In the winter of '73 I had charge of the
small-pox, hospital. There were four thousand vaccinations
made under my directions, when I took patients out of houses
if I could vaccinate the occupants within seventy-two hours.
If not, it would not protect them.
As to the question of what form of virus was used. I used
Dr. Martin's virus. I also got some virus from abroad. It
came in small tubes. I got very good results, though not
always as rapidly as the other in taking. It would be five or
six days before it would show.
The question of the early diagnosis of small-pox is a serious
one, and one we ought to meet. A case of small-pox, if not
under vaccination, will run a much more rapid course than
\
368 TAe New England Medical Gazette, July,
any other eruptive disease. The only way to distinguish is
to take a group of eruptions on the face, or chest, or back.
Individual groups will have every stage of the eruption. If
you have a doubtful case, I can give you good advice from my
own experience. When I had charge of the small-pox hospi-
tal I received the kindest treatment from the old school
physicians. . When they had a doubtful case they sent for
me, and left it to me to decide, because, they said, if they
made a mistake every one would be down on them, but the
town was back of me. I advise you to call the Health Officer
and let him do the deciding.
Dr. Piper : I would like to know what the experience with
glycerine lymph has been. It has not been as satisfactory to
me as that made here in Chelsea. I had a much larger per-'
centage of failures with the glycerine lymph than I formerly
had with the lymph from Chelsea.
Dr. Chase : The only difference, I think, is the Chelsea
lymph would have a larger percentage of takes. I have used
the glycerine lymph, but I have had no serious trouble follow-
ing its use. In the other form I have had quite a number of
cases of lymphangitis following, so I think it the safest thing
to use.
Dr. Amsden : I had occasion to vaccinate with Mulford's
lymph in the tube, but with excellent results. When using
the point the virus is carried a little further into the system.
I use a needle only to scarify with.
Regarding remedy : I was guided by the bronchial symp-
toms of tartar emetic. As I stated in my paper, I do not
think it is wise to draw conclusions from a single case. The
husband of my patient was attended by a physician two
weeks before the wife came down. The physician also came
down with varioloid. The husband, with a broken rib, was
more susceptible to small-pox. In this case the period of in-
cubation had elapsed. It was of some interest to me in my
explanation of the case.
3. Dr. Allen's paper covering report of cases treated at
the hospital from Jan. ist to Apr. ist, 1901, brought out sev-
1901 Societies. 369
eral interesting points in the treatment of pneumonia and
typhoid fever.
Dr. Thomas: I do not think I can say anything in addi-
tion to what Dr. Allen has said. It was very gratifying that
the cases of typhoid fever responded to treatment so well.
The case of the school teacher was the worst cases I ever
saw. She raised clear blood, which was controlled by oxygen.
In regard to the boy ill with acute nephritis I have seen him
several times since his discharge, and he is entirely well. Dr.
Allen has covered the cases very well, and the charts and
pathological specimens will speak for themselves.
Dr. Piper : I would like to ask if saline solution is given
in the hospital in pneumonia }
Dr. Allen : Not since I have been connected with the
hospital.
Dr. Sutherland : I have never used it m pneumonia, but
have given it subcutaneously for hemorrhage in typhoid fever
with most gratifying results.
I want to say in regard to the service reported, that it was
rendered chiefly by Drs. Thomas and Allen, which was
omitted from the paper, but it seems a fair thing to mention
it at this time.
4. Dr. W. H. Watters read the next paper on "Some Ex-
periences with the Plague," and it was a very interesting
account of his work abroad during the summer of 1900, in the
laboratories at Glasgow.
Dr. Sutherland: I do not know just why I accepted an
invitation to discuss the paper. I knew nothing about the
plague forty-eight hours ago, except what I saw in the paper
last summer, but I think my chief object was to look up the
subject, so I should not remain ignorant. It is possible for
the disease to progress in a very short time ; and it is the
deadliest of all diseases. Upon looking into the matter I
found only a very meagre account, and almost nothing re-
garding the etiology. I obtained possession of a little pamph-
let on the disease, and I was surprised to find the difficulty
that attends the diagnosis. I was surprised that enlarged
370 The New England Medical Gazette. July,
glands are not all necessary. Sometimes it simulates typhoid
fever or takes a diarrhoeal form. There are various types of
the disease. A case of typhoid fever, where there is a pecu-
liar septic condition and the patient has come from a distant
country, requires unusual care. If tjiere are so many types,
there can not be only one or two remedies. I think I am,
perhaps, as much at sea here as before. If a case, from the
symptoms, looks like typhoid fever, treat it as typhoid ; if
cholera, as cholera. With our improved sanitary conditions
the disease ought not to be as fatal as in the past.
Dr. S, C. Fuller exhibited the following pathological speci-
mens :
1. Specimens showing secondary carcinoma of mesenteric
lymph glands.
2. A dilated heart, showing endocarditis and degeneration
of the myocardium.
3. A large splenic tumor.
4. Chronic trichinosis of the intercostal and pectoral
muscles, the structures being studded with hundreds of en-
cysted parasites.
Adjourned at 10:25.
Edward E. Allen,
Secretary,
WORCESTER COUNTY MEDICAL SOCIETY.
The regular quarterly meeting of the Worcester County
Homoeopathic Medical Society was held at Worcester,
Wednesday, May 8, 1901. The meeting was called to order
at 10 A. M., with President Luscombe in the chair.
The records of the preceding meeting were read and
approved. Drs. J. L. Bacon, of Westboro, and Alice E.
Rowe, of Springfield, were elected to membership. The
name of Dr. Burleigh Parkhurst, of Clinton, was referred to
the board of censors.
Dr. John F. Worcester, of Dorchester, was appointed dele-
igoi Societies, 371
gate to meeting of the American Institute of Homoeopathy,
with Dr. J, P. Rand, of Monson, substitute.
Drs. Luscombe, Rockwell and Nichols were appointed a
a committee to take charge of the library of the society, and
to superintend its removal to a new location when necessary.
The following motion, made by E. B. Miller, M. D., was
carried by a unanimous vote :
Moved, that at each meeting of the society, a brief re-
sum6 of the literature of the proceeding year on the subject,
or subjects under discussion at that meeting, be presented by
one or more members of the bureau reporting. Such mem-
bers to be appointed by the chairman of the different bureaus
as early in the year as practical.
The society was invited to hold its mid-summer meeting at
Fitchburg, by the president of the society, Dr. Luscombe,
which invitation was accepted and a vote of thanks extended
to Dr. Luscombe.
Following the business session, the bureau of Neurology,
Dermatology and Diseases of the Nervous System, reported
the following papers. Dr. F. P. Glazier, chairman, was un-
avoidably detained, and Dr. Ellen L. Keith, of Framingham,
was appointed to take charge of the meeting.
1. *• Thyroid feeding in Insanity." Dr. George S. Adams.
2. "What can we do for the Consumptive." Dr. A. M.
Gushing.
Dr. Adams' paper embodied his experience \yith the use of
thyroid extract, in cases of myxodema with marked mental
symptoms, at the Westboro Hospital. He had found it of
great value in this condition, and cited several cases where
he had used it with marked success.
Dr, Cushing's paper dealt with the modern methods of the
treatment of tuberculosis, and he spoke particularly of the
use of different oils and balsams by absorption and inhalation.
These papers were topics for general discussion.
Dinner was served at the Newton at i p. m.
F. R. Warren, M. D., Secretary .
372 The New England Medical Gazette, July,
PERSONAL AND NEWS ITEMS.
Dr. John McE. Wetraore has removed from 41 East 29th
Street to 43 West 54th Street, New York City. Telephone,
48s3-38th Street
Dr. Frederick W. Payne, of Steinert Hall Building, Boston,
will spend the summer in Europe, returning the last of
August.
We have just received word of the death of Dr. Byron D.
Spencer, of Bangor, formerly of Rockland, Me.
Dr, G N. TowLE, class of '90, B. U. S. of M., formerly
located at Bucksport, Maine, has taken the practice of the
late Dr. S. Stuart Webb, of Houlton, Maine.
REVIEW.
"King's American Dispensatory." New edition. En-
tirely rewritten and enlarged, by Harvey W. Felter, M.D.,
Adjunct Professor of Chemistry in the Eclectic Medical In-
stitute, Cincinnati, O., and John Uri Lloyd, Ph.M., Professor
of Chemistry and Pharmacy in the Eclectic Medical Institute,
Cincinnati, O. Two volume Edition, royal octavo, contain-
ing together 2,284 pages, including complete indices. Cloth,
$4.50 per volume, post paid^ Sheep, $5.00 per volume,
post paid. The Ohio Valley Company, Publishers, Cin-
cinnati, O.
The issue of volume II completes this excellent work, the
first volume of which was issued in 1898. It combines
many valuable features and is probably the most complete
work of its kind in existence. Much of the subject matter
has been entirely rewritten besides which, a vast amount of
new material has been added. An acceptable feature to
homoeopathic practitioners is to be found in the mention of
many homoeopathic remedies and their recommendation in
the form of triturations. The work contains a large number
of very good illustrations, and the subject matter is treated
in considerable detail. It is full of information and should
constitute an acceptable work of reference to every physi-
cian of whatever school.
THE NEW ENGLAND
MEDICAL GAZETTE
No. a AUGUST, 1901. Vol. XXXVI.
COMMUNICATIONS.
THE 5URQICAL TREATMENT OF TUBERCULAR JOINT
DI5EA5E.
BY GRORGE W. ROBERTS, M.I)., NEW YORK.
[Read before the Mast. Surgical and Gynecological Society, June, 1901.]
Had the authpr something new and striking to offer, purely
upon treatment, it might be excusable to delve at once into
the subject with no word upon preliminaries ; but as it is,
with no great advances to report, no new remedy or opera-
tion to describe, we are obliged to deal with facts, and it
would be a grave omission were we to fail in calling attention
to the great importance of early diagnosis in its bearing upon
the successful surgical treatment of tubercular joint disease.
It would, of course, be futile to attempt in a short paper the
discussion of particular lesions, except incidentally, and,
therefore, it is the general subject which will command our
attention.
Strictly speaking, "joint tuberculosis " does not in the be-
ginning have to do with the joint except in rare instances.
In nearly all cases it begins as a tubercular osteitis in the
epiphysis, and in an appreciable number of cases it ends
without ever involving the joint structures themselves.
374 The New England Medical Gazette, Aug.,
Tubercular synovitis, tubercular chondritis and tubercular
osteitis beginning at the very end of the epiphysis are at least
rare. The vast majority of tubercular joint lesions begin an
appreciable distance from the joint itself, produce recogniz-
able symptoms before they reach the joint, and are quite
amenable to operative treatment before that time. When the
process has involved the joint we do not believe it possible to
avoid in more than a very small percentage of cases serious
limitation of motion, and only too frequently there is com-
plete destruction of the joint. It, therefore, needs no extend-
ed argument to convince one that early diagnosis is essentially
a part of surgical treatment.
It is a fact, however, that by far the larger percentage of
cases find their way to the physician and surgeon only after
that precious prodromal stage has passed, and, therefore, we
are to divide tubercular joints into two grand classes, /. e,, —
(i) Those in which the disease is still — speaking strictly —
extra articular, and (2) those in which the synovial mem-
brane was affected from the beginning, or has become in-
volved later in the progress of the disease.
This classification differs somewhat from that usually fol-
lowed by the text-books ; it is by no means complete, and is
suggested merely in order to facilitate the discussion of sur-
gical treatment. The distinction is not as important with
some joints as with others, but in general it is clear, and often
it is all-important. This applies particularly to the knee and
shoulder, for here the distance from the starting point of the
epiphyseal focus to the joint surface is often so great that
extensive operative procedures can be executed without the
least danger of seriously affecting the joint mechanism.
The same statement applies to occasional cases of tuberculo-
sis at the elbow — beginning in the lower end of the humerus.
In this class of cases it is usual to find marked epiphyseal en-
largement with muscular atrophy, spasm and flexion deform-
ity, with absence of joint effusion and swelling of the synovial
membrane.
190 1 Treatment of Tubercular Joint Disease. 375
In our judgment early extra-articular incision, followed or
rather accompanied by the free use of the trephine, drill and
Volkmann's spoon for removal of the osteitic focus by an extra
articular route, is not only justifiable, but is an eminently
conservative operation. It is to be chosen in preference to
any form of medical or even mechanical treatment under the
circumstances described.
The older the patient the more forcibly does this apply,
and in the adult one cannot doubt that a very large propor-
tion of cases can be diagnosed early enough, and saved
months of suffering and serious deformity by this means. In
childhood, when most of the tubercular bone lesions occur,
the progress of the so-called bone abscess toward the joint
is far more rapid, since there is more cancellous structure
present and correspondingly less of the resisting mineral
matter. But even in children, especially in knee-joint tuber-
culosis, it is not at all infrequent to see nature herself pursue
this course, i, e. — the tubercular focus enlarging in all direc-
tions finds an opening through the compact bony tissue at an
extra-articular point, the periosteum gives way and finally the
abscess presents at the surface, leaving the joint not at all, or
only slightly, damaged.
Whether mechanical treatment can have a very direct in-
fluence upon these cases is to our mind a fairly debatable
point, and we confess that the explanation of such influence
is quite beyond us.
However, protective apparatus can never be injurious to
these patients, and, while our experience has never shown its
advantage, we must admit that the inference would be a hard
one to draw.
The second class of cases, those in which the lesion invol-
ves the joint itself, either having begun in the synovial mem-
brane, or having extended from the epiphysis to the joint
cavity, presents an entirely different clinical picture, in addi-
tion to muscular spasm and atrophy, the cardinal symptoms
of joint or epiphyseal tuberculosis — we find in case of the
376 The New England Medical Gazette. Aug.,
superficial joints the diffuse, fusiform enlargement, which in
addition to the other symptoms almost always portends
chronicity and ultimate serious impairment of function. No
class of surgical cases is as trying to the surgeon's time and
patience, — you may spell the word both ways. If he is to
be adequately paid for his services the patient's pocket-book
must also suffer, but — Ah ! How frequently are these cases
among the dispensary class, and how rarely among the opu-
lent. And this circumstance has a direct bearing upon the
prognosis, for hbwever altruistic the surgeon there soon comes
a limit to his possible accomplishment, unless generous means
are at his disposal. In the vast majority of such cases it is
absolutely useless to start with any method of treatment
without impressing upon the patient, parents or guardian the
extremely chronic condition of this disease, the fact that in
order to accomplish even a tolerably good result, months and
years, rather than weeks, of care will be necessary.
In the Laura Franklin Free Hospital for Children, where
we always have a large sprinkling of these cases, we find that
a generous proportion of them have been ** cured " at one
time or another, according to the parents' story, and we must
confess that parents, particularly of the poorer classes, can
hardly be blamed for failing to see necessity of such prolonged
treatment as is often necessary in order to save a joint which
has become tubercular.
The surgical treatment of these cases is both mechanical
and operative. Considering the mechanical side first we are
at once confronted by a score of opinions and theories which
are more or less antagonistic in their details, but, at the same
time, the general principles underlying all are annually becom-
ing better defined, and perhaps we may be pardoned for confin-
ing ourselves to the main features, rather than entering into
details which would necessitate intolerable prolixity.
We firmly believe that mobility of the limb, together with
the constant increased intra-articular pressure engendered by
muscular spasm, are the greatest auxilliary factors in de-
IQOI Treatment of Tubercular Joint Disease. 377
struction of the joint and in aggravation of the tubercular
process. Both fixation and extension are therefore indicated
if we would minimize the damage and place the limb in the
best possible condition for recovery. The theory that fixation
of a tuberculous joint tends to its ankylosis is quite exploded
in our opinion.
The question before the orthopoedist is not " whether to
fix and extend/' but " how to fix and extend." Unfortunate-
ly, perfect fixation and perfect extension are each quite im-
possible, and we must therefore be content, even in the most
favorably located joints, with as good approximation of these
two conditions as circumstances will permit. In some joints,
notably the ankle and those of the upper extremity, extension
is quite out of the question, but here Nature has been kind
to us, in that in each instance we are dealing with a joint in
which the disease is never as serious as in the knee or hip,
and the result of simple fixation and non-use is quite satisfac-
tory.
In tuberculosis of the hip we are in the habit of using the
Phelps method, which consists, briefly, in first placing the
child in bed, and having fixed the body and well leg in plas-
ter of Paris, extending the leg with the weight and pulley, in
the line of the existant deformity.
As soon as complete relaxation of the muscular spasm has
been attained (three to eight weeks), we apply the long
Phelps' splint, which provides both traction and fixation.
When the knee is affected, the Thomas knee brace is preced-
ed by fixation with plaster of Paris, and, in the more aggra-
vated cases by traction.
One of the most important and, unfortunately, frequently
neglected points in the use of traction is that, as its object is
the diminution of intra-articular pressure, it must be executed
in the line of deformity.
Frequently physicians, carrying in mind the fact that
their object is to straighten the limb, pull it toward the
straight line. In the more pronounced angular deformities
378 The New England Medical Gazette, Aug.,
this result is an increase instead of diminution of intra-artic-
ular pressure, for the reason that the long bone to which the
traction is applied, having inserted into it the rigidly spastic
muscle acting as a fixed point, acts as a lever of the first-class
in which the weight moves in a direction opposite to that in
which the power is acting.
Another grave error is the omission to fasten the child's
body and the well limb when applying extension in hip dis-
ease. If we fail to fix the pelvis there is no use in fixing the
diseased limb, for motion of the pelvis has the same effect
upon the joint that the femur has.
In tuberculosis of the ankle, tarsus, shoulder, elbow, wrist
and corpus, immobilization must suffice, since efficient exten-
sion is quite impracticable.
In all serious cases of tubercular joint disease there is op-
portunity for difference of opinion as to when mechanical
treatment must be supplemented by some of the more radical
operative measures. It is exceedingly difficult to express an
opinion which will apply to all classes of cases. A small so-
called cold abscess, when in relation with the deeper joints
like the hip and shoulder, is in our judgment best handled by
simple aspiration. The injection of various solutions and
emulsions of iodoform have given us poor satisfaction, indeed.
The procedure is painful and not without danger, and does
not in our experience present any advantage whatever over
simple aspiration. If the fluid re-collects once or twice it is
usually bound to come to the surface, and we take this or a
large collection of fluid as an indication for operation. By
operation we, of course, do not refer to mere incision. If
these fluid collections — the result of caseation — are to be in-
terfered with at all beyond simple aseptic aspiration, the
operation must be as complete and radical as possible. In
operating these cases it must be borne in mind that the fluid
and the cavity are, so far as the ordinary pyogenic germs arc
concerned, aseptic but capable of infection.
The abscess cavity invariably connects directly or indirect-
190 1 Treatment of Tubercular Joint Disease, 379
ly with the joint cavity or with the epiphyseal focus, and if
we would avoid a mixed infection, which is always serious and
frequently fatal, the operation must be conducted upon the
same lines of asepsis as we would employ in opening a healthy
joint, or the abdominal cavity itself. The short incision
is a delusion ; if we cut at all it is far better to incise
the cavity from one extremity to the other. It is our custom
to make — barring anatomical barriers — an incision which
equals or exceeds the longest limits of the cavity, to retract
widely, and, having evacuated the fluid, to expose every nook
and comer, using the Volkmann's spoon to remove the tuber-
cular membrane, with the most painstaking precision. From
some portion of this cavity will be found the tortuous sinus
leading to the joint and the original bone focus. This sinus
may be small, but the spoon will easily make it large enough
to admit the finger with which the joint is explored ; diseased
bone is then freely scraped away, or the joint resected if nec-
essary.
A large rubber drain pipe, as large as the finger and with
stiff walls, is then introduced, entering the joint by the most
direct route from the surface. The rest of the wound is
closed, and we, as a rule, get aseptic healing of all except the
drainage tract.
Arthrectomy and excisions must be looked upon as major
operations, and the greatest discretion is necessary in their
election ; the advisability, methods and results of a single
class of excisions is an ample subject for a long article. We
can, therefore, only consider one or two important points. In
children any amount of temporizing which does not endanger
the limb or life is justifiable rather than the performance of
a resection, which removes epiphyseal lines before the bone
has nearly or quite completed its growth. Resection of the
knee under twelve years of age is followed by disastrous
shortening of the limb. Each bone has its peculiarities in
this respect, and he who disregards them brings upon the
patient serious results and upon himself the patient's just
380 Ihe New England Medical Gazette. Aug.,
condemnation. In conclusion it may be said that this sub-
ject might better be handled in a volume than in a paper of
respectable length, — that it tries the surgeon more sorely
than does the delectable vermiform appendix and the serpi-
ginous pus tube put together, — that our mistakes in these
cases are far more hideous than the ill-adjusted fractures
which haunt us in our dreams, and send us to the Fidelity
and Casualty for a mal-practice policy, — and our triumphs are
often more beautiful when described than when seen with
the naked eye.
nODERN AIDS TO ACCURATE DIAGNOSIS.
KY J. I*. RAND, M. D., MONSON, MASS.
(Read at the annual meeting of the Mass. Horn. Med. Society, April 10, 1901.)
Ladies and Gentlemen:
The subject assigned to me is too large for anybody to com-
prehend within the limits of a single paper, since all that has
proved valuable in the past we still retain to form with dis-
coveries of later date the modern aids to accurate diagnosis.
I will therefore make no attempt to cover the whole ground
but state as concisely as possible some of the methods by
which medicine has been taken out of the mysticism and de-
veloped into an actual science.
Disease was formerly supposed to be the result of some
offence to Deity, and even yet the superstition is implied in
our formal expressions of condolence. We still hold the Deity
responsible for our personal bereavements when .we say,
*Whereas it has seemed best to an all wise Providence to take
our dear brother or sister, etc."
But the golden thread of truth runs through all ages and
superstitions alike Our deities change with the measure of
our comprehension, and while the religion of the savage and
scientist has but little in common, in this they both agree :
Disease is still an offence to the Deity — the Deity of natural
law by which our material bodies are governed.
190 1 Modern Aids to Accurate Diagnosis. 381
There are a few diseases mentioned in the New Testament
in connection with the miracles of healing, viz.: leprosy,
metorrhagia, epilepsy, congenital amaurosis, paralysis, fever
and dropsy, though some of these we consider as symp-
toms only. From this small beginning of nineteen hundred
years ago diseases have been studied, classified, and divided
until they are far more numerous than the hair upon some of
our heads, in short, are practically without number. I do not
mean by this that diseased conditions have materially in-
creased, of course they have to some extent, but not greatly.
The difference comes rather with our improved habits and
means of observations which constitute the words of my sub-
ject. Diseases themselves are not new.
But what are some of the ''Modern Aids to Accurate Diag-
nosis ?" First — The improved forms of surgical technique by
which the "exploratory incision" is made a warrantable pro-
cedure. Seeing puts an end to guess-work. Prof. Helmuth
used to tell his classes, "It is a very easy thing to diagnose a
tumor when you have it on the table". That was before the
days of license in abdominal explorations. To-day the con-
servative surgeon will very rarely venture a positive opinion
in an obscure case. With the sweetest tones of assurance
the patient is invited to come to the hospital for an "explora-
tory incision" and so trivial has the procedure become to the
mind of the operator that it is advised with less hesitation
than a young physician would feel in asking a patient to dis-
robe for a physical examination.
The exploratory incision however is a great "eye opener,"
in short is an autopsy in the original and best sense of the
word. It lets light into many an obscure corner and often
prevents and takes the place of a post-mortem examination to
establish a diagnosis.
How many cases of ovarian disease have been mistaken for
appendicitis — how many distended gall-bladders for malignant
growths — how many normal pregnancies for uterine fibromo
only thoise who have had experience can appreciate or under-
stand.
382 The New England Medical Gazette. Aug.,
Almost every surgical device contributes in some way or
other to accuracy in diagnosis but the ones upon which we
especially rely relate particularly to the organs of sight. Take
so simple an apparatus as the conical speculum, the convex
mirror and a condensed light and you have the open door to
the diagnosis of almost every disease of the nose, ear, throat,
vagina and rectum.
The Opthalmoscope constructed upon a little different plan
makes it possible to inspect the anterior chamber of the eye
and to see highly magnified, the terminal branches of the op-
tic nerves and blood-vessels as they appear upon the choroid
and retina. Nowhere else are the nerves and blood-vessels ex-
posed to such direct observation, and strange, but true, dis-
eases of remote organs, especially the kidneys, can often be
detected in this way.
More wonderful still is the cystoscope with its incandescent
electric light for examination of the distended bladder, and a
like apparatus for exploring the stomach through an oesopha-
geal tube. Prof. Doughty, of New York, told us at our meet-
ing last October, you remember, his method for injecting the
kidney itself through the ureter in order to determine its po-
sition, distensibility and size.
But there is a world beyond our feeble vision in which lies
hidden the key that unwraps the mysterious origin of disease.
Here are the secrets of life and death, here the wonders of bi-
ology and pathology and the microscope is the "open sesame"
to them all.
The essential principle of the microscope is not new. In
1671 a Jesuit priest named Kircher, with a crude magnifying
glass discovered "minute living worms" in putrifying cheese
and meat. Only four years later a Dutch linen merchant,
Anthony Van Leewwenhoek, beheld in the saliva, intestinal
contents, rain water, and decomposing fluids "minute living
particles" which he called animalculce.
In 1762 Plencig, of Vienna, after much careful observation,
asserted his belief that the phenomena of disease and the de-
composition of animal fluids were wholly caused by these mi-
I go I Modern Aids to Accurate Diagnosis. 383
nute living germs. And yet for over two centuries the theory
of spontaneous generation held sway and had it not been for
the indefatigable labors of Cohn, or Koch, and the peerless
Pasteur, might still remain.
The evolution of the microscope has been the evolution of
pathology and the evolution of pathology means accuracy in
diagnosis.
Think of what the microscope has already done for the ad-
vancement of science! Beginning with scabies which was
once supposed to be a constitutional taint it brought the
acarus into view and proved the parasitic origin of the dis-
ease. Then came hydatids in recurring abscess of the liver
and traechini in diseased pork, and then that line of abnormal
tissue formations we designate as innocent and malignant
growths.
It is no secret that the master minds in the profession
await the report of the microscope before venturing a diagno-
sis.
By the aid of chemistry, centrifugal sedimentation and the
microscope, urinary analysis has been brought to a high state
of perfection. There is no disease of the kidneys in which the
urine does not afford reliable information and in some it is our
only source. Here we find renal and bladder epithelium,
crystals of many and various salts, corpuscles of blood and pus,
masses of fibrin or albumenoid material thrown off as casts,
numerous forms of minute vegetable growths known as bac-
teria, and possibly the male element of reproduction. Com-
pare the one crude test of boiling a suspected urine with the
many delicate and distinct analyses that we now employ and
you can gain some idea of the tremendous advances made in
a single department of diagnosis.
But the microscope cannot work alone. Diseases are for
the most part associated with, if not produced by, minute liv-
ing vegetable growths called germs. Just how these germs
produce the phenomena known as disease is not fully under-
stood, but the fact of their etiological relation is no longer
doubted. The modern pathological laboratory is the oracle
384 The New England Medical Gazette. Aug.,
of scientific investigation. Here are prepared those culture
beds upon which are propagated and grown almost every form
of bacteria which produce disease. The hanging gardens of
ancient Babylon were surely not more wonderful.
You are all familiar with the methods commonly employed
for the detection of diphtheria by our municipal authorities.
The germ of this disease was discovered by Klebs in 1883
and a little later was studied by LoefHer who proved it to be
the cause of diphtheria. Under favorable conditions this germ
multiplies very rapidly, much more so .than the ordinary
forms of bacteria, so that we are able to recognize it by the
rapidity of its growth as well as by its microscopical appear-
ance.
It is only a few years since that the brightest clinicians
were wrangling over the differential diagnosis of diphtheria and
membranous croup. The one was supposed to be a constitu-
tional disease highly contagious with a local manifestation in
the throat. The other was regarded simply as a local dis-
ease. But the microscope found in both the same pathogenic
bacteria and settled the whole question at once.
But diphtheria is not the only disease of obscure origin
which the microscope has made plain. Already the test has
assumed formidable proportions but the end is not yet. In
1885 Pollender discovered the germ of that disease common
among cattle but sometimes present in the human subject,
anthrax. In 1879, Hansen, that of leprosy, in 1889, Eberth,
that of typhoid fever, in 1882, Koch, that of tuberculosis
following with that of Asiatic cholera two years later. In
1884, Nicolaier, that of tetanus, in 1886, Frankel proved the
diplococcus of pneumonia to be the cause of that most fatal
disease. In 1894, Kitasato and Yersin discovered the germ
of the bubonic plague, that "black death" which swept over
Europe in the fourteenth century destroying twenty-five
millions of people, and in 1894 Canon and Pfeiffer claimed to
have discovered that smallest and most active of known mi-
crobes, viz., the grippe germ with whose result we are all of
us more or less familiar.
IQOI Modern Aids to Accurate Diagnosis. 385
But the causes of our most typical of all infectious diseases,
small pox, measles and scarlet fever have thus far eluded
detection. All are without question of bacterial origin. The
very fact of a period of incubation is proof that the original
infection was not sufficient at the start to produce immediate
results. It requires time for it to multiply and grow before the
characteristics of the disease appear. Newton had no clearer
demonstration of the law of gravity in the falling apple than
have we of a specific living germ in every diseasp that exhib-
its a period of incubation. We may not find this germ, our
glasses may be too weak, yet it is there.
All pathogenic germs, however, are not of vegetable origin.
One at least, plosmodium malariae, is an animal parasite
which was discovered in the blood of afflicted patients, by
Laveran in 1880. It had been long observed that malaria was
most prevalent in low marshy districts and that infection was
most likely to follow exposure to the night air in the summer
or early autumn. It had also been observed that the disease
was not directly communicated from one individual to another.
People living in malarious districts had well held the mosquito
as an object of detestation, with him they had fought and
bled and died. Then came a pause in the denunciations of
the poor insect ; scientists had found the germ of malaria in
his insatiable maw and the cry arose, "the mosquito is God's
good angel sent to eat up and destroy the malevolent bacteria
that devastate the race. But the pause was only a brief one.
Soon the apprehensions- came that the mosquito who could
take up germs might scatter them as well, and his winged
majesty became an object of suspicion.
In 1896 Dr. Bignami published in the Lancet a very strong
argument in support of the theory that the infection of mala-
ria was usually due to the bites of mosquitoes, but it was left
to the closing year of the nineteenth century to demonstrate
the fact. Italian observers had repeatedly shown that mos-
quitoes from a malarious district when allowed to bite perfectly
healthy persons, who lived outside, would communicate to
them the disease.
386 The New England Medical Gazette, Aug.,
History has shown no grander display of enthusiam than
that of Dr. Sambron and his companions who exposed their
lives to the contagion of malignant malarial fever in the
marshes of Campagna, Italy, only last summer: Dr. Sambron
believed that a certain variety of mosquito called the
anopheles was the agent by which the malarial germs were
communicated and the experiment was tried to prove it.
With one sole companion he camped out for three months in
a most intensely malarial district taking no medicine or any
precautions whatever against contagion, except to protect
himself from the bites of mosquitoes, and neither he nor his
companion took the disease.
A very strong counter-test was also made a few months
ago when mosquitoes that had bitten malarial patients in Italy
were sent to London, where there is no acute malaria, and
there allowed to bite the son of Dr. Manson, who, according
to Dr. Osier, really suggested the mosquito theory of malaria.
Dr. Manson's son was strong and perfectly healthy, but in a
few days following the bites of the mosquitoes he developed
a typical attack of malaria.
Compare this nicety of observation with what was consid-
ered good practice in the diagnosis of malaria only a few
short years ago, viz., the administration of heroic doses of qui-
nine. If the patient lived it was malaria, if he died it was
not, though the dose taken might have been enough to kill
him.
We smile at the credulity of our English ancestors whose
test for witchcraft in the seventeenth century was by wrap-
ping the suspected individual in a sheet with his thumbs and
great toes tied together and then dragging him through a
mill pond. If he sank promptly, he was considered innocent,
if he did not he was condemned to death.
Some day the therapeutic method of diagnosing malaria by
quinine and syphilis by merucry and iodide of potash will ai>-
pear as crude to the scientific physician as the barbarous tests
for witchcraft do to us. The Philadelphia Medical Journal of
March 30, 1901, in speaking of suppurative conditions simu-
I go I Modern Aids to Accurate Diagnosis, 387
lating malaria, says, "The delay caused by the administration
of quinine in order to exclude malaria is as a rule inexcusable
for we have at our command that more reliable source, the
microscopical examination. ... A single droplet of blood
will not only determine the presence of the disease but will
also indicate our therapeutic measures and the necessity of
proper isolation to prevent its spread by means of mosquitoes."
And right here let me call your attention to a very inter-
esting report presented at the Pan-American Medical Con-
gress in Havana only last February, by Dr. Reed and his as-
sociates of the U. S. A. on the propagation and spread of
yellow fever.
I cannot go into the details of his experiments, but the gist
of his conclusions were: that in no instance was yellow
fever communicated by fomites or contaminated clothing, as
we have hitherto supposed, but that in all eases the agent ol
infection was a variety of mosquito known as the ciilex
fasciatus, and this being true, the most effectual methods of
preventing the spread of the disease must be the destruction
of mosquitoes and the protection of both sick and healthy
against their bites.
I will also add that the specific germ of this disease, though
claimed to have been discovered by Sanarelli in 1897, is not
known.
The question of malaria opens up the whole subject of
blood examination and the possibilities that go with it. Of
late much attention has been paid to this branch of pathology
as a means of diagnosis.
With suitable apparatus we may count the different varieties
of blood cells and ascertain their relative numbers. Normally
there is about one white corpuscle to three hunc'red red. A
moderate increase of white corpuscles, say one white to one
hundred red is called hyperleucocy-tosis. A still greater in-
crease of the white corpuscles is leucaemia. If there is a
marked diminuation of the haemaglobin or coloring matter of
the blood without a corresponding decrease of the red corpus-
cles the condition is called chlorosis. If we have the clinical
388 The New England Medical Gazette, Aug.,
features of leucaemia, such as enlargements of the spleen
and lymphatic glands without the characteristic changes in the
proportion of blood cells, we have a pseudo leucaemia or
Hodgkin*s disease. When the red corpuscles are very much
diminished in number and deformed in outline, the amount of
haemogoblin relatively increased and the number of cells nor-
mal or diminished, we have all the conditions known as per-
nicious anaemia whose prognosis is very grave.
Here are at least five diseases once classified under the gen-
eral terra, consumption of the blood, which the microscope
has made possible to differentiate. And we must not forget
the achievement which this society has already recognized,
of that promising young pathologist, Dr. Solomon C. Fuller,
who first observed and published to the scientific world, crys-
tals of morphine in the blood of an opium eater.
• There is one aid to accurate diagnosis too old to be called
modern and too valuable to be set aside, and that is the steth-
oscope which was introduced by Laennec in 1816. I will not
attempt to describe its various forms and modifications. The
principle of all is the same and the best instruments of to-day
possess little advantage over the one oiginally devised By
means of the stethoscope we are enabled to recognize and
interpret the various sounds associated with the heart as well
as the grosser forms of pulmonary disease, It is a very easy
thing to diagnose a pleuritic effusion, a large cavity or ex-
tended area of consolidation by percussion and auscultation.
But I doubt if the man lives who can tell infallibly whether a
given consolidation is tuberculous or not by the physical signs.
He may think he can, and in the great majority of cases his
judgment may be correct, but unless he has actually seen the
germ of tuberculosis present he cannot be sure.
And right here I crave your indulgence if I digress for a
single moment to enter a protest against the sending of a sus-
picious patient to a hospital for consumptives whose sputum
is not known to contain bacilli. It is wholly possible that the
patient may not be tuberculous at all, and, if he is not, you
are exposing him to an unnecessary risk.
igoi Modern Aids to Accurate Diagnosis, 389
Be the hospital ever so cleanly there is still a certain dan-
ger of contagion and the weakened and debilitated constitu-
tion is just the one to suffer by it.
Personally I believe the microscope to be the consummate
diagnostic test in pulmonary tuberculosis.
Three years ago I obtained the records of 273 patients
whose sputa I had examined. Of this number 177 showed
bacilli and 96 did not. Of the former 81 per cent, had already
died of tuberculosis, of the latter only 3 per cent., and some
of these may possibly have become infected subsequent to the
examination. At any rate the presence of bacilli in the spu-
ta of a suspicious patient diminished his chances for recovery
forty-eight times.
If the death rate was any evidence of a correct diagnosis
the microscope surely made a creditable showing.
I cannot forego the temptation to digress a little farther and
tell you the glad news that consumption in this state at least
is on the decline. According to the official returns of the
Massachusetts Board of Health, in 1890, 130 out of every 1000
deaths were due to consumption, while in 1899 there were
only 99.5. An actual decrease of 3 1-2 per cent, as compared
with the entire death rate and a comparative decrease of
nearly 24 per cent, if consumption is considered alone.
Remember this when the climate of Massachusetts is com-
plained of. Instead of the old stereotyped statement that one
seventh of our people die of consumption, we can now say,
that in 1899, not one-tenth of our mortality was due to this
disease.
But I must not digress farther ; I wish I had the ability to
crowd the wisdom of a thousand pages into a brief statement
of fifteen minutes I would like to speak of cerebral locali-
zation and of the advances made in diagnosis of diseases of
the stomach, but there is not time.
I cannot close however without at least a reference to that
modern and most wonderful electric invention known as the
X Ray. From a surgical standpoint it forms with anaesthesia
and antisepsis a trinity of tremendous possibilities.
390 The New England Medical Gazette. Aug.,
The importance of this discovery when all the world was
bristling with bayonets can hardly be overestimated. The X
Ray and the R/d Cross Nurse are the two lone stars in the
dark horizen of a wounded soldier.
I will not describe the apparatus or its use ; you are all fa-
miliar with both. It is no longer impossible to see through
the solid flesh, and when we think of Garfield, and the lives
that might have been saved in years gone by by just such an
instrument, the words addressed to the Master by the sisters
of Lazarus appeal to us with peculiar significance; "If thou
hadst been here our brother had not died".
And lastly, let me emphasize my belief that the achieve-
ments of the century just passed are but the earnest of better
things to come.
There are men in this society who have watched the evolu-
tion of medical diagnosis from small beginnings until it is
almost a science. It will be a science sometime, and some-
time we shall be able to recognize and understand the various
phenomena known as disease as easily as we can now com-
prehend the cause and periodicity of a solar eclipse.
Sympathy Between the Eyes and Teeth. — To cases of
neuralgia of the eyeball and surroundings produced by dental
irritation McQuillen added an important report, a case of se-
vere attack of neuralgia of right side of face, extending to the
temporal and frontal region and involving the right eye. Her
physician being under the impression that the teeth were at
fault, brought her to him. The pulp of the right canine was
found exposed ; four of the other teeth were also badly de-
cayed, and it was thought advisable to extract all of them and
make a new plate in place of the defective set which the
patient was wearing at the time. There was not the slightest
recurrence of the neuralgic pains. McQuillen adds that if
every physician recognized the importance of a prompt exam-
ination of the teeth under similar circumstances, a great deal
of unnecessary pain could be spared their patients.— y<?//r«a/
of Ophthalmology.
190 1 Tuberculosis and the Great Soutlnuest. 391
TUBERCULOSIS AND THE GREAT SOUTHWEST.
By Dr. Merrill, Colorado, Texas.
In submitting the following article, the writer begs to state
that he is fully aware of the fact that there is already in exis-
tence a sufficiently cumbrous list of places to which those
afflicted with pulmonary tuberculosis may resort. This arti-
cle is not intended to call attention to a location necessarily
more favorable than any other to the phthisical patient, but is
designed to describe as briefly as may be, a region which,
while remote from New England, may perhaps be available to
the use of some practioner. The locality referred to is situa-
ted in the west central and western portions of the State of
Texas, in general along the line of the Texas and Pacific rail-
road. Pure and bracing air, suitable elevation, generally fa-
vorable climate, and easy conditions of existence are some of
the advantages which prove beneficial to a certain class of tu-
bercular patients. The expression "certain class" is used ad-
visedly, because the patients who derive most benefit from a
stay in this part of Texas are those who have little or no tem-
perature, slight consolidation, and who, in brief, present incip-
ient cases. A noticeable peculiarity of the region consists in
the fact that many tubercular patients gain strength and ac-
tivity, become free from expectoration, and are enabled to live
apparently in perfect health, so long as they remain here. A
return to the North is frequently attended with recurrence of
temperature, cough, sweating, emaciation, and other unfavor-
able signs ; and several cases where permanent stay at the
North was attempted terminated in death. Cases showing
comparative advance in the disease seem to be arrested, but
cough is not always permanently stopped. In one case com-
ing to the writer's notice, the patient had had numerous hem-
orrhages, very copious expectoration, and other signs of well-
established phthisis. Life in the open air caused the cough
and expectoration to disappear, but they recur when the pa-
tient is overfatigued or otherwise physically depressed. Ad-
vanced cases are not at all benefited by a life here, but gener-
ally progress rapidly to a close. We have now spoken of the
392 The New England Medical Gazette, Aug.,
effects of this region upon different stages of phthisis. For
those contemplating a trial of the curative Texan plains it is
well to understand the mode of living most conducive to im-
provement and recovery. A life of activity in the open air
should be the object to be attained. Cattle-raising is the chief
industry here, and it is generally easy to make some sort of
arrangement to become located on a ranch. Many ranchmen
willingly receive those too ill to labor. A patient able to do a
limited amount of work can nearly always find opportunity to
do ranch work for his board.
Regarding now the region itself. As before indicated, it
lies in the west-central and western portions of Texas, and
that part of it of which we have personal knowledge comprises
an area lying about the town of Colorado. The soil, climate
and other natural features of the territory lying within thirty
miles of Colorado in any direction are practically the same.
Even two hundred miles west of the town the same favorable
natural conditions obtain, and El Paso, three hundred and
eighty-five miles west of it, is a flourishing and. somewhat
noted resort for tubercular patients. It is not, however, so
advantageous as places east of it. The area we are describing
lies nearly in latitude 32*^, and longitude loi®. Its elevation
varies from 2,000 to 3,000 feet. Farther west, the elevation
ranges higher ; at El Paso it is 3,700 feet, and at one or two
points about one hundred miles east of El Paso it reaches
4,500 feet.
The soil is sandy or rocky, may be clay or rich earth, vary-
ing even in narrow limits of territory. It is generally dry.
The country is undulating prarie, diversified by creeks, by
cliff-like formations, and by steep and rocky slopes. The
creeks consist at times of a dry and excavated bed only,
and again after excessive rains may be roaring torrents of
water.
The drainage at any given location is nearly alway excel-
lent. The drinking water is generally obtained from wells
varying from forty to three hundred feet in depth, the water
being pumped by wind-mills. The water is often very hard
I go I Tuberculosis and the Great Southwest, 393
but varies considerably. The atmosphere is clear and dry.
More rain falls in the early spring than at other seasons of
the year, and varies greatly from year to year. The past sea-
son (1901) has been exceptionally dry.
The precipitation of dew is very slight. At times a heavy
mist in the morning wets the grass and foliage thoroughly.
During the winter, cold rains, sleet and hail are apt to be fre-
quent ; of course protection against these should invariably
be the rule.
The temperature is most enjoyable from October to Janu-
ary, being pleasantly cool and bracing during this period.
From January to March the weather is often very cold, al-
though varied by mild days. At this period "northers" are
most frequent, and the norther generally brings with it tem-
perature below freeezing.
Here it is well to emphasize the importance of being prepared
for the northers, for they come up quickly and are attended
with a sudden drop in the temperature, which remains at a
comparatively low point for three or four days. The mercury
does not often reach the zero point, but one feels the cold
more keenly on account of the frequently mild days. A
sweater is very valuable and can easily be packed on the sad-
dle or carried ; an inadequacy of proper clothing is apt to
be attended with discomfort and risk. From March to Octo-
ber the temperature is higher. The early days of spring are
frequently very warm, and the summers are apt to be hot, al-
though the heat does not seem to be unfavorable to the pa-
tient. The temperature is variable from year to year. At
times during the summer it reaches 105® in the shade. Two
factors aid materially in rendering the summers tolerable and
even pleasant. There are, respectively, cool nights and daily
breezes. As soon as night approaches the air begins to cool,
so that with almost no exception one can enjoy a comfortable
night's rest even after the hottest day. Still, sultry days are
infrequent, for the air is usually stirring, and removes much
of the discomfort incident to a hot summer day.
The winds are higher and most frequent in the spring and
394 The New England Medical Gazette, Aug.,
summer. They sometimes bring with them heavy charges of
sand and dust, and at times constitute veritable sand-storms.
Cyclones are occasional all through this region. As has been
previously stated, life in the towns should in general be avoided-
The towns are small, of the bustling western type, and possess
hotels not well adapted to the needs of a person seeking
healthful activity. Life on a ranch is interesting, varied, and
above all, healthful. Horseback riding is a prominent feature.
In addition there are wood-chopping, fence-building, work
among the cattle, farming, and all of it full of interest to one
who is at all partial to life out-of-doors.. The life is a rough
and ready one. Lady patients of refined and -delicate taste
who contemplate a stay here should be impressed with this
fact and the effect of these new surroundings upon the patient
should be carefully estimated before advising a journey which
may perhaps be inconvenient. The ranch houses are gener-
ally rough, and are invariably unplastered. Each individual
supplies his own bedding, which may of course be varied ac-
cording to taste. This had better be procured here, or bought
after ascertaining particulars from the locality planned as one's
stopping place.
The stranger will find the people very warm-hearted and he
will generally receive courteous and kindly attention. Every-
one is interested in his state, county, town, and ranch, and is
glad to point out interesting features of each. Rides over
the prarie, through the mesquite trees and brush, rounding-up
handing, farming, — a free and easy open-air existence, life in
a new and favorable environment with small encouragement
to continued thought of one's ills and symptoms ; all of these
forces combined should be as effectual as any in securing to
an unfortunate phthisical patient a life of cheerfulness, use
fulness, and of perfect, or comparatively, satisfactory health.
In closing I wish to express due acknowledgement of assis-
tance kindly rendered me by Mr. B. S. Van Tuyl, to whom I
am indebted for most of the data contained above.
Colorado, Texas,
May /f, i<)oi.
IQOI Notes on Pathology, 395
NOTES ON PATHOLOGY.
The Protozoon of Cancer.
HY G. C. FULLER, PATH. WES TBORO STATE HOSPITAL.
Qaylord, (Amer. Jour. Med, Sciences^ May^ 1901) reports
the result of his work on the etiology of cancer. Gaylord
claims that certain bodies — presumably Sporoza, which he
found in the juices and fresh scrapings of cancer, and in the
peripeheral blood of cases in which cochexia was advanced,
bear a direct causative relation to cancer and malignant tumors.
These bodies he also identifies with certain cell inclusions in
the cancerous process which may be readily demonstrated by
special methods of fixations and staining. Dr. Gaylord also
states that he has succeeded in obtaining pure cultures of the
organism on Cellis fucus crispus bouillon.
It is interesting to note that the injection into animals of
small portions of cancer material, and scrapings and juices
from cancers have resulted in lesions identical with certain
cancerous processes. In one experiment, which is given in
detail, a guinea pig was inoculated with material from an
adeno-carcinoma in roan, and killed fifty days later showed be-
ginning foci of adenocarcinoma in lungs. To be sure this re-
sult and others reported indicate the highly infectious nature
of the material injected. It is, however, difficult to ascribe
these results to Gaylord's protozoon, for as has been pointed
out (editorial in Boston Med. Sur. Jour., May 16, 1901) there
has been no satisfactory demonstration in his published arti-
cle of the "pure cultures" of this organism. Certainly at least
not in the generally accepted sense of the term "pure culture".
It is to be regretted that this description is reserved for a later
publication.
In this connection is of interest the case reported by De-
Messer.* In a typical epidermoid carcinoma removed from the
arm of an old man lycopodium spores were found. These spores
♦Vichow's Archiv. 1901, vol. clxiii, page iii, cited in Progress of I^ath-
Am. Jour. Med. Science, June, 1901.
396 The New England Medical Gazette. Aug.,
were found in the connective tissue stroma, in the clefts be-
tween the cells, or enclosed in giant cells. The man, it was
learned later, had been using lycopodium as a dusting powder
before operation. The review of the literature by De-Messer
showed that the absorption power of granulation tissue under
certain circumstances was marked, being able to absorb solu-
ble substances (alkaloids) or insoluble substances (cinibar) or
living organisms (bacteria).
The inference to be drawn from this case is natural. The
blasto-mycetes found in cancerous tissue may have a similar
origin. Further, the introduction of blasto-mycetes into ani-
mals by other observers have produced only granulomata;
still further, the mesoblastic nature of sarcomatous cells may
possess phagocytic qualities and because of this, ingest wan-
dering blastomycetes which have but a limited power q^ mo-
tion.
The Preliminary Note on tlie Relation of the Form the
Tubercle Bacillus to the Clinical Aspects
of Pulmory Tuberculosis.
Sewall, i^Med, TimeSy Mar. i6, 1901) in his studies on the
form of the tubercle bacillus proceeded in his investigations
from two points, (i.) Pure cultures of tubercle bacilli were
studied as to form and staining qualities ; and (2) the arbitrary
grouping of tuberculous patients into {a) those recovering, {b)
those holding their own, and {c) those which were manifestly
failing.
Virulent bacilli from pure cultures resisted the action of the
decolorizing fluid longer than cultures less virulent. The
plausible assumption is made that the virulent culture, exposed
to the diffuse light of the laboratory little by little, looses its
toxic power and its tenacious hold on the aniline dye. Dr.
Sewall states that the morphology of the bacilli in virulent
cultures are uniformly like those in the sputum of rapidly tail-
ing clinical cases examined by him, while no virulent cultures
presented the features of the so called "good" clinical cases.
IQOI Notes on Pathology, 397
He classifies the tubercle bacilli found in sputum as follows:
(i) a very short, relatively — broad rod ; (2) along form repre-
sented by a chain of rods ; (3) a long form, homogeneous in
structure ; (4) a long form of beaded appearance.
In the sputa of cases examined at the Adirondacks' sanita-
rium he found in the failing cases with active destruction of
lung tissue the shortest rod-like form of the bacillus. In
cases doing well the slender form prevailing while the short
and pointed forms were few or absent. In old chronic cases
where the loss of tissue had been great, but in which the dis-
ease was fairly well arrested, or in which the malady had made
such extensive havoc that the maintenance of life itself was a
demonstration of the low virulence of the infecting organism,
the bacilli were long and beaded.
The Sputum of the same case varies from month to month,
depending upon the state of patient regarding the disease.
Sewall thinks the form of the bacillus in the sputum has a
prognostic value.
With regard to the relation of the shape of the tubercle ba-
cillus, Craig* states that in his experience the beaded form of
the bacillus is found most often and numerously in the sputa
of acute rapid ily advancing cases of tuberculosis. This state-
ment is certainly of interest in this connection. Craig also
goes into a fuller description of the morphology of the tuber-
cle bacillus and their probable relation to the clinical aspects
of the case. The reader is referred to Dr. Craig's report for
furthur details.
♦Report Surg. General Army, 1900, page 63.
Ferrum Phosphoricum in Earache. — This is the remedy
par excellence in this painful affection. If the attack has
been induced by wet weather, the pain comes on in paroxysm
and after the discharge appears there still remains pain, it
will prove curative in a large number of cases. — Exchange,
398 The New England Medical Gazette. Aug.,
EDITORIAL.
Contributions of original articles, correspondence, etc., should be sent to the publishers, Otis
Cla])p & Son, Boston, Mass. Articles accepted with the understanding that they appear only in
the GazttU. They should be typewritten if possible. To obtain insertion the following month,
reports of societies and personal items mmt be rtceived by the t^ih. of the month preceding.
CEPHALIC HYPERTROPHY.
It is always interesting to watch the progress and develop-
ment of the recent graduates, as they begin practice, to note
their untiring energy, their boundless hope, their self-reliance,
their ready application of modern methods, in which they
have been well equipped, and their encouraging optimism.
All this, of course, provided they are individuals who have in
themselves the elements of progress and development.
It is remarkable as it is most gratifying to note how rapid-
ly they build up a practice and how successfully they manage
it. Having rapidly and successfully established themselves
in business, there comes a more or less critical time in their
existence, a time when they are in danger of a most serious
complaint, known as cephalic hypertrophy, and happy and
fortunate is he who escapes.
A not uncommon manifestation of this condition is the idea
that the homoeopathic profession is not large enough for a
proper display of their ability, and they gaze with loving
eyes toward the allopathic branch of the profession, where
there are so much larger hospitals, greater and more vigorous
societies, and, above all, greater social prestige. All this is
much enhanced if they happen to fall in with some of the
better, more liberal minded good fellows among " our friends,
the enemy," who assure them it need make no difference
with their methods of practice, they can prescribe just as be-
fore, homoeopathic medicines in the homoeopathic way, if they
choose, only they must not ally themselves with anything
called by that name, etc., and they will gain immeasurably in
their freedom of action and in their social and professional
position.
I go I Editorial, 399
All this is very enticing and very alluring, and the per-
spective is vast and beautiful. There is only one trouble with
it ; it is not true. ** What profiteth it a man if he gain the
whole world and lose his own soul." He will forever be
looked upon as an outcast by his former associates, and as a
renegade by his new. He will command the respect of none,
the detestation of many, and the much sought for social pre-
ferment will never come. Does he wish to perfect himself
in surgery ? the competition for opportunity so to do is far
greater in the old school than the new. Does he desire to
become an adept in the cure of disease by the application of
medicines and by a knowledge of what can be done by the
administration of drugs to that end ? The advancement in
the old school along this line has been practically nil in the
last century. If you doubt it, watch the scientific (?), ration-
al (J) treatment of a case of pneumonia, as we had an oppor-
tunity of doing within six months. Not one single dose of
medicine given with the intent or with the pretence of an
intent to affect the diseased lung tissue in the slightest
degree. To one wishing to perfect himself in a knowledge
of drug action, no school offers the chance that the homoeo-
pathic does, and never was the opportunity greater than now.
No, my young friends, don't let them fool you with plaus-
ible talk. If you no longer honestly believe in homoeopathy,
go, and God-speed ! but if you do, stand up and be counted
as our fore-bears did, and pray that you may be respected
for it as they have been.
There is but one remedy for this rapid, excessive cranial
development, and that is patience. Therefore, we say to the.
afflicted, let your *' think-tank " settle a bit, — "say nothing,
but saw wood " for the next five years, but be sure that the
wood is good and that you saw it well. Remember that if
our neighbor's pasture looks greener than our own, should
we possess ourselves of it, it would no longer be our neigh-
bor's.
400 The New England Medical Gazette. Aug.,
EDITORIAL NOTES AND COMMENTS.
HAnPDEN HOnOEOPATHIC HOSPITAL.
The executive officer of the Hampden Homoeopathic Hos-
pital reported at the trustees' quarterly meeting yesterday
afternoon that the hospital is in a prosperous condition and
that for three months ending July 1,75 patients were treated
with only two deaths ; these patients entering the hospital
moribund. It was also reported that from the opening of the
hospital 105 surgical operations have been performed without
a death. Drs. O. W. Roberts and F. M. Bennett were re-
appointed as members of the executive committee. The res-
ignation of Dr. H. E. Rice, who is to leave Springfield, was
accepted with regret and Dr. J. H. Carmichael was appointed
surgeon-in-chief. Dr. Sidney F. Wilcox, of New York and
Dr. Nathaniel W. Emerson, of Boston will be consulting sur-
geons- as heretofore.
Resolutions of condolence and regret were read upon the
death of Miss Minnie J. Thrall, a member of the board of
trustees. D. B. Wesson was elected a trustee to fill the va-
cancy. The Visitors* Aid Association profited about tyio
by the lawn party of June 14 on the grounds of President
Lewis J. Powers.
Prevention of Pelvic Troubles after Labor. — Durinpj
labor much may be done to prevent subsequent pelvic
troubles, (a) Limiting the duration of labor. Vesico-vaginal
fistula is an outcome of protracted labor, and nuay be pre-
vented by the timely use of forceps. Too prolonged efforts
to retard the delivery of the head, in order to prevent lacer-
ation of the perineum, may give rise to permanent relaxation
of the muscular structures of the pelvic floor, (b) The im-
mediate repair of lacerations which endanger the muscular
structures of the pelvic floor is important. These repairs
must be made with careful antiseptic precautions. Cervical
tears need not be immediately repaired unless there is hemor-
rhage, (c) Rigid attention to asepsis and antisepsis during
labor will decrease the number of cases of chronic uterine
and periuterine inflammations. — Medical News,
igoi Societies, 401
SOCIETY REPORTS.
BOSTON HO/Vl<EOPATHIC MEDICAL SOCIETY.
BUSINESS SESSION.
The regular meeting of the Society was held at the Boston
University School of Medicine Thursday evening, June 13,
igoi, at eight o'clock, the President, T. Morris Strong, M. D.,
in the chair.
The records of the last meeting were read and accepted.
Charles W. Bush, M. D., of Newtonville, was elected to
membership.
The resignation of W. Louis Chapman, M.D., of Provi-
dence, R. L, was read and accepted.
Voted : That a committee of three be appointed to use
their influence to secure as full reports as possible in the
local papers of the meetings of the American Institute of
Homoeopathy. Drs. Wells, Sutherland and Thomas were
chosen to serve on this committee.
The following committees were appointed to draw up reso-
lutions on the deaths of J. K. Culver, M. D., and William
Woods, M. D. :
Dr. Culver : Drs. A. B. Church, Mary L. Swain and S. W.
Windsor.
Dr. Woods : Drs. Conrad Wesselhoeft, Hiram B. Cross
and Herbert C. Clapp. ^
Report of the Section of Diseases of Children.
H. L. Shepherd, M. D., Chairman.
Ckacb Cross, M. D., Secretary. C. £. Montague, M. D., Treasurer.
The President appointed the following committee to nomi-
nate sectional officers for the ensuing year : Drs. Colburn,
Estes and Mosher. The committee reported as follows :
Chairman, W. T. Hopkins, M. D, ; Secretary, C. C. Burpee.
M. D. ; and Treasurer, Lucy A. Kirk, M. D., who were duly
elected.
402 The New England Medical Gazette. Aug.,
PROGRAMME.
1. **Some Favorite Remedies for the Summer Diarrhcta
of Children." Everett Jones, M. D. Discussion opened by
N. M. Wood, M. D.
2. *'The Best Diet of Children with Summer Diarrhoea."
W. T. Hopkins, M.D. Discussion opened by W. N. Emery,
M. D.
3. " General Treatment of Summer Diarrhoea in Children."
H. H. Amsden, M. D. Discussion opened by C. C. Burpee,
M. D.
I. Dr. Wood, in opening the discussion of Dr. Jones*
paper, said, in part : It is rather a difficult question for me
to discuss this subject, not having had many years' e^cperi-
ence ; but I have had some experience and learned some
things. I will speak of one or two of the leading symptoms
that I know can be depended upon. If I am called to the
case early and find the child restless and very sensitive, I
think first of aconite. It must be given in the early stages,
and by so doing we get very good results. If the child has
passed that first stage and there are symptoms of tenderness
in the bowels and perhaps some bloody stools and some
straining, belladonna is the first remedy, then arsenic. For
prostration and weakness arsenic is one of the best remedies,
and can be depended upon more than any other. Nux vomica
I use on general principles in cases of indigestion caused by
imprudent eating. The remedy I lisemost is mere, dulcis for
greenish and slimy stools, and get better results from it than
from any other. Napthalin I use quite a little in cases of bad
odor and slimy, waterish stools. I try first to remove the
cause, while giving remedies. Boiled or distilled water I
consider the best remedy. Nitrate of silver I consider good
for chronic pain in the stomach. The three remedies I
should select would be Aconite, Belladonna and Mercurius
Dulcis,
Dr. John H. Sherman : Of course, when one has practised
medicine as long as I have he has had some experience with
190 1 Societies, 403
diarrhcea. I depend more upon management than medicine.
I prohibit all eating. It will not hurt the child to go without
food, but a free use of water I believe in. Let them drink
all they will. I prefer to have them take it warm, then after
that begin to feed with a little white of egg beaten up with
the water (two-thirds of a glass), and follow that with malted
milk. I have had a child pick up nicely on malted milk. I
think the cause of diarrhoea is bad food. I instruct those in
care of children to have two nursing bottles, and they should
be thoroughly cleansed in sterilized water before using a sec-
ond time.
I use mercurius dulcis in the first and second triturations,
but where there are bloody discharges I give mer. cor.
Colocynth is another remedy I use, giving it in hot water.
Dr. Sutherland : There are a few other remedies that
might be mentioned. I should like to get physicians, who
have been practising fifteen or twenty years, to name their
favorite remedies. I do not think they would agree on five
but might agree on one or two. But there are so many reme-.
dies that will produce diarrhoea, we have a good many to draw
from. How many are used as cathartics 1 certainly, not
many. I think we should select our remedies for diarrhoea
from cathartics. I agree with Drs. Sherman and Wood in
speaking of calomel first. The first remedies mentioned by
them are reliable and produce free, easy stools. Mercurius
dulcis is more closely applicable to the condition in which
the enteron is found involved; and I am sure that this idea
will be testified to that mere. cor. will reach the condition
growing out of ulceration. Aloes is not used a great deal,-
and produces mucous discharge, with a great deal of flatu-
lence, and seems to have an affinity for the colon. Rhubarb
also is a useful remedy. One remedy that is seldom used I
want to refer to, and that is colchicum. I think it is a drug
that ought always to be studied when a case of diarrha»a is
on hand. If you want to get a good picture of the drug read
the article in the encyclopcxdia. You will find a list of cases
of poison. In cases of Solera infantum, colchicum and nux
404 The New England Medical Gazette, Aug.,
vomica, sometimes lead camphor. China is used a great deal,
but large doses have to be taken before large discharges are
produced. Castor oil is very effectual and very laxative. I
do not know that it is generally used. Cascara is one of the
popular drugs of to-day.
Dr. Miller : I would like to ask Dr. Wood if he has used
mercurius in the same way as castor oil ?
Dr. Wood : I do not know as I have used it in the same
way. When I find that castor oil does not work and mercu-
rius is indicated, I use mer. cor.
Dr. Mosher : Boiled water, or boiled water and listerine,
will reduce the fever, and there most always is fever, and in
one or two cases I have known the temperature to come down
after an enema. I give it once or twice a day and find, if it
does not do any good, it never hurts and often helps.
Dr. W. M. Townsend : Does the matter of location have
anything to do with the selection of the remedy } I know
that last summer one or two remedies were called for, and
one of those remedies I have not heard mentioned to-night :
cuprum arsenite. I used it for some time; it agrees very
well with our cases of summer diarrhoea. I have used it more
than all the others. I do not know that I have used them
because they were favorites, but because there were more in-
dications of these remedies.
Dr. A. G. Howard : I have always found it difficult to
select a remedy for diarrhoea, and in children I find it difficult
to get the important symptoms.' One remedy has been im-
pressed upon me from a case, at the dispensary, of head cold
Arsenicum 3^ was prescribed, one tablet in three hours. If
worse, a tablet m twenty minutes. The patient took about
one-half ounce of the 3x, when word came to the dispensary
that he was dying. I went to the house and found him vom.
iting, with almost constant movement of the bowels, pressed
out with considerable pressure, a rapid, weak pulse, very pale
and prostrated, all typical symptoms of arsenical poisoning.
It did not seem possible to get a proving from 3X. I saved
I go I Societies. 405
the urine from that time and sent a sample (a wine glass two-
thirds full) to Dr. Wood for examination. He reported a
considerable quantity of arsenicum found in the sample. I
wrote back and wanted to know how much, and he replied
I -10 of one milligram in one sample. Movements and pers-
piration continued all night after sample was taken, and it
impressed upon me the value of that drug, and that picture
has been useful to me when I have found those symptoms
prominent. With colocynth I have had as successful results
when there was no pain as when there was any.
I would like to ask Dr. Wood how important a symptom
he considers the character of the stool in the child, and if
pain is an important symptom }
Dr. Wood : I think it is quite important. Mucous and
bloody stools you can tell from the action of a child. When
they are greenish and yellow, I think the color is due to the
color of the poison which caused the diarrhoea. Children get
hold of all sorts of things, which get into the stool, but it is
not always a symptom to be depended upon. Take into con-
sideration the cause of the diarrhoea, if known, and select the
remedy that will clean up the intestines.
Dr. Sherman : I have not seen any diarrhoea from i-io
tablet of mercurius dulcis. In cases of green discharges I
think it is indicated and I think it acts as a germicide in the
intestines. I give it a number of times and then stop it.
Dr. Carvill : Speaking of the action of mercurius dulcis,
it acts internally as an antiseptic, but causes profuse secretion
of bile, and is a wonderful benefit in cases of indigeston, and
a very excellent remedy. There are some cases where it is
not suitable. Some adults can not take i-io of a grain.
2. Owing to the absence of Dr. Hopkins his paper on
"The Best Diet of Children with Summer Diarrhoea " was
omitted, and Dr. Emery was not present to open the discus-
sion.
Dr. W. M. Townsend : The thing which I deem the most
important in the average case of summer diarrhoea is rest. I
think it is one of those diseases which requires rest. Con-
4o6 The New England Medical Gazette, Aug.,
siderable summer diarrhoea comes from three causes : indiges-
tion and too rapid feeding, taking food that has undergone
chemical changes, and sudden changes of temperature from
heat; to cold. From all conditions you get practically the
samie result : irritation of the mucous membrane. Absolute
rest is of great importance, I saw a case in consultation a
few years ago; the attending physician was trying to give
food and medicine at the same time. The bowels and stom-
ach should have absolute rest. There are very few children
who can not get along very well without food for twenty-four
hours. When teeth are the irritants, give them distilled
water. I give them sterilized water in place of the bottle.
Abstinence from food gives the intestines a chance to rest
and the bowels to be cleared of all irritants.
I believe most thoroughly in water as a food and local wash,
and in all cases I use solution of saline instead of clear water,
and a generous amount for the time it is used. I prefer it to
clear water, as it helps to allay thirst. I also give barley
water ; sometimes white of egg in water is good. In fourteen
hours, as a rule, the looseness is pretty well under control,
and the irritation relieved. Barley water without any remedy
will do a great deal to get the child in better condition. In
summer time the child is easily upset. I put a child upon
mutton broth, or chicken broth, instead of milk ; broth does
well for nourishment and allays irritation, and the bowels are
got into good condition. I think to prepare the milk with
barley water, instead of full strength of water, is a good way,
increasing in strength until the child can go back to the usual
diet. From twenty-four to forty-eight hours I recommend
plenty of sterilized water, and in that way get along better
and there is less chance of relapse. Water and broth are
better than malted milk and prepared foods. Many cases of
bowel trouble are from too frequent feeding ; they should
rest until the irritation is over. Simply get the parents to
look at it in a sensible manner and not overfeed the child.
Regarding prepared foods, I use them comparatively little,
and in many cases I went through the entire summer without
iQor Societies, 407
losing a case. But the main thing is to give the bowels and
stomach a chance to rest, and then keep the food down until
the stomach has had a chance to rest.
3. " General Treatment of Summer Diarrhoea in Child-
ren." Dr. Amsden's paper was a clear and concise rendition
of a very important subject, and covered the whole matter in
a very practical way.
Dr. C. C. Burpee : Dr. Amsden's paper leaves very little
to be said. Where there is more than one child great care
should be used in handling the movements. Enema I desire
to emphasize if the child is feverish, using water a little over
100^, cooled gradually by ice. Then, if the child is very
restless, head hot, and as the ice cap is almost impossible to
fit, I think the water bag is of value at such a time and acts
very satisfactorily. Another thing, I think we ought to use
more than we do in summer diarrhoea, where we get more or
less vomiting, and that is stomach washing. Last summer it
was very satisfactory, and 1 intend to use it more this season.
Then, bovinine is of great benefit and more or less stimulat-
ing, and is one of the best preparations of this kind. After
a while it is common to find the movements mucous and con-
siderably conjested. I think then the best thing, for this
class of cases, is strained cornstarch water. But, as Drs.
Townsend and Amsden have said, the important thing is to
keep the child without food lor twenty-four hours, and the
trouble is with the mother and other relatives and nurse. In
two cases I have kept them forty-eight hours on sterilized
water only with very satisfactory results.
Dr. Shepherd : The ice-bag as a pillow for all brain
troubles has been followed by most excellent results. Wash-
ing out the stomach is performed very simply by the nurse
giving them all the water they want, a pint if they want it,
and, if thrown up, the stomach is washed out.
Dr. Wood : In cases of local enteritis I give the enema
myself, because neither mother nor nurse will give it right.
Place the child on a pillow, as if catherizing, and give normal
saline slowly; it goes higher and is more absorptive and acts
4o8 The New England Medical Gazette, Aug.,
on the diseased membntne. Keep the child in a horizontal
position, and let it be retained as long as possible.
Dr. Townsend : I am glad to hear Dr. Wood speak of in-
jecting saline solution. Three cases last summer demon-
strated the value of that treatment. Cases that were practi-
cally hopeless, which had been sick thirty-six or forty-eight
hours, and were living skeletons, vomited everything. As
the result of injections of saline, an increase of pulse (which
had been very weak) was obtained in a short time. The
children began to show improvement ; local treatment and
stimulant followed, and life was saved. Of the three cases
two recovered and one died. It seems to me that it was an
ideal case for the use of saline. It practically fills up the
place of blood serum that has been lost, and there is a great
use for it in such cases.
Adjourned at 9.35. Edward E. Allen,
Secretary,
HASS. SURGICAL AND QYNECOLOQICAL SOCIETY.
The fifty-seventh session of the Mass. Surgical and Gyn-
ecological Society was held at the Hotel Nottingham, Boston,
on June 12.
The President, Dr. Henry E. Spalding, in the chair.
The following were elected members :
Dr. G. F. Allison, East Providence, R. I.
Dr. E. R. Johnson, Wollaston.
Dr. F. De Forrest Lambert, Salem.
Dr. J. Arnold Rockwell, Boston.
Dr. Harry O. Spalding, Boston.
The Necrologist. Dr. H. P. Bellows, presented appropriate
memorial notices of the death during the past year of the fol-
lowing members :
Dr. Henry F. Batchelder, Danvers.
Dr. Sarah E. Sherman, Salem.
Dr. Jane K. Culver, Boston,
Dr. William Woods, Boston.
IQOI Reviews and Notices of Books. 409
In the scientific session papers were presented by Dr. Geo.
W. Roberts, of New York City, on The Surgical Treatment
of Tubercular Disease of the Joints, and by Dr. H. C. Clapp,
on The Surgical Treatment of Tubercular Diseases of the
Lungs. These papers elicited a very interesting and free
discussion.
Over 100 members sat down to the dinner following the
session, and the feast of reason and flow of soul were contin-
ued under the guidance of Dr. Winfield Smith. In this
'*Clinique Extraordinaire", the demonstrators were Drs. Win-
field Smith, Geo. W. Roberts, J. P. Rand, and H. C. Clapp,
and the subjects were, "The Anesthesia", "The Exploratory
Incision", "The Capture of the Tumor", and "Intravenous
Saline".
The next meeting of the Society will be in December, and
will be the Twenty-Fifth Annual Session. The Bureau of
Gynecology will report under the Chairmanship of Dr. Mary
E. Mosher.
REVIEWS AND NOTICES OF BOOKS.
Obstetric and Gynecological Nursing. By Edward P. Travis.
Illustrated. Philadelphia and London : W. B. Saunders & Co.
1901, pp. 402. $1.75.
This an excellent and timely book by a writer whose position in
this profession carries weight and authority, and who has clearly
written out of the fulness of his own experience. The work presents
in plain language, free from needless phrases and technicalities, all
that a Durse should know in her relation to the specialties here in-
cluded. All rules and directions for her guidance are fully laid
down, and prefaced in every case by a chart, well considered exposi-
tion both of the abnormal condition to be met and the operation or
procedure, in the hands of the operator, at which the nurse's assis-
tance is demanded. In this way she is not only instructed in the
technical part of her duties, but have to understand distinctly the
bearing of these duties to the case in hand and the doctor's work.
4IO The New England Medical Gazette, Aug.,
She has, in fact, what a modern, fully-equipped nurse so much needs
here given her in one proportion,- -the theory and practice of ob-
stetric and gynecologic nursing, and in a form for which she cannot
be too grateful to the author.
The subject of diet, the duties and conduct of the nurse in the
absence of the doctor, the care and feeding of the new-born are
treated as fully and as wisely as the strictly surgical portions, in all
of which departments the author proves himself in advance of the
common practice of the day. We, therefore, recommend the book
most heartily, not only to nurses, but also to all medical students
and to any practitioners who earnestly desire, as they should do, to
know precisely what skilled and intelligent assistance means.
But it is not to the author alone that those who read and study
the work should acknowledge their indebtedness. The publishers,
too, have left nothing undone to make it both useful and attractive
in the highest degree. The good paper, clear print, careful proof-
reading— let this be especially noticed in these days of hasty book-
making — the admirable illustrations, few, but well executed and
instructive, and the full index, all combine to prove the high standard
kept in view in placing this book before those for whom it is
written. w. w.
CHARACTERISnCS OF THE HOMEOPATHIC MATERIA MeDICA. By M.
G. Douglass, M. D. L'oericke & Runyon. New York. 1901.
It is encouraging to find not only that in the field of materia
medica " the harvest season is not yet over," as the author quotes
from Dr. Hering, but that there are still among us laborers who wil-
lingly subject themselves to the arduous task of gleaning after those
who have already gathered, and of winnowing that which for a cen-
tury has been garnered. The gathering and gleaning are difficult
and laborious, but the most difficult of all labors connected with the
utilization of the rich stores brought in is the winnowing ; the sepa-
ration of the grain from the chaff, then the separation of the sound,
full weighted grain from that which is tainted and light of weight.
We must accord to Dr. Douglass all praise for the fulness of the
work he has undertaken. He has, indeed, gleaned in many fields ;
spared no pains, until hardly a medicinal substance anywhere used
or suggested remains unnoticed. No less than nine hundred and
thirty remedies are here marshalled for the use of the practitioner
1 90 1 Reviews and Notices of Books. 4 1 1
and the memoriziDg of the medical student, Happy and powerful as
a leader, he who can retain in his memory even a hundredth part of
all that is here spread before him !
Where so much has been done, and in the main done well, it
would be a relief to say no more. But a book of nearly one thous-
and pages, and more particularly a book of materia medica, is not
to be dismissed with a mere laudatory book notice. Whoever comes
before the profession with a new work on this subject demonstrates
by this very act his sincere desire to further the cause of homoe-
opathy by making its resources more available ; and, what is more, he
does this with a clear understanding, not only of the difficulties, but
also of the thanklessness of the task. He knows the obstacles to be
met in attempting to gain not only the needful popularity, but even
a hearing for his efforts. He cannot fail to be aware of the adverse
spirit of the day, — the spirit of scepticism, of cavilling, perhaps, of
gross materialism in all that pertains to therapeutics, or to disregard
the advances in all those fields which invite to specialism, thereby
retarding and warping not only the growth of homoeopathy, but of all
genuine reform practice in so far as it deals with curative action of
drugs. He must be aware that it is no longer possible to enlist the
enthusiasm or win the interest of the rising generation of homoe-
opaths in the subject of pure materia medica, unless, indeed, they
have been reared from their infancy to respect nothing but the
labors of Jahr, Hering, Lippb, Raue, and their followers. To these
this work will unquestionably be a most welcome addition to their
armamentarium, while to all those who in the multi-parvumness of
their surgical, obstetrical, gynecological and other practical work,
can find neither time nor leisure to delve in the diraly-lighted shafts
of symptomatology, it will probably prove less attractive. This class
of practitioners, whether right or wrong, is apt to demand that the
resources of medicinal therapy be not only spread plainly before
them, but also that it be adapted to their mode of viewing diseases
and their methods of finding indications for treatment.
The question, then, arises at once from which point of view to
consider this book. If we approach it in the simple and childlike
faith of the pure homoeopathist, of him who comes to every ca§e
thinking only of the characteristic symptoms and keynotes presented
by the patient, and to be sought for in the whole range of drug
pathogenesy, we may be persuaded that nothing of practical impor-
412 The New England Medical Gazette, Aug.,
tance has been omitted, and that all has been so simplified and re-
duced to the needs of daily practice that this has now been made
far more easy than by any known work of equal comprehensiveness.
We shall observe that nothing has been neglected from A to Z : Aya-
dirachta, Badrago, Homtyx chysorrhoea and processionea, Comocla-
dio, Dorris pinnata and Doryphora, Erichthites and Echites,
Elasis and Epiphegus, Eupion and Fagopyrum, Fragaria, Kedysarum
and Hydrocodyle, Iteris amara, Itu, Jacaranda, Karakas, Katepo,
Mancinella and Meticthsma, Musa, Mygale, Napulus, Narzau,
Osimurss, Oxytropis, Optea Jurinosa, Oxcodaphre, Paracea, Porthos
and Pyrethrum, Sabbatia angularis, Spiggurus, Stachys betonica,
Thevetia, Yolotyochitl and Zisia, besides all mineral waters, cis and
transatlantic; the nosodes with cimex and pediculus, and all the
hundreds of others more or less familiar to those who use or review
our work on materia medica. Of all, whether well, or ill, or un-
known, " only the most characteristic indications have been retained,
symptoms that the author has himself verified in a practice of twenty
years, or which have been verified by trustworthy physicians." This
is the assurance given in the preface.
But here, unluckily, certain questionings arise in the soul even of
him who comes with the most simple and childlike faith for aid and
direction, questionings for which even the most patient research
fails to bring satisfactory answers. The book contains no word of
introduction explaining either the comparative value of drugs, or the
tnanner of their presentation, which differs widely not only for dif-
ferent drugs, but for the indications which shall guide us in their
selection and clinical use. Why, for example, should our confidence
in some remedies be fortified by giving the names of their provers
or of those who introduced them into practice, while an almost
equal number of others, especially the newer and less known ones,
those for which we most need authoritative statements, are present-
ed without as much as a hint of the origin of the knowledge con-
cerning them ? And why, in the same way, are the common names
and the preparations of some drugs, chiefiy those better known,
carefully mentioned, while not a word in regard to these matters is
vouchsafed concerning those newly introduced and little known.
We do not say that these things are absolutely essential in a work on
materia medica which has for its purpose only the presentation of
symptoms pathogenic and clinical. But if given in one case, surely
1 90 1 Reviews and Notices of Books. 4 1 3
we have a right to demand these in the other. Is adonis vernalis,
with half a page of indications, less worthy of such additional infor-
mation than aesculus glabra, with but one line ? For the last named
are given the common names and pharmaceutical preparation,
while for the first he who practices far from a homoeopathic pharmacy
and is often called upon to prepare his own medicine must look
where he may ior the needful information.
And, again, in regard to the clinical value of symptoms as deter-
mined by experience and observation, are Ruchmann and Burt, the
foremost provers of aesculus hippo castanum, and Bojanus, who
proved convalaria majalis less authoritative and worthy of mention,
and Dr. Swan who proved medorrhinuro, or Dr. Mure, of Brazil, who
proved and introduced, as is said, cimex and pediculus and many
other drugs of most questionable value ? These are instances of
what occurs on almost every page of the book, and lead us to fear
that Dr. Douglass and his editior, who is thanked in the preface for
his careful work, have either yielded to some prejudice in the matter
of mentioning authorities, or to some disinclination to take that
trouble which is absolutely essential when men write in a great
cause.
In regard to the verification of symptoms the same doubts and
questionings arise. The preface is of such very modest length and
fulness that we are left to guess that the symptoms given in italics
are those " verified by the author in a practice of twenty years and
by other trustworthy physicians." We may say at once, and we say
it cheerfully, that we have nowhere seen the polychrests^-of which, as
a matter of course, the list has been lengthened since Hahnemann's
day — more succinctly and practically presented than is here done.
But the same mode of praise cannot conscientiously be accorded to
the treatment of that '' large and valuable class of remedies found
scattered thro' the various society reports, magazines, etc., and now
gathered in one convenient volume." This treatment here is for
the most part quite too cursory or " machine-made," if we may use
the expression, to be of any value practical or scientific. Here,
however, it is impossible to criticize the author's method, since
there is nowhere to be found the least evidence of a method or any
principle of selection or classification from which a method might
be derived or inferred. All symptoms are made to appear as of
equal value, unless, indeed, those italicised are intended to represent
414 ^^^ New England Medical Gazette, Aug.,
the more exact indications. Perhaps there remains as yet the only
course for a *Miberal homoeopath" who refuses to decide whether
objective or subjective symptoms, pathological lesions or sensations
and their modalities are to be accepted as guiding and characteristic
indications. But when a new book on materia medica is offered to
the profession with a distinct claim that it contains only that which
has been verified as clinically valuable, we are warranted in looking
for a long step in advance of the older authorities.
It is this advance which, with much regret, we fail to recognize
here. In fact, no progress in the direction of placing our materia
medica, our one dislinctive, therapeutic feature, on a sound and
genuinely practical basis, save by the most careful observation and
experiment, conducted not alone in private practice, as hitherto, but,
above all, by collective work, well systematized and planned for the
exclusion of error. This can be done only in our hospitals, which
have existed and continue to exist, primarily, for the greater glory
of homoeopathy, and, secondarily, for the advantage of such patients
and, we may add, of such practitioners who may choose to take ad-
vantage of them. That they have in any sense advanced the power
of our method over disease few will venture to assert.
Until some concerted action in the direction of greater exactness
and sounder knowledge, not only in the matter of reproving our
drugs, but mainly of observing and determining their clinical effects,
we must gratefully accept from private practitioners such results of
their experience as they may offer, and doubt their verifications only
when these are stated in terms too autiquated or too vague. Instan-
ces of drugs so presented in this new work are so numerous that
they affect its whole character, otherwise we should be but too glad
to make no mention of them. What justification can there be to-day
in a book written in the English language by an American author
for retaining so many of the old terms, peculiar to early homoeopathic
literature, which so plainly bear the mark, " Made in Germany " ?
It is certainly no longer hypercritical to demand that symptoms
should be expressed in plain English for our use.
What we must look upon as a more serious fault, however, is the
utter vagueness and utter inadequacy of so many of the indications
offered as characteristics. What shall we say, for example, of Mer-
curius jodatus cum Kali jodatum (sic), under which formidable and
learned looking head nothing is given but " secondary and tertiary
1 90 1 Reviews and Notices of Books. 4 1 5
syphilis " ; or Yosotis : " cough with purulent expectoration *' ; or
of Phosadendron : " hastens labor and prevents miscarriage " ; and
many more of the same kind. And, furthermore, can the author
truly say that he or any other trustworthy physician has verified in
practice the curative effects of laughing gas, of which the pathogenic
symptoms, although clearly and distinctly stated, are here introduced
without any sponsor for their clinical validity ?
It would lead quite too far to analyze the whole work in the same
spirit of demanding exactness where as yet no exactness has been
attained. The criticism we feel called upon to offer is simply this :
that in so large a number of cases verifications and characteristic
indications are declared to exist where nothing but vagueness and
routine are exhibited. The work is in this way made to lose both
in authoritativeness and practical usefulness in the proportion of its
increase in size ; a matter to be profoundly regretted where so much
of unquestionable value has been brought together. That the pub-
lishers have done their work well goes without saying, although the
proof reading here and there leaves something to be desired. Paper,
binding, print and index are excellent. w. w.
Principles of Surgery. By N. Senn, M. D., Ph. D., LL. D., Pro-
fessor of Surgery in Rush Medical College in Affiliation with the
University of Chicago ; Professorial Lecturer on Military Surgery
in the University of Chicago ; Attending Surgeon to the Presby-
terian Hospital ; Surgeon-in-Chief to St. Joseph*s Hospital ; Sur-
geon-General of Illinois ; Late Lieutenant- Colonel of the United
States Volunteers and Chief of the Operating- staff with the Army
in the field during the Spanish- American War. Third Edition.
Thoroughly Revised with 230 Wood- engravings. Half tones, and
Colored Illustrations. Royal Octavo. Pages, xiv — 700. Extra
Cloth, J4.50, Net; Sheep or Half- Russia, I5.50, Net. Delivered.
Philadelphia: F. A. Davis Company, Publishers, 19 14-16 Cherry
Street.
To those familiar with the two preceding editions of this work,
and no surgeon is not famihar with them, comment on this, the third
edition, is hardly necessary.
It has added two new chapters, one on " Degeneration," and one
on " Blastomycetic Dermatitis," which very materially enhance the
value of the work. The surgical pathology of the various subjects is
4i6 The New England Medical Gazette, Aug.,
exhaustively considered and well illustrated. The subject matter is
treated under the following heads : Regeneration, Degeneration,
Inflammation, Necrosis, Suppurative Ulceration, Osteomyelitis, Sep-
ticaemia, Pyaemia, Erysipelas, Tetanus, Hydrophobia, Tuberculosis,
Actinomycosis, Blastomycetic, Dermatitis, Anthorix, and Glanders.
The illustrations are numerous and good ; the text explicit and
easily understood. It is a book of value either to the student or
the practitioner.
Clinical Pathology of the Blood, by James Ewing, A. M., M. D.
Lea Brothers & Co., Phila.
The growth of haemotology within the last decade has materially
added to the diagnostic ability of the clinician. Unfortunately,
however, of the several monographs which have appeared there have
been but few handy for reference to the busy physician. This vol-
ume of Ewing will, therefore, readily commend itself to the practi-
tioner who wishes to know the characteristic features of the blood
in certain pathological conditions, as well as to those who may ap-
proach the subject from its purely scientific side.
A valuable feature of the book is the extensive bibliography at
the end of each section. This gives evidence of a wide acquaintance
with the literature of the subject, and forces the respect of the reader
for the opinions and interpretations of Dr. Ewing on those questions
which are still subjudice.
An idea of the scope of the work is best obtained by the follow-
ing enumeration of the different divisions of the text : Part I, Gen-
eral Physiology and Pathology of the Blood; Part II, Special
Pathology of the Blood; Part III, Acute Infectious Diseases; Part
IV, Constitutional Diseases ; Part V, General Diseases of Viscera ;
Part VI, Animal Parasites.
The text is illustrated with fourteen colored plates drawn by the
author. These plates impress us as being largely diagramatic, and,
perhaps, would have given more correct impressions had smaller
magnification been adopted. From the above statement we would
accept the plates illustrating the chapter on malaria, which although
drawn to the same scale as the others, are far more instructive.
A section of the work which seems to us worthy of special men-
tion is the one on malaria. It embodies the recent views on the
1 90 1 Reviews and Notices of Books, 4 1 7
disease, as well as most valuable coatributions to our knowledge of
the subject by the author himself.
The volume is one which the up-to-date physician can not well
afford to be without.
The publishers work is well executed. s. c. t.
A Text- Book of Embryology. By John C. Heisler, M. D., Pro-
fessor of Anatomy in the Medico- Clinurgical College, Philadelphia.
Octavo volume of 405 pages. Cloth, {2.50 net. W. B. Saunders.
1899.
It is with keen pleasure in these boasting days of " practical med-
icine " that one welcomes a book thus systematically and compre-
hensively treating this fundamental subject.
The author modestly calls attention to the importance of a
knowledge of embryology in order that the " proper comprehension
of human anatomy " may be possible. Anatomy, however, is not
the only subject related to medicine which cannot be brought into
proper perspective without an intimate knowledge of the subject of
this notable work. Because of a growing appreciation of the relation
between the character of embryological and pathological processes,
as well as its importance as an aid to the proper study of histology,
obstetrics and the like, this treatise is in the first sense <* practical."
Embryology has risen from what were considered the systematized
vagaries of the biologist to a commanding position in practical
medicine.
Commanding because an ever increasing band of physicians
search for the truth by the light it gives ; and practical because fun-
damental.
The text is clear and concise, the illustrations copious, and
mechanically the book is everything which one expects from the
Saunders' high- standard press. a. e. p. r.
The Feeding of Infants — Home Guide for Modifying Milk.
By Joseph E. Winters, M. D., Professor of Diseases of Children,
Cornell University Medical College. New York : E. P. Button
& Co. 1 90 1, pp. 47. Price, cloth, 50 cents.
Mother's milk, other things being equal, is the ideal food for
infants. When this is not obtainable a substitute must be provided
which fairly approximates it. Dr. Winters shows the enormous dif-
4 1 8 The New England Medical Gazette, Aug.,
ference in mortality between babies naturally and artificially fed,
and endeavors to teach methods by which the mortality under the
latter conditions may be greatly lessened. He gives formulae for the
modification of milk adapted to infants at different ages, and pro-
vides some excellent hints on such points as the appropriate
amount of food, dangers of over- feeding, milk supply, pasteurization,
etc. He has nothing very favorable to say of the prolonged use of
predigested, or ** Infant Foods " so-called, and we must say we are
inclined to agree with his strictures.
Taylor on Genito-Urinarv and Venereal Diseases and Syphilis.
The Pathology and Treatment of Genito- Urinary and Venereal
Diseases and Syphilis. By Robert W. Taylor, A. M., M. D., Pro-
fessor of Venereal Diseases in the College of Physicians and Sur-
geons, New York. New (2) edition. In one very handsome
octavo volume of 720 pages, with 135 engravings and 27 full-page
plates in color and monotone. Cloth, $5.00 net ; leather, W.oo
7iet ; Lea Brothers & Co., Publishers, Philadelphia and New York.
Dr. Taylor's reputation among the profession is such, that any-
thing from his pen on genito- urinary and venereal diseases commands
at once the attention.
This is the second and revised edition of his work, the first edi-
tion of which is already an authority in the profession and the med-
ical schools. The author's aim is "to present an up-to-date, prac
tical and compact treatise" ; this he certainly has accomplished.
The instructions for treatment of the various diseases, especially Gon-
orrhoea, are given with a minuteness of detail that make them
especially valuable ; at the same time there is evidenced a conser-
vativeness of opinion which impresses one with the seriousness and
gravity of the disease. This work is invaluable in its line and sure
to maintain its place as among the foremost of our text-books.
35,000 Questions on Medical Subjects Arranged for Self- Ex-
amination. Third edition, enlarged. Philadelphia : P. Blakis-
ton's Son & Co. 1901. Price, 10 cents.
The above comprises questions only, upon all the main branches
of medicine. Answers are referred to as found in some sixteen or
seventeen books, most of which are merely quiz- compends. We
I go I Reviews and Notices of Books. 419
think the latter sufficiently cover the ground, and that it is hardly
advisable for a student to depend too much upon such condensed
aids. The book under notice, contains the questions given by the
State Examining Boards of New York, Pennsylvania and Illinois in
recent examinations.
International Homceopathic Medical Directory. London :
Homoeopathic Publishing Co. 1901. pp. 122. Price, 50 cents.
The International Directory for 1901 gives the names and ad-
dresses of all homoeopathic physicians practising on the Continent
of Europe, in the British Empire and in Mexico. It is proposed,
in a future edition, to include the names of those American homoeo-
pathic physicians who care to subscribe for the directory at the rate
of {i each. Any who are interested and desire further infonnation,
should send their address to the publishers, 12, Warwick Lane,
London, E. C, who will mail circulars when the next edition is
being compiled.
A Manual of Homceopathic Materia Medica. By J. C. Fal-
mestock, A. M., M. D. Published by the author, Piqua, Ohio,
1 90 1. For sale by Otis Clapp & Son. Price, cloth, ^1.25.
Cloth with blank pages, S1.50. Flexible leather, {2.00, net.
This is a manual for ready reference, giving in brief the character-
istic symptoms of the remedies. Each alternate page is blank to
enable one to make additional notes or to emphasize verification.
The work is thoroughly and painstakingly done and promises to be
a very helpful one, both to the student and the practitioner.
William Wood & Co. announce the following recent publications :
Clinical Lectures on Stricture of the Urethra and Enlarge-
ment OF THE Prostate. By P. J. Fceyer, M. A., M. D., M. Ch.
Surgeon to St. Peter's Hospital. Lieut-Colonel Indian Medical
Service, (Retd).
An Index of Symptoms as a Clew to Dugnosis. Just published.
By Ralph Winnington Leftwitch, M. D., late assistant physician to
the East London Children's Hospital.
Aphorisms, Definitions, Reflections and Paradoxes. Medical,
Surgical and Dietetic. By A. Rabagliati, M. A., M. D., F. R. C. S.
Ed. Late President of the Leeds and West Riding Medico-Chi-
rurgical Society, etc.
420 The New England Medical Gazette. Aug.
PERSONAL AND NEWS ITEMS.
Dr. J. Fred'k Norwood has removed from Rockport,
Maine, to Camden, Maine.
Dr. G. N. Towle has returned from his sojourn in the
West, and has located in Houlton, Maine.
Dr. Frank B. Foster, class of '99, B. U. S. of M., has
removed to Santa Barbara, California.
During August and September Dr. T. M. Strong will be
at Nonquitt, Mass.
Dr. Harry A. Cheney, class of '01, B. U. S. of M., has
opened an office at Newburyport, Mass.
Dr. Fred'k M. Sears, B. U. S. of M., '01, has opened an
office at 50 Bloomfield Street, Dorchester.
Dr. Frederick C. Robbins, class of '96, B. U. S. of M.,
has removed from Yarmouthport, Mass., to 25 Village Ave.,
Dedham, Mass.
Announcement is made of the removal of Dr. Howard P.
Bellows, Dr. Geo. B. Rice and Dr. Geo. A. Suffa from the
Woodbury Building to the Guildford, comer of Clarendon and
Newbury Streets, Boston.
On account of ill health, a homoeopathic physician in a
large railroad town in eastern New York will dispose of prac-
tice and complete outfit at a bargain. Fine opportunity for
a young man. Address Dr. F. C. Brush, 1244 Broadway,
New York.
At the June meeting of the Faculty of the Chicago Homoeo-
pathic Medical College a beautiful loving cup was presented
by the Faculty to Prof. N. B. Belamater as a token of the
esteem and affection in which he is held by those who have
been associated with him during his twenty-five years' service
in the college.
Under the management of the new business manager the
Chicago Homoeopathic Medical College has undergone a
thorough renovating, having had two new lecture rooms, with
sub-clinic rooms, and it is in a most excellent condition. The
college is in excellent financial state, owning property to the
amount of $100,000, having a debt of but a little over $25,000.
THE NEW ENGLAND
MEDICAL GAZETTE
No. 9. SEPTEMBER, 1901. Vol, XXXVI.
COMMUNICATIONS.
A LETTER FROH QERHANY.
BY HORACE PACKARD. M. D.
HOMCEOPATHY ON THE CONTINENT A DAY WITH BASSINI
VIENNA WANING AS A WORLD'S MEDICAL CENTRE PRO-
FESSOR SCHROTTER AND THE HEILANSTRALT ALLAND
(hospital for consumptives) BOTTINI'S OPERATION
AND FRENDENBERG's WORK MEDICAL EDUCATION IN
GERMANY.
Berlin, July 21, 1901.
In my journeyings it has been my pleasure to look up, as
far as opportunity has offered, the present status of homoeop-
athy. These inquiries have been made to satisfy my curi-
osity as to the truth of the claims frequently made that
homoeopathy is on the decadence in Europe. To such hom-
oeopathic physicians as I have met, my queries have been
mainly as follows : —
1. Is the number of homoeopathic physicians increasing in
the city or town where you reside ?
2. Are homoeopathic remedies becoming widely used by
old school physicians ?
3. Is the relation now existing between the representa-
tives of the two schools a friendly one ?
4. What is the attitude of the public at large toward
homoeopathy ?
/
422 The New England Medical Gazette. Sept.,
5. What, in your opinion, is to be the final destiny of
homoeopathy in your country ?
The first physician with whom I had an interview was
Dr. Bernard S. Anneply, of Nice, France. To Dr. Anne-
ply's opinion I attached much weight, for he has travelled
abroad, has been in the United States for thirteen years,
was at one time Professor of Theory and Practice in the
Hahnemann College, Chicago, and is now the foremost
representative of homoeopathy in Southern France. The
doctor is a naturalized citizen of the United States and his
sympathies are all with the free democratic government of
his adopted country. With tender solicitude for the health
of a member of his family he returned to the mild climate of
the Riviera.
His father. Dr. Pierre Anneply, was the pioneer homoeopa-
thist of Northern Italy and Southern France. Nice, and
what is now the French Riviera, was at that time Italian
territory and the residence of many persons of education,
wealth and influence. His practice became large and re-
munerative, and with the aid of his patrons he established a
homoeopathic hospital which flourished for years. The num-
ber of homoepathists increased to seven or eight in the few
succeeding years, but grave political complications arose
which changed a long stretch of the Riviera, including Nice,
into French territory. Many of the wealthy Italians who
had been patrons and supporters of Dr. Anneply and the
hospital which he established, moved away to regain their
native soil, and as a result the hospital languished and was
finally obliged to close its doors.
The present Dr. Bernard S. Anneply said, ** While homoeo-
pathy is showing progress in Germany, England and Spain,
it is at a standstill in France. We find a sturdy group of
good practitioners in Paris, although there also the older and
abler men are passing away and are hardly to be replaced
by men of equal merit. In the provinces we find but few
representatives of homoeopathy. Our numbers are decreas-
I go I A Letter front Germany., 423
ing here in Nice, but I hope to jetrieve lost ground. At
one time there were seven homeeopathists here, now they
are reduced to three. My father's followers and supporters
have become scattered. Young men who study medicine,
though some of them have a preference for homoeopathy, are
subject, in their course of study in our established universi-
ties, to anti-homoeopathic influence and with the attractions of
specialties, hospital positions, government and army appoint-
ments, they cast their lot with the old school. In France
our total number is now about sixty, most of wjiom are in
the large cities and towns. The use of remedies in homoeo-
pathic indications by the old school physicians is increasing.
As I come occasionally in consultation with them I find
them using bryonia for acute pleuritic affections, Pulsatilla
for dysmenorrhoea, etc.
*' It is not very difficult for a well-trained homoeopathic
physician to make a place for himself in any community
about here. Cannes, a charming place near Nice, has no
homoeopathist although it could easily keep two good men
comfortably busy. In France homoeopathy as a distinctive
school of medicine is making no progress, but it is being
quietly amalgamated with the practice of medicine in gen-
eral. Little if any of the old spirit of intolerance and per-
secution shows itself. Friendly relations exist, and amicable
consultations frequently occur."
In Rome I had a very entertaining interview with Dr. Vin-
cenzo Liberali. His father was a homoeopathist, and he
has a son now studying medicine. He said, " We number
five homeeopathists here in Rome, and about forty in Italy.
We have a hospital in Turin, which has recently had a
legacy which will enable it to maintain a capacity of about
thirty beds. In the larger cities of Italy there are from four
to six homeeopathists each, but in the smaller towns and
cities it is unknown. Of increase in numbers there is none,
and homoeopathy is but little known or practiced among my
old school colleagues. I occasionally hear of them using
/
424 The New England Medical Gazette. Sept.^
glonoine, on homoeopathic indications, for heart troubles,
but in such large doses that disagreeable cephalic symptoms
follow.
" The outlook in Italy for the growth of homoeopathy as a
school is not hopeful. I include in my practice some of the
most wealthy and intelligent families of Roitle; and there is
a place for homoeopathy among the better classes of people.
All influences, however, lead the young man toward the
attractions of the old school hospitals, colleges, societies and
associations. The friendship and good will of the estab-
lished professors and practitioners seem to them, and are
stepping stones to practice and a livelihood. After all, with
most, the latter is the chief incentive."
Salzburg (Austria, the home of Paracelsus in the sixteenth
century), a flourishing city of thirty thousand inhabitants,
directly in the line of travel between Paris, Munich, Vienna,
and Constantinople, and much visited and admired for its
beauty by tourists, has one homoeopathist, Dr. Gregor
Gfrerer. His sign reads, " Physician and Hydrothera-
peutist.*' He said, " Formerly there were three homoeo-
pathic physicians here, but one has died, and the other is
aged. No young men are in view to take their places.
They all cast their fortunes with the dominant school.
Homoeopathic remedies are unused and unknown by my old
school colleagues. The druggists here keep no homoeopa-
thic preparations. I must send to Leipsic for all my tinc-
tures and triturations. I am viewed as a charlatan by my
old school colleagues and homoeopathy is denounced as a
humbug. My field is difficult. I see but little promise for
the future."
Vienna. Dr. Ignatz W. Klauber is one of the foremost
homoeopathists in Vienna and enjoys a large, lucrative prac-
tice. He said, "We have two hospitals here under homoeo-
pathic management : a general hospital of eighty beds and
a children's hospital of thirty beds. The number of pro-
fessed homoeopathists here at present is about fifteen.
I90I A Letter from Germany, 425
There are many more who practice homoeopathy quietly and
affiliate with the old school. We have no homoeopathic
organization in Austria, i,e. no national society, and probably
homoeopathy never will exist as a separate school, con-
sequently our young men who believe in and practice hom-
oeopathy perfer to do so quietly, in which they are not
antagonized by their old school colleagues, and thus they
maintain friendly relations with the dorminant organiza-
tions.
" No, homoeopathy is not on the decline in Austria. The
germ of truth enunciated by Hahnemann is penetrating
more deeply into the body medical. There will always be
people who want homoeopathic treatment and there will
always be physicians, and in increasing numbers, who will
practice homoeopathy.
" Some of the professors in the Vienna University main-
tain cordial relations with us and meet us courteously in
professional consultation."
In Dresden, Dr, Hermann Elb (member of the Royal
Saxon Sanitary Commission) is the pioneer homoeopathist of
Saxony. For many years he held the field alone, but in
recent times accession to the ranks have occurred. At pre-
sent there are four physicians practicing homoeopathy in
Dresden. Dr. Elb said, "Yes homoeopathy is gaining
strength in Germany. Our National Homoeopathic Medical
Society has a membership of about two hundred, and meets
annually in the larger cities, alternately. It convened here
in Dresden last year, at which time I served as president.
This year it meets in Frankfort, August 8th — will you
come } At the present time there is a factional dispute
over the attenuation question, but that will adjust itself.
As physicians and scientific men we cannot ignore progress
in medical science, whether such be in the line of homoeo-
pathic therapeutics, serum therapy or sanitary science.
Homoeopathy was never more directly in the line of progress
than at the present time. There are more physicians prac-
426 The New England Medical Gazette. Sept.,
ticing homoeopathy, more old school physicians giving ear to
it than ever before. Dr. Hugo Schultz, Professor of Materia
Medica and Pharmacology in the Greifswald University (old
school) is in a quiet way disseminating homoeopathic teach-
ings. It is an interesting story. He believes in homoeo-
pathy but his position forbids declaration of such. As a
child he was cured of some distressing malady by homoeo-
pathy. As an adult and after he became professor in the
university he was stricken with a severe enteritis. Nothing
availed as a cure. At last after seven weeks had elapsed
he was persuaded by his parents, who were still firm believ-
ers in homoeopathy, to summon a homoeopathic physician.
Colchicum was administered. In two days he was well. A
little while after, he was relating to one of his old school
colleagues the details of his experience and his rapid recov-
ery after taking colchicum. His companion said in answer,
** It is impossible that colchicum could have had anything to
do with your recovery. Why^ it produces just such symp-
toms!' The next step is the appearance in old school jour-
nals of provings of various drugs on Hahnemannian plan by
Professor Shultz, conducted in a masterly manner, to which
no objections have thus far been offered by' his old school
colleagues. It is an open secret that his sympathies are
with homoeopathy, that he seeks conference with homoeo-
pathic physicians, but that thus far, from motives of which
judgment should not be hasty, he does not announce himsetf
a homceopathist
In Berlin I found an enthusiastic, hard working coterie
of homoeopathic physicians numbering about forty. I spent
a very pleasant evening with Dr. Gisevius and Kroner dis-
cussing medical education in Germany and the present and
future of homoeopathy. They said, " We have at present
about four hundred professed homoeopathic physicians -in
Germany and about four hundred more who practice hom-
oeopathy but prefer to affiliate with the old school. We
conduct three dispensaries here in Berlin and have already
I go I A Letter from Germany, 427
in hand seven hundred thousand marks towards the founding
of a hospital. We are now moving in the matter of the
establishment of a homoeopathic pharmacy under the same
governmental regulations which control the old school phar-
macies. This means much for it will be the first govern-
mental recognition which has been accorded us.
" A committee of physicians is now busy upon a new
work on homoeopathic pharmacy and materia medica. Pro-
fessor Schultz's work at Greifswald University is doing
much for the dissemination of homoeopathy among the pro-
fession at large. Young men who seek training in homoeo-
pathic materia medica attend his lectures from all over
Europe. His course is a wise one in making no declaration
of his homoeopathic convictions. His work is so profoundly
scientific that he is unassailable by any of his old school
colleagues who may be chafing at the impetus which he is
giving to homoeopathy. That his work receives the com-
mendation of the regents of the university is evidenced by his
recent advancement to a position of higher dignity.
" A few years ago Professor Rapp, of Tubigen Univer-
sity, became a convert to homoeopathy and made open decla-
ration of the same. He was quietly deposed and sank into
oblivion.
" As to the future of homoeopathy here in Germany it is
rash to prophesy, but there are certainly no signs at present
of its decadence.
" Our relations with the old school are tranquil, and ami-
cable consultations frequently occur.
" There is a strong friendly feeling on the part of the pub-
lic towards homoeopathy as is evidenced by recent large con-
tributions to our hospital fund."
Conclusion, There is no prospect of the extinction of
homoeopathy in, Europe in this era of the world's history.
While in some countries and sections of countries homoeop-
athy is making little or no progress, e.g.^ Italy and Southern
Austria, yet it is almost the universal testimony that the
/
428 The New England Medical Gazette. Sept.,
number of physicians who practice homoeopathy is augment-
ing. In Germany the expected has at last occurred, viz. :
A professor of materia medica in an old school medical
college has taken up the investigation of drugs on the Hahn-
emannian plan, and his work and teachings are accepted
and incorporated in the latest and most authoratative text-
book {Lehrbuch der Allgemeinen Therapie und der Thera-
peutischen Meto die l8g8).
After this there seems no need to discuss the future of
homoeopathy. As a therapeutic method it has stood the test
of a century and it now takes its place in the great field of
medicine as a method among other methods to be used
according to the light and convictions of each physician.
{To be continued,)
THE MATERNITY DEPARTMENT OF THE MASSA-
CHUSETTS HOnCEOPATHIC HOSPITAL.
With a Report of the Services of Walter Wesseihoeft, M.D.,
Obstetrician.
REPORTED BY J. EMMONS BRIGGS, M. D., ASSISTANT OBSTETRICIAN.
[Read before Mus. Horn. Med. Society, March 7, 1901.]
The first definite steps toward the establishment of a
Maternity Department to the Massachusetts Homoeopathic
Hospital may be said to have originated with a motion made
by Dr. Walter Wesselhoeft at a meeting of the Medical
Board of the Hospital held in June, 1896. His suggestion
was that a part of the medical wing of the hospital be used
as an obstetrical department. The matter was placed in the
hands of a committee who agitated the subject, with the re-
sult that on April 30th, 1 897, the trustees of the hospital ob-
tained possession of a large house No. 40 West Newton St,
I90I Maternity Dept. Mass. Homceopathic Hospital, 429
Boston, which had previously been remodeled into a private
hospital.
During the spring and summer a considerable amount^of
work was done in adapting the building to the needs of a
maternity hospital. Finally, on September 5 th, 1897, the
work was completed and the first patient was admitted.
The capacity of the hospital is at present seventeen beds.
On the first floor are the reception-rooms, dining-room for the
staff and nurses, a ward with a capacity of five beds, a serv-
ing-room and bath. On the second floor is one small private
and two large rooms, accommodating two and three patients,
respectively ; also a bath-room. The third and fourth floors
are arranged in a similar manner. The fifth floor contains
the delivery and sterilizing rooms, also a small room, where
patients wait until the first stage of labor is completed. In
the basement is the kitchen and a room for the examination
of patients. The nursery is a large room with a southern
exposure. There are cribs with accommodations for seven-
teen babies. There is a porcelain bath tub and all necessary
appurtenances for their care, including an incubator of the
latest design.
The delivery-room, a room 14 x 15, is supplied with over-
head and northern light. The furnishings are of metal and
glass and comprise an operating or delivery table, instrument
and dressing table and porcelain utensils. The room is
lighted by electricity and gas. Opening out of this is a room
for instruments and sterilizing.
The private rooms vary in size from those moderately
small, at $15 a week, to commodious and very handsomely
furnished apartments at $30. There is only one general
ward, and it contains five beds. A limited number of free
patients can be accommodated.
The house physicians are appointed for a term of six
months, the first three months serving as junior and the sec-
ond as senior housa physicians. The requirements call for
a graduate in medicine for the position of senior house physi-
430 The New England Medical Gazette. Sept.,
cian. He, assisted by the junior, is entrusted with the care
of patients before, during and after confinement, under the
in>mediate supervision of the attending or assistant obstetri-
cian. He keeps the records and has authority to admit
patients in emergency. The internes are usually those who
have served or have been appointed to a term of twelve
months at the Massachusetts Homoeopathic Hospital. The
nursing is under the immediate supervision of the superin-
tendent of nurses and the matron of the maternity depart-
ment.
In the three years during which the hospital has been in
operation it is a noticable fact that nearly all the private
cases which have been treated have come from the practice
of the obstetrical staff. It does not seem to be generally
known that other physicians who are members of the Massar
chusetts Homoeopathic Medical Society can bring their
patients and care for them in the private rooms of this insti-
tution. Here are all the appliances for meeting emergencies,
and especially, through its corps of house physicians and
nurses, for reducing to the minimum the great hazard that
is sometimes foreseen must attend the approaching parturi-
tion.
That you may have an idea of the amount and character of
the work which this institution is conducting, I have had a
summary made of all cases treated in the hospital from the
date of opening to January ist, 1901.
See Third Annual Report,
REPORT OF THE SERVICE OF WALTER WESSELHOEFT, M. D.,
OBSTETRICIAN.
Patients who desire admission to the Maternity Department
either apply in person or through their family physician. In
either case they are encouraged to submit to examination as
soon as practicable. This primary examination is to de-
termine approximately the position of the foetus, the pelvic
190 1 Maternity Dept, Mass. Hommopathic Hospital, 431
diameters, and, in fact, to ascertain whether, there be be any
abnormality. The urine is examined and the patient instruct-
ed when to call again. Subsequent examinations are re-
quested in cases where the position is faulty or other marked
pathological conditions exist. If the urine is scanty, low in
specific gravity and urea, and contains albumin or casts, the
patient complaining of dullness of vision or headache, we in-
sist upon immediate admission. If any of the above men-
tioned complications exist, we prefer to have our patient
under our immediate observation, that any tendencies toward
uraemia may be immediately discovered and the appropriate
treatment instituted.
If everything appears normal in the primary examination
patients are instructed to enter the hospital at a time which
is set about one week before the expected confinement. They
are, however, instructed to report immediately in case labor
pains occur.
If patients are in labor when they arrive, if time will allow
they receive a bath and their bowels are evacuated. They
then go either to their rooms or the delivery suite, as the cir-
cumstances require. During the first stage of labor patients
remain in their rooms, and are encouraged to move about,
but after the cervix is dilated they are taken to the delivery-
room. Ether or chloroform are frequently administered as
the head begins to dilate the vulvar orifice. Here it serves
two purposes, viz. : to retard and render the propulsive pains
less violent, and thus give ample time for the soft parts to
stretch ; also to relieve the woman from the agony often ex-
perienced as the head is bom and the perineum injured. It
is impossible at this writing for me to say just what propor-
tion of cases receive an anaesthetic.
The perineum is never repaired nor forceps applied
without anaesthetic. Chloroform is the anaesthetic par excel-
lence for obstetrical work. It is quick in its action, and,
unless operative interference is demanded, only a few drops
need be used on a handkerchief as the patient realizes the
432 The New England Medical Gazette. Sept.,
oncoming of a pain. Complete anaesthesia is scarcely ever
employed, nor is it desirable in uncomplicated cases.
Frequent vaginal examinations are undesirable and add to
the dangers of infection. After having determined the posi-
tion of the foetus, and assured oneself that no abnormality of
the bony pelvis or soft parts exists, nothing is gained by re-
peated exaniinations. I use the rubber finger cots for exam-
ining purposes and the rubber gloves during delivery. I
have formed no opinion as yet as to their merits in obstetrical
practice, as they were used only during the last term of
service. No sepsis developed, but it is probable that such
would have been the record had we not used them. I had
become an ardent believer in* the rubber glove for surgical
work, and was anxious to give them a trial in obstetrics.
Whenever a chemical disinfectant has been required, we
have used formaline solution, one-half of one per cent.
Douches are not given during or after delivery unless special-
ly indicated. A foul lochial discharge appearing a few days
after delivery is an indication for a douche of sterile water,
followed by a pint of one-half per cent, formaline solution.
Lacerations of the cervix are not repaired unless very
severe and stitches have to be taken to control the hemor-
rhage. Post-partem hemorrhage is treated by compression of
the uterus through the abdominal wall, by hot or cool
douches to which vinegar is added if necessary. If the
bleeding be occasioned by a cervical laceration the uterus is
pulled down by the cervix forceps and two or three deep cat-
gut sutures are adjusted in the cervix in such a way as to
control the hemorrhage. If patients suffer from an excessive
loss of blood we have recourse to the intravenous saline
injection. Ruptures of the perineum are invariably repaired
immediately, and we exercise as much care in accurate sutur-
ing as in cases requiring secondary operation. The suture
material is cat-gut and silk worm-gut, the latter being re-
moved on the tenth day. Patients with rupture of the peri-
igoi Maternity Dept. Mass, HomceopatHic Hospital. 433
neum are allowed to sit up on the fouteenth day and leave
the hospital on the twenty-first.
Babies are car^d far in the nursery by a nurse who is de-
tailed for that w6rk exclusively. They are brought to their
mothers to be nursed at regular intervals.
During Dr. Wesselhoeft's terms of service several extremely
interesting cases have been treated. Lack of time forbids
me to report them all, and I must select a few. I have de-
cided, therefore, to give you brief reports of those which ter-
minated fatally. These comprise two cases of eclampsia and
one of placenta previa.
Case I. — Mrs. B., age 23, nationality, English. She en-
tered the hospital at 10.30 A. M., June 20, 1899, and gave a
history of having had nephritis for four years. Her father
and brother both having died from it. During her pregnancy
she had suffered less than usual. Early in the morning of
June 20th she had a severe convulsion, which was followed
by two equally severe, before she arrived at the hospital. She
was unconscious, and her temperature had risen to 103
degrees and her pulse was 1 20. Her countenance was livid
and her skin dry and hot. Examination per vaginam showed
a cervix undilated. Dr. Walter Wesselhoeft was summoned
in consultation. As the patient was in a desperate condition,
her temperature rising at the rate of nearly a degree an hour
and her pulse increasing in rapidity, with absolute suppression
of urine, it was thought best to interfere and deliver her as
soon as possible. With this end in view, forcible and rapid
dilitation of the cervix was undertaken, but on account of the
great rigidity of the cervix and the narrow vagina and peri-
neum, it was quickly found that delivery through the vagina
could not be accomplished without extensive injuries to the
soft parts. At the suggestion of Dr. Wesselhoeft, I made a
Caesarian section and delivered the woman of a living child.
The placenta being very adherent, and its detachment being
accompanied by severe bleeding, ligatures were thrown about
434 Tf^^ New England Medical Gazette, Sept.,
both broad ligaments and the uterus removed. An intra
venous injection of salt solution was then administered. The
patient had another convulsion shortly after completion of
the operation, from which she never rallied, and died about
8 P. M., about four hours after the operation. The child
survived only eight hours.
Comments : This was a typical case of puerperal eclamp-
sia in its worst phase. The woman had been in convulsions
and unconscious nine hours. Her temperature and pulse
were exceedingly high and the cervix not dilatable. There
was absolute suppression of urine ; less than a tablespoonful
was procurable by the use of a catheter, and it contained
eight per cent, albumin and numerous granular and fatty
casts. No expectation of saving the mother's life was enter-
tained. By Caesarian section we hoped to save the child.
Case II. — Miss C, aged 14, Irish parentage;- entered the
hospital at noon of October 28, 1900, in a semi-comatose
condition. Her mother found her that morning in convul-
sions and apparently unconscious. There was a record of
four well-marked convulsions and several less pronounced.
A very severe convulsion occurred at 12.15 P. M. I exam-
ined her at that time and found the cervix partially dilated.
At Dr. Wesselhoeft*s suggestion chloroform was administered
and the cervix manually dilated. At 12.30 P. M. the mem-
branes were ruptured and high forceps applied. The child
was delivered without any difficulty and with scarcely any
tearing of the soft parts. Three pints of an intra-venous salt
solution were given at 1.40 P. M. At 2 o'clock a slight con-
vulsion occurred, and another somewhat later. Two more
followed in close succession. At about 3 P. M. several high
saline enemata were given. Half an hour later the convul-
sions were very severe and frequent. Only two drams of
urine could be obtained by the use of the catheter. It con-
tained eleven per cent, albumin, numerous granular hyaline
and epithelial casts. Veratrum veride in 5 gtt. doses was
given and frequently repeated. With every convulsion the
I go I Maternity Dept. Mass. Homceopathic Hospital, 435
pulse increased in rapidity. At 5 P. M. the temperature had
reached 104.5 ; at 7 P. M., 105.8 ; at 9 P. M., 1077, with a
pulse estimated at 180 per minute. At this hour the convul-
sions were not so well marked, but there was constant
twitching and stertorous breathing. She died at midnight in
a convulsion. Her temperature by rectum was 108.4.
Comments : In this case the indications were clear as to
the course to be pursued. The cervix was obliterated and
the canal was opened sufficiently to admit the finger, there-
fore the delivery was easily accomplished. This case, how-
ever, proved more rapidly fatal than case i, where Caesarian
section was made, and was, likewise, doubtless attributable
to the total suppression of urine.
Case III. — Placenta previa. — Mrs. F., aged 30, Irish na-
tionality. The first seven months of pregnancy progressed
normally, when suddenly a severe hemorrhage occurred.
After that date she had several other hemorrhages, but less
severe. She had been compelled to spend a large portion of
her time in bed, as exercise was accompanied by loss of
blood. She entered the hospital June 13, 1898. At this
time she was flowing badly, and there was a foul odor to the
discharge. Examination revealed a transverse presentation,
with the head to the right side. The cerv-ix somewhat dilat-
ed, and within were clots of blood which protruded through
the OS. On deeper penetration the placenta was made out
centrally located. The patient was put in bed and the
vagina was cleansed by antiseptic douches.
We kept her under observation one week, during which
time she flowed quite constantly, but not alarmingly. On the
20th of June she had a severe hemorrhage. The vagina was
packed, but the flowing continued. As the hemorrhage
could not be controlled we thought best to interfere. The
patient was etherized, and Dr. Wesselhoeft dilated the cervix,
grasped a foot and delivered forcibly. Considerable difficulty
was experienced in delivering the aftercoming head. The
cervix was badly lacerated, the tear extending high to the
436 The New England Medieal Gazette, Sept.,
left side of the womb. It evidently opened some large ves-
sel, possibly the uterine artery, for the hemorrhage was pro-
fuse and the blood bright red and spurting. The patient
was in collapse, and three quarts of saline solution were in-
jected. Cat-gut stitches were adjusted in the cervix, which
controlled the bleeding. The patient's pulse was very rapid
and soon became imperceptible. She died from hemorrhage
at I P. M. June 21st. The child was still-bom.
A CASE OF CHRONIC SUPPURATIVE OTITIS MEDIA.
F. W. COLBURN, M. D.
In presenting a report of a case of chronic suppurative
otitis media, I am well aware that certain points must of
necessity be brought up which are old and familiar to each
of you.
The title in itself suggests a combination of familiar symp-
toms : a moderate degree of deafness, noises in the ears, and
a more or less offensive purulent discharge from the ear.
The case in point had all of the^e and more.
Mr. H., 49 years of age, married, a native of Finland.
Until fifteen years ago he was a seafaring man, since that
time has been employed in a mill.
Thirty years ago patient was rendered unconscious by
a blow from a staysail block, received just posterior to the
right mastoid process. This was accompanied by hemor-
rhage from the ear. The site of the blow is now marked by
a large scar and deep depression in the skull at that point.
The patient rallied from the immediate effects of the
injury, but from that time until last spring had had a recur-
ring otorrhoea and has been deaf upon that side.
His general health has not, however, been impaired until
the present illness which began about May 25, last. He
was attacked with severe neuralgic pains extending over the
igoi Chronic Suppurative Otitis Media, 437
whole right half of head, radiating apparently from the ear.
He kept at his work in the mill, however, until May 29,
when he was seized with vertigo and was absolutely unable
to ride home upon his wheel at night as was his custom.
The following day had a chill accompanied by vomiting.
He sought aid from a local physician and later from one
of the large hospitals here in the city. Both prescribed, but
with no beneficial effect. The pain increased and the ver-
tigo remained. Then as a last resort he visited a homoeo-
path who sent the patient into the hospital, where I first saw
him for Dr. Bellows on June 12.
Patient emaciated, face flushed, inclined to be drowsy ;
temp. 98 ; pulse 72. Complaining of severe pain in whole
right side of head, radiating from the ear to and bounded by
a median plane. Eyes ached, pupillary reflex unimpaired.
Complains also of weakness and aching in lower extremi-
ties, especially about the knees.
Vertigo intense whether in bed, standing or sitting. No
nausea or vomiting.
Appetite good. Sleepless nights caused by the nocturnal
aggravation of the pain.
Examination of the ear revealed right external meatus
filled with a brownish purulent discharge with an exceed-
ingly offensive odor. After cleansing with hydrogen dioxide,
removing much thick, cheesy material, it was found that only
a crescent shaped portion of the lower anterior quadrant of
the membrana tympani remained. The malleus and incus
were gone. Posteriorly and above appeared a sensitive
granulation which bled profusely upon the slightest touch
from the probe.
The patient was kept in bed for a week or more, having
the ear thoroughly cleansed with hydrogen dioxide night and
morning. Liquid diet was prescribed and as the general
condition began to improve a gradual increase was made in
the menu. In the course of ten days the patient was able to
sit up for a short period several times a day. With patient
438 The New England Medical Gazette, Sept.,
in a sitting posture the granulation which was previously noted
was easily dislodged and swung downward into the tympanum,
being suspended from above by a pedicle. This was re-
moved under cocaine, with the result that the vertigo grad-
ually but steadily decreased until entirely gone. The pain
was temporarily relieved.
A second polypus appeared about August first and was
removed, only slight relief following.
From the date of admission to the hospital to the first
week in August the patient's general health had been
steadily improving.
The vertigo was entirely gone and the pain and headache,
which had been constant, now had periods of amelioration,
although frequently at night it came with its former severity.
About August 4, pain again began to increase, and at
night the patient occasionally became semi-delirious in con-
sequence.
On August 10, after consulting with Dr. Colby, operation
was advised and quickly accepted by the patient as a possi-
ble relief from such agonizing pain.
There was not, as is often the case, oedema of the soft
parts over the mastoid process, neither was there marked
tenderness upon pressure. Tenderness was limited to a
small area, over the mastoid antrum, about the size of an old
fashioned three-cent piece and then only upon hard pressure.
On the other hand there was a purulent discharge from
the tympanum, associated with the polypoid growths from
the additus, and what was far more annoying to the patient
that severe, persistent, neuralgic pain which was relieved by
neither hot nor cold appplications, and at night was almost
intolerable.
OPERATION.
After anesthesia was complete, scalp shaved for a radius
of two and one-half inches from the ear and the field of oper-
ation rendered as nearly aseptic as possible, incision was
made through the soft tissues in a line parallel and one-
IQOI Chronic Suppurative Otitis. Media. 439
fourth inch posterior to the insertion of the auricle. This
incision was two and one-half inches long and clean to the
bone. Bleeding vessels secured and periosteum retracted.
Ear was then laid forward and membranous canal separated
from posterior and superior bony walls of external meatus.
Then with chisel and mallet the mastoid process was laid
open to the antrum, which in this case, by the way, was the
only mastoid cell present, and was filled with granulations
and purulent material. The rest of the process was hard as
ivory.
With the antrum as a guide then the opening was ex-
tended to the middle ear, removing the entire posterior and
superior bony walls of canal and external wall of the epitym-
panic space in so doing.
This done the whole cavity, including antrum, epitym-
panic space, and tympanum, was thoroughly curetted to
remove all diseased tissue, the utmost care being taken to
avoid injuring the semicircular canals or the Fallopian canal
through which the facial nerve passes on the internal tym-
panic wall.
A careful search was then made with a fine probe, for any
small sinus which might extend deeper.
None being found the cavity was packed with iod. gauze
to arrest oozing.
The membranous canal was then slit from within, out-
ward on its posterior aspect, to the concha, and the flaps
reflected upward and downward upon the cut bony surface
of the cavity, were held in place by a single suture each and
firm pressure from within by means of gauze introduced
through the meatus. This left the antrum, tympanum exca-
vation in the mastoid process and the external canal all in
one large cavity to be dressed as a unit through both the
canal and the posterior auricular opening. A sterile gauze
dressing and bandage and the patient was put to bed to re-
main until after the first dressing.
For five days following operation the patient suffered
440 The New England Medical Gazette, Sept.,
severely from the same persistent neuralgic pain which, if
anything, was slightly aggravated by the operation.
The patient was blue in the extreme and I did not much
blame him, for it was bad enough before.
The first dressing was made on the morning of the fourth
day.
After packing had been removed there was profuse oozing
from all the cut surface. Cleansed with hydrogen dioxide
and again packed with iodoform gauze. From this time
until October i8, dressing was done daily, H^O, and for-
malin one-half per cent. On the sixth day the pain began
to abate, and on the ninth the patient was free from pain
and has so remained.
The whole cavity remained clean with exception of a
small spot on the anterior wall of tympanum. This grad-
uallly cleared and the entire cavity became lined throughout
with healthy epidermis, an extension of the reflected flaps
from the canal.
The posterior auricular opening has been maintained to
facilitate removal of wax and epithelial debris which is prone
to collect within the cavity.
I last saw the case on October lo. The cavity was abso-
lutely dry and the patient had had no return of the pain.
His hearing distance for my watch at that time was
about two inches, a little better than when he entered the
hospital.
A few points worthy of note might be mentioned : (i)
The temperature in this case never rose above 99° until
after operation, notwithstanding the other symptoms. Im-
mediately before operation temp, was 98 T, pulse 68;
on the following morning it had jumped to 103 j and 112 re-
spectively. On the second day it was normal again and
remained between that and 99*° until August 23, when il
reached 100°, but was normal thereafter.
(2.) The intense vertigo disappearing after the removal of
the polypus.
(3.) The relief of pain following operation, and lastly,
absolute cessation of discharge from the tympanum.
190 1 Pernicious Anamia in Insane Subjects. 441
FOUR CASES OP PERNICIOUS ANiCHIA IN INSANE
SUBJECTS
With a Consideration of the Co-existin; Nervous Features
of tlie Disease.
BY S. C. FULLER, M. D.
(Preaented to the Section Mental and Nervous Diseases Mass. Horn. Med. Society.)
Aside from the purely nervous conditions, insane subjects
are liable to almost any form of disease. It is also true that
their mental disturbances may be directly traced, in many
cases, to somatic lesions.
Just how much the pernicious anaemias have been responsible
for the nervous and mental disturbances in this series of
cases or vice versa, or, further still, was simply a condition
paripassuy will not be easy to determine. The mental dis-
turbance in at least two of the cases, I think, can be safely
attributed to the pernicious anaemia. One of these two
cases improved mentally and physically under treatment
directed largely to the pernicious anaemia, and was dis-
charged. Later the case was admitted to the Mass. Gen-
eral Hospital, where she died. The autopsy confirmed our
diagnosis of pernicious anaemia. Two of the cases in the
series died at the Westborough Insane Hospital and were
autopsied, but in only one of them was the brain and a por-
tion of the cord examined. In the other case an examina-
tion of the brain and cord were not permitted. One of our
cases is still alive.
In another case which I have tentatively added, the
autopsy revealed carcinoma of the lower third of the stom-
ach with metastasis to the mesteneric lymph glands, and to
the liver. The stomach, however, was freely patent. The dis-
covery of carcinoma casts a shadow of doubt on the diagno-
sis of pernicious anaemia in this case. In carcinoma of the
stomach with marked cachexia and rapidly developing
asthenia, and especially in those cases where the orifices of
the organ are not involved and no tumor is discoverable on
palpation, the differential diagnosis becomes difficult between
442 The New England Medical Gazette, Sept.,
pernicious anaemia and a grave secondary anaemia subsequent
to malignant disease. In the above condition Bramwell * has
pointed out that a survey of the clinical symptoms together with
the blood examination are necessary to correct diagnosis.
Cabot ' lays stress upon the presence of a leucocytosis in carci-
noma of the stomach while in pernicious anaemia leukopenia is
the rule. Ewin' maintains that " leucocytosis of carcinoma is
referable largely to complications, and these complications
are such as appear very constantly in rapid or advanced
cases." . . . Therefore ** the great variety of these compli-
cations render it unwise to draw any narrow diagnostic con-
clusions from the presence or absence of leucocytosis." A
further characteristic of carcinoma is the low color index
of the blood, and especially, is this true of visceral carcinoma.
Leichtenstern*, however, has called attention to the rapid
increase of Hb. in gastric cancer shortly before death. In
this case, however, after a review of the literature, the
increased color index, the leukopenia, the presence of
myelocytes and megaloblasts determine me in maintaining
a coexisting pernicious anaemia. The report of this case
appears below (Case V).
Lichtheim* in 1887 first described the changes in the
cord of two subjects dead from pernicious anaemia. He
discovered degenerations of the posterior columns, aud also,
though to a less degree, changes in the lateral tracts.
Later ^' he called attention to the difference between the
changes in the cord in pernicious anaemia and in tabes. In
the former disease the sclerosis was most marked in the
cervical region. The lesions in the cord of pernicious anae-
mia subjects are not symmetrical, but nearly so, and the
scleroses in the lateral columns are always separated from
the posterior horns by areas of normal white matter. These
findings of Lichtheim have been confirmed by other observ-
ers. The writer was able to demonstrate the characteristic
changes in one of the cases sectioned. The lesions are not
constant as will be seen from one of the cases which was
I go I Pernicious Anaemia in Insane Subjects, 443
thoroughly studied in the Pathological Laboratory of the
Mass. General Hospital.
In 1 89 1 Putnam' reported a group of eight cases with
diffuse degenerations of the spinal cord, " in one or two " of
which " the spinal lesions had been associated with anaemia
of a profound type, and in the rest with other forms of mal-
nutrition not definitely classifiable." Later Dana® reported
cases which confirmed the observations of Putnam. Under
the heading " The Combined Scleroses of Pernicious Anae-
mia and Cachectic States," Dana'*, in his recent work, de-
scribes the histopathologic changes in the cord as consisting
of two varieties. In the one set the lesions are old, consist-
ing of comparatively dense scleroses, while in the other set
the changes are subacute in character. This latter condi-
tion is manifested by the perforated appearance of the struc-
ture, a condition suggestive of rapid destruction of nerve
fibres. There is also oedema of the connective tissue septa.
In the gray horns the degenerative changes are partly recent
and partly old. Within the present year Putnam and Tay-
lor ^^ have contributed to the literature on diffuse degenera-
tions of the cord a paper in which is represented a clinical
analysis of fifty cases and five pathological reports. They
accepted provisionally the classification of Bastinelli", who
groups the cases of anaemia with diffuse degenerations in
one class and those of malnutrition in another. They, how-
ever, maintain that there can be drawn no fast line, for there
may be gradations between the two groups. In support of
their claim they cite a case in which "pernicious anaemia
was present and ran a typical course, yet spinal symptoms
were recognizable for three years, their onset nearly coincid-
ing with the onset of pallor and with a loss of flesh."
Adami^*, considering the etiologic factors in pernicious
anaemia, lays great stress on infection, either a latent or a
subinfection. In this process the bacterial flora of the intes-
tine play quite a role. To combat the toxines thus pro-
duced, Adami suggests the possibility that the essential cells
444 ^^'^ A^ifzt/ England Medical Gazette, Sept.,
of the nervous system may successfully resist local infection,
but in so doing exhaust themselves, and consequently readily
succumb to later toxic influences. In the formal discussion
on the intoxications and infections in the pathogenesis of
mental diseases and neuropathies before the tenth congress
of the Societa Freniatrica Italiana, D'Abundo^' maintained
" that infections and intoxications are the most frequent
sensible and active factors in the pathogenesis of nervous
diseases in general, in every period of life both intra uterine
and extra uterine. . . . The infections and intoxications of
the nervous system facilitate the evolution of secondary in-
toxications which feed, re-enforce and complicate the clinical
phenomena and result in complex forms due to multiple
intoxications.'* The writer has elsewhere" called attention
to the role of auto-intoxication as a causative factor in the
production of mental disturbance. It is well, however, to
bear in mind the possibility of cachectic states supervening
upon purely nervous conditions. A positive demonstration
of this is obviously difficult. But I have frequently seen
insane subjects whose blood examination showed on admis-
sion, and for a considerable period thereafter nothing of
import, subsequently develop a profound secondary anaemia,
and for which there could be discovered no assignable cause
save the onward progress of their nervous condition.
From the prevalance of intestinal symptoms in cases of
pernicious anaemia, a condition which was a feature of the
majority of the cases in this series, the suggestion of the
influence of the intestinal flora advanced by Adami seems
plausible. Ashford" has recently demonstrated the frequent
association of ankylostomum duodenale with the pernicious
anaemia so common among Porto Ricans. Chapirou" as far
back as 1888 reported the case of a boy with pernicious
anaemia who had associated bothriocephalus latus.
With regard to the prevelance of pernicious anaemia in
New England, Cabot" thinks the disease is common. In
May, 1900, he reported to the Association of Americian
1 9^1 Pernicious Ancemia in Insane Subjects, 445
Physicians 1 10 cases which he had collected in seven years.
He states that one-third of his cases showed nervous symp-
toms. In more than 700 individuals whose blood the writer
has examined, all living in New England, pernicious anaemia
has been observed 9 times. Six of these cases have been in
insane persons.
Abstracts from the clinical records and pathological
reports of five of the cases are. here presented :
Case I. Mrs. B., aet, 49, was admitted to the Westbo-
rough Insane Hospital Sept. 1 2, 1 898, her insanity at that
time being of four months duration.
Family and previous history unimportant.
Status PrcBsens. A slightly built and poorly nourished
female weighing 109 lbs. Heart and lungs normal. The
urinalysis shows nothing of importance. The pupillary reac-
tions are normal. The patella reflexes are diminished.
Mental activity is diminished ; the perceptions, memory and
will are normal ; the emotions are unstable and the reason-
ing power weak.
The blood examination on admission showed an increased
color index and an increase of small lymphocytes which com-
prised 44 per cent of the total number of leukocytes. The
red cells and haemoglobin were not, however, greatly dimin-
ished, a condition which may have been due to the concen-
tration of the blood. The patient for four or five months
made no improvement. She complained of abnormal pain,
and diarrhoeic attacks began to be common. A blood exam-
ination at this time revealed Hb., 63 ; red cells, 2,320,ocx);
leukocytes, 3,320. Differential count of leukocytes : large
lymphocytes, 3 1-5 per cent. ; small lymphocytes, 47 1-5 per
cent. ; neutrophils, 49 per cent. ; eosinophils, 2-5 per
cent.; myelocytes, 1-5 per cent. Normoblasts, macrocytes,
niicrocytes and poikiolocytes were observed, but no mega-
loblasts nor microblasts were encountered. Five months
later the blood picture was worse. Hb. 25 ; red cells,
1,600,000; leukocytes, 3,000. Differential count: large
446 The New England Medical Gazette, Sept.,
lymphocytes, 6 4-6 per cent. ; small lymphocytes, 45 per
cent. ; neutrophiles, 46 per cent. ; eosinophiles, i per cent. ;
myelocytes, i 2-6 per cent. Normoblasts and poikilocytes.
were observed. The pallor was now more marked, assuming a
yellowish tinge, and asthenia and emaciation were progress-
ing. The administration of iron having failed to produce
satisfactory results. Fowler's sol. was exhibited with a most
gratifying outcome. Six months after this time the mental
and physical condition were much improved. The blood
picture approached more nearly the normal, but there was
still a color index of i plus. The patient was discharged,
having recovered from her insanity which was acute melan-
cholia. At a later period she was admitted to the Mass.
General Hospital where she died. I am indebted to Dr.
James H. Wright, pathologist to that institution, for the
anatomical diagnosis of the autopsy on this case.
Anatomical Diagnosis. Pernicious anaemia, fatty degen-
eration of myocardium, defective closure of foramen ovale,
ecchymoses on pleura, oedema of lungs, syphilitic hepatitis,
chronic, passive congestion of spleen, fibro-myomata of
uterus, polypi of uterus, chronic internal haemorrhagic pachy-
meningitis, osteomata in pia-mater of spinal cord, and lipoma
of subcutaneous tissues in the region of the left posterior
axillary line.
Microscopical Examination of Cord, Sections of the cord
from the cervical, thoracic and lumbar regions prepared after
Vassale's modification of the Marchi method fail to show any
good evidence of degeneration. Sections stained by Mal-
lory's method for proliferation of neurologlia or degeneration
in nerve tracts were negative. Pal's modification of Wei-
gert's method showed no degeneration (Dr. Wright).
Case II. Mr. L., an Italian fruit pedler, aet, 30, was
admitted to the West borough Insane Hospital May 19, 1900.
Nothing is known of his family history. Of his previous
history very little is known. He had formerly been an in-
mate of the New York City Insane Hospital, and had been
IQOI Pernicious Ancemia in Insane Subjects, 447
discharged recovered. Six months prior to admission he
had been an inmate of the Marlborough Almshouse where
he had acted strangely and given evidence of possessing hal-
lucinations of sight which led to his commitment.
Status Prcesens. The patient is a male of slight build,
weighing 1 26 lbs. Although possessing features of a dark
cast, pallor, with a decidedly lemon yellow tinge, is marked.
The heart sounds are normal. The lungs give evidence of
bronchitis. The urinalysis is negative for kidney lesions.
The patella reflexes are diminished, the superficial reflex nor-
mal. There is no Romberg sign, no Babinsky phenom-
enon. The pupillary reactions are normal. Memory is
impaired. The blood examination shows Hb., 55 ; red cells,
1,800,000; leukocytes, 4,520. Differential count: large
lymphocytes, 1 8 2-6 per cent. ; small lymphocytes, 5 1 2-6 per
cent. ; neutrophiles, 29 per cent. ; eosinophils, i per cent. ;
myelocytes, 2-6 per cent. Normoblasts, megaloblasts and
poikilocytes are present.
The patient did not respond to treatment although Fow-
ler's sol. and bone marrow were administered. Repeated
examinations of the blood showed that the disease was not
being impeded in its onward march. In the short space of
two months the Hb. had been reduced from 55 to 11, and
the red cells from 1,200,000, to 608,000. An increasing
asthenia, marked and rapid in its development, frequent
attacks of epistaxis of an exhausting nature, and later pro-
nounced anorexia were the leading and most distressing
features in the clinical history of this case. The patient
toward the end was unable to walk, or even sit up or move
himself in bed, but this inability, so far as the attending
physician (Dr. Klopp) could determine, was due to the
asthenia rather than to paraplegia. The mental feature was
that of secondary dementia. The patient died after a hospi-
tal residence of two months and eleven days. Unfortu-
nately a section was not permitted.
Case III. Mr. L., act. 63, was admitted to the hospital
44 8 The New England Medical Gazette. Sept.,
nine years ago (1892). his insanity at that time being of
three years' duration. His family history is unimportant.
The patient at the time of admission gave a history of a fall
ten years previous, with resulting injury to the spine. Until
August, 1 899, there is nothing of special interest to report.
He has always had delusions of persecution, and is hypo-
chondriacal. He has for several years complained of a gir-
dle-like constriction about the chest. A recent examination
(Dr. Colby) reveals no spinal deformities, no Babinsky phe-
nomenon ; and an attempt to elicit the Romberg sign is
attended with only a slight swaying. There is " flat foot "
of both sides and a tendency to varicosis. The pupillary
reactions are normal, the knee reflexes diminished. The
elbow jerk is absent. The urinalyses show hyaline casts which
are fairly numerous and which have been persistently present
for more than two years, but albumin has been observed in only
the slightest possible trace. The pericardial dullness is in-
creased, the heart's action weak and irregular, no murmurs
could be heard. Moderate exertion is followed by shortness
of breath. There are fine muscular tremors.
In August, 1899 the attending physician noticed in the
patient a loss of flesh, an increasing asthenia and pallor, and
frequent attacks of diarrhoea. Aug. 28, 1899, I examined
the blood, which showed Hb., 36; red cells, i,6oo,cxx);
leukocytes, 4,200. Differential count : large lymphocytes,
3 per cent. ; small lymphocytes, 32 2-10 per cent. ; neutro-
philes, 63 per cent. ; eosinophiles, i 8-10 per cent., the
majority of the last being of the myelocyte type. Normo-
blasts, megolablasts, mibroblasts, poikilocytes and polychro-
matophilia of red cells were observed. Clinically the patent
has improved under the treatment directly to the pernicious
anaemia. While the general condition of the blood is in a
way better, repeated examinations show a color index of i
plus, the persistence of myelocytes, microblasts and poikil-
ocytes. There is no longer pallor, in fact the man has a
florid complexion and the diarrhoea is not now a factor. He
I go I Pernicious Ancemia in Insane Subjects, 449
is becoming more corpulent and has a good appetite. The
diagnosis of the mental condition is Secondary Dementia.
Case IV. Mrs. S., was admitted to the Westborough
Insane Hospital Jan. 5, 1895. Her age at this time was 45.
Her mother and a sister were insane. The menopause in
her case was at the age of 30. The physical condition at
the time of admission is unimportant. For five years her
physical condition had been such as to enable her to render
very useful service in the hospital laundry. In July, 1900,
she began to develop an asthenia, and rest in bed was insti-
tuted. There was pallor of a waxy appearance, which later
took on a decidedly lemon yellow tinge, and the asthenia
became rapid in its" progress. July 23, 1900, the blood con-
dition was Hb., 30; red cells, 1,280,000; leukocytes, 5,000.
Differential count : large lymphocytes, 3 8- 10 per cent. ; small
lymphocytes, 46 6- 1 o per cent. ; neutrophils, 46 8- 1 o per cent,
eosinophils, i per cent. ; myelocytes, i per cent. Megalc-
blasts, macrocytes, microcytes and poikilocytes were ob-
served. Four months later the Hb. was 1 4, red cells, 800,000,
leukocytes, 3,000 and numerous megaloblasts were present.
The blood condition grew even worse, so that in the week prior
to death the Hb. registered less than 10, and the red cells
540,000. The patient died Jan. 19, 1900. The mental
condition was paranoia. Autopsy, 26 hours after death.
Anatomical Diagnosis, Pernicious anaemia, ansemia of
brain and upper cervical cord (only the upper portion of the
cord could be autopsied, as much as could be removed with
a myelotome), " thrush heart," fatty degeneration of the
myocardium and dilatation of the right ventricle ; pleurisy
with effusion and hypostatic congestion of the lungs ; paren-
chymatous nephritis ; fatty degeneration of the liver ; anaemia
of spleen, stomach and intestines, with old adhesions of the
last ; osteoma in the upper external quadrant of the right
mammary gland ; general anasarca of the musculature ; and
proliferation of bone marrow.
The most interesting histological changes were the degen-
4SO The New England Medical Gazette, Sept.,
eration in the posterior and lateral columns of the part of the
cervical cord studies, the lateral degenerations being sepa-
rated from the posterior ones by bands of normal white
matter (Weigert Pal Method). In the marrow of the femur
there was present the characteristic hyperplasia, the major-
ity of the red cells were nucleated, and there were but a few
fat cells present. The sections from the myocardium
showed characteristic fatty degeneration, as well as those
from the most degenerated areas in the liver.
The protocols and full microscopic reports of these cases
have been omitted so as not to render the article tedious.
Case V. Ida M., aet, 35, was admitted to the Westbo-
rough Insane Hospital June 8, 1 898, her insanity was then
pf one week's duration.
Her mother was insane, a sister committed suicide and
there is a brother with unstable mentality.
Status PrcBsens, The patient is a woman of small build,
weighing 86 1-2 lbs., and is very poorly nourished. The
lungs are normal. There is a mitral regurgitant murmur
of the heart. The urinalysis reveals no kidney lesions.
The pupillary reactions are normal. The knee reflexes
absent. No Babinsky phenomenon, and slight swaying
when the attempt is made to elicit the Romberg sign.
There is nothing of special interest in the clinical history of
this case from June, 1898, the time of admission, to Feb. 13,
1900, on which date a small circumscribed oval growth, 7
mm. in its longest diameter, was removed from the external
surface of the upper lip. The clinical diagnosis of this
growth had been carcinoma, sections of the tumor showed a
typical adenoma, and the opinion was given that the growth
was probably non-malignant. The patient made an un-
eventful recovery and there was never any recurrence of
the growth. No other evidence of carcinoma could be phy-
sically determined.
Pallor, emaciation and asthenia progressed. Late in the
course of her disease vomiting, after taking nourishment,
IQOI Pernicious Ancemia in Insane Subjects. 451
became a prominent symptom. There was tenderness over
the epigastric region, but no tumor could be outlined. At
the autopsy the external contour of the organ was normal, but
on section, the lower third was the seat of an annular
thicknening which was in some portions as much as 4.5 cm.
thick, and causing considerable diminution in the calibre of
the organ, but no obliteration. Oct. 3, 1900, a blood exam-
ination showed the following : Hb., 52 ; red cells, 2,000,000 ;
leukocytes, 5,600. Differential count : large lymphocytes,
2 1 per cent. ; small lymphocytes, 30 per cent. ; neutrophiles,
37 per cent. ; eosinophils, 4 per cent. ; basophiles, i per
cent. ; myelocytes, 7 per cent. Normoblasts, megaloblasts,
poikilocytes and Grawitz degeneration of megaloblasts were
present. The patient died Oct 29,* 1900. Her insanity was
mania. Section 8 hours after death. Unfortunately permis-
sion to examine the brain and cord could not be obtained.
Anatomical Diagnosis. Mitral insufficiency, degenera-
tion myocardium ; emphysema of lungs ; anaemic kidneys ;
metastatic carcinoma of liver ; carcinoma of stomach ; metasta-
tic carcinomata of mesenteric lymph glands ; chronic inter-
stitial pancreatitis ; cystic ovaries ; and proliferation of bone
marrow.
Histologically the bone marrow showed the characteristic
changes of pernicious anaemia.
SUMMARY.
I. and n. are the cases whose mental condition it is con-
sidered may have been due to the pernicious anaemia. In
the case of the Italian fruit pedler (Case H.), there was a
history of an admission to a hospital several years previous,
and at which time, it was later learned, he had pernicious
anaemia. He recovered and was discharged. Presumably
with a remission of the disease we have a return of the men-
tal symptoms followed by death.
Case I., to be sure, gave evidence of syphilis, as shown in
the syphilitic hepatitis and, perhaps, also in the chronic
452 The New England Medical Gazette, Sept.,
pachymeningitis, but it is to be remembered that her mental
condition greatly improved under treatment directed to the
ansemia.
Cases III. and IV. did not develop the clinical symptoms of
pernicious anaemia until after a hospital residence of several
years. At the period of their admission it was not the cus-
tom to make systematic examination of the blood. It is
impossible, therefore, to state the condition of the blood at
that time. But the apparently fairly good physical condi-
tion of the two cases, despite the hypochondriacal delusions
of one case which have been present since admission, war-
rants the assumption that the nervous and mental disturb-
ances were etiologic factors in the pernicious anaemia of
these two cases.
The influence of pernicious anaemia in the production of
nervous and mental disturbances was advanced by Lepine^'*,
Wilks, Coupland, and subsequently illustrated in cases re-
ported by Curtin. Ewing*', however, in his recent work
states that " the functional disturbances of the nervous
system cannot be claimed to act as more than somewhat
distant predisposing causes."
Of Case v., which is the one tentatively added, I would
state that annular carcinomata of the pylorus have been fre-
quently seen at autopsy where the blood had shown before
death the typical changes of pernicious anaemia. The ex-
planation of which is advanced (Ewing) " that there is a
rapid and general or slow and partial establishment of the
marrow changes."
Spinal symptoms were not prominent features of any of
the cases in the series.
REFERKNCES.
1. Bromwell. Anaemia and Some Diseases of the Blood-forming Organs
and Ductless Glands, p. 92, 1899.
2. Cabot. Clinical Exam, of Blood, p. 130, 1897.
3. Ewing. Clin. Path, of the Blood, p. 372, 1901.
4. Leichtenstern. Ziemsenn's Handbook Bd. 8, p. 344. Cited by Ewing.
190 1 The Plague in India. 453
5. Lichtheim. Zur Kentniss Perniciosen Anaemia. Munich Med. Wchn-
schr. xxxiv, 301.
6. Cited by Stengel XX. Cent. Practise Med., vol. vii., p. 380.
7. Putnam. Jour. Mentol, Nerv. Diseases, Feb. 1891.
8. Dana. Jour. Mental, Nenr. Diseases, Feb , 1891 and Jan., 1899.
9. Dana. Text-Book Nerv. Diseases, p. 299.
10. Putnam and Taylor. Jour. Ment., Nerv. Diseases, Jan. and Feb., 1901.
11. Bastinelli. Bui. Delia Royal Acad. Med. Di Roma, 1895-6, Pasciolo
I., II. Cited by Putnam and Taylor.
12. Adami. Annual Address Soc. Internal. Med., Chicago, Nov. 29, 1899.
13. D'Abundo. Cited in Progress Neurol. Boston Med. Surg. Jour. April
18, 1901.
14. Fuller. N. £. Med. Gazette, June, 1900.
15. Ashford. Army Notes, Boston Med. Surg. Jour., April 12, 1900.
16. Chapirow. Med. Press, Jan. 25, 1888.
17. Cabot. Boston Med. Surg. Jour., May 24, 1900, p. 546.
18. Grawitz. Am. Jour. Med. Science, Sept., 1900, and Deutsches Archiv. f.
Klin. Med., 1900, No. 67, p. 357.
19. Lepine, Wilks, Coupland, Curtin. Cited by Stengel, loc. cit., p. 365.
20. Ewing, loc. cit., p. 183.
The Plague in India. — In conclusion I will briefly re-
view the lessons to be learned from Indian experience of
plague and the difficulties to be contended with. The lesson
which stands out in large letters is that the compulsory
measures attempted have failed to have the desirable repres-
sive effect on the disease, because the populace have, to a
man, been dead against them and the authorities. . . . The
main line of objection to plague measures have always been
a dread of segregation, with separation of members of fami-
lies ; and Government orders that no wife would be separated
from her husband, or a mother from her children have not
succeeded in inspiring confidence. The people display an
absolute apathy and indifference to plague, as a rule, but let
the Government suggest means by which they may be spared
the affliction and a panic ensues. Cases of illness are con-
cealed with every ingenuitv, and each one vies with his
neighbor in giving false information. Violation of caste is
made an excuse for objection to any preventive measures,
such excuse having no foundation. Facilities have been
given for the institution of private and caste hospitals, but
no advantage has been taken of them. Ignorance, distrust
and predjudice have held their sway, supported by supersti-
tion.— Major H, E, Deane in Calcutta Journal of Medicine.
454 ^^^ iV^ze/ England Medical Gazette, Sept.,
MODERN 5URQICAL TECHNIQUE.
BY GEO. H. EARLE, M. D.
The title of this paper hardly indicates what is in the
writer's mind to say.
My wish is to compare, very briefly, the present surgical
methods, in operating, with those which prevailed in the old
days, that is fifteen or twenty years ago.
You are more or less familiar with the present methods.
I mean the various plans and devices by which the field of
operation, the instruments, dressings, and the operator's
hands are made clean. Cleanliness is recognized as the one
thing for which to strive. But let us look back for a few
moments along the road we have traveled and note some of
the milestones by the way.
We, as homoeopathic physicians, have much to be proud of
in this connection, for here in surgical therapeutics, as well
as in medical therapeutics, time is proving that "the mild
power is greatest." What was embraced in surgical tech-
nique twenty years ago } Would not the term dexterity and
celerity in operating cover it } Very nearly if not quite.
Pardon me a personal reminiscence. Less than twenty
years ago, in the amphitheatre of the great institution just
across the way, the surgeon does an amputation of the thigh,
clad in a blood-glazed frock coat, which had evidently seen
long service, and which, between times, hung on its hook
behind the door. If he washed his hands before operating
it was not evident, and he certainly handled the coat the last
thing before beginning. That, to be exact, was seventeen
(17) years ago this winter.
Operations upon the eyes were performed, the various
instruments sticking in the hair of the operator between
times. At that time the surgeons in our hospital had
adopted the use of clean, white frocks, while operating.
These same frocks were a source of more or less amusement
to our friends, and styled by them " butcher frocks."
IQOI Modern Surgical Tec/mique. 455
Operations were performed in the room below us, where
perhaps an autopsy had been held the day before, and where
anatomical specimens were in daily use for the purposes of
teaching. The "cleaning up" process consisted only of a
few flourishes of the janitor's mop.
From that time to the present, what has not been done in
the way of inventing antiseptics.? The complicated and
cumbrous technique of Lister. The spray, douche, mercu-
rial compresses, etc., etc. What violence has been done to
tender, bruised and vulnerable tissues in the name of anti-
septic surgery! For instance, an amputation of the leg,
done with a stream of mercurial solution running over the
field of operation during the entire time. The result is a
shoughing of the flaps with mercurial ulceration, absorption
of the infected material, and death from septicaemia.
In obstetric practice it became fashionable among the ex-
tremists to administer an intra-uterine mercurial douche
after any interference, instrumental or manual, within the
uterus. This was done as a prophylactic against infection.
Several deaths, with distinct symptoms of mercurial poison-
ing, discouraged this plan as a routine method
I can remember that, as a student, I came to feel that an-
tiseptic surgery practically meant the soaking of everything
in a solution of carbolic acid ; and that when a surgeon ven-
tured to operate, after a simple cleansing of the field of
operation, and with his instruments lying in a pan contain-
ing clean water and so harmless a drug as calendula, I
gasped at such foolhardiness.
But what has the result of all this effort and experi-
ment been } Just this. That asepsis is recognized in all
departments of surgical work as the ideal to be striven for,
and that any plan of antisepsis is only a means to that end.
Some of the essentials of modern surgical technique are :
Great care in cleansing the hands and field of operation with
soap and water and friction. Simple boiling of instruments.
Live steam under pressure for dressing and sponging mate-
rial. The least possible handling and the protection of
456 The New England Medical Gazette, Sept.,
tissues, especially if vulnerable. Dry dressing when practi-
cable and then severe letting alone. I might add, the avoid-
ance as far as possible of poisonous antiseptics.
These things have been instrumental in helping to accom-
plish the present success of surgery, and do they not justify
us in claiming that here, also, " The mild power is greatest ? "
THE ACETIC ACID HEART.
BY T. C DUNCAN, M. D., CHICAGO.
(Professor Diseases of Chest, Clinician Cook Co. Hospital.)
This drug, like most of the acids, first slows the heart,
through the vagus, and then follows, tachycardia and weak
heart. The alkalinity of the blood is supposed to be less-
ened so that the muscularity is weakened. This will explain
these cardiac symptoms : " Heart beats more frequently ; "
"heartbeat cannot be felt by the hand;" "pulse 96 and
full " (poisoning); "pulse accelerated and small, contracted ;"
" pulse weak and small " (Vide Cyclopaedia of Drug Path 0-
genesy).
It is believed that the constant use of vinegar tends to
produce a small heart and is a direct predisposing cause of
pulmonary tuberculosis. This acid causes wakefulness so
that the relief from its use is by urine, skin or lungs. The
urine is profuse and the skin thickens. " All the lobes of
the lungs are filled with tubercles somewhat like a bunch
of grapes." Therefore, we would expect " haemoptisis " and
"angina pectoris." "Likes to lie on stomach." Perhaps
the Mexican people are immuned from tuberculosis because
they do not use vinegar.
The characteristic symptoms of weak heart would suggest
this drug. It may be indicated in mitral stenosis and attend-
ant upon phthisis. Here we often have haemoptisis as well
angina
CEdema is a pathognomic symptom (Vide Cyclopoedia). It
has been curative in dropsy after digitalis has failed. How
1901 The Acetic Acid Heart, 457
it doesitmaybe of interest. It maybe from its relaxing
action. Grauvogl says on evaporation it appears electro
negative. In the respiratory tract and skin it may so act
and prove curative.
On account of the general use of vinegar we should know
its relations and antidotes. Before Hahnemann's day it was
regarded as a universal andidote. It antidotes the action of
aconite, asarum, coffee, euphorbium, hepar, ignatia, opium,
stramonium, tobacum and alcohol. It aggravates the action
of belladonna, mercurius and lachesis. It follows well after
cinchona. Disagrees when given after borax, causticum, nux,
vomica, ranunculus b. and sarsaparilla.
The antidotes to acetic acid are : Large doses magnesia or
calcarea (lime water) ; small doses, for the depressing, agoniz-
ing feeling, tobacum or aconite; for gastric, pulmonary and
febrile symptom, natrum mur. high may be followed by sepia
(see phosphorus). The general use of vinegar should put
us on our guard in cardiac cases. Attacks of "weakness of
the heart " may be due to this condiment and call for one of
its antidotes or analogues.
The Rich Family of Mitsui, of Tokio, has offered an
extensive site in that city for the erection of a university for
women, and three other citizens have, between them, contrib-
uted a sum of $120,000 for the cost of the necessary buildings.
The work is already in progress, and it is hoped the new uni-
versity will be opened the coming spring. It is not likely
there will be any want of students, as, in recent years, very
many young ladies of good family have applied to be admitted
to the university courses, especially to the Faculty of Medi-
cine and the Polytechnic School. The latter institution is in-
tended for the training of civil engineers, a circumstance
which seems to show that Japan is about to set an example
to Europe in opening up a new sphere of labor for the women
of the future, — Med. Times.
458 The New England Medical Gazette. Sept.,
EDITORIAL.
Contributions of original articles, correspondence, etc.» should be sent to the publishers, Otis
Clapp & Son, Boston, Mass. Articles accepted with the understanding that they appear only ia
the Gazftit. They should be typewritten if possible. To obtain insertion the following month,
reports of «ocieties and personal items must 6e received by th* i^ik of the m0Htk preceding.
The letter from our good friend, Dr. Packard, in the pres-
ent number is very interesting. The information it contains
concerning the status prcBsens of homoeopathy on the conti-
nent is thoroughly reliable, from men capable of passing the
best judgment. The doctor's questions were to the point,
and our thanks are due him for the information obtained.
While it is evident that homoeopathy does not advance with
such strides as in this country, still there seems legitimately
to be no basis for the claim that our method is losing ground.
As regards the outlook for future growth, however, there
seems to be the same danger there as here, that while our
method grows apace, our school does not. The tolerance of
the old school is and always will be much more dangerous
than its open hostility. The only way to combat this dan-
ger is to so educate our students and to so conduct ourselves
as to make the name homoeopathy synomymous, not only
with the highest professional skill and learning, but with the
very best development in every way. To be a homoeopath
should be an honor.
EDITORIAL NOTES AND COMMENTS.
From the Detroit News of July we have that the Trustees
of the Detroit Homoeopathic Hospital have purchased a new
site with building admirably adapted for their purpose.
The location, we judge, is a central one, and an emergency
department is to be established, an ambulance being on
duty.
Our Detroit friends are to be heartily congratulated.
IQOI Items of Interest. 459
ITEMS OF INTEREST.
Acquired and Inherited Syphilis. — Wm. S. Gottheil
{Med. Standard, Dec, 1900) says : As in cases acquired in
the ordinary manner, congenital syphilis can only be trans-
mitted during the primary and secondary stages of the
disease in the parents. Cases showing only the tertiary phe-
nomena cannot, as a rule, transmit the disease to their
offspring.
The fetus may be infected in two ways ; in the first place
the zoosperm or ovum or both of them may contain the
virus ; and in the second p!ace, the mother, gravid with a
healthy fetus, may transfer the affection by the placenta to
the child. In either case the course of the disease is the
same.
The first and most marked effect of syphilis on the fetus
is the interruption of pregnancy. In 330 syphilitic gravidi-
ties Kossourtz saw abortion or premature delivery in 127 or
about 2-5 ; only 3-5 reached term. The essential cause of
this is placental disease, which may either be an endarteritis
or gummatous in its nature. The nearer conception is to
infection the more certainly does interruption of the gravid-
ity occur. Gradually, however, the intensity of the specific
influence becomes less. Where many conceptions occur in
such cases, the earliest ones end in abortion ; later ones ter-
minate in the delivery of dead children ; then occurs the
premature delivery of living children ; then the delivery of
full-term syphilitic children; and, finally, that of full-term
healthy children.
Infection is most certain and severe when both the par-
ents are syphilitic. The prospects for the child are almost
as bad if the mother only is affected. When the father alone
is syphilitic the earlier conceptions terminate in the same
way as when both parents have the disease. But while the
maternal influence is persistent and abortions and the birth
of syphilitic children may occur for years when that is pres-
460 The New England Medical Gazette, Sept.,
ent, the parental influence i^ less enduring, and the symp-
toms of hereditary poisoning become less and less in a
comparatively short time.
When the mother becomes infected after pregnancy has
occurred (postconceptional syphilis), the child is usually poi-
soned through the placental circulation. During the first
month this invariably occurs ; but after the fifth month many
of the children escape, and during the last two months hered-
itary transmission does not occur. Profeta's law is the name
given to the fact that children who thus escape placental in-
fection, and do not contract the disease intra-partum are, as
a rule, immune to lues.
Colles' law is to the effect that the mother of a syphilitic
child, even when she has shown no evidence whatsoever of
the disease, is immune against it. She never becomes in-
fected on the nipple, no matter what the condition of the
mouth of her child ; nor can her husband infect her. Exper-
imental inoculations by Caspery, Neumann and Finger
show that it is impossible to give such a woman syphilis.
On the other hand, the child is very contagious to non-pro-
tected women.
When neither abortion nor the delivery of a dead child
is the result of a syphilitic pregnancy, the child may be
born showing some of the early symptoms or it may be
apparently healthy. In the latter case the first signs may
appear immediately after birth, usually manifesting them-
selves during the first three or four weeks of extrauterine
life. In exceptional cases they are postponed till the third
or fourth month, and they never appear later than the sixth
month. — Pediatrics.
True Dental Stigmata of Syphilis. — These become
more easily understood when we remember that hereditary
syphilis is a disease already present in ntero, and that its
malign influence is at hand, as a rule, during the entire de-
velopmental period of the unborn infant. This explains why
teeth not appearing till the fifth year when perhaps the child
I go I Items of Interest, 461
has been for several years cured to all intents and purposes
of the initial rashes, mucous patches, or what not, may yet
show a fundamental defect.
In the order of their diagnostic importance we may men-
tion these changes in the second teeth as follows :
1. Irregular decay — cupping or hollowing, or general
"callapse," This may be suspicious but is too often seen
elsewhere to be of great value.
2. Furrows (dents ray^s). Certain of these may be cause
for serious consideration ; the " sulciform erosion " of Parrot
belongs to this class.
3. Microdontism, This is emphasized by Fournier. He
attributes greatest significance to the "dwarfism" of the in-
cisors, and particularly of the two middle upper incisors. If
these be " doll-teeth," the diagnosis of syphilis is nearly cer-
tain to be confirmed by signs of lues elsewhere. In the
same class may be placed tuberosites and projections
" Amorphism " of the teeth in the stricter sense {e.g.^ incisor
for canine), and genuine monstrosities fall (through with less
certainty of specific relation) under the same heading.
4. Atrophy of the crown. This may occur as far back as
the first molar, giving the top of the tooth a shrunken and
wrinkled look, comparable to a small tobacco pouch with the
strings pulled tight. The same tooth in the region of the
incisors is apt on first emergence to have a narrow, brittle,
cutting edge, from which two or more fine spines project.
The spines soon break, the cutting edge of the tooth decays
somewhat more at the centre than the margins, and we thus
finally get the tapering tooth with concave "half-moon " cut-
ting edge, which was first described by Jonathan Hutchinson
and which, when occurring in the upper middle incisors is
practically pathognomonic of heredity syphilis.
5. Chalk lines (sillons blancs). These are equally charac-
teristic though far more rare. They are described by Fournier
as "milky" or "chalky" in color, being in fact discolorations
and not erosions. They should be found on the two upper
front permanent teeth and are as permanent as the teeth
462 The New England Medical Gazette, Sept,,
themselves. They are horizontal, symmetrical, about i mm.
in width, and occur about midway between the gum and the
crown. Their rarity detracts, unfortunately, from their
semeiological value. — Pediatrics,
Hemorrhoids. — The following suppository is recom-
mended by La Presse Medicale for hemorrhoids : Aqueous
extract of ergot, 3^ grains ; Oil of theobroma, i dram. —
American Medicine.
Dose of Antitoxin. — Dr. Wm. H. Park, in a paper on the
" Quantity of Diphtheria Antitoxin Required in the Treat-
ment of Diphtheria," published in the Archives of Pediatrics y
says : " From my observation in both hospital and private
practice, I have been led to adopt the following dosage :
**Very mild cases, 1000 to 1500 units for the first dose.
Moderately severe cases, 2000 to 3000 units for the first
dose. Very severe cases, 4000 to 5CXX) units for the first
dose. Laryngeal cases, according to tiieir severity, 2000 to
5CXX) units.
" For children under one year I should give about one-
third less than for older children and adults, I believe the
condition of the throat as to swelling, extent and nature of
the membrane, etc., to be a better guide to antitoxin dosage
than the general condition of the patient. The duration of
the disease influences the curative power of the antitoxin
rather than the dosage.
" If at the end of twelve hours after the injection the in-
flammation is advancing, or if at the end of eighteen hours
the inflammation has not clearly begun to subside as shown
by lessened congestion and swelling, I believe a second
dose of antitoxin should be injected. In a very few cases a
third dose is required at the end of twenty-four to thirty-six
hours. For the broncho-pneumonia and sepsis complicating
some of the worst cases antitoxin is generally of no avail.
Although I cannot agree with Dr. McCollom in regard to the
necessity of from 40,000 to 60,000 units in the very bad
cases, nevertheless, his results certainly encourage us to give
I go I Items of Interest, 463
all the antitoxin that we think indicated. It is better to give
too much rather than too little. I think I am correct in
saying that it is the opinion of the visiting physicians at the
hospital that moderate doses accomplish as good results as
very large ones. — Cleveland Medical Gazette.
Inebrity. a Study of its Causes, Duration, Pro-
PHYLAXSis, AND MANAGEMENT. By Dr. Charlcs L. Dana. —
The author's opinion is that drinking is largely a matter of
habit and environment. The victims of it have always some
neuropathic or temperamental basis, of which excessive
drinking is only the accidental expression. It would seem
that the capacity for a man to get drunk over a thousand
times was rare, and that two thousand was the maximum
limit in any ordinary inebriate experience. The agencies for
preventing and lessening the injury done by alcohol consist in :
(1) Teaching; (2) control of the sale; (3) regulation of mar-
riages between alcoholics ; (4) personal supervision of those
who become inebriates. The ideal treatment is supervision
of the case in an institution, insuring absolute abstinence
from alcohol in all forms for at least one year. Further per-
sonal supervision and watchfulness are needed for two years.
The next best thing a drinker can do is to take some kind of
a "cure" under the care of his own physician. The treat-
ment should be planned to last a year. The patient should
stop drinking and, usually, smoking also, and should take for
three weeks a mixture of nux vomica, capsicum and cinchona.
Receipe : Tinct. nucis vomicae, one ounce ; Tinct. capsici,
one drachm ; Tinct. cinchonae rubrae, five ounces.
M. Sig. : One teaspoonful three times a day, increased by
twenty drops daily to half an ounce.
The maximum dose should be continued for a week, and
then reduced as it was increased. Two weeks' rest should
then be taken, before repeating the course, then a months*
interval, and so on for a year. The patient should be fed
well and very often, and should avoid getting tired and
hungry. — Medical Record,
464 The New England Medical Gazette, Sept.,
Arsenicum in Skin Diseases. — Theskinof thearsenicum
patient is white, pale, waxy with ecchymosed looking spots ;
pale blue skin, with blue lips and blue nails, with a tendency
to edema. This speaks of a venous stasis, and directly
points you back again to a weakened circulation.
The next consequence will be a dry skin, an inactive skin,
a skin that is deficient in its nutrition. Let us reason fur-
ther: A skin that is defective in its nutrition must neces-
sarily tend toward necrosis, therefore we see the arsenicum
patient constantly throwing off quantities of dry epithelial
scales, which is a mild process of necrosis of the skin. Nor
does this process limit itself here, for necrosis of tissue may
also occur, and is beautifully told by the language of the
meteria medicist, thus : Gangrenous ulcerations, with blue
margins and foul discharges, purulent and fetid discharges.
Acne vulgaris in people of a lowered vitality with many
comodones and pustules again showing the sluggish nature of
the cases covered by arsenic ; edema about the eyes and pur-
plish zones about the acne papules point to a vasomotor
paralysis. Therefore arsenic is more often useful in the
chronic, the latent, dry, indolent and scaly stages of disease
than in the acute, inflammatory, moist or bullous.
The diseases in which arsenicum is most often called for
are chronic dry eczema, subacute acne, seborrhea-sicca, ich-
thyosis, varicosis and psoriasis. — The Clinique.
Don'ts in Connection with Heart Disease, — Don't feel
called upon to give digitalis as soon as you hear a murmur
over the heart. Study and treat the patient, not the murmur.
Don't conclude that every murmur means disease of the
heart.
Don't forget that the pulse and general appearance of the
patient often tell more than auscultation.
Don't neglect to note the character of the pulse when you
feel it. Possibly you may look at the tongue to satisfy the
patient ; feel the pulse to instruct yourself.
Don't think that every systolic murmur at the apex indi-
I go I Items of Interest, 465
cates mitral regurgitation; every systolic murmur at the
aortic interspace, aortic stenosis. The former may be trivial ;
the latter may be due to atheroma of the arch of the aorta.
Don't say that every sudden death is due to heart disease.
Don't forget that the most serious diseases of the heart
may occasion no murmur. A bad muscle is worse than a
leaky valve.
Don't examine the heart through heavy clothing.
Don't give positive opinions after one examination. — Phil-
adelphia Medical Journal.
The Therapeutic Indications of Cannabis Indica. Dr.
H. Edwin Lewis finds in pain not due to distinct pathological
lesions the chief indication. In migraine, hemicrania, the
various neuralgias, and the headaches due to eyestrain, it may
be used with marked success. In the pain of multiple neu-
ritis and tabes dorsalis, it is one of the best of anodynes, and
to relieve the chest pains of phthisis it is often very serviceable.
In the various neuroses of pregnancy and the climacteric, and
the particularly violent nerve storms of the artificial meno-
pause, it is satisfactory. Dysmenorrhea, not due to anatomi-
cal or inflammatory causes, is promptly relieved, with few
after effects. Impotence more or less complete, which is due
to urethral hyperesthesia, is certainly benefited by the seda-
tive or analgesic action of cannabis indica. In several instan-
ces of diabetes mellitus improvement has followed its use. It
will relieve the intolerable itching and burning of various skin
neuroses.
The dose is one fourth to one grain of the assayed solid ex-
tract. A quarter of a grain may be repeated every one, two
or three hours as required. Merck's Archives.
Effects of Ether on the Kidneys. — Dr. Dudley
Buxton, anaesthetist to the University College Hospital,
London, and Dr. A. G. Levy, have published the results of
their investigations, which were conducted in the Laboratory
of Pathological Chemistry in University College, London.
466 The New England Medical Gazette. Sept.,
The authors do not consider that any specific ether effect
and consequent kidney ischaemia and albuminuria should
ever occur in the course of ether anaesthesia for operative
purposes, provided the administration is performed with rea-
sonable care. They think, however, that in the case of
ether, owing to its comparative safety as far as the vital cen-
tres are concerned, there is a danger lest, owing to a false
sense of security, excessive quantities are administered.
Where quantities of ether are given — where the patient is
"soaked" with ether — we meet with "ether effects" on the
kidneys. Such effects are probably transient in most cases,
and produce no acute or lasting mischief ; but even these
are not necessary, and are, in fact, the result of the abuse
rather than the use of ether. — New York Medical JouniaL
Painless Removal of Adherent Dressing. — Patients
as well as practitioners, are familiar with the suffering en-
tailed by the removal of gauze dressings, these dressings
having the drawback of adhering very closely to the granula-
ting surfaces owing to their loose texture. Anesthesia has
abolished the pain attending surgical operations, but leaves
the patient exposed to the pain of repeated renewal of the
dressings. Dr. von Mikulicz, of Breslau, suggests an easy
means of obviating this drawback, viz., by wetting the dress-
ings with oxygenized water. This provokes a copious evolu-
tion of bubbles of gas, the mechanical effect of which is to free
the gauze and allow its removal without causing pain. The
method is so simple as to deserve the notice of surgeons. —
Med. Press and Circular.
Death of an Eminent Foreign Professor. — Joseph
Fodor, M. D., professor of hygiene at the University of Bud-
apest, has recently died. He was born in 1843, studied under
Pettenkofer at Munich, and later under Baron Liebig. Dr.
Fodor was, after his master Pettenkofer, the best known of
the European sanitarians, and did much toward rendering Bud-
apest the healthy and beautiful city it now is. He was a man
of many gifts and was for .some time joint editor of the med-
ical journal, Orvosi Hetilap,
190 1 Revieius and .Notices of Books, 467
REVIEWS AND NOTICES OF BOOKS.
Orthopedic Surgerv. By Royal Whitman.
This book is one which is sure to be of great service to the gen-
eral practitioner as well as to the special student of orthopedic
surgery.
Special attention is paid to the causes and prevention of deform-
ities, and it is in the early recognition of diseases which cause de-
formities that the general practitioner oftenest fails.
Most of the four hundred and forty- seven illustrations are new
and many of them especially clear and instructive.
The colored plates showing the attachment of muscles concerned
in movements of the foot are especially good.
The gymnastic treatment of lateral curvature receives the atten-
tion which it deserves and the photographs illustrate the move-
ments and their effects almost like a clinical demonstration.
Any physician who has the least mechanical ability would be able
with the assistance of this volume to make and apply apparatus
which would be efficient in the beginning of ordinary deformities.
Each detail in diagnosis and treatment, as well as in measuring
for apparatus, is given minutely and clearly. g. h. e.
Pocket Manual of Homceopaihic Materia Medica. Comprising
the characteristic and cardinal symptoms of all remedies, by Will-
iam Boericke, M. D., San Francisco. Boericke & Resuyou Co.,
1901.
This is a convenient pocket edition of the Materia Medica. Ar-
ranged alphabetically after the usual schema. It also contains symp-
toms of some hundred and twenty "minor drugs" which are in-
dexed. The book is conveniently gotten up and valuable for those
who find it necessary to look up the case at the bedside.
468 ^he New England Medical Gazette, Sept.
PERSONAL AND NEWS ITEMS.
Dr. a. Miller, the oldest homoeopathic physician in
Chicago, died July 29, in his ninety-second year.
Dr. Horace Packard will return from Europe in season
to resume practice October i.
Dr. J. Arnold Rockwell, Class of '99, B. U. S. of M., has
opened an office in the Hotel Kensington, 685 Boylston St.,
Boston. Office hours 11.30 to 1.30 and by appointment.
Telephone, Back Bay 418.
There is an opening for an homoeopathic physician at
Yarmouthporth, Mass., and one is wanted for the place. Dr.
F. C. Robbins, Dedham, Mass., who has recently moved from
Yarmouthport, will be glad to advise in regard to the location.
We have received the following notice : " A splendid loca-
tion for a homoeopathic physician, information of which can
be obtained by addressing Lock Box 244, Uhrichsville, Ohio,
or by addressing Dr. Thos. M. Stewart, Secretary of Pulte
Medical College, 704 Elm St., Cincmnati, Ohio."
\
THE NEW ENGLAND
MEDICAL GAZETTE
No. lo. OCTOBER, igoi. Vol. XXXVI.
COMMUNICATIONS.
A LETTER FROM QERHANY.
BY HORACE PACKARD, M. D.
(Concluded.)
A DAY WITH BASSINI.
In the little city of Padua, Italy, about thirty miles from
Venice, Professor Bassini has lived and labored faithfully and
modestly as surgeon of the Hospital and Professor of Surgery
in the University of Padua. About ten years ago his name
began to be heard in surgical circles as the author of a new
operation for inguinal hernia. His published results were
so much superior to anything before attained that the atten-
tion of the whole surgical world was turned to him. Time
has shown that his claims were well supported, for at present
his method is followed by surgeons in all civilized countries.
In response to his courteous invitation, I presented myself
in the amphitheatre of the Padua General Hospital.
He is apparently over sixty years of age, with gray hair
and beard, sharp, penetrating eyes, spare and tall but slightly
stooping. He welcomed me in broken English, and after-
wards spoke freely in German. His operative technique is
very simple, and he does everything possible himself, from
the preparation of the field of operation to the last detail of
the dressing. He has but one immediate assistant besides
470 The New England Medical Gazette, Oct.,
the anaesthetist. His armamentarium is very simple and un-
assuming. He has nothing of the modern equipment in the
way of steam-pressure sterilizer. His instruments, dressings,
etc., are boiled in ordinary porcelain pots over a gas flame.
His person and clothing are protected by a long rubber
apron, which he does not change between cases, but mops
off himself with sublimate solution. He uses silk exclusive-
ly for all ligatures and sutures, both superficial and buried.
He thinks if all the details of the operation are aseptic, the
buried ligatures become encysted and suppuration never oc-
curs. His clean wounds are not drained. He assured me
that he rarely has suppuration, and in evidence showed me
an abdominal wound made eight days before, then dressed
for the first time — not a trace of suppuration was apparent.
I marvel at his results when I looked about his operating
room. Although the operating area was fairly neat and up
to date with its terezzo floor, the bank of seats, walls and
ceiling were grimy with the dust and dirt of time. Areas
from which the ceiling had fallen had been recently plastered
without attempt to harmonize the whole by fresh whitening.
All soiled water from hand washing and scrubbing of the
patient, as well as blood and bits of tissue from the operation,
went onto the floor and gravitated toward a drain opening in
the middle.
All these unfavorable surroundings only impressed me
more profoundly with the genius of the man. In this com-
monplace environment, and with meagre equipment, he has
attained world wide eminence in the field of hernial surgery.
His name is probably now as widely known over the whole
world as any surgeon who has ever lived.
He kindly gave me opportunity to watch every detail of
his operations. The first was an ordinary right inguinal her-
niotomy, which went off without incident. The second was
for left inguinal hernia, with adhesion of the bladder to the
sack. In the process of clearing away the sack, the bladder
was accidentally opened. This he closed with silk sutures
I go I A Letter from Germany. 471
and dropped back into the pelvis. The operation was com-
pleted in the usual way without drainage.
Some details of his method of operating were slightly dif-
ferent from anything I had seen or read of before.
I was told afterward that the poverty of the public hospi-
tals in Italy is very great, and the apparently inexcusable
lack of tidiness is unavoidable.
VIENNA AS A MEDICAL CENTRE.
Vienna no longer holds its former prestige as the world's
greatest medical centre. At present not more than one-
quarter the former number of foreign physicians visit it for
study. The Allgemeine's Kraukenhans is totally out of date
as a hospital, and impossible of remodeling on modern lines.
A rumor is afoot, and I am told it is founded on fact, that
plans are already matured for removal to the suburbs, and
construction of new buildings according to modern ideas.
It is twenty years since I spent the autumn, winter and*
spring here in study. Great changes have occurred. Fine,
wide streets have been cut through the old parts of the city ;
a magnificent city hall has been erected ; new university
buildings have been constructed ; a Museum of Fine Arts
and Natural History established ; and a comprehensive system
of electric street cars installed.
But few of my old professors and instructors are remain-
ing. Billroth and Albert, who conducted the principal
clinics in surgery in 1881, are no more ; Mikulicz is professor
of surgery in Breslau ; Schrotter, under whom I took courses
in physical diagnosis, is now sixty-three years old, but vigor-
ous and progressive. He welcomed me most cordially, and
through his invitation I visited Heilanstatdt Alland (Hospital
for Consumptives), which has been established through his
persistent and resolute efforts. He said, "I have put not
only the sweat of my brow but my heart's blood into this
enterprise." It is a fine institution about twenty-five miles
out of Vienna, nestling in a natural amphitheatre, with a
472 The New England Medical Gazette. Oct.,
southern exposure, overlooking a wide expanse of country.
In answer to my question as to treatment, I learned that no
systematic medical treatment is attempted. Dependence is
wholly upon maintenance of a pure atmosphere, hypemutri-
tion and rest. Harrassing cough is ameliorated with opium.
In about fifty per cent, of the cases the disease is arrested.
The patients are kept under the strictest discipline. From
seven o'clock in the morning until ten at night every hour
has its allotted duty. The regulations run as follows :
7.00. Arise and dress.
7.30. Breakfast. Cofifee or cocoa, milk, white bread.
8.00. Exercise upon the terrace or in the grounds and
woods.
9.00. Rest in recumbent posture.
9.30. Lunch. Milk, bread and butter.
10.00. Rest in recumbency.
12.30. Dinner. Soups, meat, vegetables, salad, desert.
1 .00. Promenade on the terrace for fifteen minutes.
1.15. Rest in recumbency for i j^ hours.
2.30. Walk in the fields and woods.
4.00. Lunch. Coffee, bread and butter.
4.30. Rest for one hour.
5.30. Gentle exercise out of doors.
7.00. Supper. Roast meat, vegetables, salad, i glass beer.
7.30. Reading, games, music, light work about the house.
9.30. Retire.
10.00. Lights out, all quiet.
Regulations regarding expectoration are very strict. Every
patient carries a cup with him, and on no pretense is promis-
cuous expectorating about the grounds permitted. The cups
are sterilized every day by boiling. The patients are per-
mitted— ^not compelled — to work in the fields at light farm
work if they feel inclined. A farm of sufficient size to pro-
duce vegetables and milk for the institution is maintained.
The dining-room is large, sunny and cheerful. As I
entered it I saw upon the opposite wall an inscription which
I90I A Letter from Germany, 473
I supposed was an appropriate German legend. On drawing
near, to my surprise and amusement, it read in bold English,
" Eat Quaker Oats/'
FRENDENBERG AND THE BOTTINI INCISION.
It was my intention, on leaving America, to look up, as far
as possible, recent progress in the surgical treatment of
prostatic hypertrophy. Interest in this annoying affection
has of late been much aroused through the reported results
of Dr. Bottini, of Parvia, Italy. Frendenberg, of Berlin, has
probably done more to popularize the operation, through
published writings and improvements in instruments, than
the originator. I called upon him, and derived therefrom
much pleasure and profit. He is fully convinced of the value
of the operation, but much judgment and discretion must be
observed in the selection of cases. He deems it quite un-
wise to make it upon cases accompanied with severe cystitis
and pyelitis. To secure the desired result, it should be done
before the patient's general strength and vigor have too far
deteriorated. He precedes the operation by a careful cysta-
scopic examination. As a rule he makes three incisions, two
lateral and one posterior. The operation is made under
local anaesthesia of cocaine and eucaine, unless, because of
great fear or nervousness, general anaesthesia is deemed ad-
visable. In cases not yet prostrated with long continued
cystitis and pyelitis, the operation is without mortality. He
has a book in press which will soon be issued, giving all the
literature upon the subject and his own results up to the
present time. ^
MEDICAL EDUCATION IN GERMANY.
Germany leads the world in medical education. It is in-
teresting to inquire into the cause of this superiority. In the
first place, the popular ideals regarding education in general
are high. There is no greater social disgrace than ignorance.
Professional attainments carry distinction of no inferior order.
474 The New England Medical Gazette, Oct.,
beause it is a long and difficult climb to reach them. The
course of study in the medical department of the German
universities is five years ; and after this it will be six. The
sixth year is to be a service in a hospital, or a year with a
physician, assisting him in his every-day practice. The uni-
versity course includes two terms annually of five and four
months, respectively, with vacations during April, August
and September. Each applicant must have had previous
educational training equivalent to the course of study in a
" gymnasium,'* what corresponds to our high and latin schools.
If he has not had that training, he must satisfy the faculty
that he possesses equivalent knowledge derived from other
sources before he is allowed to enter upon the medical course.
The required studies of the first year are : Inorganic and
Organic Chemistry, Physics, General and Human Anatomy,
Dissections, Osteology and Syndesmology, Zoology, Micro-
scopic Technique, Principles of Botany. Besides the above,
the following are recommended, but not obligatory : Mathe-
matics, Meteorology, Physical Geography, Mineralogy and
Geology, Anthropology, Psychology, Logic.
The second year the required subjects are : Dissections,
Physiology, Comparative Anatomy, Laboratory Chemistry,
Histology, Pathological Anatomy and Evolution. Recommend,
ed, but not obligatory: Physiological, Embryological
Zoological and Botanical Experiments and Analysis, Special
Lectures in advanced Anatomy and Physiology, Topograph-
ical Anatomy, Physiological Chemistry.
The third year includes General and Special Pathology
and Therapy, Surgery, Fractures and Dislocations, Pharma-
codynamics and Hydro Therapy, Auscultation and Percus-
sion, Obstetrics, Medical and Surgical Clinics, Minor Sur-
gery. Recommended, but not obligatory : Pathological
Chemistry, Toxicology, Laboratory work in Pharmacology
and Toxicology, Prescriptions.
The fourth and fifth years comprise lectures upon Hygiene,
Gynaecology, Materia Medica, History of Medicine, Sanitary
190 1 A Letter from Germany, 475
Science, Ophthalmology and Legal Medicine. Attendance
upon Medical, Surgical, Obstetrical, Gynaecological and
Ophthalmological Clinics, also clinics for diseases of chil-
dren, mental and nervous diseases. Pathological Anatomy,
Pathological Histology, Laboratory Hygiene, Practical work
in Obstetrics, Surgery, Ophthalmology, Vaccination, Laryng-
oscopy, Bandaging. Recommended, but not obligatory:
Special clinics for Syphilis, Skin Diseases, Otology, Clinical
Diagnosis, Electro Therapy, Dentistry, Legal Medicine.
Sixth year : Assistantship in Hospital or with a physi-
cian satisfactory to the faculty. The final examinations are
rated not in percentages, but as bad, good, superior and ex-
cellent. Those rated as bad withdrawn from studentship, or
again take the course in which they are deficient. The
others are granted a diploma which entitles them to take the
government examination. Applicants without a university
medical diploma have no footing with the Government Board
of Medical Registration, hence the gateway to the practice
of medicine is closed and barred to all except those who have
had a broad preparatory education and a most rigid training
in medicine.
It will be seen from the above that the way to a Doctorate
in Medicine in Germany is no easy road. How much more
in keeping with the dignity of the medical profession is such
a course than that in many of our American colleges ? Our
past record is unpleasant to think of. The future must be
marked with progress.
Dogs in Ambulance Service. — Scotch collies are trained
for ambulance and bearer work in the German army. Their
saddle bears a red cross, a flask and first-aid dressings. It is
claimed that these red-cross canines will scent wounded men
who under ordinary circumstances must be overlooked by
litter-bearers and left on the battlefield to die. — Exchange,
4/6 The New England Medical Gazette. Oct.,
ON THE FAITH IN THE EFFICACY OF REMEDIES.
[To the American Institute of Homoeopathy ; Read in the Section on Materia Medica. J. B.
Gregg Curtis, M. D , Chairman.]
BY CONRAD WESSELHOEFT, M. D.
The topics announced by the Chairman of this Section are
worthy of the closest study and thoughtful discussion. No. 2
reads : " Is faith in the efficacy of remedies in the treatment
of disease on the decrease among physicians t *' This timely
circular letter of the Chairman of this Section raises some
other very appropriate questions regarding the scepticism of
students, recent graduates, etc., toward the materia medica.
All this is very true, and the causes require some reflection,
which in the following has been drawn from an experience of
thirty years in struggling with the best way to teach materia
medica.
To begin with, it matters less how much of it is taught in
each of our numerous homoeopathic colleges, than it matters
what the quality of the instruction is, and upon what accurate
knowledge it is founded.
The difficulty in teaching and learning materia medica is
threefold. The first difficulty lies in the subject itself. The
various attempts to "purify" the materia medica, to separate
the wheat from the chafiF, were all very well so far as carried
out, but the subject is too vast for even one generation to ac-
complish anything. So there is little else for the teacher to
do than to assure his hearers that, after pointing out certain
faults of the materia medica, there is still much left which, if
rightly understood and used, will place our school in advance
of any other in successful healing of the sick.
The second difficulty lies in the teacher and his faulty
methods. He can produce a certain kind of result by a real
or assumed enthusiasm which he may succeed in imparting
to his students, who on the strength of imbibed faith and
belief will do wonders in the way of learning symptom-lists
regardless of their real value. Such a student can then per-
form miracles by virtue of his furor homceopathicus, but he
190 1 On the Faith in the Efficacy of Remedies, 477
will not win the confidence of his more conservative col-
leagues. This is one way to teach materia medica, but not
the most reliable one. There is a better way.
What the student most needs is not only to learn the
symptoms of drugs, but first of all he should see, touch and
smell of the actual drugs themselves. These he hardly ever
sees ; all he knows of them is that they are white pellets,
tablets or colorless dilutions. But how they became such he
never asks, and is but very imperfectly informed. No student
nor physician can be expected to acquire enthusiasm or
actual knowledge of proving-effects and the value of prover's
symptoms if he has to refer them entirely to meaningless
pellets, dilutions, or, if it comes high, to a colored tincture of
the origin of which he has seen as little as he has of tritura-
tions or dilution-potencies. And yet hundreds of our students
go out into the world with no other idea of homoeopathic
medicine than that of abstract notions of perfectly meaning-
less white tablets or dilutions. No matter how transcendent-
ally spiritual one may be inclined, he will now and then have
an ungovernable longing to see and touch something in the
material world, and it is but the natural result that he will
fly to the opposite extreme and try some big doses of visible,
tangible stuff in which he finds himself only too well sup-
ported by the more material minded intra et extra muros.
This can and must be avoided. It has been urged here
and elsewhere that before burdening and mystifying a stu-
dent's mind with symptom lists of the source and origin of
which he knows nothing, he should be instructed in practical
pharmacology. He should see and smell and taste the sub-
stances he is to study. He should see and hold in his hand
the plants, the minerals and the animal products from which
these substances are derived. He should not only see how
the tinctures are made, but he should make them himself.
He should not only be told that a certain substance is ground
for an hour with milk sugar, but he should himself grind
it for an hour once, twice and three times ; and then should
47'^ The New England Medical Gazette. Oct.,
use his microscope to see just how far he had succeeded in
reducing the substance. Having become familiar with these
things, he should then proceed to prove the products of his
labors upon himself. Such a student will not lament his
want of knowledge. But this is by no means all that is
needed in providing for proper instruction in materia medica
and its symptomatology.
One of the gravest errors committed by teachers, next to
ignoring pharmacology or pharmaceutics, is the habit of fol-
lowing the alphabetical order in their descriptions ; or, what
amounts to the same thing, of following no systematic or
natural order. It is this which makes the student heart sick.
Pages of symptoms either reeled off ex cathedra^ with vain
attempts on the part of the student to commit to memory
what seems to the learner to possess neither head, nor limbs,
nor body. Why need this be when Nature is so perfect in
her order, and when the human mind has succeeded in re-
recognizing this beautiful order and arranging it for the use
of those who wish to be guided by it }
Materia medica is called difficult ; it is shunned ; it is put
off to the last and approached only with set teeth and dogged
determination. As well might one try to learn a language
by memorizing the dictionary as to learn materia medica in
the way mostly taught. The way it probably will be taught in
the future will be by teaching the class that if they will
acquaint themselves with one member of an order, or even of
a genus of medicinal plants, they will already have acquired
some rudiments of the other members of that genus or order.
Thus, if they have seen the belladonna plant, have learned
how to prepare its tincture and have proved it a little, when
they have carefully read its pathogeny in reliable provings,
they will already know considerable about hyoscyamus, stra-
monium, tobacco, capsicum and others of this genus, for they
will see that these substances have many points in common,
from which the singular and characteristic effects are then
easily differentiated and, above all things, remembered.
igoi On the Faith in the Efficacy of Remedies, 479
The same applies to animal (e. ^., snake poisons) and to
chemically related groups of metals to be found in every text-
book.
Of course, if this is discouraged by shrugs and winks, the
student will lose confidence and he will fall back upon his
discouragement, or go where the teaching is more in accord-
ance with his prejudices.
The third cause of the student's reluctance to approach
materia medica is to be sought for in the mental ability and
condition of the student himself. Under existing circumstan-
ces in the United States a majority of medical students,
though of natural excellent mental endowments, do not bring
with them that degree of mental training which results in
ready receptivity of any new branch of science. Sudh a
student can learn only from ocular demonstration what he
can not acquire by didactic lectures or reading.
Why is it that students think anatomy, pathology and
chemistry easy, while they are actually afraid to touch
materia medica ? The answer is that it is so difficult to learn
symptoms by heart, and they shrink from voluminous text-
books or provings. That is their reply, but not the true
reason : This is that they are not made to see and feel
materia medica as they are made to see and feel, as it were,
anatomy and chemistry. What teachers of materia medica
will have to do now and in the future is to demonstrate
materia medica from pharmacy up to proving, and from this
to the didactic and clinical course, which the student then
will comprehend. When, after this, he sees his preceptor
administer pellets, dilutions and triturations he will no longer
be mystified, but he will recall the drug and remember its
sick-making power. The pellet will then have a meaning for
him which it never had before. The pellet or the liquid will
in his mind be brought into harmony with the law of cure ;
this will become luminous and intelligible now that the stu-
dent has discovered the animal, vegetable or mineral source
whence comes the power now associated and inseparably con-
480 The New England Medical Gazette, Oct.,
nected with the pellet, tablet or dilution which his preceptor
is prescribing.
These are at least the principal difficulties in teaching and
learning materia medica to be applied according to similia
similibus. But there are others. Has not homoeopathy
been taught from the beginning as being easy of application }
The first thing the student or beginner grasps is the perfect
simplicity of the law and its application : Select the remedy
according to the law : that is, seek the remedy whose proving
effects correspond to the case to be treated, and a cure will
follow. Nothing could be simpler and nothing easier. So
thinks the student, and so he is taught. The most sanguine
and enthusiastic teacher will inadvertently impress this upon
the learner, who even feels that the"'* organon " is very posi-
tive on the subject. The result is that the student's first
clinical attempts are disappointing. He comes to complain
of this to his teacher, who has to encourage and to uphold
the student in his faith as best he can.
Is not too much usually promised } It seems that in our
enthusiasm we have often, without due qualifications, pro-
mised the student too rapid a realization of success. The
qualification rests on the conditions under which medicines
are prepared ; on the conditions under which they are proven,
and on the conditions under which they are administered.
Right at the outset of his career the student, instead of
being simply made enthusiastic, should be carefully instructed
in the actual and probable difficulties in the way of realizing
quick curative results. He should be told of the imperfec-
tions with which pharmacy and the art of proving is still
beset. That in the nature of the limitations of the human
intellect in its attempts to perfect those sciences, imperfec-
tions must still hamper hoped-for results. He must be
taught that he must not be discouraged at the absence of
startling cures. He must be taught how to recognize each
imperfection in order to select from among provings that, and
that only, which is most likely to be reliable.
190 1 Study of Temp, in Puerperal Complications. 481
It will do the learner at the beginning no good to indivi-
dualize and diflFerentiate in applying a faulty proving to a
case. Therefore, let us avoid promising too much ; it will
drive the beginner to disappointment and from homoeopathy
to the other extreme of polypharmacy and nostrum vending.
Buty supposing a student is aware of the difficulties, then
the teacher can go ahead with a clear conscience, having no-
thing to conceal. His enthusiasm, now freed from that latent
shade of self-mistrust which he would gladly hide from the
student, will now burst forth into renewed delight, and
impart itself to the learner who feels that his teacher is honest
and can be trusted, and student and teacher will be carried
along by that bond of mutual respect and understanding
which alone insures success in any branch of instruction.
These are a few suggestions of which it is hoped that they
will aid in strengthening the faith' in the efficacy of remedies
in the treatment of disease among physicians, that they will
give support to the teacher and confidence to the learner.
A BRIEF STUDY OF TEHPERATURE IN CERTAIN
SERIOUS PUERPERAL COMPLICATIONS.
It would be impossible in one paper to even mention all the
post partum conditions in which abnormal temperature may
be found, so I shall not make the attempt, but shall limit my
paper to a few observations suggested by cases seen by Dr.
Earl and myself, during the last quarter at the Maternity.
I am hoping that they will prove equally suggestive to the
members present so that we may profit by the experiences
thus brought out.
At this time I am not reporting operative proceedures, for
while no one can see more plainly than I the necessity for
such treatment under the proper conditions, and we had those
during the quarter just past, yet I appreciate the fact th
482 The New England Medical Gazette, Oct.,
most confinement work appeals, or should appeal, to us, not
as mechanics but as physicians.
Before proceeding to the consideration of the cases that
prompted this paper, I shall venture to recall to your minds
certain facts that are doubtless very familiar.
It is always satisfactory and even essential to know the
normal conditions in order to recognize deviations therefrom,
so for a moment let us consider the manner in which normal
temperature, or an equilibrium, is maintained.
We know that two factors enter into this contract, viz.:
production of heat on the one hand, and loss of heat on the
other, so that we may expect to find a state of pyrexia, either
from increased heat production or decrease in heat loss. In
the healthy individual when from any cause there is an in-
creased production of heat there will at once be a counter-
balancing loss of heat, which maintains the body within a nar-
row range, known as normal temperature. Simple but inter-
esting tests have been made for the purpose of finding out
how adjustment is brought about between the production and
loss of heat in the human body. One, with the Turkish bath
showed an elevation of temperature in three-quarters of an
hour to 103.2^ followed by the loss of 185.7 mg. of sweat, and
normal temperature after another half hour.
A more commonplace test, but reported not so popular with
the performer, is the old process of sawing wood, by which a
healthy man working industriously for an hour will raise his
temperature 2.1 Fahr. with such compensating loss of heat
that no condition of pyrexia follows. From such simple ob-
servations as these we gain the idea that back of the two fac-
tors of heat production and heat loss there must be some
regulating force which gets out of order before a condition of
pyrexia can be said to exist, and this to my mind takes us
back to the mainspring of life, call it Nature's vital force or
what you will. When this is deranged, we have not only py-
rexia but general lack of harmony and the picture of disease.
One, Samuel Hahnemann said, "In sickness this spirit-like,
self-acting vital force, omnipresent in the organism, is alone
I go I Study of Temp, in Puerperal Complications. 483
primarily deranged by the dynamic influence of some morbific
agency inimical to life. Only this abnormally modified vital
force can excite morbid sensations in the organism and deter-
mine the abnormal functional activity which we call disease.
This force, itself invisible, becomes perceptible only through
its effects upon the organism, makes known and has no other
way of making known its morbid* disturbance to the observer
and physician than by the manifestation of morbid feelings
and functions ; that is, by symptons of disease in the visible
material organism."
Pyrexia is not then to be treated as an entity and sup-
pressed by sheer force, but rather regarded as one of the im-
portant symptoms of a disarrangement which we are to bring
back into harmony in the shortest, most reliable and safest
manner according to clearly intelligible reasons, removing in
each case any obstacles in the way of recovery.
The woman who has just passed through the activity of la-
bor is in a peculiarly susceptible condition, not only from the
immediate struggle but from the antecedent nine months*
strain upon the whole system, and unless her vital force is in
healthy, active power we shall experience a change from the
usual happy physiological appearance to one of discord and
dismay.
It is wonderful to see how, in the majority of cases, equilib-
rium is maintained in spite of the extreme muscular activity
and nervous excitement. The great beads of sweat mean that
our good friend Nature is at work conducting to and radiating
from the surface the excess of heat produced, and unless some
morbific influence disturbs the controlling principle the puer-
•periun will be calm and uneventful.
In the cases which I present we shall follow the tempera-
ture during disturbance manifested through three important
systems, viz. : the respiratory, the cerebro-spinal, and the re-
nal. In the first two there was no apparent reason for antici-
pating serious complications; in the third, we were forewarned
by the condition existing when the patient entered the mater-
nity.
484 The New England Medical Gazette. Oct.,
Mrs. G. recommended by Dr. Wood of Charlestown,
entered the Maternity at 3.30 Sunday afternoon, February 3.
At that time examination revealed the cervix obliterated, the
OS dilated to the size of a quarter and a foot presenting within
the bag of membrane. The position was diagnosed as a sacro,
left out. Dilatation proceeded as well as usual under the cir-
cumstances; the patient was a principara of rather slender
build, and in manner very reserved and uncommunicative;
did not want to talk and complained very little, so that in the
short time before delivery nothing was said of a "cold" from
which her husband afterwards said she had been suffering.
The second stage began about 8 P. M. and progress seemed
very slow on account of the size of the child, slight assistance
was given by traction from below and pressure from above
and the after coming head delaying, it was delivered somewhat
rapidly, thus incurring a second laceration, which under the
circumstances I considered justifiable. The baby, a fine boy
weighing a trifle over 9 lbs., was soon crying lustily and plays
no further part in the story except as a very agreeable boarder
in the nursery for the next seven weeks. During the last
pains of labor ether was administered to the patient but not
to profound anaesthesia.
The placenta and membranes were delivered not quite so
perfectly as I like to see, but considering it safer not to enter
the uterus unless necessary, and there being no sign of hem-
orrhage, the perineum was quickly repaired and the patient
taken to her room.
February 5. The patient seemed to have much irritation
in the bronchial tube, with cough, some soreness in left chest
on inspiration, thirst and temperature rising, morning loi*^,
evening 104^. Bry.^ and we prescribed for her.
February 6, Morning temperature 102^, evening tempera-
ture 1051**, pulse 130.
The lochial discharge was apparently normal and there was
no suspicious soreness, but remembering the somewhat ragged
condition of the membrane an intra-ut douche of warm sterilized
water, followed by a little peroxide, was given. Some debris
IQOI Study of Temp, in Puerperal Complications, 485
was then removed. The next day, Feb. 7, Dr. H. C. Clapp
examined the patient and pronounced her suffering from pneu-
monia and upon examination of the vaginal discharge the
micro-pneumococci of pneumonia were found. It was some-
what difficult to get symptoms from the patient; she was
hoarse anyway and at times would not speak at all. Indiffer-
ence, then anxious apprehension. The respiration was diffi-
cult and shallow ; sputa profuse. Dr, Clapp prescribed phos-
phorus. A second douche was given, which came away so
clear and the uterus itself seemed so normal that this was not
repeated.
February 7 and 8th were more encouraging and the 9th
seemed so regarding temperature and pulse, but the patient
developed a kind of sly cunning and that evening broke out
into mild delirium or mania, in which she suspected everyone
about her and startled by anyone coming in. Her eyes were
wild, with pupils dilated, face flushed and pulse full and throb-
bing. Bell, was the prescription.
February 10. Temperature and pulse better, but mental
condition not much improved so that an attendant was with
her from this time on for several weeks.
The temperature and pulse for the next day had another ex-
acerbation with an abrupt fall to nearly normal on the 12th;
this was accompanied by great prostration, a peculiar death-like
pallor and sweat, short, anxious respiration, with distressed
appearance of the face. We thought the prognosis very bad
at this time and hardly expected her to rally. Arsenicum
was given.
Next morning a temperature of 105 greeted us but the pa-
tient's mind was clearer, and a peculiarity after this for some
days was that with an increase of temperature the patient was
more rational. The chart from this time shows the decline of
the disease which did not extend evidently beyond its first
bounds. Nourishment was carefully administered all the time
and was well borne.
From February 23d, when you will see there was a sharp
tall, the temperature ran a little below normal for five days
486 The New England Medical Gazette. Oct.,
and then continued just about normal for the remaining weeks
she was with us. Her mental condition became normal.
Arsenicum was repeated at intervals and food was given as
the patient regained her appetite, which she fortunately did so
that she was growing steadily stronger when she left the Ma-
ternity on March 23. She was, however, one who suggested
tuberculosis and ought to be watched and directed for some
time. In looking back, I wondered whether ether might have
aggravated condition.
The second case was one who had been confined once
before and at the Maternity, a somewhat difficult labor. She
entered this time on February 9, at 3.30 R M., having regular
pains which began at 9 A, M. She was nervous and appre-
hensive, saying that she knew she was going to die, and this
was her constant cry. Although this may mean nothing,
yet it often indicates a lack of the persistence that will help
a woman through hard places. The second stage began at
5.35 and the baby was born in good condition at 6.40 with
slight tear into old cicatricial tissue. Placenta came naturally
in twenty minutes. The patient was put to bed and every-
thing went well except that the patient was nervous and ap-
prehensive until two days later, on February 11, when she
complained of a pain in the left side of her head which she
said was a touch of her old neuralgia. Temperature was nor-
mal and she passed a comfortable night and part of the next
day ; in the afternoon she complained of shifting pains and
feeling of coldness, and although she gave no definite signs of
chilliness her temperature arose to 103.6^ and pulse to 128.
We could discover no local condition to account for this,
the local discharge was free, bright with no odor, and it
seemed more like an hysterical condition than anything else.
The next day, February 13, the patient complained of head-
ache, soreness all over, with sore throat and it seemed as if
she might be starting a grip attack. The symptoms seemed
to call for bryonia.
February 14. Patient passed an uncomfortable day with
temperature ranging from 103.6-105.6^, pulse 128. That night
I go I Study of Temp, in Puerperal Complications. 487
she slept and the temperature (iSth) was down to 102.4 in the
morning but the day brought on a kind of delirious condition ;
she said she could not move her arms or talk though she could
do both. She was given a high enema followed by free evacu-
ation of the bowels. She was very much depressed and given
to much weeping and complained of shifting pains, and puis,
was given. On the i6th the temperature came down to
101.80; pulse, 138-114, though the delirium was marked, and
there were involuntary movements of the bowels. The next
day the patient was etherized and the uterus wiped out with
gauze, nothing abnormal could be found. Dr. Wesselhoeft
saw the case in consultation and it was thought best, on
account of the prominent nervous symptoms, to ask Dr.
Colby to see the patient. He (17th) accordingly did so, and
diagnosed the case as some form of puerperal meningitis
(non-septic) and prescribed cicuta (18th). That day and the
next there seemed slight improvement ; ice bags were
applied to the head with some apparent relief and the patient
was quieter. Speech was thick and indistinct. The next
three days (19, 20, 21) the brain symptoms increased, though
now and then there would be rational gleams. The respira-
tion became shallow, there were convulsive twichings of the
muscles, rolling of the head with sharp cries, involuntary
urine, difficult swallowing, and a general hopeless appear-
ance. Stuper finally supervined, broken by occasional cries,
and death came to her relief the morning of February 22.
There was no examination after death, but from the onset
and course of the disease it comes near to the description of
results arising from '' acute sporadic inflammation of the pia
mater of the convexity or upper surface of the brain." This
seemed to me a hopeless case at the time we had dealings
with it, but that something might have been done to affect
the diseased system by judicious previous treatment. This
is one place where a family physician has a chance to do
good work. If this patient had been known from her birth
and her antecedents known as we afterwards learned them
there might be two little motherless children the less. It
488 The New England Medical Gazette, Oct.,
seems that the mother of our patient, at the birth of her
second child died from some brain affection ; of the two girls
thus left one had died not long before our case, also with her
second child, and from brain trouble, so that there are four
children of the third generation left to perpetuate their kind.
In one of the latest text-books on nervous diseases I found
the following rather apt conclusion :
" Experience teaches that the diseases of the nervous sys-
tem may be divided with respect to their localization into
two great groups, into systematic and non-systematic diseases,
By systematic or system diseases we understand those affec-
tions in which only nerve cells and nerve fibres, that is
neurons which have a definite physiological function, are
attacked. The aggregate of all the neurons which subserve
a definite physiological function is called a neurons system.
The interesting fact that sometimes only the neurons which
belong to a certain physiological system becomes diseased, all
the other neurons remaining perfectly normal is to be ex-
plained, as far as our present knowledge goes, as follows :
first, clinical facts show that certain neurons systems are ab-
normally weak and sickly in some persons from birth. What
the primary cause is we do not know but very frequently it
presents itself most distinctly as a hereditary or family affec-
tion.'* Since, as the writer frankly states, we do not know
the primary cause, the best treatment of such cases will con-
tinue to be removal of all obstacles to recovery, careful in-
dividualization in accordance with our law. The third and
last case which I must tax your patience with is brief and
cheerful.
The efiEect of pregnancy on the kidneys has been so gen-
erally discussed that I do not need to enter upon the subject
here except [to repeat how easy it is to pass from the so-
called " physiological albuminuria '* of pregnancy to the
pathological state in which large quantities of albumen and
casts are found together with decrease in urea.
On February 12 our little Italian was admitted to the
maternity. I call her little because I saw her after she had
igoi Study of Temp, in Puerperal Complications, 489
shrunk to her normal dimensions and she was small then,
but when she was brought in about 1 1 o'clock at night on a
stretcher her face was so swollen that it looked about a foot
broad, and as we examined farther we found the same condi-
tion existing, swollen feet, hands, legs and arms, while the
labia were so oedematous that the thighs were widely sepa-
rated. . The history that we gained from a relative, for the
patient herself could not speak a word of English, was to
the effect that she had had a miscarriage seven years ago ;
that she is now nearly at full time ; thatjfor two weeks at
least she has had this swelling ; two days ago she had a
convulsion, biting her tongue badly ; this morning another
severe one, and now complains of pain through her head and
eyes. Dr. Earl and I pondered over the case and finally con-
cluded to follow a conservative course as labor had not even
begun and the condition was not threatening life. The first
thing ordered was a hot tub bath to give the pores of her
skin a chance. She seemed very loathe to lose the soil of
sunny Italy that she had evidently brought with her, but was
finally persuaded mostly by pantomime, and after that she
was put into a pack and arsenicum was prescribed. Towards
morning she had a severe convulsion. The temperature was
104.0 when she came in but the next day it had dropped to
nearly normal, and it was decided to give Nature a chance to
deliver. The labia were punctured, allowing the escape of
much fluid. Large quantities of pure water, milk and lemon-
ade, which the patient especially enjoyed, were 'given. A
sample of urine was obtained after some time, the patient
losing most of it involuntarily, and an analysis was
made :
Apis was decided upon for the remedy.
Early on February 1 5, three days after coming into the
Maternity, having had no more convulsions, pains began,
and labor was allowed to proceed under careful watching
until the baby was delivered at 11.30 A. M., still born.
There was no occasion for interference, although we were
ready to assist at the first intimation of danger. The
490 The New England Medical Gazette, Oct.,
following day the patient looked very uncomfortable and
the temperature was two degrees above normal, but the
same treatment was carried on and a steady improve-
ment followed, the temperature not rising above 100.8*^
at any time. Owing to lack of data we could not decide
to which of the three classes of kidney complication this
case belonged. Whether this was (ist) chronic Bright's
disease which existed at the beginning of pregnancy, (2d)
condition existing previously but apparently cured at the
time of the beginning of pregnancy, (3d) a condition in
which albumen began as a consequence of the existence of
pregnancy; probably the last was her condition. In any
event the patient returned to her home thin and on the high
road to health ; with the delightful uncertainty of obstetrics,
the case that threatened the most serious consequences
before labor was in the best condition when she left us.
THE SURGICAL CLINIC5 OF THE MASSACHUSETTS
HOMCEOPATHIC HOSPITAL.
SERVICE OF NATHANIEL W. EMERSON, M.D.
[For Quarter ending March 31, 1901.]
As some features of the present year's service seem
worthy of notice, this method is taken of making a record of
them. The service was the largest in the experience of the
writer, and again shows a remarkable increase in the propor-
tion of the abdominal to all other cases.
ABDOMINAL CASES.
In doubtful abdominal cases where accurate diagnosis
cannot be made — and how many of such there are — the
writer would urge an earlier consideration by counsel. Ex-
perience has taught that the prompt investigation of obscure
abdominal cases is a brilliant success. While not every case
is saved in this way, a very large number are, and those that
190 1 Surgical Clinics of ike Mass, Horn, Hospital, 491
prove inoperable are rarely complicated in their subsequent
course by the operation or its results. If anything has been
proven, it is that an exploration in competent hands is a safe
measure, and that in obscure cases patients do not die
because of the operation, but because of the disease which
is uncontrolled by interference. In looking over the data
here recorded consider the story of appendicitis as told by
the following summary :
Seven (7) Suppurative Cases, Three (3) Deaths
Thirteen (13) Acute Cases, No Deaths
Twenty-nine (29) Intermittent Cases, No Deaths
Nineteen (19) other cases in which the appendix was so
diseased that it was removed. In many of these, affection
of the appendix caused acute conditions and was itself more
or less acutely inflamed and the real cause of the precipi-
tation of a crisis, yet appendicitis was secondary to other
processes in themselves sufficient to require operation.
None of these nineteen cases were lost.
Sixty-eight (68) cases in all ; three (3) deaths. Death
rate 4.4 per cent.
Here are sixty-eight cases from which the appendix has
been removed for various causes in three months ; they pre-
sented themselves in all stages of disease, some in extremis.
The acute and suppurative cases were operated upon at
whatever hour of the day or night they presented, with no
opportunity to select time or perfect preparations and with
the operator not always in the pink of condition, yet the
results are consistent with what we have been led to expect ;
all cases of election get well ; all acute cases are immediately
cut short and also get well ; and those which are fatal are
the suppurative cases — really neglected cases — which
never rally after the operation. They die, not because of
the operation, but in spite of it, and the operation does not
appreciably precipitate the end. It would seem as if the
whole story of appendicitis has been told^ as indeed it practi-
cally has, but it is far from being wholly learned.
492 The New England Medical Gazette. Oct.,
In the above estimate the previous history of each fatal
case clearly shows that the danger-line was far past when
the operation was undertaken and that usually abundant
warning had been given, an interpreter being lacking, how-
ever. It is a conservative statement of fact, borne out by
abundant experience, that nine out of ten fatal cases of sup-
purative peritonitis, or appendicitis, could have been saved
if they had been operated earlier.
It is in no spirit of self-satisfaction that the above is writ-
ten, but rather in the fulfillment of the promptings of duty.
I consider a position such as mine in the hospital, in a meas-
ure, a professional trust and endeavor so to conduct it.
Unusual opportunities come for cumulative observation
along certain lines which should be made of practi-
cal benefit to the profession at large and which are not
usually open to it. Therefore, whatever observations are
here presented are offered with a well defined intent on my
part to demonstrate the actual local state of affairs as
regards suppurative peritonitis, and to make a sustained
endeavor to materially reduce the death rate in this disease,
not by alleged skilfulness and attention on my part, but by
going to the real heart of the whole matter and showing that
an early consideration of siich cases means a remarkable
and satisfactory diminution of the number of deaths.
Of the nine deaths here recorded, seven were in abdominal
cases. One of these was an old umbilical hernia which had
become incarcerated, the patient being seventy years old,
and death was certain without releasing it ; hence an
attempt was made, recognizing it as a forlorn hope. This
is a type of case which occurs with sufficient regularity to
cause a constant death rate in a large series of cases and is
not under discussion. Of the other six deaths, three were
from general suppurative peritonitis having its origin in
appendicitis ; and every one of the three could have been
saved if the operation had been at an earlier date. Not one
in a hundred of these cases which does not show abundant
igoi Surgical Clinics of the Mass. Horn, Hospital, 493
warning in the previous history. And these are the cases to
which I wish to draw especial attention. They are often
reported as obscure in the early stages when as a fact they
are not at all obscure except to the individual who is in charge.
I really believe that ninety-nine out of every hundred of
such cases which are now fatal could be saved by a more
prompt consideration of them by an experienced diagnosti-
cian and expert operator ; and it certainly is no presumption
to claim that the surgeons of our hospital, with their remark-
ably ripened experience in abdominal work, may be included
in this class. Therefore, we urge those who rely upon the
hospital to send their acute ^bdominal cases at an early
stage of the disease, always remembering that peritonitis
demands prompt investigation, and in ninety-five cases in
one hundred in man means appendicitis, and in a very large
proportion in woman means appendicitis or tubal disease,
one or both, and that safety to the patient, as well as subse-
quent health, lies through an operation.
Of the three remaining deaths in abdominal cases, much
that has been said above applies. They were all cases of
gall stones and only one of four was successful.
Mrs. C, age 55 years, had been married 32 years, and
had five children. There had been no menstrual difficulties
and the menopause had been normal. She had been sub-
ject to severe attacks of colic ever since she was fourteen
years old, occuring about once a year, except for the last
four or five years, when there had been none. Four months
ago she had a very severe attack lasting several days, since
which time she has had sixteen distinct attacks. The pain
was in the right hypochondrium and passed to the left and
backwards. She was jaundiced in the attack four months
ago and has been so ever since. Several years ago she
passed three gall stones about the size of a pea, which were
gray in color and rough, except where faceted. At the
operation the gall bladder was opened and about fifty stones
removed together with soft, clayey masses which were diffi-
494 ^^^ New England Medical Gazette, Oct.,
cult to handle because they were so pasty they could not be
grasped. She did very well at first but the discharge from
the wound became excessive, vomiting occurred, and a fatal
result followed.
Mr. C, age 65, had had malaria and several attacks of
inflammation of the bladder ; had been jaundiced several
times in the past. He was as well as usual up to the previous
five days when he had a severe chill and a pain in the stomach
'* like hot lead " extending to the back. Next day the pain
was more diffuse. The pain continued through the two fol-
lowing days and was worse at night, somewhat better on the
third day with the exception of general abdominal soreness.
That night the pain was of such severity he was sent to the
hospital. The ride in the ambulance relieved him and he
remained comfortable afterwards. At the operation a num-
ber of stones were removed together with soft, clayey masses
and very dark plaques which were closely applied to the walls
of the bladder and were removed only by stripping them off.
He died on the third day with no remarkable elevation of
temperature.
Mrs. C, age 38 years. She had had two children and two
miscarriages. Had had attacks of asthma but none dur-
ing the last two months. Had been in pain since the previ-
our May ; pain was worse during menses. Bowels were
regular and stools were dark. The pain was now constant
with daily exacerbations and she was jaundiced all the time.
At the operation a number of soft stones and ill-defined,
clayey aggregations were removed. She was much troubled
in breathing after the operation and coughed a good deal.
Bowels active and satisfactory, fecal matter and gas passing,
but the coughing and obstructed respiration continued.
Complained much of oppression of the chest and on the
eighth day after the operation she vomited blood admixed
with a green mucus containing some brown particles. She
died on the ninth day.
Just what the clinical significance of these forms of chole-
I go I Surgical Clinics of the Mass. Horn. Hospital. 495
lithiasis is I am unable to determine. It is a fact, however,
so far as memory serves me, that all cases where there has^
been a soft, clayey mass, difficult to manipulate, which must
be scooped away, have proved fatal ; in all cases where the
concretion takes the form of plaques applied closely to the
underlying part and coming away in flakes, the road to
recovery has been a difficult one. This pasty condition
obtained in all the above cases.
Continued observation of these cases, with corresponding
increase of experience, convinces me that here again safety
lies in promptness. The cases of gall stones which die are
the old ones with complete obstruction of the common duct
and corresponding jaundice and cholemia. It is universally
accepted that patients saturated with bile are unfit for opera-
tion, and that they are exceedingly liable to uncontrollable
secondary hemorrhage and are very prone to sepsis. Also,
the old cases require most extensive intra-abdominal
manipulation. This necessitates a larger incision to be-
gin with, with the breaking up of dense adhesions and a
difficult manipulation in the most inaccessible parts of the
abdomen. The common duct is deeply placed, of very
limited mobility, the latter becoming practically lost after
it has been inflamed, and in no portion of the abdomen do
adhesions more certainly mask the normal relationship of the
parts and make it difficult to find, and keep in mind, guiding
landmarks. Then the duct is small, and from the mechani-
cal standpoint does not lend itself readily to manipulation.
Therefore, patients deeply jaundiced and worn out with pain
are not tolerant and a fatal result seems to be easily induced.
If rupture of the gall bladder or duct has taken place, caus-
ing a sepsis already existent at the time of operation, the
danger is materially increased.
On the other hand where the gall bladder and duct are
free from old inflammatory adhesions and still intact and are
readily demonstrable, and when stones can be removed
through the gall bladder itself, most favorable results may
496 The New England Medical Gazette. Oct.,
be expected. Indeed no class of cases is more satisfactory
in the promptness of relief afforded and the gratifying
recovery.
Of many interesting abdominal cases which were success-
ful, the following are noticed because of some points of
special interest : Mrs. E. B. W., age 39. The pelvis and
lower abdomen was so packed with a solid mass that until
the patient was etherized the tumor resembled a fibroid.
Upon exploration, however, it was found to be a multiple
cyst of both ovaries, each cyst filled to extremest extension
and the general mass closely adherent throughout. These
cysts, together with the tubes were removed. Further ex-
amination of the gall bladder showed it to be full of stones,
and a nice mechanical problem presented itself. The in-
cision through which the pelvic manipulation had taken
place was in the median line just above the pubis and barely
admitted the hand, and it was out of the question to open
the gall bladder through this, without extending it above
the umbilicus. This meant at best, unless the abdomen was
opened throughout to the ensiform cartilage, a difficult
approach to the gall bladder. It was also thought that any
leakage of the gall bladder, either at time of operation or
later, would be more likely to cause general abdominal
sepsis if one large incision was made than if two separate
and smaller ones were used. Therefore the first incision in
the median line above the pubes was closed in the usual
way ; then a second opening was made over the gall bladder
through the right rectus muscle, the gall bladder opened
and two stones removed, after which the gall bladder was
attached to the abdominal peritoneum above the incision and
drained with a rubber drainage tube. This whole procedure
was conducted as an entirely independent operation. Never
before had I made two such distinct and individual operations
on the same patient at the same time ; she was observed with
much interest. The first twenty-four hours were rather more
stormy and painful than usual, but after gas began to pass
I go I Surgical Clinics of the Mass. Horn. Hospital, 497
freely relief was prompt and she made more than an ordi-
narily gratifying recovery.
Mrs. F., age 63 years, was an unusual case. She had had
ten children, one miscarriage which preceded the last five
children ; youngest child twenty-two years old. Eleven
years since menopause. Two years ago she began to flow
again, a little at a time but quite constant. Recently the
flow had been severe and she had had two bad hemorrhages
which reduced her very much. She had had two or three
attacks of pain across the abdomen lasting two or three days
each, with nausea and vomiting, which were called "gall-
stone colic.*' She was very fat and unwieldy and apparently
not a desirable patient from the standpoint of physique.
There was a multiple fibroid of the uterus which was well
up to the capacity of the vagina for delivery and her symp-
toms were difinite and becoming urgent ; as the tumor
seemed to be growing and the flow increased both in fre-
quency and in quantity, I unhesitatingly advised removal.
A vaginal hysterectomy was undertaken and the mass of
fibroid was fully up to the limit of size capable of being
extracted by way of the vagina. This, could only be done
by morcellment. After the left half of the uterus was
removed, with the tube and ovary, a tumor of considerable
size was still attached to the right half and above it. Had
the vagina not been very capacious this could not have been
removed except through an abdominal opening above the
pubis. The whole hand, however, was introduced through
the vagina into the abdomen and the tumor so brought
down by the aid of pressure from above, that it could be freed
and made to engage in the vagina. It was finally delivered
and removed and found to be a true dermoid cyst, con-
taining muth hair and a peculiar greasy, oily substance. It
was oval in shape and as large as the head of a child weigh-
ing ten pounds at birth. There was no difficulty in remov-
ing the right half of the uterus with its tube and ovary.
This patient made a complete and satisfactory recovery.
498 The New England Medical Gazette, Oct.,
GENERAL CASES.
The other two deaths were in cases requiring amputation
of the middle of the thigh ; the first one was because of
diabetic gangrene of foot and was the expected result in
this case.
The last case was an amputation through the middle of
the thigh and could have been saved, I believe, by a greater
experience than mine at that time. It is worth a more
extended notice here, because it is a most unusual one and
also because it points to a lesson missed by me on this occa-
sion. Mr. F. H. C, age 55 years, previous good health,
while sitting in his office felt a sting in the calf of his leg,
and before his attention had been fully attracted to it, it was
gone. It ,was but a short time before the sensation was
repeated and more prolonged than previously, yet quickly
passed away. This occurred several times, but caused no
more than a passing notice until he started for home at the
end of his day's work. He then found pain and difficulty
in walking, which increased rapidly and so severely that it
was only with great exertion and difficulty that he made the
last stage of his journey from the car to his house. The leg
was then beginning to swell, was very painful, and he passed
an uncomfortable night. In the morning the leg was so
much swollen that the family physician was called, but the
pain and swelling increased with such rapidity that the fol-
lowing day I was asked to see him in consultation. The leg
from the knee down was enormously swollen and oedematous
and the pain intolerable. I had him removed to the hospital
and the following day opened the calf of the leg, finding a
quantity of pus, without odor, which had dissected the mus-
cles along the plains of aponeuroses in a very extensive and
unusual manner. A free opening was made and the leg
thoroughly washed out with peroxide of hydrogen, full strength
and drained with gauze. Previous to this the temperature
fluctuations had been extreme, going as high as 102 degrees
in the evening and falling to subnormal in the morning,
I go I Surgical Clinics of the Mass, Horn, Hospital, 499
going to 100 degrees the next evening. After that it went
higher, reaching loi and 102 degrees in the evening.
Microscopic examination of the pus showed that there was
a streptococcus infection of the leg, and for the next five
days he was given twice daily a hypodermatic injection of
ten c.c. of antistreptococcus serum. This, however, did not
apparently affect his condition in any appreciable way.
There was a copious discharge of pus from day to day with-
out marked improvement and as there did not seem so be a
proper drainage about the ankle, eleven days after the pre-
vious operation he was anaesthetized and free openings made
about the ankle. Two days later he was anaesthetized with
the intention of amputating his leg at the middle of the
thigh, but after he was etherized there seemed to be so
much local improvement in the deeper portions of the leg
that amputation was deferred and additional means of drain-
age furnished. Again it was washed out with pure peroxide
of hydrogen and enveloped in a compress, moistened with
one-half of one per cent, formalin solution. His general
condition not being improved, the next day he was again
anaesthetized and the leg amputated at the middle of the
thigh. Everything went well for forty-eight hours when a
marked change in his condition rapidly developed. He be-
came violently delirious, went into a state of clonic convul-
sions and episthotonos, and died five days later. This case
is not detailed at this length merely because it is unique,
but rather to record the conclusions drawn from it. I could
find little in the literature to assist me in the conduct of this
case and I believe I made a serious mistake in delaying
radical measures for so long a time. I also believe that had
I amputated the leg as soon as I had made a diagnosis of
streptococcus infection the man's life would have been
saved. Therefore, in a similar case I would urge a more
prompt and radical operation.
The case of A. B., age 10 years, is worthy of brief men-
tion. This lad was hit on the left side of the head by a
Soo The New England Medical Gazette, Oct.,
stone thrown by another boy from a distance of about fifty
yards. Although he was knocked down and received a
scalp wound from which there was considerable hemorrhage,
he was not considered seriously hurt and received domestic
care only. The next day he was up and about and shoveled
snow, and made no complaint. On the following day, how-
ever, February 23, he complained of headache and was
inclined to be dull and stupid, and his temperature went as
high as 1 01 degrees. On the 24th, he was even more dull
and stupid, was not readily aroused from an appearance of
drowsiness, vomited several times, and his temperature went
to 102 degrees. On the next day, the 25th, he was sent to
the hospital. We found him without pain with the exception
of a slight headache, very drowsy and dull, only responding
when spoken to and the question often requiring repetition.
His answers were correct but rather slow in coming. He
had the appearance of being asleep most of the time and
was aroused with increasing difficulty. The wound on his
head was puffed and angry looking and not healing by first
intention. He made no complaint. On the 26th, all the
above symptoms were aggravated, and after consultation
with Dr. E. P. Colby and with his approval, I decided to
trephine. I therefore removed a button of bone at the point
of impact of the stone but could not determine that either
plate of bone was depressed. The wound in the soft parts
was septic and there was a sharply defined dent in the outer
plate of bone. The dura was congested and inflamed and
bulged into the opening. The wound was drained by a
bundle of rubber tissue and dressed as usual. The subse-
quent course was very interesting. After the trephining he
grew rapidly worse, becoming at first very restless and more
stupid, then wildly delirious, muttering and talking much of
the time, with rising temperature and pulse. On March i,
the evening temperature was 1043-5 degrees, by rectum,
and the pulse was 120; at 8.30 that evening he had a con-
vulsion beginning in the hands and arms but soon becoming
I go I Surgical Clinics of the Mass, Horn. Hospital. 501
general and lasting four minutes. Following it he went into
a state of complete coma. From this time until March 8,
he was entirely unconscious and had almost innumerable
convulsions, at times as many as four in an hour. On
March 8, following a two-minute convulsion, he complained
of the light, which was the first symptoms of consciousness.
The convulsions were more brief, and for the first time he
seemed to have short naps of natural sleep. The tempera-
ture was still high, 103 degrees, and the pulse 112. At
midnight of the 8th he perspired very freely and after 3 a.m.
had some sleep. In the forenoon he again noticed his sur-
roundings, complaining this time that the room was dark,
although he could see. There was some swelling of the
neck and of the bridge of the nose. On the night of the
9th he slept about five hours, and on the morning of
the loth the temperature had declined to 1002-5 degrees,
and the pulse 88, which was decidedly lower than at any
time for ten days. On the night of the loth he slept even
more, but in the moyning there was no doubt about his hav-
ing contracted measles, and he was removed to the isolation
cottage. He had an ordinary attack of measles, following
which, an abscess formed in the axilla and was opened on
April 5. He finally made recovery sufficient to be dis-
charged on May 8. The unusual features about this case"
are the long continuance and violence of the brain symptoms
with the final recovery, although the recovery was compli-
cated by measles.
SUMMARY OF CASES.
DiACNOcn.
•
Opbration.
11
"1
^1
I
Improved.
Improved.
1
1
ABDOHINAL SECTIONS.
Appendicititf acate.
Appendicectomy
II
II
7
4
" " ; CTstonutU of ovary.
" ; resection of ovary
a
, int.
>4
»4
n
t
" , int. ; cvstomata of ovaries.
" , int.; nematoma of broad
" ; resection of ovaries
4
Appendioectomv ; tubo-ovariotomy, r.
I
ligamenti r.
Appendicitis, sup.
" , sap.; gen. tup. peritonitis.
Appendicectomy ; drainage
Abdominal section ; drainage
3
1
a
I
1
Gardnoma uteri.
Vaginal hysterectomy
I
Cholelithiasis.
1
S
Cystomau of ovaries.
Ovariotomy, 1. ; resection of ovary, r.
1
I
(( f« •«
Resection of ovaries
3
1
(( i( It
Tubo-ovariotomy, r. ; resection of ovary,
1.; appendicectomy
Tubo-ovariotomy, d. ; ventral suspen-
1
I
*' " ;appendicitb,int.
1
(« «l U II II
1
endometritis ; ruptured perineum.
tomy ; curetting ; perineorrhaphy
" •• " , I ; retroversion
'
1
Cystomau of ovary, r. ; retroflexion uteri
Resection of ovary, r. ; ventral suspen-
sion
Curetting ; trachelorrhaphy ; perineor-
1
Endometritis, tubercular ; lac. cervix ;
I
rupt« perineum.
rhaphy ; vaginal hysterectomy
Extra-uterine pregnancy.
Abdominal section ; removal of foetus ;
drainage
1
" ;appendidtU.int.
" " " ; cystomau of
I
Tubo-ovariotomy, r.; reaection of ovary, 1.
1
ovary, 1.
Extra-uterine pregnancy, rupt.
Tubo-ovariotomy, r.
1
Fecal fistula.
Abdominal section ; enterorrhaphy
3
a
Hernia, ind. ing.
Herniotomy
5
1
" '• : strangukted.
" , umbilical.
If
fl •
I
a
; Incarcerated.
If
1
" , ventral.
It
3
1
" ;fistu]ainano.
*' ; opened, curetted anddrained
1
Hydro-Salpingitis.
Tubo-ovariotomy, d. ; ventral suspen-
sion
Tubo-ovariotomy, r. ; salpiregectomy, I. ;
appendicectomy
Tubo-ovariotomy, d. ; ventral suspen-
1
" *' ; appendidtU, int.
1
1
1
" *' : cystomau of ova-
I
1
ries ; cholelithiasU.
sion; choiecystotomy
Curetting : vaginal hysterectomy
Abdominal hysterectomy
X
MyomaU uteri.
3
1
<i II
Curetting
1
If •«
" ; vaginal hysterectomy
1
1
,
u u
Not treated
I
fl 11
Vaginal hysterectomy
5
1
" " : adeno-fibroma mammae
" '• ; extirpation mam-
I
" ; appendidtU, int.
mas
tomy
Myomectomy ; reieotion of ovaries
3
" " ; cystomau of ovaries.
3
" " ; hydro-salpingitis, d.;
Myomectomy ; tubo-ovariotomy, d. ; vent.
(
adenoma mamnue.
Myomectomy ; tubo-ovariotomy, d. ;
appendicitis, int.
MyomaU uteri ; pyo^salpingitis, d.; ap-
(
vent, suspension ; appendicectomy
Myomectomy; tubo-ovariolomy,d. ; vent
1
pendidtU, int.
suspension : appendicectomy
Procidentia uteri.
Ventral fixation
I
I
Abdominal hysterectomy; appendicec-
tomy
Tubo-ovariotomy, d. ; appendicectomy
3
t
U « II If
a
a
41 11 II li
*' " ventral suspen-
sion; appendicectomy
1 1
" " ; cyst of ovary, 1.; appen-
No operation
' 1
didtis, int.
Recto-vesical fistula.
Abdominal section ; inguinal colstomy
I
1
Ventral suspension
X
I
Viginal hysterectomy : clamps & cautery
'
SUMMARY OF CASES.— Continued.
Diagnosis.
Opbratxon.
2|
t
•8
>
a
^1
t
1
Salpingitis ; cystomata of ovaries.
Tubo-ovariotomy, d. ; ventnd suspen-
3
3
J
a
" , 1.; cystomata of orary, r.;
sion
Tubo-ovariotomy, 1. ; resection of ovary,
I
X
X
rctroTcrsion ateri.
Sinus following appendicitis.
Abdominal section
X
X
z
«37
«46
87
'
a
7
40
GSNERA
X CASSS.
Abortion, septic
Curetting
AUcessof
Extraction of teeth; opened, curetted
Alveolar process.
and drained
Arm.
Opened, curetted and drained
AzUla.
n <( II
X
Ch^w^
t« ti II
•1 «i II
Leg.
(» 1* II
; streptococcus infection.
- - " ; amputa-
tionofli^
Opened, curetted wmi^kmmtA
■
Neck.
Pelvis.
II II II
ti «< II
Peri-rectal.
II II it
Adenitis, axillary ; tubercular.
Extirpation of gUnds
'
«« •< ' u
Opened, curetted and drained
X
" , cervical.
Extirpation of glands
a
" " , suppurative.
Opened, curetted and drained
X
AmpnUtion of fingers.
Rrmoval of stitches
z
Atony of bladder.
Not treated
X
Atrophy of mamma.
Exthrstion
Excision ; resection
Bunions ; exostoses of feet.
Bom of leg.
No operation
Carcinoma of clitoris.
Extirpation
•* cervical glands.
" " cervix uteri.
Opened, curetted and drained
No operation
I
X
" face.
'* mammae.
Extur^tion
z
Carcinoma vaginx.
Extirpation
X
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-
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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
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All the newest medical works and books on related sub-
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It is greatly hoped that the members of the homoeopathic
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contribute brief original papers dealing with their personal
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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.
yo2