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NORTH CAROLINA

MEDICAL JOURNAL.

THOMAS F. WOOD, M. D., Editor.

Number 1. Wilmington, January, 1882. Vol. 9.

ORIGINAL COMMUNICATIONS.

REMARKS ON OVARIOTOMY— CYSTOCELE, RESTORA-
TION OF LACERATED PERINEUM.

A Clinical Lecture Delivered at the Hospital of the University of
Pennsylvania, November 9, 1881.
By William Goodell, M. D.,
Professor of Clinical Gynaecology in the University of Pennsylvania.
Reported by "Wm. H. Morrisoj^, M. D., for the North Caro-
lina Medical Journal.

Gentlemen :-^I bring this case before you to show you the re-
sults of an ovariotomy which I performed three weeks ago, Thurs-
day. Tliis was a very difficult case. There were many abom-

abdominal adhesions (I was going to say abominable, and they were
indeed very abominable).

Where the adhesions are simply parietal, we do not consider the
.case difficult, but when the cyst is fastened to the bladder^ the
womb, or the intestines, we have a very serious matter in releasing
them and sometimes wo are unable to do so.

O f\

^ Q O a

o <i o J

2 REMARKS OJ^" OVARIOTOMY.

In this case there were two firm adhesions to the omentum.
These were tied and divided. Then there were very firm adhesions
to the abdomen, and in some places these could not be broken up
and portions of the cyst had to be allowed to remain. The bleed-
ing from these surfaces would not be entirely checked. Tliere was
a large surface up towards the liver, where they were eighteen or
twenty little bleeding vessels. We tried to stop the oozing but
could not succeed. I therefore put in a drainage tube. This was
nothing more than a glass tube with perforation at the sides. The
object is to allow the blood that oozes out to escape. The fear being
that the blood, if allowed to remain, may become changed and
cause the woman to die from septicaemia, poisoned blood.

There is a diversity of opinion among ovariotomists in regard to
the use of the drainage tube. Dr. Keith, of Edinburgh, invariably
uses the drainage tube when there is much oozing. Dr. Wells, who
has operated some 1,000 times, does not use it. Dr. Thornton does
not nse it and he argues that with the use of carbolic acid and the
spray, there is no daoger of septic poisoning and that this large
peritoneal surface, which is a good absorber, will take up the blood
that oozes into the cavity. Dr. Keith has given up the spray be-
cause he thinks that some of his patients were poisoned by it. The
carbolic acid causing a nephritis. I still adhere to the spray and
intend to do so until I have good reason for giving it up.

There was no need of a drainage tube in this case, for during the
the first twenty-four hours only two ounces of blood escaped. The
next day there was a teaspoonful. On the third day the tube was
removed. Immediately after the wound was dressed, a large layer
of cotton was placed over the abdomen and firm pressure made.
This stopped the bleeding. She has not had a single bad symptom.

She is going to leave the hospital on Thursday, but she will have
to Avear a binder made with a gore for the next six months, in order
to prevent any tendency to the formation of hernia. The objections
to the drainage tube are, firstly, that it is a foreign body and
secondly, that it leaves a weakened cicatrix, at which point there is
a liability to hernia.

I have performed ovariotomy in the hospital ten times thus far
this year. Of this number all were successful except one. One of
the cases was in a very hopeless condition, but she got well.

The history of the fatal case is as follows :

REMARKS OX OVARIOTOMY. 3

A week ago last Saturday, I removed a large ovarian cyst. When
I opened the abdomen and found only a few omental and parietal
adhesions, I thought I was goingto have an easy time oi it. But
on further investigation, I found that the cyst had developed be-
tween the two layers of the broad ligament and was firmly adhe-
rent to the womb. That patient was in a bad condition when I
operated. She was weak and miserable, excessively timid and ner-
vous about her condition. She died within forty-eight hours from
exhaustion. At the autopsy there was found a slight peritonitis, as
is always found in these cases, but not enough to causo the death
of a healthy woman.

Day before yesterday I had a very interesting case. I undertook
it with fear and trembling, for this reason : A year ago she came to
me and said that she was flowing very badly. On examination I
found multiple fibroids of the womb. I then lost sight of her until
a month ago when she again came and told me that she was loosing
a great'deal of blood, the menstrual period would last for three
weeks. To my surprise, on examining her, I found a large cystic
tumor. I tried to exclude this cyst from the womb, but could, not.
My diagnosis was that there was either a cyst of the ovary in addi-
tion to the fibroid tumor, or else there was a fibro-cystic tumor. I
told her what I intended to do, that if I found it to be a fibro-cystic
tumor, I should try to remove the womb. If I could not do that I
should then endeavor to, remove the ovaries and bring on the cli-
macteric. The removal of the ovaries under such circumstances is
not an easy matter. The womb is enlarged and in lifting it up to
get at the ovaries some vessels are liable to be broken causing
troublesome bleeding.

When I came to operate, I found a large ovarian cyst, on the
right side, then passing down and exanciiuing the womb, I found it
covered with fibroid tumors and directly in front lying in the peri-
toneal pouch between the womb and bladder was this hard, firm
calcareous tumor which I now show you. That has evidently been
a sub-peritoneal fibroid tumor which has become detached from the
womb. On examining the left ovary, I found it also diseased. I
therefore removed it with a portion of the Fallopian tube. I always
remove the firmbriated extremity of the Fallopian tube, when I re-
move the ovary for if it is allowed to remain the disease may reap-
pear in it. I then found this fibroid tumor which was attached to

4 CYSTOCELE, KESTOllATIOlSr OF LACEUATED PEIUNEUM.

the womb by a very short pedicle. When I passed the needle
through the pedicle, it bled furiously. I had to enucleate the
tumor partly in order to get sufficient pedicle to hold the thread.
She must have had some twenty or thirty fibroid tumors in her
Avomb, varying in size from a marble to an apple.

Yesterday her temperature was 99° and the pulse was good. To"
day, her temperature is 100.4°, which is an excellent one after ova-
riotomy. Her pulse is a little rapid being 114 in the minute. She
has been 48 hours without anything to eat. To-day I shall allow
her a little milk.

All these operations have been done in a private room carefully
cleaned, and I think they show a very good record for a general
hospital.

Of my last twenty-five cases I have lost four, two of these were
almost hopeless, they were forlorn hopes. One of them had been
tapped seven times and once the canula had been allowed to remain
in the vagina for seven weeks. When I first saw her she was suffer-
ing from septic fever and had a temperature of over 103°. I aspi-
rated the cyst and pure pus came out, the smell of which made me
almost sick. In two weeks the cyst had again filled and the ques-
tion arose as to what was to be done. Ovariotomy was her only
chance. I gave her that chance, but she died.

The other of these two cases also had septic fever. She had been
tapped with a large trocar without the spray. The evening before
the operation her friends had assembled around her bed to see her
die. I will confess, that at first, I did not care about operating on
this case for I wanted to have good statistics but when I met the
case fully and squarely, I saw that it was my duty to operate. I did
so and the result was what I had expected. I should say, however,
that she did very well for four days after the operation and I thought
that she was going to get well, but the septic condition again man-
ifested itself and she rapidly sank.

CYSTOCELE, KESTORATION OF THE LACERATED PERINEUM.

Here is a case that I brought before you two weeks ago. She had
what is called a cystocele, a prolapse of the anterior wall of the
vagina carrying with it the bladder. The operation has been very
successful. There is only one point where there are a few granula-

CYSTOCELE, llESTORATION OF LACERATED PERINEUM. 5

tions. Everywhere else the woiuidhas healed. We have no longer,
that protruding tumor. As I told you, this operation is not a very
successful one as far as curing the cystocele is concerned. The op-
eration consisted is denuding a surface, fully as large as a trade dol-
lar, on the anterior wall of the vagina, bringing the edges together
and uniting them by transverse sutures, thus, shortening the vagina.
What I wish to do to-day is to give her a better perineum. She
lias simply a skin perineum. In one of her labors she has had a
rupture of the perineum and only the skin has united. The pres-
sure of the cystocele has also helped to thin it.

When you have a woman under ether it is always a good plan to
examine the anus. From a physiological [point of view, man has
been defined to be a laughing animal. From a pathological point
of view I should define woman to be a costive animal. The result of
this costiveness is that women are more liable than men to piles and
fissures about the anus. Where you find one man with fissure, you
will find a dozen women. By examining the anus you will often
gain great credit for yourself. How, will you do it ? Pass a finger
into the vagina and cause the bowel to protrude through the anus.
I do not see any fissures here.

Now for the operation. I shall close the vulva up more than I
ordinarily do, because the woinan is a widow. I pass one finger into
the rectum and cause the vagina to protrude and commence to de-
nude. Now, although she is snoring under ether, you see that she
flinches as I denude about the vulva. As I said in my lecture the
other day, I consider this, by far, the most sensitive portion of the
body. When I pass the vulva and enter the vagina, it is no longer
sensitive.

I now have the right side pretty well denuded, but the left side
gives me a little trouble because I am a right handed man. If I
were ambidextrous I could take the scissors in my left hand and
denude without any trouble, I can perform all obstetric operations
with my left hand but I cannot use the sciss#i's with that hand.

I want to tell you of one mistake that beginners always make ;
they do not denude enough. Physicians often say to me after I have
performed this operation, ''I did not expect that you would have
cut one half as much." The greater the denuded surface, other
things being equal, the better will be the result. The same is true

6 CYSTOCELE, KESTORATION OF LACEK.VTED PERINEUM,

ill vesico-vaginal fistula, if you can bring the parts together readily,
the broader the denuded surface the better will be the result. I
have now a case of vesico-vaginal fistula on which to operate, but I
do not bring it before the class because only a few of the gentlemen
on the front seat could see it. I shall bring it before the ward class
on Thursday.

I am trying to get these surfaces as nearly alike as possible, but
of course not with mathematical accuracy. This is not the pre-
cision that could be attained by rule and compass, but it issufiicient
for my purpose and brings the parts into apposition. It is impossible
to pass the stitches at the same point on each side, but the elasticity
of the parts will allow them to be brought into accurate coiiptation.

It is much easier to denude these surfaces with the scissors than
with the knife. I have gone at least two inclies up the posterior
wall of the vagina and I shall bring tlie vagina forward, thus form-
ing a thick perineum.

I am ready to pass the first stitch which is a very important one.
If the sphincter had been torn I should have introduced the needle
at least half an inch below the anus, but as it is not torn, I pass the
needle only a short distance below. With my finger in the rectum, I
pilot the needle through the tissues so that it will appear neither in
the rectum nor in the vagina, and bring it out at a point opposite
the point of entrance. The next stitch, I pass a little higher bury-
ing it also in the tissues. The wire will sometimes appear in the
vagina but that does not make much diiference. The wire that I
use is the No. 2 of the instrument makers. There is a wire sold as
perineal wire, but I do not use as it is too thick and cuts out quickly.
That is something that I want you to remember; the thinner a wire
is, thelesslikely it isto cut ont. A priori reasoning would not lead
you to that conclusion. The thicker wire has a greater surface and
ulcerates its way through very quickly. I pass the next stitch up
to the very highest point of the denuded surface without its appear-
ing in the vagina or rectum. There is considerable strain upon the
needle as I pass this stitch. I once broke a needle in the perineum.
The lady was unconscious of it and I took good care not to tell her.
I could not get it out and as it was a clean piece of steel I suppose
it has become encysted. It has never given any trouble.

Your books advise you to wait until the bleeding ceases before

CYSTOCELE, RESTORATION" OF LACERATED TERINEUM. 7

bringiog the surface together; but you cannot stop that bleeding as it
comes to a great exent from veins which liave no valves. If, however,
you tighten the stitches the pressure will usually stop the bleeding.
When I draw the stitches together, it draws the vagina down-
wards, so tliat the denuded surface which extended two inches is
not more than an inch in extent. To make a strong perineum you
must not bring simply the edges of the skin together, but you must
bring the edges of the posterior wall of the vagina back of it.

This is a very successful operation ; I mean the operation on the
periceum. I shall get a good perineum, but T am not certain that
it is going to keep up that cystocele. When you find a great many
operations proposed for remedying a certain deformity, you may
be sure that the results are not very successful. There have
been any number of operations recommended for the cure of
cystocele.

I am now ready to run down the shot. Before tightening each
wire, I syringe carbolized water directly on the part, in order to get
rid of the clots. This I consider an important measure. I now
run down the shot, bringing the parts together.

This is a very painful operation. The pressure of the stitches
on this tender region causes great suffering. For a week the pain
will be great and we shall have to relieve it by giving large doses of
morphia.

Sometimes there will be a little bleeding after the operation. If
this is the case, the injection of a solution of alum will stop it and
docs not seem to interfere with union by the first intention.

I shall introduce this self-retaining catheter (Skene-G-oodman's)
which does not irritate the bladder because it simply extends to the
neck of the bladder. Twice a day the nurse will take an ordinary
Davidson's syringe and inject water at a temperature of 100° to
105° through the rubber tube connected with the catheter in order
to prevent the little perforations in the end of the instrument from
being closed. If this is done, it will probably not be necessary to
remove the catheter for a week. How will you insert the catheter ?
The best way to do it, as the w-onian*s legs arc tied together, is
to extend the legs and raise the feet in this way and then you can
easily reach the urethra.

As soon as we get her into the ward, an opium suppository will

8 vAcciisrATioisr.

be slipped iuto the bowel so that by the time she comes out of the
ether, she will be under the influence of the opium. She will
be occasionally turned ove'r on her side so as to rest her back. I
shall leave the stitches in until Tuesday or Wednesday of next week.
Of what will her diet consist ? She will have beef tea, milk
toast (when the sphincter aui is torn I do not give much milk as it
causes very hard fseces) eggs, and in two days, if the appetite is good,
she can eat whatever she wants. She will have as much opium as
is necessary to relieve the pain. It may be given either by the
mouth or by the rectum. I prefer the latter method as it is nearer
the part, and I think, acts more efficiently.

VACCINATION : A CONSIDERATION OF SOME POINTS AS
TO THE IDENTITY OF VAEIOLA AND VACCINIA.*

By Thomas F. Wood, M. D., Wilmington, N. C.

The physician of the present day is no longer an anxious inquirer
about the minute details of the theory and practice of vaccination.
He regards all the difficulties as having been overcome, and he is
Avilling to rest his opinion upon the theories which Jenner enun-
ciated. But notwithstanding the apparently settled state in which
we find vaccination to-day, there are few more intricate studies un-
derlying any subject than the origin and natural history of cow-pox,
or cruder ideas as to the principles upon which the practice of vac-
cination should be based.

*Tlie above article was written some months ago, in reply to some of the points in
an article contributed by Professor Henry M. Lyman, M. D., to the Chicago Medical
Journal and Examiner, in S\\\y, 19,9,1. Dr. Lyman published a rejoinder in the No-"
vember Journal above referred to, but my article did not reach me until late in De-
cember. So long a time had elapsed that it was deemed best to reproduce what I
hadalready written, and give the controverted points in foot-notes. I had some
hesitation in doing this, but rather than weary the patience of our very courteous
confrere of the Chicago Journal it seemed best to reproduce it in this way.

T. F. W.

VACCINATION. 9

The original works of Jenner, Woodville, Pearson, Bryce, "Willan,
Steinbrenner, Gregory, Bousquet, "Waterhouse, Kedmond Coxe, and
the hundred other carefully prepared volumes which from 1798 to
1843 were read and studied with so much anxiety, are fast disap-
pearing from private libraries, and they are for the most part only
known to the reader of to-day by the meagre extracts made from
them, and which are found in the current standard text-books.
American text-books to this day are utterly lacking in a well written
summary of our knowledge of vaccinia, and the medical student is
warranted in the belief that no department of the practice is easier.
The literature of vaccination embraced within the dates mentioned
above, marked the most brilliant era in medicine, and no richer
field of study can be found to-day, than the treatises on vaccination
prepared by so many careful writers. He who would be master of
the vast questions which go to make up our knowledge of vaccina-
tion, cannot do so and neglect the original works of Jenner and his
cotemporaries. Many of the principles there wrought out stand
fast to-day. Many of the fast rules laid down by Jenner, and neg-
lected by a few generations, we gladly return to eighty years after
they are announced, because of the fatal errors a neglect of them
has brought upon us.

We wish we could feel as confident as Professor Lyman that recent
studies of the nature of vaccine {Cliicago Medical Journal and Ex-
aminer, July, 1881, p. 1) have given any material weight to the
doctrine of identity. He thinks " we are now in a position to form
a clear idea regarding a subject in connection with which there is
no longer anyplace for mystery."

He furthermore says, in the same article :

"The opinion was long entertained vaguely by many physicians
that small-pox and vaccinia were entirely distinct, though similar,
diseases. This belief was based upon the fact that Jenner did not
himself fully comprehend the manner in which these two forms are
related. He believed that they were identical in their origin, but
be did not demonstrate that identity."

The opinion is still held by eminent vaccinologists of the non-
identity of variola and vaccinia. Eeceut investigations upon the
sul^ject have tended to confirm the opinion that the diseases are
structurally and clinically different. Surely, in the estimation of

10 VACCINATION.

most excellent students, the beautiful experiments of the late
lamented Ccely, as to the production of vaccinia by the inoculation
of cows with, variolous matter, are seriously doubted. These
experiments by Ceely, of all the series now so famous in the history
of vaccination, were the most reliable and convincing, although we
think we can show that good reasons exist why we should regard
them with distrust, if not reject them entirely. I contend that
small-pox and cow-pox are not identical :*

1. Because cow-pox has never been converted by any means into
small-pox. f

2. Because, in the light of the attempts made by many careful
and truthful experimenters, to produce small-pox by the inocula-
tion of the cow with small-pox virus, the number of failures on the
part of such a very large majority of them, together with the nu-
merous positive denials made of the possibility of success, it may
be concluded that small-pox virus is never converted into vaccine by
transmission through the cow. The results of Gassner, of Ceely,

*I mean by identity the condition of being the same witli tlie thing described, find
not merely similar. There need be no confusion about this when we remember
that the classification adopted of Variola vaccinaj, V. Equinfe, etc., etc., are founded
upon the pure assumption of the question by Jenner. Had it been possible to have
analyzed the pathology of these diseases clinically and microscopically, as thor-
oughly as a botanist can analyze a plant, it is just as likely that Jenner would have
seen no good ground to have adopted the genus Variola at all. But even if he had
demonstrated that the structure of a pustule in Vaccinia and Variola had been the
same, such evidence could not be accepted if it could also be proved that the disease
resulting from contact, or by inoculation with the fluids from these pustules were
essentially dissimilar in, their course and sequela). After all medical nosology is a
matter of convenience rather than an accurate scientilic exiiression.. For in the
construction of our nomenclature, we have to deal with intangible and imperfectly
understood vital phenomena, and we should not fall into the error of constructing
a theory upon a foundation which is so purely artificial. In using the word identity
I mean that sort of identity that can be established and sustained only by the most
rigorous and careful comparison, and not by reference to ancient precedent. '

fit has been objected to this by Dr. Lyman {Cliicago MedicalJournal and Examiner
p. 483) that "the efforts of experimenters have not yet been knowingly turned in
this direction." It is very certain, though the acts were not done intentionally, that
for three-fourths of a century during which cow-pox has been inoculated, and that
in every degree of attenuation by transmission, no cases of small-pox have ever
resulted from the inoculation of cow-pox virus. The ingenuity of a score of Tas-
teurs could hardly devise greater follies than have been attempted by vaccinators
of all nations, but the conversion of this thousand-times manipulaled and trans-
mitted virus has never played any such freak as to burst out into small-pox. The
most memorable story on record was the one by Woodville, Baron's Life of Jenner,
Vol. 1, p. 310-12, showing the error there which had been committed of mixing the
two diseases.

YACCINATIOX. 11

and Thiele, and Badcock* are not left out of consideration in mak-
ing this statement.

3. Cow-pox does not become epidemic,f nor does it spread by
effluvia from the human subject. It is always confined to the point
of insertion in the human subject, never producing a general erup-
tion of vaccine vesicles. J

*I have carefully read Badcock's little pamphlet of 30 small pages, and the appen-
dix of certiflcates. I agree with Dr. Lyman that they are "interesting experiments."
But I submit that it is a little singular that his successes should have been so many,
and that after he detailed his method of inoculation no one else got the same results.
(Ceely did not learn his method from Badcock.) One thing to be noticed that in all
the histories of variola-vaccination by both Ceely and Badcock, we have cases
like the following : On the 18th July, 1S44, four children, whose father at the time
had smallpox, were brought to Badcock for vaccination with "the new virus." "Three
days after, I saw the children again. All, excepting the infant, were doing well.
One small pustule was observed on the ancle" [of a girl named Sarah] " which had
the appearance of a variolous pustule, but the child having no constitutional symp-
toms to confirm it." The infant spoken of above was vaccinated the second time,
froni-the brother's arm, [and he had originally been vaccinated with the new virus]
and it " died from small-pox," although Badcock infers that it was caught in the
casual way from the father. "A detail of experiments proving the identity of cow-
pox and small-pox, by John Badcock, chemist, Brighton." Pp. 25-20. Such evidence
ought not satisfy one seeking after truth.

fAn Inquiry iuto the Causes and Eflfects of Variolte Vaccinite, Edward Jenner,
M. D., F. R. S., Springfield Edition, 1802, pp. 51 and 55. " If [cow-pox] has been con-
ceived to be contagious among cows without contact; but this idea cannot be well
founded, because the cattle in one meadow do not infect those in another, unless
they be handled or milked by those who bring the infectious matter with them."

|Dr. Lyman does not see the relevancy of my fourth proposition to the question of
identity. Dr. George Gregory adduced this very reason, however, to show that cow-
pox in the respect above stated showed a very great dissimilarity to sinall-pox, and
I think, its relevancy quite obvious. And Dr. Lyman's authority, Mr. Badcock, enu-
merates the points of difliercnce between the two diseases as follows : (P. 20) says :
"Small-pox is infectious, but cow-pox is not so; small-pox diffuses itself all over
the whole surface of the body ; but cow-pox does not do so," and so on with a num-
ber of striking contrasts far more to be relied upon than the scientific accuracy of his
descriptions. I have seen numbers of cases of auto-inoculation from mature vesi-
cles, and general eruptions of a marked character, but no general eruption of vac-
cine vesicles. Dr. Marson's experience, amounting to about 60,000 vaccinations
(Seaton's Hand-Book of Vaccination, Macmillan's Edition, p. 82) does not enable
him to say more than that he has seen cases of additional vesicles which he thinks
were eruptive. Dr. Seaton has seen cases of supernumerary vesicles, but never any
which he could regard as eruptive.. (Ibid, p. 82, foot-note). Ceely remarks : " It is
rare, indeed, for them" [additional vesicles] "to be found on spots to which lymph
might not have been directly applied," furthermore, in those cases in which there
are numerous supernumerary vesicles, having somewhat the character of a general
eruption, we must be sure that we have not mistaken for vaccine vesicles an erup-
tion of modified variola accompanying vaccinia, such as happens in a person vacci-
nated during the inoculation of small-pox. The variolous eruption under such cir-
cumstances being often very sparse, and the vaccine vesicles and small-pox vesicles
more or less resembling one another. The experience of Marson and Seaton goes a
long ways with me to confirm a well founded belief gained by my own experience,
that " not proven" is still the verdict against the theory of occasional general erup-
tion succeeding vaccination.

12 VACCINATION.

4. Stnictunilly considered, the vesicles of vaccination, and the
pustules of small-pox inoculation are very dissimilar. Clinically
considered, the course and duration of the two diseases are not un-
like, but certainly not identical, having enough points of difference
to enable the skilled diagnostician to differentiate them.*

It becomes necessary, in order that we shall not do injustice to

*Dr Lyman thinks that the fact of structural difference between the vesicles in the
two diseases " cannot be urged against the identity of cow-pox." He says : {Chicago
Medical Journal and Examiner, November, 1881, p. 484) "The structure of the vesicle
depends upon the kind of animal on which it is developed, and upon the manner in
which the virus is introduced into tlie body. By inoculation with variolous virus a
pustule is developed on the human body which is almost identical in appearance
and in its course with the results of similar inoculation on a horse or a cow." I do
not know whether Dr. Lyman's statements above are founded upon his own exper-
iments or not. If he has had the good luck to perform variolous inoculation on the
cow, and has watched the resulting vesicles through their course, I would think that
his opinion was important. But merely to state it as his opinion, and to follow it
up with the further observations that the " energy of virus [inoculated] is so weak-
ened by the local processes of vesiculation that it does not produce any extensive
eruption like that which often follows inoculation with small-pox virus in the hu-
man subject;" and to deduce from these opinions "the complete evolution of small
pox is subject to modification in accordance with the nature of the animal in which
the process is carried out," is merely to assume a position not warranted by actual
experiments.

There is no confusion as to differentation of small-pox and cow-pox. Small-pox
inoculation gives modified small-pox, but, nevertheless, a small-pox Avhich has lost
none of its potency as regards its ability to attack an unprotected person, having,
indeed, the same ability to communicate a severe small-pox as a confluent case has.
And so with cow-pox. Let it be reproduced through ever so many generations, how-
ever attenuated it may become by repeated transplantation into a new soil, it is
clinically and structurally cow-pox, and nothing else.

No known germs or seed preserve more effectually their peculiarities than small-
pox and cow-pox. The former when inoculated has a constant tendency to revert
to the original type, when propagated on the human subject, and the latter a con-
stant tendency to depart rrom the original when so propagated. Both in their natu-
ral soil (the human subject being that of small-pox and the cow that of cow-pox)
preserve structurally their individual characteristics, never »-tmnm</ into each other,
even when the two viruses are mixed and inoculated in the human subject. This latter
fact is set forth by Badcock among many others. It is certainly incontrovertible.

Now as for mitigating small-pox virus by atteuuation with milk as claimed by
Thiel^, it can only gain credence by being successfully done by others. It was tried
in the South during the war, without success. Furthermore, it is easy enough to
recall many instances of a virulent small-pox having been contracted from dead
bodies, old clothes a long time buried, during which time it is highly probable that
the attenuation of the virus was carried to a far greater degree than by the ThielG's
method.

I sympathize entirely with Dr. Lyman in the new hope which Pasteur's inocula"
tions have raised as regards the general theory of substituting a mild and harmless
disease for a serious one, but he must remember that Pasteur's experiment are not
more than a year old, and they must go through a serious probation before we can
generalize about their results, or be satisfied with their analogies to the older the-
ories.

YACCINATIOX. 13

the experimenters who have claimed to produce genuine cow-pox by
the inoculation of cows with small-pox virus, to go over the history
of these attempts as briefly as possible.

The impulse given to these attempts was by Jenner's theory, that
vaccine was but a species of small-pox. His nomenclature proves
this : thus, he names the vaccine disease variolce vaccincB. More-
over, he fully enunciates his belief in the identity of small-pox and
cow-pox, and his biographer says :* " Healvvays considered small-
pox and cow-pox as modifications of the same distemper ; and that
in employing vaccine lymph, we only made use of means to impreg-
nate the constitution with the disease in its mildest, instead of pro-
pagating it in its virnleot and contagious form."f There has been
always a traditional opinion of the identity of cow-pox, founded
upon the statements of writers, contemporaries of Jenner, or fol-
lowing closely after him. There was little originality in any of the
volumes advocating this theory, many of them following Jenner's
narrative precisely, adding only some cases coming under their ob-
servation.

None of the variolous inoculations of cattle for artificial cow-pox
claimed to be successful]; until 1807, nine years after Jenner gave
his ''Inquiry" to the world, — the first attempt reported as being
successful, were performed by Dr. Gassner, of Giinzberg. The re-
sults were called in question, says Trousseau. § Twenty-nine years
later, Thiele, of Kasan, in Eussia, announced successful produc-
tion of artificial cow-pox. The small-pox matter employed in these
inoculations was taken immediately from variolous pustules, while
they wore yet transparent, nacreous, pearly and of which the lymph
was still very limpid ; or, better still, he used lymph which had
been kept ten or twelve days between two pieces of glass. || Stein-
brenner, in remarking on the results of Thiele, says : ''Let us say
furthermore, en passant, that this author, convinced by his expe-
rience of the analogy of the vaccine and variolous virus, had the

*Baron's, Life of Jenner, p. 2U.

tThe theory of the transmission of grease from tlie horse to the cow was the fa-
vorite theory of Jenner. Inquiry, pp. 58 and 59.

tThese inoculations had been tried in vain by Coleman, Ring, Sacco, Numann,
Fiard, Bousquet, Dalton, etc. Steinbrenner, Traite Sur la Vaccine, p. G13.
^Lectures on Clinical Medicine. Vol. II. English Edition, p. 115.
liSteinbrenner, p. 6U.

14 VACCIXATIOX.

idea of trying to mitigate the latter, in order to make it produce
the same results as vaccine, and that without making it pass previ-
ously through the body of the cow. He pretends it will become so
by leaving variolous virus for ten or twelve days between two glasses
closed with wax ; then he only dilutes it with tepid milk, and uses
it thus prepared. He repeated the same thin^ with new lymph for
many [series] following. The secondary fever did not show itself ;
the virus becomes so mitigated in the sixth generation that it pro-
duces nothing more than the symptoms of ordinary vaccine. Ic
can then be employed without further precautio:.^s to vaccinate
from arm to arm." (Steinbrenner.) p. 615.)

It is very evident from the above statement that if Thiele's obser-
vations as to variolous inoculation are no sounder than his opinion
'of extracting the virulency from small-pox virus, that we must be
exceedingly guarded how we accept his opinion. In the light of
our present knowledge, it would be the height of folly to dare to
go before the public with such an announcement. Small-pox virus
cannot be tamed by such gentle means ; you may destroy it utterly,
but so long as tliere is any activity left, it maintains its same conta-
gious properties, and probably cannot be so diluted as to be harmless.
It is true, there are degrees of small-pox. Some types are so mild
as to appear harmless. I inoculated one patient with small-pox
virus in 1865, and he had only two resulting pustules, although there
was no evidence of vaccination, judging by absence of cicatrices.
But can any one deny that an uuprotected person coming in con-
tact with the midest cases of small-pox, one like this, for instance,
would not be liable to take small-pox in some form ?

Steinbrenner himself also failed to inoculate two cattle upon
which he made the attempt, although ho says that he was not then
informed of the minutiae of the process as detailed by Thielc and
Ceely.

Dr. Ceely's cases are not so easily disposed of by merely denying
his success. Dr. George Gregory* was willing to admit Ceeley's
success. " No doubt,'' he says, '' can be entertained of their cor-
rectness." * * * <» j3^^t the lymph thus obtained has
been called variolo- vaccine, to distingush it from the idiopathic
affection of the animal." "One effect of these experiments (of

*Gi'egory, Lecture.s on " The Eruptive Fevers." Am. Edition, 1S51, p. 203.

VACCI]SrATION. 15

Ceely's) has been to refute Jenner's favorite notion, that the cow-
pox is the joarent of small-pox. So far as they go, they tend to
show that small-pox is the primary, and cow-pox the secondary dis-
order. But it may be reasonably asked, do these experiments war-
rant the conclusion that cow-pox and small-pox are identical ?
To me it appears that they do not. The disorders are allied (so
are measles and scarlatina), but they are not therefore identical.
* * * * Unlike small-pox, cow-pox produces no erup-
tion, no constitutional disturbance ; it throws off no contagious
emanation^s. It can be perpetuated from man to man in a uniform
state of intensity ; whereas the inoculation of smallpox produces
the disorder iu varying shades of severity. The local characters of
each malady are no le,ss strikingly contrasted. The variolous action
goes on to ]mstulation, to the acummation of the pustule, to
sloughing of the corion, and implication of the subjacent cellular
membrane. The vesicle of cow-pox never loses its umbilicated
character ; no purulent matter forms ; the areola is circular, not
irregular, like that of the inoculated small-pox."

The above quotations are made from this well-known master, who
for 3^ears was physician to the Highgate Small-pox Hospital, and
who was a teacher of recognized ability at St. Thomas' Hospital.
These opinions were expressed only a few years aster Ceely's famous
experiments were published.

When we consider these inoculations in the light of our present
knowledge of the natural history of c:w-pox as observed in the
large number of vaccinations directly from the cow, it is plainly
evident that the matter obtained by Ceely was quite different from
the animal virus of the Beaugency stock, now so well known in the
United States.

It will be observed that writers upon the use of vaccine directly
from the cow, especially as to the use of variolo-vaccine, give warn-
ing that a more violent form of vesicle would result from the inser-
tion of such lymph ; or, they instruct the vaccinator that frequent
failures might be expected.

Dr. Seaton says (Handbook of Vaccination, p. 87): "Ceelyfound
that more than half his attempts to vaccinate with primary cow-
lymph, taken from vesicles at a proper stage, and possessing all the
characteristics of perfection, resulted in entire failure, the same

16 VACCINATION^.

individuals being successfully vaccinated immediately afterward
with the current humanized vaccine lymph."

With our knowledge of the course of a vaccination from the cur-
rent Beaugency stock of animal virus, it is not difficult to believe
that this virus which behaved so uncertainly had little relationship
to the certain, normal, active stock now propagated in this country.
All along through the history of the Ceely virus we read of uncer-
tainties, of abnormal actions, and of suspicious phenomena, which
virtually rendered its use impracticable, and which gave little en-
couragement for others to follow, except as a dernier ressort.

A new chapter on the production of artiGcial cow-pox was worked
out during the late war, in the Confederate States. The question
of the supply of genuine vaccine became such a serious one, that
medical officers were commissioned to undertake the study of the
immense number of spurious vaccinations, and devise the remedy.
I speak within bounds when I say that in this country it was rare to
find a medical man who was at all 'skeptical as to the possibility of
IH-ocuring artificial vaccination at will. The experiments of Ceely
were studied with peculiar interest, as wore those of Sonderland.
After attempting again and again to restore the efficacy of vaccine
by careful cultivation among country children, no adequate supply
was obtained, and then the variolation of cattle, by the Ceely and
Sonderland method, was resorted to. Dr. James Bolton, late of
Richmond, Va., undertook the experiments for the production of
artificial cow-pox. He says :* " I made experiments upon seven
animals during the war. Five of them were young cows, or heifers,
which were furnished me by the Commissary Department, by order
of the Surgeon-General. They were kept at Howard's Grove, in the
immediate vicinity of tbeSmall-pox Hospital. From the latter place
I procured variolous virus in the form of lymph and crust. This I
inserted into the udder by making light incisions, and rubbing into
them while in the liquid state, by dipping threads into the lymph
and passing them by means of a needle under the integument; and
finally by making punctures with the lancet and introducing pieces
of crusts ; but all these attempts failed. In two instances pustules
were produced, followed by thin yellow crusts, which were evidently
spurious results." * * * ''I have my doubts that genuine

*Non-Identity of Vaccinia and Variola, bj' Tliomas F. Wood, M. D., 1807^ p. 17.

VACCINATIOX. 17

vaccine is obtained by inoculating cows with small-pox virus."
Subsequently Dr. Bolton wrote me : '^ I have my doubts that the
small-pox virus can be inserted at any part of the udder from which
it cannot be licked off. The tongue of the cow can be protruded
so far, and can bo drawn into such anomalous curves, "with such
prehensile power, that I think any part of the udder can be
reached." The details of Dr. Bolton's experiments were destroyed
by the casualties of war, and his account was written from memory.

Dr. S. P. Crawford, of Greenville, Tenn., writes to Prof. Joseph
Jones, M. D. :* " About this time" (January, 18G3) ''orders were
issued from Surgeon-General Moore to procure fresh vaccine virus
through the cow. I tried the experiment three times, "without suc-
ceeding. First on a cow seven years old, "with a calf six months old;
then a young heifer two years old, and finally the calf. I inserted
the matter in the teats, nose, ears, and various parts of the skin,
but never succeeded in getting a crust. Finally I fed the calf on
the dried scabs, but it died "without yielding the much sought
treasure."

Dr. William J. Love, of Wilmington,f "had occasion to attempt
the same experiment" [variolous inoculation of a cow], "and
failed." He introduced the small-pox virus into the teats and
udder, by means of a saturated thread. He also made incisions a
little deeper than in the human subject for like purpose, and intro-
duced the lymph in this way. Finally he smeared collard leaves
"with the lymph, and fed the cow on them. He saw no other phe-
nomena, except such as would result from the insertion of any
foreign matter.

I bad occasion just after the war (1865-66), while in charge of
the "Wilmington Small-pox Hospital, during an epidemic of the dis-
ease, to go over the same ground of attempting the production of
artificial cow-pox. My experiments were done without any knowl-
edge on my part of the details of the operation, except such as I
had received through the gentlemen above quoted, and by the peru-
sals of Ceely, Thielo's fnd Sonderland's experiments. It is not
necessary to detail these experiments, as they differed in no respect,

^Researches Upon "Spurious Vaccination"' During ilie American Civil "SVar. By
Joseph Jones, :M. D., NashviUe, 1867, p. 99.
tXon-Identitj' of Vaccinia and Variola, p. 17.

18 VACCINATION.

as fa; as I was able to jnclgc, from tlio descriptions given by these
autbcrs.* The failure was complete, in my opinion.

It ' appened, though, that during the progress of the experiment,
that an army medical inspector, whose name I have forgotten, was
making a tour of the hospitals, hearing of my experiments, visited
my hospital, and after examination pronounced the small vesicles
genuine cow-pox, and confirmed his faith in his opinion by making
some inoculations on the arms of two children in an Irish family
near by. The inoculation resulted in a genuine small-pox, which
■went through the family in various grades of intensity.

A reviewer in the Medical Times and Gazette, July 2, 1881, dis-
cussing j\Ir. Fleming's recent work, "Hnman and Animal Variola3,"
says : " It seems to me commonly held among medical men in this
country that cow-pox is not a disease natural to the bovine species,
but merely small-pox conveyed to them from man by inoculation,
and that in the operation of vaccination we avail ourselves of the
modification which it has undergone in the body of the cow, precisely
as Dr. Greenfield confers immunity from anthrax on cattle by
inoculation with bacilli which have passed through the system of
the rabbit.

"In support of this view, it is usual to adduce the supposed rarity
of cow-pox now that small-pox has become almost unknown in rural
districts, the asserted exemption of the male sex among cattle, the
successful inoculation of cattle with small-pox, with the production
of what Thiele and Ceely believe to be cow-pox, and the vaccination
of infants therefrom, by the same observers.

"Mr. Fleming has collected a vast amount of evidence from
French, German, Scandinavian and Italian sources, and has care-
fully scrutinized the scanty English experimenters. He gives irre-

*Dr. Lyman considers the above a case of the conversion of cow-pox from the cow
i nto small-pox in the child. There is nothing to warrant this belief. The inspector
above alluded to committed a blunder, which several before and since him have
done, of assuming knowledge of the subject. He did not remain at this station long
enough to see the troublesome cases of small-pox he had caused. If Dr. Lyman will
take the pains to conduct variolation experiments he will be easily convinced that
the body of the cow is not anything like such a certain laboratory that it can con-
Tert a virulent into a benign fluid at the will of the operator. Taking Hering's
beautiful drawing in his " Kuhpocken an Kiihen" as a guide neither the inspector
or Dr. Lyman could have mistaken what I saw upon the udder of this cow for genu-
ine cow-pox.

vACCi]srATi02fr. 19

sistable evidence of the prevalence of cow-pox in countries where
small-pox is almost unknown,* of the equal susceptibility of bulls,
if exposed to the contagion with cows, and satisfactorily proves that
the supposed vaccinations of Mr. Ceely were, in fact, nothing more
or less than an inoculation with small-pox unchanged by its trans-
mission through the cow. Such inoculation of the cow is not often
successful, but in several instances the real nature of the lymph
thence taken and implanted in children has been manifested not
only by the eruption following, but by the communication of un-
mistakable and fatal small-pox to other infants bj ordinary infection
— a caution to those who would attempt to reproduce a more active
vaccine through such a procedure as mediate variolation. * * *
The disastrous results of mediate variolation instead of vaccination,
in America and India, show the value of a knowledge of the dis-
eases of domestic animals.''

The 02nnions as to the non-identity of vaccinia and variola are
very numerous, and writers are about equally divided, perhaps. It
possibly may not be definitively settled in our day, and indeed, the
question of identity may be no longer a practical one. This will
depend greatly upon the way in which the medical profession makes
use of the triumphant solution of the question as established in the
introduction of animal virus by Dr. Henry A. Martin. It does not
seem possible that with our present enlightment, a vaccine famine
can occur in this country, and for years no more attempts will be
made to produce artificial cow-pox. Nevertheless, the warning
should go forth authoritatively, that the production of artificial vac-
cination is a myth, for in the times of great danger from variolous
epidemic, the time when it is most eagerly desired that it should
prove an effectual source, it has most signally failed.

Let the decision be what it may as to the theory of identity, an
acceptance of the affirmative, is practically valueless, and always
dangerous, both on account of the uncertainty of inoculating cattle,
and of the risk of pure variolous inoculation upon the human sub-

*Cow-pox has appeared in communities where there has been no small-pox at the
time. A recent most convincing series of cases were reported by Dr. Henry A, Mar-
tin, of Boston, at thelast meeting of the American Medical Association. These cases
of spontaneous cow-pox occurred in 1881, in Massachusetts, and their relati n was
rather to horse-pox than small-pox, a case of the former having also occurred in the
same neighborhood.

20 MEDICAL JOUKNAL PKEMIUMS.

ject that may result. Those who have claimed success have left
such a record of difficulties to overcome, and disappointments to
suffer, that we can no longer have faith in it as a source of vaccine,
even though we should not discredit the truth of identity.

I had intended to discuss more fully the points in Dr. Lyman's
paper on vaccination, above referred to, but I have overstepped the
bounds in consideration, mainly, of the question of identity. lam
pleased to see that we agree as to efficacy of animal virus. I have
nothing butpraise for the results of vaccin'ition done with Beaugency
virus. I trust that the potency of this virus may forever prevent
the adoption of Dr. Lyman's suggestion: "The only efficient
remedy for this deterioration [referring to the possibility of the de-
generacy of bovine virus] consists in occasional reversions to the
original product of the variolated cow. I am convinced that more
diligent searching by experts will detect now and again genuine cow-
pox. From this source alone will the pure succession be maintained.
Knowledge is accumulating very greatly upon the natural history of
cow-pox, and a wide-spread interest will surely manifest itself among
intelligent farmers in the future, so that the detection of cow-pox
among herds, will be more frequent.

The I^jorth Carolina Medical Journal offers as a premium
for the best prepared and complete herbarium of the medicinal
plants of the .State, the following works, or their equivalent, in vol-
umes the successful competitor may choose :

Curtis' " Woodi/ I^hmfs" and "Catalogue of Indigenous Plants"
in one volume.

'' Fhichiger and nanlury''s riiannacographia," one volume ; and
''Flora AfnericcB Septentrionalis ; or a Systematic Arrangement
and DescriiMon of ilie Plantfi of North America" By Frederick
Pursh, two volumes.

The collection must be prepared by the person presenting it.
Each specimen must be neatly mounted on stout white paper 0x14
inches, (two or three specimens can be put on a sheet when they arc
small) and the name marked on each. This offer is made to mem-
bers of the State Medical Society, and to licentiates of the Board
of Examiners who may not be members.

Herbaria must be sent in on the 2d Tuesday in May,'lSS3, at the
Concord meeting. For further particulars address Editor of the
Journal.

21

SELECTED PAPERS.

REMARKS ON THE TREATMENT OF GUN-SHOT WOUNDS
OF THE ABDOMEN IN RELATION TO MODERN PERI-
TONEAL SURGERY.*

By J. Mariok Sims, M. D., LL. D., etc.

The death of- President Garfield by tl-.eassasin's bnllet has excited
an intense interest in the public mind, throughout the civilized
world, in the subject of gun-shot wounds. It was at first supposed
that the ball had perforated the liver and traversed the peritoneal
cavity ; but as death did not occur in two or three days, it was then
thought that it had been deflected down behind the peritoneum in
the right iliac fossa. The post mortem examination alone revealed
the true course and position of the missile. The wound was, then,
not one of the peritoneal cavity ; it was a flesh-aud-bone wound, as
much so as if the ball had perforated the thigh and shattered the
femur. The President's case is, therefore, excluded from consider-
ation here, as I propose to si^eak only of shot-wounds involving the
peritaneum. Besides, I have elsewhere {North American Review
December, 1881) given my opinion of the President's wound and its
treatment.

The great military surgeons of the day have long felt dissatisfied
with the do-nothing system of treating shot-wounds of the abdo-
men. Longmore and Legouest, Langenbeck and Nussbaum, and,
in our own country, Gross and Woodward, Otis, McGuire, and
others, have all plainly indicated by their writing the probable
future treatment of such wounds.

Does the recent progress of peritoneal surgery lead to a better
treatment of gun-shot wounds of the abdomen ? is the pressing
question of the day, and must be solved sooner or later.

Ovariotomy is the parent of peritoneal surgery. It is based on
certain fixed principles, essential to success, which do not belong to
it alone, and cannot be monopolized by it. They belong to all ope-
rations involving the peritoneum, and to all organs contained
in its cavity ; and the governing principles of the one must govern
all operations of the other.

^P.ead before the New York Acndcmy of Medicine, October Gtli, ISSJ.

23 GUNSHOT WOUNDS OF THE ABDOMEN.

Peritoneal surgery is a new domain, jnst opened to the profession
at large by a few bold pioneers, who, in science as in the physical
world, go before and blaze the way for ns to follow and take pos-
session.

The principles essential to success, which guide us in all these
operations, were neatly formulated by Mr. Spencer Wells at the
meeting of the late International Medical Congress. They are :

1. All hasmorhages must be promptly controlled by pressure, lig-
ature, or hnemostatic forceps. This principal is common to all
operations.

2. The peritoneal cavity must be thoroughly cleaned after opera-
tions, and before the abdominal incision is closed. This is the great
lesson taught by Tliomas Keith, and followed by all successful
operators.

3. The abdominal incision, usually in the middle line, must be
properly closed.

Twenty years ago, Spencer Wells performed some experiments on
the lower animals to prove the importance of uniting the divided
edges of the peritoneum at the time of uniting the edges of the
parietal section ; and, as the propriety of this had lately been que?,
tioned, he thought it worth while to bring his pathological speci
mens from the Museum of the College of Surgeons before the late
International Medical Congress, to demonstrate anew the great
truth, long ago fully proven. But, independently of Spencer Wells'
timely philosophic experiments on the lower animals, we have the
best reasons, clinically, why we should always reunite the severed
edges of the peritoneum. If the edges of the peritoneum are not em-
braced in the sutures that close the abdominal section, a raw surface
is left on the inner face of the wound, which immediately adheres
to the subjacent parts. If it happens to adhere to the omentum,
well and good ; but if to intestine, the result may or may not be
fortunate. For if the adherent intestine happen to be convoluted
in such a way as to obstruct the bowel, a fatal result may follow ;
and we cannot afford to risk the possibility of such accidents.
Hence the necessity of uniting the divided edges of the peritoneum.
Clinical experience furnishes still another argument why we should
always unite the divided edges of the peritoneum. I have seen
three cases in which the edges of the peritoneum were firmly united?

GUNSHOT AVOUNDS OF THE ABDOMEN. 23

while the parietal wound gaped widely open. Thus, if the perito-
neum had not been closed, there would have no' union whatever in
the line of abdominal incision.

There is another principle in peritoneal surgery which is still s«Z)-
judice, and that is —

4. Drainage or no drainage. Chassaignac was the first to point out
the source and dangers of septicaemia and pyaemia, and at the same
time to designate a preventive in his tubes a drainage.

The precepts and practice of Chassafgnac are accepted and acted
upon every day and everywhere, but the name of this great French
surgeon seems, for the moment, to be forgotten in this relation. In
general surgery, complete drainage is essential to successful results.
We cannot now dispense with it, whether we use antiseptics or not.
If, then, drainage is so important in general surgery, why should
we be so much afraid of it in peritoneal surgery. There is no special
danger in introducing a glass drainage tube into the peritoneal
cavity at the lower end of the abdominal incision ; for it immedi-
ately becomes sacculated, and thus nature protects the peritoneum
against the presence of a foreign body in its cavity. If there be
no bloody serum to drain off, the tube can be removed in a few hours;
but if there be any serum it soon makes its appearance at the sur-
face, and is readily absorbed by sponges placed to receive it.

The drainage tube is now wholly excluded by Spencer Wells,
Thornton, and many others, on the theory that Listerism renders
tho peritoneal effusion aseptic, and therefore that its absorption
will not be attended with danger. But is this always so ? In my
early operations I occasionally saw cases -where the accidental dis-
charge of bloody serum through the external wound gave prompt
relief of urgent symptoms, and led to speedy cure. All other ope-
rators have had a like experience. With me, these were before an-
tiseptics and drainage-tubes. But even now, under the best anti-
septic precautions, are not such cases met with occasionally ?

In December 1878 I assisted my friend Mr. Spencer Wells with
an ovariotomy in the suburbs of London. The case was a very bad
one. Knowing full well its difficulties and dangers, he had wisely
procrastinated the operation to the latest jnoment compatible with
safety to his patient. Adhesions in the bottom of the pelvis were
universal and very strong, and it was difficult to arrest the exuda-

24 GUNSHOT WOUNDS OF THE ABDOMEN.

tion of blood. AVheii the external wound was being closed, Mr.
Wells saw that there was some exudation still going on ; but,
thinking that Listerism had rendered it aseptic, he had no 'ears for
the result. The patient did well for about thirty-six hours, when
she became rapidly septicoemic, and feers were naturally felt for
her safety. Fortunately, just at this juncture, bloody serum was
found exuding from the lower angle of the wound. Mr. Wells
then removed some of the sutures, and opened the wound a little ;
there was a free discharge of septic fluid, and the patient made a
rapid recovery.

Now, I do not pretend to say that this patient would necessarily
have.died, if nature had not so unerringly pointed out the method
of immediate relief to urgent symptoms. She might possibly have
safely eliminated all this septic fluid ; and then, again, she might
not. But of this I am sure : if the drainage-tube had been used
at first, tlie poisonous bloody serum would have been drained olf as
it was extfavasated, and there would not have been the least cause
of alarm for the safety of the patient.

The only valid objection that can bo urged against the drainage-
tube in abdominal surgery is, not in its immediate danger, but in
its ultimate tendency to develop ventral hernia. And this is a se-
rious objection, which we, who advocate its use, must learn to ob-
viate. This is a problem to be worked out, and I am sure it can
and will be done. But till then it is better, in doubtful cases, to
risk the production of ventral hernia, with all its inconveniences,
than to risk the life of the patient.

So much for principles of treatment governing all important peri-
toneal operations. Now let us see what has already been accom-
plished in this department of surgery in the last ten years, and
then we can determine with greater certainty what we may reason-
ably expect in the next.

A review of this sort may be irksome for some of you, but, as
my argument depends wholly upon what has already been done
with such wondrous success in the domain of peritoneal surgery, I
must be allowed to state tlie premises from which my conclusions
are drawn.

Extirpation of the uterus for bleeding fibriods was a legitimate
sequence of ovariotomy. At first, it was done by accident, then in-

GUKSHOT WOUXDS OF THE ABDOMEN. 25

tentionally. The early operations were uot successful ; but now,
Kojberlc and Pean on the Continent, and Spencer Wells and
Thomas Keith in England, can boast of magnificent results ; and
already it is an accepted operation in properly selected cases.
Pean's peculiar method of operating is by removing portions of the
tumor, morcellement (as he terms it), till it is small enough to be
easily turned out of the abdominal cavity. He then makes a pedi-
cle of the cervix, and secures it in the lower angle of the aWominal
incision, as we formerly did with the pedicle in ovariotomy.

The late Dr. Wright, of Cincinnati, the most successful opera-
tor in our country, tied the broad ligaments separately, amputated
the uterus, then Ecooped out the cervix funnel-shaped, and brought
together the opposing surfaces antero-posteriorly, united theni by
suture, and dropped the stump back into the peritoneal cavity, and
closed the wound. Thus the amputated cervix was covered over
with peritoneum, which protected the viscera against the dangers
of adhesion to a raw surface.

Schroder, of Berlin, does the same, not knowing he had been pro-
ceeded by our countryman, Dr. Wright.

And now comes Zwann, of Holland, (International Medical Con-
gress), who greatly modifies Pean's method of operation. He makes
the abdominal incision large enough to draw the tumor out of the
cavity at once. After this, this, he then rapidly introduces three
or four temporary sutures, closing the incision suflBciently to pre-
vent the prolapse of the intestines. He next encircles the pedicle
with a strong elastic cord, on the principles of Esmarch's bloodless
method. He then amputates the tumor just above the cord, and
finishes the operation, as Pean does, by transfixing the pedicle
antero-posteriorly, securing the ligatures one on each side, and
bringing it out at the lower angle of the wound and fixing it there.
After this, the abdominal incision is neatly brought together by
sutures. The advantages claimed by Zwann are : 1. Facility of
operating; 2. Protection of dbdominal organs against sudden chill;
3. Prevention of prolapse of intestines ; 4. Bloodlessness of oise-
ration. •

One of the most important advances in peritoneal surgery in
connection with bleeding uterine fibroids is Battey's operation to
bring about the menopause. It is likely to be substituted entirely

26 GUlSrSHOT WOUNDS OF THE ABDOMEN.

for the mor9 formidable operation of extirpation. It is less dan-
gerons ; it promptly arrests the bleeding. The fibroid growth bo-
gins immediately to decrease, and in some instances it has wholly
disappeared.

Freund's operation of extirpating a cancerons uterus by abdomi-
no-vaginal section has not fulfilled the expectations of its author.

Spencer Wells has recently performed successfully a Freund-
Porro operation, rxtirpating a pregnant uterus at the sixth month,
in which the cervix was cancerous {British Medical Jomnial, Octo-
ber 29th, 1881).

Bantock has also lately extirpated with success a cancerous uterus
by Freund's method. These gentlemen have greatly simplified the
operation (ib., November 12th, 1881).

Half a century ago, or more, Bluudell suggested tiie removal of
the cancerous uterus by the vagina, and performed the operation.
The Blundell vaginal operation has recently been performed success-
fully by Professor Beverly Cole, of San Francisco. He separated
the cervix uteri from its attachments with a Paquelin cautery, pulled
down the uterus, secured the broad ligaments, and removed the
uterus by a compai'atively bloodless operation.

Dr. Lane, of San Francisco, late Professor of Surgei-y in the
University of the Pacific, has performed this operation successfuly.
So has Dr. Clinton Gushing, of San Francisco. Thus we see
Blundell's operation for extirpating the uterus tlirough the vagiua
has so far been monopolized by the surgeons of San Francisco.

Extirpation of the spleen cannot be claimed as an offshoot of
ovariotomy. According to statistics worked up by the late Dr.
Otis, of the Army Medical Museu/n, Washington {Medical and Sur-
gical History of tlie War, etc., part second, surgical volume, page
152), the spleen has been extirpated between 1549 and 1849, sixteen
times with but one death ; and, between 1849 and 1869, ten times
with five deaths. The deaths were from hremorrhage, immediate
or secondary.

Splenotomy has lately been done by Pean, Spencer WelLs Martin
(of Berlin), aud others. I assisted at Spencer Wells' last operation.
The patient died of secondary haemorrhage. The spleen weighed
ten pounds, and there were three pounds of blood in the peritoneal
cavity. In this operation it is important to tie the pedicle in seg-
ments, to guard against the possible slijjping of tiie ligature.

GUXSHOT WOUK^DS OF THE ABDOMEN". 27

Extirpation of the kidney by the lumbar region has been often
done Eiiccessfnlly. Martin (of Berlin) has removed the kidney six
times by abdominal section, with four recoveries. The operation
has been done by others.

Laparotomy and cystorraphy were advocated by Vincent of Lyons,
at the International Medical Congress. The bladder has been
wounded in ovariotomy and in extirpation of uterine fibroids. This
accident happened once in the hands of the great ovariotomist,
Washington Atlee. It happened in the practice of an eminent sur-
geon in the interior of New York ; and occurred to me in the re-
moval of an enormous uterine fibroma. The bladder was cut across
for several inches, as it was extensively spread out over the anterior
face of the tumor. The wound of the bladder was closed with fine
silver wire. The patient died a few hours afterwards of shock and
hsemorrhage. Dr. Thomas reports a case where he found the blad-
der closely attached to the anterior face of an ovarian tumor.
There was some doubt about it, and he cut into the bladder, passed
his finger in to clear up the diagnosis, then closed the incision by
suture, and the patient quickly recovered. With the lights now
'before us, we should be able to suture the peritoneal portion of the
bladder with the same impunity that we do the vaginal.

Fischer, of Buda-Pesth (International Medical Congress, 1881)
performed a series of experiments on dogs to establish the propriety
of suturing wounds on the bladder. He says the success of the
operation depends entirely on the accuracy with which the sutures
were placed. He used catgut and antiseptic silk with equally good
results. He infers that the operation will be more successful on
man than on the lower animals, for the reason that a catheter can
be kept in the bladder and irrigated antiseptically, while the patient
rests quietly in bed.

Billroth has recently extirpated the pylorus for carcinoma. But
as the ulterior results are always unfortunate, we can only admire
the heroism and genius of the surgeon, and the brilliancy of the
operation, while we deplore its uselessness. But it proves conclu-
sively what we dare do now-a-days in the region of abdominal
surgery.

Gastrostomy has been often performed for the removal of foreign
bodies and for artificial feeding. It has been done by Labbe, of

^8 GUKSHOT WOUNDS OF THE ABDOMEN.

Paris, for extracting a fork from the stomach of a man who swal-
lowed it in a playful freak. And it has been recently frequently
where the oesophagus was mechanically obstructed by stricture or
malignant disease.

The Cesarean section is rather going out of fashion. But if
surgeons would take care to clean out the peritoneal cavity thor-
oughly and then suture the incisions in the uterus with silver wire,
there is no reason why it should not be as successful as any other in
the whole range of abdominal surgery.

Look through the literature of tlfb Caesarian section, and see the
absence of all precautions to prevent sepsis, and can we wonder that
the operation has not been more successful. How any surgeon
could make an incision three or four inches long through the walls
of an impregnated uterus, and then leave it open for the lochial
discharge to run out into the peritoneal cavity is incomprehensible.
By the light of modern science, and by the skill of the present
generation of surgeons, there is no reason why the Ca3sarean sec-
tion should not again come into vogue.

Porro's operation, which is now accepted and lauded by all who
have done it, is the professed substitute for Cassarean section, and a
direct offshoot of ovariotomy. It seems destined to be recognized
as a legitimate and justifiable procedure. In Vienna, in 1878, I
saw two cases,a year after they were cured, one by Prof. Spilth, and the
other by Prof. Carl Braun. Prof. Horatio R. Storer, of Boston,
extirpated the uterus by abdominal section on account of uncon-
troll h\e haemorrhage after delivery, long before Porro's operation
(1867) ; and by some writers it is called the Storer-Porro operation.
Porro's operation is usually performed in cases of deformed pelvis,
when the child cannot safely be delivered in the natural way. So
far, it has been more successful than the Ctesarean section, as here-
tofore performed ; and it protects the patient against the dangers of
a subsequent pregnancy.

Laparotomy, in mechanical obstruction of the bowels, has been
frequently performed successfully within the last three or four years.
This is another triumph following in the wake of ovariotomy. In
America and Great Britain, we are ahead of our French confreres
in this operation. It was but the other day (July, 1881) that all
Paris was wrapped in gloom by the sudden death of one of its most

GUNSHOT WOUNDS OF THE ABDOMEN. 29

promising young physicians, Dr. Cbantreiiil. Cliantreuil was a man
in the very prime of life, only about forty. Young and vigoroup,
he was doing a great work, and able to do it well. He was the
picture of health ; but one day he was suddenly taken with severe
gastric pain. His friends hurried to his assistance. There was no
relief ; he rapidly sank, and died in twenty-four liours. A 2J0st
mortem examination revealed an intussusception. French surgery
must look to its laurels, for it has many ; but it cannot afford to
stand still while Ave move on. In no medical centre in this country
or Great Britain could such a life as Chantreuil's have passed away
without prompt efforts to save it. With the lights now before us,
no man has the right to die of mere mechanical obstruction of the
bowels.

Lumbar colotomy is frequently performed when the lower bowel
is mechanically obstructed by carcinomatous or other foreign growth.
It often prolongs life twelve or eighteen months, and during this
period gives complete relief to suffering. It has been done by ab-
dominal section ; tut this has not yet come into general use. In
the present state of our knowledge, I believe it would be an easier
and a safer operation than the lumbar, and it would make the arti-
ficial opening more convenient for comfort and cleanliness. It will
eventually supplant the lumbar method.

Certainly the most important advance made in peritoneal surgery,
growing out of ovariotomy, is Battey's operation for arresting ovu-
lation and bringing about the menopause. This valuable contribu-
tion gives well-deserved fame to our countryman — fame that will
endure, and, like that of McDowell, will become more brilliant as
time rolls on. You know its literature, and the battles it has had
to fight ever since it was brought before the profession in 1872. Its
enemies are, day by day, deserting to the opposite ranks, and soon
it will meet with no more opposition than does ovariotomy to-day.
Its victory has been easier than that of ovariotomy, because tlie one
is but a mere corollary of the other. It is more difficult than ova-
riotomy, because the abdominal walls have not been distended and
relaxed by internal centrifugal pressure, and because^tberoffending
organ does not boldly present itself at the median section as ovarian
or uterine tumors do. The ovary lies deep down in the pelvis, and
it is often difficult to find it, and sometimes more difficult to bring

30 GUNSHOT WOUNDS OF THE ABDOMEN.

it into view, I think I have facilitated this part of the operation
very much by the use of my uterine redreaser. Sometimes the
uteius in these cas'es is re*roverted, and then it is still more difficult
to reach the ovaries aud bring them to the surface. Whether the
uterus be retroverted or not, it will materially aid our endeavor if
the uterine repositor be used to elevate the fundus uteri to the lower
aigle of the abdominal incision. Here it must be held firmly in
position by an assistant. By rotating the handle of the repositor
on its axis to one side of the patient, the opposite ovary is made to
approximate the abdominal incision, so that the finger following
the Fallopian tube soon finds the ovary, which is drawn into view,
and then the pedicle is tied and the ovary removed. In like man-
ner, the opposite ovary is dealt with by turning the handle of the
repositor in a contrary direction, and the operation is finished as in
ovariotomy.

When we first began to perform this operation, we were less suc-
cessful than at the present time; but the labors of Lawson Taitand
of Thomas Savage, both of Birmingham, prove that the opera-
tion is quite as safe, and quite as successful, as that of 'ovariotomy.
Thomas Savage has performed the operation tliirty times witliout a
deatli. Lawson Tait has done it more frequently than any one
else — seventy times — with marvellous success. His unlucky cases
has been those for intractable bleeding fibroids.

The operation has been done often, and w'ith great success, by
Hegar, of Freiburg. Spencer Wells, Professor Simpson, Heywood
Smith, and others in Great Britain, have done it successfully. In-
deed, the operation, as performed by our brethren in England, is
no longer on trial. It is now accepted there as a legitimate opera-
tion by every gynecologist who pretends to be a surgeon. Battey
thinks it very important to do the operation with the utmost
thoroughness, not leaving the smallest panicle of ovarian stroma.
Lawson Tait goes further, and insists that the Fallopian tubes should
be removed with the ovaries, if we would insure the arrest of ovu-
lation and hasten the advent of the menopause. It is for this that
the operation was projected, aud for this that it is now performed.

In April, 1878, I operated on a case of dropsy of the gall-bladder
Having published the case in detail, I shall here but briefly allude to
its general features. I drew oS the contents of the gall-bladder by

GUNSHOT WOUXDS OF THE ABDOMEIs'. 31

aspiration. The sufferings of the patient were temporarily ameli-
orated. The sac soon filled again. I then conceived the idea of
cutting down on the sac, of opening and emptying it, and then of
securing the edges of the incised sac to the edges of the abdominal
incision. This was done ; but the patient was too much exhausted
before operation, and died two days afterwards of black vomit.
Tho blood had become so disintegrated by the admixture of bile,
that it was untit for sustaining the vital powers ; and her death was
just such as we see in yellow fever, by black vomit. The jwst mor-
tem examinahon showed that the 0})erat!on was a perfect success.
The gall-cyst bad adhered to the abdominal parietci', where it was
secured by suture. There was no peritonitis, and no evidences of
inflammatory action were anywhere to be seen. In this cas.*, T re-
moved sixly gall-fctones, varying in size from a pea to a filbert.

Tiie success of this operative procedure in this case established a
princi])le which has been applied by Lawsou Tait and o.hers with
marvellous results in peritoneal surgery. Lawson Tait has twice
performed successfully the operation of cholecystotomy as above
described, and he ha.s applied the same principle in operations fur
hydatids of the liver. He cuts down on the tumor, and then
empties it by aspiration. He then incises the cyst to a proper ex-
tent, cleans out its cavity thoroughly, sews the cyst-walls to the
edges of the abdominal incision, and introduces a drainage-tube.
He has done this hepatotomy in seven successive cases in the last
two years, and effected a perfect cure in every one of them. In
every instance, the substance of. the liver was incised to reach the
hydatid cyst. In one, the thickness of liver-tissue through which
he cut ''was nearly an inch". {Birmingham Medical Review, Oc-
tober, 1881.) In all, the liver was itself stitched to the walls of the
abdomen. This is certainly a brilliant achievement in peritoneal
surgery, and establishes a precedent that we may all safely'follow
hereafter. It simplifies and perfects a method of operating in a
class of cases in which heretofore we dallied, hesitated and tempo-
rized. But Lawson Tate has formulated a rule of action, and de-
monstrated its successful application, which gives us confidence in
the future. He has carried the same principle to the treatment of
hydronephrosis. He has operated six times successfully in the last
two or three years He opens the abdomen in the middle line,

32 GUKSHOT WOUXDS OF THE ABDOMEN.

punctures the cyst, guards the peritoneal cavity against Lhe admis-
sion of cystic fluid, opens the cyst to the proper extent, and thou
stitches the cyst-walls to the edges of the abdominal incision, and
introduces a drainage-tube. Prof. Czerny, of Heidelberg performs
this operation in the same way in hydronephrosis, empyema of the
pelvis of the kidney, and echinococcus, incising the cyst-walls, and
attaching them to the external opening.

Lawson Tait has also carried out the principle of suturing cyst-
wall to abdominal incision, followed by drainage-tube, in other
cystic diseases within the peritoneal cavity. These operations may
be classified as follows : Abscess of spleen, 1 ; extra-uterine preg-
nancy, 6 (1 death); hsemato-salpinx, 1; hydro-salpinx, 2; pyo-
salpinx, 3 ; hydrometra, 1 ; hydatid tumor of liver, 8 ; cystic ab-
scess of liver, 1 ; dropsy of gall-bladder, 1 ; pelvic abscess, 18. All
of these were treated on the same principle — viz., stitching the
cyst-walls to the abdominal incision ; and all recovered except one
case of extra-uterine pregnancy, in which the operation was too
long delayed. Thus, of six Fallopian pregnancies, he lost but one;
of twelve pelvic abscesses, all were speedily cured ; of forty-two
operations involving cystic disease in the peritoneal cavity, he lost
but one. His marvellous success in all these proves the correctness
of the principle of operating, and makes the way clear for other
surgeons.

Thus we see thatLawson Tait has gone ahead of us all in opening
up new fields in the great domain of abdominal surgery. He has
done it all in the last three years, simply by adopting the principle
set forth in the operation of cholecystotomy. His success estab-
lishes this procedure and these operations as legitimate, and com-
pels us to accept them without question as he presents them to us.
Well may I close this rapid resume of recent advances in peritoneal
surgery in recounting these brilliant achievements of Lawson Tait.
By his daring and skill, he has made easy for us many things that
were before attended with difticulty and danger. He is now the
leader in this department of surgery, and has succeeded in opening
up fields of great fertility, which we may all freely cultivate with
profit.

I have now given you, as hurriedly as possible, a brief outline of
the work lately done in peritoneal surgery. The whole of it is the

GUNSHOT WOUXDS OF THE ABDOMEN". 33

outgrowth of ovariotomy. Most of it has been done since Batley
first performed his operation in 1872, and a very large part of it
in the last three years. This work became possible as ovariotomy
grew more and more successful. The principles of peritoneal sur-
gery are now so well established, so thoroughly understood, and so
successfully put in practice, that we are bound to achieve still
further triumphs in this direction. Believing firmly in the lessons
of this retrospect let us, now look forward ; and forecast where, and
to what, they necessarily lead us. Past success, based on princi-
ples universally applicable, guarantees like results under analogous
circumstances.

The great Dr. Physick, of Philadelphia, was, many years ago,
called the Father of American Surgery. One of the most impor-
tant and original of his operations was that for artificial anus,
which, until his day, had not been cured. His operation was based
on an accurate knowledge of physiological laws ; but it was not
always applicable, and not always successful. Well do I remember
a case in Paris, in 1867, on which M. Nelaton had operated several
times unsuccessfully, and how he deplored the uncertainty of his
art. This was before we had learned with what safety wo could
freely lay open the peritoneal cavity. Doing this now with absolute
impunity, we can cut loose the injured bowel from all unnatural
relations ; resect portions of it, if need be ; apply sutures where
necessary ; and return it, in a normal state, to the peritoneal cavity.
There is now evidently a great future for this operation ; but it
must not be forgotten that, from long disuse, the lower end of the
wounded bowel becomes abnormally contracted. Before uniting the
upper and lower ends of the injured bowel, whether large or small
intestine, it will be necessary to dilate the latter mechanically. Dr.
Kinlocb, of Charleston, professor of surgery in the Medical College
of that city, has already performed this operation.* A shot-wound
(October, 18G2) of the abdomen resulted in artificial anus in the
iliac region. The patient was eventually worn out by suffering and
inanition. Dr. Kinloch opened the abdomen (June, 1863), excised
half an inch of the upper portion of the ileum, and two inches of
the lower, v/hich last was abnormally contracted for want of use.

*Journal of Medical Sciences, July, 1867 ; and Medical and Surgical History of the
War, etc., part second, surgical volume, p. 113.

34 GUNSHOT AVOUNDS OF THE ABDOMEN.

lie ir.en united the two cut ends of the intestine by silver wire, and
then closed the wound. On the third day, some of the intestinal
sutures gave way, and there was a f^cal discharge. Dr. Kinloch
succeeded in substituting a small foecal fistula for an extravasating
artificial anps; and would have succeeded perfectly in his well-
planned timely operation, if he had had the means of securely co-
apting the ends of the wounded intestine. Too much credit can-
not be given to Dr. Kinloch in initiating an operation that must
become the rule of practice in the future.

Fallopian pregnancies, terminating in death by haemorrhage from
bursting of the Fallopian tube, a few weeks after conception, are
not uncommon. Almost every practitioner of thirty years has
seen such cases. One of the deputy-coroners of New York made
necropsies in ten cases in five or six years. Three of my young
friends died in this way. I saw one of them with Dr. II. D.
Nicoll, in New York, in 1874. The patient, aged 30, mother of
two children, was taken suddenly at seven o'clock in the morning-
while dressing. Dr. NicoU saw her in an hour. I saw her about
2 P. M. She was then in collapse. I had no doubt that she was
dying of internal basmorrhage, or of perforation of the bowel. She
died in twelve hours from the time of the attack. The post mor-
tem examination showed the peritoneal cavity to be full of blood.
If we had in time opened the abdominal cavity, it would have been
easy to secure the bleeding Fallopian tube. But the golden mo-
ment for this had passed before we grasped the case in its entirety,
and a valuable life was lost. With a sharp diagnosis, and prompt
action, nothing would be easier, now, than to save life under these
circumstances.

The late Dr. Stephen Rogers, of New York, wrote an admirable
monograph on Extra Uterine Foitation, in 18G7. He reviewed the
subject in all its bearings ; and said : " To me, therefore, a correct
diagnosis indicates, as the first thing in order, the prevention of any
further loss of blood ; to accomplish which there is no choice of
methods ; the jjeritoiieal cavity inust he opened ; tlie bleeding vessels
must he ligatured." Rogers' advice must become law for our future
government.

The illustrious George McOlellan, the father end founder of Jef-
ferson Medical College, of Philadelphia, was a truly great surgeon

GUXSHOT WOUNDS OF THE ABDOMEN. 35

— bold, original, brilliant, and successful. In the year 1847,
McClcllan left his home one bright May morning to make his usual
daily rounds. He walked erect along Chestnut Street, seemingly
full of health and vigor, going from house to house to see his pa-
tients ; while his coachman drove leisurely along, waiting when-
ever his master entered. Soon he Avaa seen slowly descending the
steps of a marbled mansion, bent over with agonizing pain. He
entered his carriage, and Vas driven rapidly homo. His medical
advisers were summoned. In ten hours he was in collapse, and in
six hours he was dead. He died of perforation of the bowel,
below the sigmoid flexure. The cause of death was shock and
septicaemia.

We often see patients dying of perforation of the bowel, from
wasting disease — such as chronic diarrhoea and typhoid fever. In
these cases, the poor sufferers are too exhausted, too near death's
door, before the perforation occurs ; and we can only look on, try
to ameliorate symptoms, and wait for the end. But George Mc-
Clellan was in the prime of life; and would, in all probability, have
lived to a ripe old age but for this sudden taking off.

Given a case of perforation of intestine in such a man as George
McClellan ; and, giving a correct diagnosis, which is by no means
difficult — what are we to do in the present state of our knowledge ?
Why, of course, we should open the abdomen promptly, clean out
the peritoneal cavity, search for the perforation, pare its edges, and
bring them together with sutures ; and treat the case as we now
treat other cases involving the peritoneum. Eest assured that the
day will come, and it is not far off, when an accurate diagnosis in
such cases, followed by prompt action, will save life that must other-
wise quickly ebb away ; and the same thing must be done in gun-
shot wounds of the abdomen.

Death from wounds of the abdomen may occur from shock, from
hemorrhage, or from^septicaemia ; seldom from peritonitis, properly
speaking. When from shock or haemorrhage, there is no reaction,
and death is comparatively sudden. Keiiction once established,
shock is over, and direct danger from haemorrhage is passed. The
great danger is septicaemia from effusion into the peritoneum. Some
years ago, it was thought that peritonitis was the chief cause of
death after ovariotomy. But this is not the accepted doctr,".icof
the present day. — British. Medical Journal.

36

EDITORIAL.

NOKTH CAROLINA MEDICAL JOURNAL.

A MONTHLY JOURNAL OF MEDICINE AND SURGERY, PUBLISHED
IN WILMINGTON, N. C.

Thomas F. Wood, M. D., Wilmington, N. C, Editor.

Original communications are solicited from all 2}(^rts of the
country, and esjjecially from the medical ^Jrofession of The Caro-
LiNAS. Articles requiring ilhistrations can he inomptlg suiipliedhij
previous arrangement with the Editor. Any subscriber can have a
sjjecirnen number sent free of cost to a friend ^vhose attention he
desires to call to the Journal, by sending the address to this office.
Prompt 7'emitta7ices from subscribers are absohitely necessary to
enable us to tnaintain our work with vigor and accejdability. A II
remittances must be made payable to Thomas F. Wood, M. I).,
P. 0. Draiver 791, Wihninqton, N. C.

THE JOURNAL— THE PROFESSION— THE OLD~YEAR.

With this number we begin the fifLli year of the North Caro-
lina Medical Journal. At the Fayetteville meeting (May 187G)
of the Medical Society of North Carolina, one of the editors of this
Journal gave it as his opinion that a State medical journal could
not be sustained, and fortified his opinion with arguments which
seemed then conclusive, in the negative, to the committee appointed
to consider the subject. In less than two years this adverse opinion
had been so far reconsidered, as to make the way clear for the
initial number, and the work was begun witli great anxiety as to its
future.

Our first year was a year of ceaseless anxiety and embarrassment.
With but little knowledge of the task we had undertaken, uncer-
tain of the reception we would meet at tlie hands of the profession,
we were only sure of one thing, and that was of the zeal and energy
we could bring to the task. It was not until the end of the third
year of publication that we could see our way through the difficul-

THE JOURNAL — THE PKOFESSION — THE OLD YEAR. 37

ties, financial and liteniry, which beset us. In the latter part of
1880, Dr. DeRosset's health began to fail, and he was obliged to
lay aside his gifted pen, and with tuany regrets and a nfiournful
heart, he relinquished the position he had filled so ably. When we
consider the varied talents of our colleague, — his mature learning,
his roadiness to discuss the newest or the oldest subjects, his poly-
glot education, — we cannot mention his death without feeling our
great loss, and feeling afresh the sad calamity of his death.

The year 1882 has brought us some distance on our journey and
co.li paring our condition with our first years, we are glad to an-
nounce a degree of prospeiity, sutficienlly pronounced, to encourage
us to continue our work. Our subscription list has iucrea.-ed, and
our subscribers iiave been more punctual in remitting their sub-
scrij)tions. We are also indebted to the generous manner in which
the Medical Society has aided us in our work. Without this sub-
stantial aid we could rot have survived. To the Society and to the
individual members, we express our gratification at this unqualified
exhibition of their approbation. We trustthat wiih our increas-
ing facilities we will make the Jourxal more of a necessity to the
reading physicians in the State.

AVe have unusual opportunities to know the status of the medical
profession in this State during the past four years. Our editorial
correspondence with many, our connection with every county of
the State through the State Board of Health, our service on the
Board of Medical Examiners, have helped us to measui'ewith some
degree of accuracy the condition of the profession.

We believe that there has never been as great a degree of mental
activity at any time in our knowledge, as is now shown. Surgical
operations of the gravest character are undertaken in remote sec-
tions, far away from the aid of skilled assistants, or the advantages
of intelligent nursing ; more physicians devote time and attention
to the purely scientific and literary parts of the profession ; there is
a beginning awakening to the value of original studies. All these
are signs of good augury. On the other hand, by far the greater
number of the profession are satisfied with the degree of scholar-
ship attained at tlieir graduation, and find time to indulge in the
excitement of politics and other things entirely at variance with
success in" a calling as serious as ours. Work undertaken by the

38 THE JOURNAL — THE PROFESSION"— THE OLD YEAR.

few, inaugurated by them, is too often carried on without the
assistance due from the whole body of the profession.

There is an awakening interest in preventive medicine. Espe-
cially is it noticeable in the times of threatened epidemic disaster.
This was the force which brought the National Board of Health
into existence. The yellow fever calamity in the Mississippi Valley
had touched the pocket and heart of the whole country, and the
economy of preventing disease was made to stand out in bold relief.
So now the threatened approach of small-pox has aroused the many
county boards of health to energetic action. There is very much
yet to be done, among our physicians, not only by studious consider-
ation of the principles underlying State medicine, but also in the
dissemination of sanitary knowledge among their patients. Not-
withstanding the industry the State Board of Health has exhibited,
their efforts have been very feebly seconded by the profession at
large. Requests and appeals from the Superintendents of Health
to their confreres have been greatly neglected by them, causing the
delinquency in reports of most of the Superintendents. But the
interest which has been already shown is sure to increase, if the un-
remitting zeal of the past is shown in the future.

The accession to our ranks of young physicians shows that med-
ical education is a very variable thing. It is very apparent, taking
the various grades of intellectual ability into consideration, that
the licentiate of the minimum grade, is to the licentiate of the maxi-
mum grade, as a practitioner of ten years standing to a novice.
The licentiate of maximum qualifications is a small minority in a
class of forty. What we have noticed more particularly in the
minimum licentiate is an apparent lack of desire to do more than
pass the board, and, of course, such men will only drag along a
weary life of mediocrity, and add no honors to the profession. But
for all this the standard of acquirements has never been as high, nor
has the scientific zeal of the new generation been equaled.

The moral tone of the profession too has undergone a decided
improvement. Not only as regards a stronger allegiance to profes-
sional ethics, but also as regards the attainment of a higher dignity
and purity of character do we notice a higher standard reached
year by year.

Of the achievements in medical science and art during the old

THE JOURNAL — THE PllOFESSIOX — THE OLD YEAR. 39

3'ear wc have borne a modest and honest iiart. While the established
conservatism of Carolinians has imbued the medical profession
there has been no lack of bold surgical practice, directed by a learned
an intelligent analysis of fitness to the end.

The great medical event of medical world in the old year was the.
Seventh International Medical Congress held in London in August.
The addresses alone, delivered before this body, will be diligently
studied and admired by physicians of all nationalities, for they serve
to mark the condition of the profession, and also to forecast the
probable direction in which medical thought and investigation are
leading us.

The address of Dr. Billings on ''Our Medical Literature" is
spoken of as being '' the most remarkable for its practical value,
its originality, the wit and humor that illumined it throughout, and
the skill wath which it was delivered."

The Sectional work too was of good quality, except that it was
more remarkable in all the departments than in than of therapeu-
tics and pharmacology.

In this department of our healing art, the last year has been no-
ticeable, partly for the introduction of new remedies, but more par-
ticularly for studies of the action of the older drugs. So great a
matter is the introduction of new remedies that one journal devotes
its columns exclusively, and another almost entirely to the descrip-
tion and analysis of the hundreds of new articles reputed to heal.
It is well for the profession that such articles can live a probationary
life in the Therajmitic Gazette and Neio Remedies, and so relieve
the columns of journals devoted to general medicine.

The greatest amount of zeal has been shown in the direction of
experimental research into the properties of antiseptics and antipy-
retics. Only a short time ago, carbolic acid as an antiseptic, and
salicylic acid as an antipyretic and antiseptic, were at the head of
the list, now many other candidates for favor are being extolled by
their champions. Among them may be mentioned resorcin, eucalyp-
tol, salicylated camphor, thymol, as well as boric acid, are now more
or less in favor, with a fair promise of eclipsing carbolic acid, which
latter article has latterly grown into disfavor with some experienced
surgeons on account of the poisonous symptoms it sometimes causes.

Of the antipyretics or antiperiodics it was announced in somewhat

40 THE JOURNAL— THE PROFESSION^ — THE OLD YEAR,

exultant terms, that an artificial quinine named cbinolin had been
discovered, — a chemical product from coal tar, — as cheap and effect-
ual as quinine. The time of probation has been too short to en-
tirely determine the value of this chemical, but it is almost sure
that its febrifuge qualities, if any, are far inferior to that of quinia.

The experiments published by Dr. E. L. Payne, Jr., of Lexing-
ton, in the May Journal, 1881, on the physiological and therapeu-
tical action of Phoradendron flavescens, attracted much interesting
enquiry from all points of the country, and he is still pursuing his
investigations with industry. That the American mistletoe possesses
marked influence over the gravid uterus it now appears to be settled.
On the other side of the ocean, Viscum album the nearest botanical
relative of Phoradendroii flavescens, has been shown to possess the
properties of relieving cardiac distress, in some degree superior to
digitalis.

The various attempts made in the South to get a cheaper alkaloid
to substitute quinine, that ever recurring question of economy
to so large a number of the population, especially in the rural
districts, may now be said to have been in a measure solved, by em-
ploying preparations containing all the alkaloids of the bark. Some
of the manufacturers guarantee an assay of 45 per cent, of^^bark
alkaloids. The experience of many physicians with these prepara-
tions seems to sustain the opinion expressed by Briquet and others,
that in chronic malarial fevers especially, a combination of the alka-
loids succeeded better than any one of them.

Now that the art of the pharmacist has been entirely removed
from the domain of medicine, the physician must rely upon the
skill and honesty of the pharmacist, in selecting "and preparing
drugs. As a class, the educated iiharmacists^ in this country are
better prepared for their business, than an ecjual number of physi-
cians selected at random. This may be accounted for in the fact
that pharmacists have much narrower range ofjstudy, and by going
over and over again the same ground, their proficiency is easier of
accomplishment. We were pleased, therefore, to see that there
was sufficient esprit dii coiys among the pharmacists of this State
to organize, upon a legal and sound basis, a Society for the advance-
ment of the mor'^1 tone of the pharmacal profession, and excite
emulation in the science and art of pharmacy. We welcome this
organization as a helpful auxiliary to our State Medical Soci2ty.

ABOUT VACCINE. 41

In tlie domain of surgery nothing has come to our attention dur-
ing the year of more importance than the brilliant operation by
Dr. T. B. Wilkerson, of Granville, — the removal of both ovaries
for the cure of insanity. The acuteness of the diagnosis, the un-
faltering steadiness of the surgeon in the face of a probable failure,
make the outcome of the operation the most brilliant success in the
annals of Battey's operation, and really adds another to the pitifully
few operations designed to restore dethroned reason.

In the department of literature, the old year has been prolific of
good bool^. Some excellent ones have taken their places upon our
book-shelves. Especially in the department of dermatology,
Duhring, Piffard, Fox and Bulkley have made material additions to
the fame of American authors. In the department of Obstellfics
in addition to the large number of articles of permanent value ap-
pearing in journals, we have the excellent work of Dr. Lusk, on
Obstetrics. A thorough acquaintance with this volume shows ifeto
be most thorough and reliable, and destined to supplant, in a great
measure the other American text-books.

We have rambled over the old year thus hurriedly, because we
feel that we owe very much to its work, and because for many years
we may not witness such firm and decided progress. But wao
knows what a year will bring forth ? The host of restless medical
scholars arc still pushing forward, taking no note of the artificial
distinctions of time, but bringing successes out of blunders and
wringing applause from the incredulous pessimist. "\Ve welcome
the new year, and wish that it may bring to us as many successes as
the last, not only for ourselves, but for all our kind readers.

About Vaccine. — Wo will endeavor to keep a supply of vaccine
equal to the demands made upon us, for the convenience of our
friends. The Board of Health has no money to supply virus gra-
tuitously. We say this because the language of the barren law un-
der which the Board works has lead many to believe that the Board
is required to furnish vaccine supplies. There is not money enough
furnished by the State to pay postage and freight, much less send
out vaccine free. See advertisement in another column.

42

REVIEWS AND BOOK NOTICES.

The Opium Habit and Alcoholism. A Treatise on the Habits
of Opium and its Compounds ; Alcohol ; Chloral Hydrate ;
Chloroform, Bromide of Potassium; and Cannabis Indicus. In-
cluding their Therapeutical Indications ; With Suggestions for
Treating Various Painful Complications. By Dr. Fred Heman
Hubbard. A. S. Barnes & Co., Ill and 113 William Street.
New York : Pp. 259.

We do not know the extent of the author's experience in treating
the opium habit, but he shows a marked lack of experience in
authorship. It is much easier to pay a passing compliment to a
book than to analyze a poor one, and point out the faults which lead
the reviewer to an adverse opinion. We must state, though, that
the author explains that a growing general practice has made it
necessary for him to prosecute his labors during the limited time at
his disposal between calls.

Book-making follows fashions very much. Let one author produce
a good book on any popular medical topic, and we have following
in its wake volume after volume on the same subject, feeble imita-
tions, many times, until one tires of the dreary dilutions of ideas.

This book has the misfortune of following an excellent one, and
for that reason if for no other, it is at a great disadvantage. But
comparison aside, this volume is so full of gross errors, repeated
over and over again, as to lead to the inference that it is due to
something besides careless proof-reading.

In the chapter (XXIV) " On the Hypodermic Administration of
Morphia" Codeia is spelled twice on one page cod^a, and on the very
next page we find "slufSng" for sloughing, and the same phonetic
equivalent, ''sluffing" on p. 44, and again the same on jd. 108,
a word entirely new to lexicographers "pertusions." On page 153
we read of congestion of the "conjnnctile" membranes; p. 49 of
"seminiferous secretions" ; p. V. of '' catamenics."

We learn from the author that lager heer counteracts the effects
of opium, as no other remedy known to him does, and while he
uses tincture of belladonna he prefers not to use atropia hypoder-
mically.

We have a digression (Chapter XIX) on the pathology and treat-

KEVIEWS AND BOOK NOTICES. 43

ment of rheumatism in which we are enlightened on the subject of
" cellure" contraction, and upon a morbid principle existing in the
blood as a materis morli. We have such new spelling of old words
as digitilis for digitalis ; lielitude for hebetude ; ad-libitum as a
compound word ; pruitis for pruritis ; pcrcusson for percussion ;
sopor-fic for soporific and so on.

The author refers repeatedly to No. 1 and No. 2, favorite pre-
scriptions, the one containing morphia and the other Cannabis
Indica. Another marvellous prescription containing whisky, sherry
wine, port wine, lager beer, gin, cider, rum, and champagne, is used
to impregnate every particle of food eaten by a person to effectually
debar him from consuming as a beverage any of the popular drinks
that intoxicate.

We have only pointed out the little blunders in this book, and
assure our readers that the larger ones are not less conspicuous. It
is an utter waste of time to reach such a production.

The Nurse and Mother. A Manual for the Guidance of Monthly
Nurses and Mothers. Comprising Instructions in Kegard to
Pregnancy and Preparation for Child-birth. With Minute Direc-
tions as to Care During Confinement, and for the Management
and Feeding of Infants. By Walter Coles, M. D. J. H.
Chambers & Co. 1881. Pp. 153.

Dr. Coles gives in his preface the outline of this work. He says
he has discussed the. several important topics from a strictly pro-
fessional standpoint, and as far as possible, in a professional manner.
He has attempted to replace many injurious popular superstitions
and traditions, by the teachings of enlightened common sense, and
the results of scientific study and experience. In this design he
has succeeded.

No book is more needed, than a short simple manual for the
guidance of monthly nurses. No set of people are more ignorant,
and meddlesome, and useless, in their management of the lying-in
woman than the majority of the so-called midwives. If they could
be made to master this little work they could nut fail to be more
useful. But the great difficulty would be to get any considerable
number of them to read this or any other book.

Tliere is one part upon which tlie nurse needs to be instructed and

44 REVIEWS AND BOOK NOTICES.

that is, in time of need, to introduce a cathefer. It is often a matter
of great importance, and no nurse can be considered even moderate-
ly well prepared who does not know enough for this.

Geneeal Medical Chemistry for the Use of Practitioners
OF Medicine. B} R. A. Witthaus, A. M., M. D. New York:
Wm. Wood & Comt)any, 27 Great Jones Street. 1881. Pp. 443.
" In the arrangement of this work, it has been deemed advisable
to d'epart in certain points, from the methods usually followed in
chemical test-books. Those portions treating of technical processes
have been condensed to a minimum, while the bearings of chemistry
upon physiology, hygiene, therapeutics, and toxicology, have been
treated of as fully as the limits of the work have permitted. The
division of the elements into metals and metalloids has been aban-
doned as unscienti6c, and a classification has been adopted which
the author believes to possess advantages over those hitherto fol-
lowed, especially in that it is based upon purely chemical characters.
" Organic chemistry has not been considered as a distinct divi-
si' n of the subject, but simply as the chemistry of the compounds
of carbon ; an arrangement not only logical, but sanctioned by the
works of Feser, Schiitzenberger and others. The classification of
the carbon compounds is based, as far as possible upon their rela-
tions to the different series of hydrocarbons." (Author's preface.)
Based upon the above, we have a chemistry fully up to the needs
of the practising physician, giving him all the more recent methods
in analysis for clinical purposes, and is a useful addition to Wood's
library.

Essentials of the Principles and Practice of Medicine.
A Hand-book for Students and Practitioners. By Henry
IIaktshorne, a. M., M. D. Fifth Edition. Thoroughly Re-
vised and Improved. With 144 Illustrations. Philadelphia :
Henry G. Lea's Son & Co. 1881. Pp. 6G9.
This work has now reached its fifth edition, and has been increased
in size and value, by the additions of sections on many of the newer
developments in medicine. We suppose this volume was written
for students preparing for examination, but it is also valued by
many practitioners as a hasty reference book. As far as the labor

EEVIEWS AND BOOK NOTICES. 45

of the author is concerned, he could have just as easily written a
fuller treatise with the work expended on this. But conciseness is
even more difScult than originality, and this work is valued by
students for the former quality.

Dr. Haitshorne, apparently belongs to the older school of thera-
peutists, but is none the less reliable for all that.

Coudemn such books as much as wo please, they seem to be the
necessary outgrowth of the American system of education, and are
certainly not despised' by the student. This is the best of them all
as far as we know.

A Manual of Organic Materia Medica. Being a Guide to
Materia Medica of the Vegetable Kingdoms, for the Use of Stu-
dents, Druggists, Pharmacists and Physicians. By John. M.
Maisch, Phar. D., Prof. Materia Medica and Botany in Philadtl-
phia College Pharmacy. With Many Illustrations on Wood.
Phihidelphia : Henry C. Lea's Son & Co. 1882. Pp. 459.
The study of pharmacognosy is neglected by physicians. It
seems to be considered an extra accomplishment to know anything
of crude drugs. This evil begun after the doctors in the smaller
towns gave up their *' shops" and transferred the whole drudgery
of pharmacy to the gilded " stores" of the druggist. Is was a great
help to the doctor who had a large following of respectable paupers
at^ainst whom he ''charged" clysters, and emetics, and leeches, and
pills through the whole list of pharmacy stuff, to receive but a lean
income, just enough always to keep him in debt to the thrifty drug-
gist. This is the Southern history of the causes which have led to
the neglect of pharmacognosy.

Prof. Maisch has given us a book which ought to entice the med-
ical students in the profession to renew their love of the knowledge
of roots, leaves and barks. Nearly every substance is illustrated
with a good wood-cut of some part of the plant used medicinally.
The author says he has "given what may be considered the essen-
tial physical, histological, and chemical characters of the organic
drugs, so as to render the work also a useful and reliable guide in
business."

He has derived also, an artificial classification, which will serve
as a key to the recognition of unknown drugs. It is a valuable
volume.

46 EBVIEWS AND BOOK NOTICES.

A System of Surgery, Theoretical and Practical. In
Treatises by Various Authors. Edited by T. Holmes, M. A.,
Cantab. First American from Second English Edition. Thor-
oughly Eevised and much Enlarged. By John H. Packard,
A. M., M. D. Assisted by a Large Corps of the Most Eminent
American Surgeons. In Three Volumes, with Many Illustrations.
Vol. II. " Disease of Organs of Special Sense." " Diseases of
Circulatory System." '' Diseases of the Digestive Tract." ''Dis-
eases of the Genito-Urinary Organs." Philadelphia : Henry C.
Lea's Son & Co. 1881. Pp. 10G3.

We noticed the first volume of this sumptuous work in the Jour-
nal, September, 1881. The second volume now before us is very
valuable as to its contents, and the mechanical work much superior
to the English edition.

The additions by the American editors are important and volu-
minous, the entire article on " Injuries and Diseases of the Absorb-
ent System" havinig been written by Dr. S. C. Busey, of Washing-
ton, D. C.

To review critically such a great work would take more time than
we can devote to the subject. The best test of the value of Holmes'
Surgery is that it has been so highly esteemed as a book of refer-
ence during several years. The expense of the volume debarred many
from adding it to their library. The present reprint cheapens the
work, so that its circulation must be greatly increased.

A Manual of Ophthalmic Practice. By Henry Schell,
M. D. With 53 illustrations. Philadelphia : D. G. Brinton,
115 South 7th Street. 1881. Pp. 263.

This is a convenient volume of reference for the general practi-
tioner,containingall the essential matters in eye practice, and treat-
ing of some subjects, of course, quite out of the range of any but
the specialist. The illustrations are good, well-selected, and instruc-
tive. The descriptions are clear and concise. A sheet of Snellen's
test-type is appended. The work is well printed, and will no
doubt supplant the more elaborate and expensive foreign works an
the same subject.

The Country Practitioner.— We are sorry that this excellent
Journal has been suspended because of Dr. Town send being dis-
abled by failing eyesight. We trust that he will ere long be restored,
and that he will resume his editorial work with renewed ability.

47

WASHING PUT THE STOMACH IX INCONTKOLLABLE

VOMITING AND VOMITING OF PHTHISIS.

Translated by Wm. G. Egglestox, M. D., of Hami^deti Sidney,

Virginia.

M. See has had remarkable success in incontrollable vomiting,
not dependent on grave lesions of the stomach, by employing the
above means.

Cereuville also, has published some cases in which he used the
washings with great advantage.

Among his patients some were subjects of variety of vomiting
which resisted opiates, antispasmodic, alkalies, gaseous and cold
drinks, as well as revulsives and electricity ; others were consump-
tives in the second and third stages of the disease.

The first subject was ten years old, of good constitution and
robust originally, who vomited regularly after each meal, im-
mediately after eatiog, and had become markedly emaciated.
"There was no symptoms of gastric embarrassment, no sensibility
of the epigastric region either spontaneous or on pressure. On ex-
amination, percussion showed marked dilatation of the stomach,
vomiting comes on suddenly, with previous nausea. The ingesta
are expelled with little or no mucus, and slightly marked acidity
exists. The evacuations are regular.

The divers means ordinarily employed were used in vain, when he
tried washing out the stomach with a soft sound and simple water.
Since that day, the meals are not rejected, and the patient took his
milk that evening. The washing was not repeated, and the vomit-
ing has not returned.

The second case is more complex and obscure ; there was a man,
who, after a fall on his head, had various lesions, cephalalgia,
buzzing in his ears, vomiting and vertigo, in a word, seemed a typ-
ical case of Meniere's disease. All the therapeutic remedies were
tried for the obstinate vomiting, until the stomach was washed out
for three successive days with infusion of quassia amara, when the
vomiting and vertigo disappeared.

Lastly, in a young woman, 20 years old, who had daily vomiting
during a parametritic ephidrosis following an acute vaginitis, the
results were most happy, though manifested slowly. These are only

48 IMPURE AND PURE CHLOROFORM.

a few of thecases observed by the author. His opinion of the value
of washing out the stomach rests on a large number of successes.

With phthisical patients the vomiting is frequent and sufficiently
obstinate to cause grave apprehension for the nutrition. Whenever
they cough violently they vomit ; in later stages it is provoked by
the excessive expectoration, the huge masses requiring for their ex-
pulsion an effort of the stomach.

Whatever may cause the vomiting, medicine sometimes seem pow-
erless to arrest it. Washing of the stomach renders valuable aid in
these cases. The author has had decided benefit in two phthisical
cases, and his results merit the attention of practitioners. — Revue
Med. Franc, et Etrang.

IMPUKE AND PURE CHLOROFOEM.
Translated by Wm. G. Eqgleston", M. D., of Uampdeu Sidney,

Virginia.

' Surgeons are aware that patients bear chloroform differently. M.
Lucas-Champonniere insists upon this fact, but says that much de-
pends upon the purity of anesthetic. He has noticed several cases
f© of^shivering, of coldness, and even asphyxia, with more or less
slowness of hypnotisation in a series of patients on whom he used a
certain kind of chloroform ; accidents which disappeared when the
chloroform was changed. He has noticed this in several obstetrical
cases in^hospital and private practice, and attributes it to impuri-
ties. An^'analysisof this chloroform was made by M. Trou, who
found the boiling point modified and raised; and while ihQ ordinary
reactions showed purity, ^permanganate of jjotash showed, a chlo-
roform containing organic matters, a change of color, it becoming
green. This is probably due to the employment of methylio instead
of etliylic alcohol in the manufacture. After testing with perman.
potash and distilling M. Trou, obtained a chemically pure agent,
differing from ordinary chloroform in a sweeter odor and in more
rapidly anaesthetizing with a much smaller quantity. The respira-
tion is not constrained, and it is rare that the tongue had to be

ANTISEPTICS DUKING PREGNANCY. 49

pulled out. The recovery is perfect and accompanied by neither
nausea nor vomiting.

Good chloroform, says M. Berger, has a sweet and penetrating
odor ; that used in the hospitals, on the contrary, an odor resembl-
ing that of acetic acid. Furthermore, it leaves a brownish or
grayish stain on the inhaler, while it should leave no trace. In
using it, in place of the calm and steady respiration, which succeeds
the period of excitation during the use of the pure article, we notice
a diminishing respiration. Each movement is followed by a rest
of five or ten seconds thus markedly reducing the number of respi-
rations per minute. This is due to laryngeal spasm causing syncope
by arrest of the heart's action. The patient is actually asphyxiated,
the jugulars beating isochronous with the heart, from venous sur-
charge of the heart. The hospital chloroform is very unstable and
it has been noticed that these suspensions of respiration always oc-
curs when the anaesthetic presents that bad odor. M. Pervin has
had the same experience as M. Berger.

M. Eegnault purifies chloroform for the hospitals by freeing it of
excess of alcohol by washing and treating with dry lime, in the
presence of an oil. Chloroform should be perfectly protected from
the light, and experience has shown that it is better when freshly
prepared. It would be well to test it each time that it is used. As
for artificial respiration for preventing asphyxia, M. Berger thinks
that the method of Pacini, of Florence ranks all others. — Revue
Med. Franc, et Etrang.

ON THE USE OF ANTISEPTICS DUKING PREGNANCY,

PAETURITION, AND THE PUERPERAL STATE.
Translated by Wm. G. Eggleston, M. D., of Hampden Sidney,

Virginia.

M. Labesque in an essay with the above title concludes as follows;

1. Puerpcrrl accidents are caused by septic germs; in combatting
these we must employ antiseptic agents, of which carbolic acid is
preferable.

50 THE FUTURE OF INOCULATION.

2. All the best clothes, the body linen, the walls, floors and ceil-
ing should be washed with a 50 per cent, solution of carbolic acid.

3. The persons of the lying-in chamber, the physicians, and the
instruments which they use should also be disinfected with thcsame
agent.

4. The linen of the parturient woman should be placed in a 100
per cent, and then in a 40 per cent, solution if accidents are feared.

5. After labor a permanent compress soaked in a 100 per cent,
and then in a 40 per cent, solution should be applied.

6. When the labor presents anything abnormal a precautionary
intra-uterine injection of 20 per cent, to 40 per cent, solution should
be used, preceded by an injection of ergotine to cause contraction
of the vessels, and prevent penetration of the injection into the
uterine sinuses, and to obviate also any intoxication by the anti-
septic.

7. As for permanent irrigation and drainage of the uterus, the
author suspends judgment, on account of the small number of
cases in which these proceedings have been employed. — Revue Med.
Franc, tt Etrang.

Tlie Future of Inoculation. — Customer — " My nephew is just
starting for Sierra Leone, and I thought I could not make him a
more useful present than a dose of your best yellow fever. Would
you tell me the price please?" Chemist — "Well, ma'am, the germs
are so difficult to cultivate in Europe that I would advise your wait-
ing for the next West India mail, when I am expecting a nice, fresh
consignment from St. Thomas. Meanwhile we would recommend
ourhalf-guinea travellers' assortment of the six commonest zymo-
tics, and could add most of the tropical diseases from stock at five
shillings each. We have some nice Asiatic cholera just ripe, but
they are more expensive. — Punch.

Mr. Stephen Jenner, grand-nephew of the discoverer of vaccina-
tion, and himself in childhood the subject of many his uncle's
experiments, is living, at the age of eighty-eight, in great poverty,
at Ileathfield, near Berkeley, England. — Scottish American.

51
SPONGE GRAFTING.

AmoDg the new things recently introduced into medicine, ''sponge
grafting" stands conspicuous. The process consists, nothing more
or less than in introducing into the system a piece of sponge, ■which
is intended to do its work as a stimulus to the reparative process,
and then to be absorbed and eliminated. Dr. D. J. Hamilton, pa-
thologist in the Edinburgh Royal Infirmary, claims the honor of
having introduced the method, and in the November number of the
Edinhurgli Medical Journal he reports in detail liis experiments, the
practical conclusions to which they led him, and the crucial tests
corroborative of such conclusions.

In a paper prepared some years ago. Dr. Hamilton made the
statement that the vessels of a granulating surface are not newly
formed, but are simply the superficial capillaries of the parts which
have become displaced ; that they have been thrown upwards as
granulation loops by the propelling action of the heart, because the
restraining influence of the skin has been removed. While making
observations with which to substantiate this claim, he was struck
with the similarity of the process of vascularization as seen on a
granulating surface, and that which occurs when a blood-clot or
fibrinous exudation is replaced by vascular cicatricial tissue. Blood-
clot or fibrinous lymph he came to regard as merely playing a me-
chanical and passive part, in any situation where it becomes replaced
by fibrous cicatrix, and that their vascularization is not owing to
new formation of blood-vessels, but rather to a displacement and
pushing inwards of the blood-vessels of surrounding tissues. Being
convinced that the blood-clot, or fibrinous lymph, before organiza-
tion takes place, was just so much dead matter in a tissue, it oc-
curred to him that if some dead porous animal tissue could be sub-
stituted for the natural exudate it would, in course of time, become
vascularized and replaced by cicatricial tissue. An accidental cir-
cumstance in the summer of 1880 suggested to him that in sponge
we have a substance which he had long vainly sought to discover.
It is porous (thus imitating the fibrinous net-work in a blood-clot
or fibrinous lymph), it is an animal tissue, thus, like catgut, it is
capable of absorption), and it is of such pliable texture as permits
of its adaptation to surfaces and adjustment to cavities. — 3IicMgan
Medical Xeivs.

52 SPONGE GRAFTING.

Before relating the experiments and views on the changes which
grafted sponge may undergo, we may just remind our readers that
the organization of a blood-clot or of fibrinous lymph depends
essentially on its vascularization. Pathologists are agreed on this
point ; but as to how this vascularity is brougnt about, there are
wide differences of opinion. The first change noticeable is dilata-
tion and tortuosity of the existing blood-vessels of the part on which
the lymph rests ; next, the tissue becomes "fnfiltrated" with a vast
number of cells. It is at this point that divergence of opinion
commences. Whence comes these cells ? Virchow and his imme-
diate followers regard them as the offspring of the fixed '' con-
nective-tissue corpuscles" of the part ; while Conheim and his dis-
ciples regard them as "wandering cells" derived from the blood-
vessels. The majority of pathologists at the present time would
probable adhere, more or less, to this latter view, although a more
correct view would perhaps be an amalgamation of the two. These
infiltrated cells, however, cannot organize and form tissue (cicatrize)
without becoming vascular, and this is another bone of contention
among practical pathologists — How are the earliest vessels formed ?
Dr. Hamilton boldly rejects the outgrowth of shoots from the sides
of the vessels, as taught by Arnold and others : he substitutes the
doctrine that the tortuous and distended vessels are displaced and
pushed outwards towards the clots or lymph lying on the surface of
the wound. These blood-vessels carry with them great numbers of
actively proliferating connective-tissue corpuscles. " The vascular
loops, surrounded by their tissue-forming cells, continue to pene-
trate further and further into the clot ; and as successive meshes of
the fibrinous network are filled by them, so they appear to cause its
destruction, until the whole- clot becomes in this way removed, its
place being taken by new vessels and the above-described cicatricial
elements. The latter soon elongate into spindle cells, and these in
three weeks to a month become transformed into fibrous tissue.

" It was from observing the merely passive part played by the
blood-clot when undergoing organization in wounds, in blood-ves-
sels, and in other parts, that I was led to suppose that a porous
substance like sponge, if applied under the same circumstances,
would serve a similar purpose." We may now attempt to follow
Dr. Hamilton's experiments, five of which on the human subject are

SPOXGE GRAFTIKG. 53

recorded. We may say that the spoDge to be used is carefully se-
lected ; it must be soft and fine in texture. All silicious and cal-
careous salts are dissolved out by steeping in weak nitro-hydrochlor-
ic acid. The sponge is then soaked in liquor potass^, and finally
steeped in carbolic solution 1-20 strong. We will quote experiment
No. 3. This was carried out under Mr. Bell's direction in the
Royal Infirmary. In one of his wards was "a patient suffering
an intractable ulcerating wound of old standing on the left leg. It
had been previously healed, and had again broken out, and there
was great cicatricial contraction of the shin and deep tissues around
preventing the wound from closing. * * * * See-
ing that it was proposed to amputate the limb if it would not heal,
Mr. Bell thought it right to make a trial of sponge grafting. The
object in doing so was to grow sufficient young tissue to allow of
the necessary contraction, and at the same time to afford a healthier
— that is, a more embryonic — surface for the epithelium to spread
over.

'' The wound measured two inches and a half by two inches, and
on January 8th of this year it was covered by a layer of fine sponge
rising a little higher than the level of the skin. It was dressed with
Listerian antiseptics, but, at the time of application, was in a sep-
tic condition, and remained so throughout. The patient's age was
twenty-nine.

"In from a week to a fortnight after application it had taken a
firn;hold on the exposed surface, and Mr. Bell noticed in dressing
it that it appeared to be slightly vascular, an*d bled when pricked.
The daily record of the case it will be unncessary to follow out ;
but suflSce it to say that it shortly became filled with young vascu-
lar cicatricial tissue, which grew up from below, filling the cavities
of the sponge as in the first case. The discharge from the wound
was considerable, and remained of a septic nature throughout the
course of the organization.

" The patient in time was dismissed with the sponge completely
organized and the wound healed. There did not appear, moreover,
to be any injurious stretching of the parts, the newly formed tissue
having allowed for this."

In order to study the changes which had taken place or were
taking place, pieces of the organizing sponges were cut off for

51 SPONGE GRAFTING.

microscopical investigation. It was remarked that the patient did
not feel any pain, and hence it was surmised that nerves had not at
that period found their way into the organizing sponge. The case
from which the sponge was taken was a recurrent mammary tumor,
in which a large gap of raw surface had been covered over with a
layer of fine prepared sponge. It had become completely organized
and was healed, all except a small patch of the size of a shilling.
Microscopic sections of little bits, which had been removed and
hardened in Miiller's fluid, showed that " the whole of the sponge
interstices were filled with what would generally be called young
connective tissue-cells," among which and for the most part
hugging the keratode frame work of the sponge, were to be seen
great numbers of unusually large giant-cells. Dr. Hamilton has
illustrated his paper by some drawings of the microscopical appear-
ances ; and without which it will be difficult to accurately repro-
duce his descriptions. In some of the giant-cells there were as
many as thirty nuclei ; around them lay spindles and round-cells of
a connective-tissue type. " In fact, the appearance was like that of
a typical giant-cell sarcoma."

" The sponge frame work appeared somewhat altered from its
usual homogeneous aspect. It was marked by many little lines, and
at its ends was thinner than usual — appearances which seemingly
indicated that it was dissolving. That such will be the ultimate
result I cannot fail to believe. Being an animal texture, it will, like
catgut, in course of time undergo tissue digestion."

It is right ttf state that one experiment failed. This was in a case
of old necrosis of the lower end of the tibia communicating with a
wound of considerable size. The want of success appears to have
been due to a want of granulating power in the wound.

With the view to further test and study this process, some exper-
iments were tried in Vienna on animals by Dr. Woodhead (who had
formerly assisted Dr. Hamilton), Dr. Strieker having placed his
laboratory at disposal. One set of experiments consisted in placing
pieces of sponge within the peritoneal cavity; another set com-
prised the introduction of sponge into muscular parts ; a third
series was made by inserting two thin glass plates, with a layer of
sponge between them, into the subcutaneous tissue. The result in
all cases which went on favorably was invariably the same, namely.

SPONGE GRAFTIXO. 55

that the sponge in a few days after insertion began to organize in
tlie same manner as in the human subject.

Dr. Hamilton describes minutely the changes which a piece of
sponge underwent after being ten days in the peritoneal cavity. He
says, "There was considerable peritonitis, and this occurrence, either
of a local or a general nature, is extremely liable to be set up in all
such experiments on the peritoneum of the lower animals, chiefly
from the difficulty of avoiding septic contamination. The sponge,
a,s generally happens, was found to be adherent to a loop of the
intestine. The union was so firm that it could with difficulty be
detached. Throughout the abdominal cavity there was a consider-
able qaantity of fibrinous lymph, but the part of the sponge not
attached to the intestine was only partially covered by it. The
greater part of the unattached surface was still porous, and did not
present any evidence of organization."

Sections were made through different parts: the first thing no-
ticed is the infiltration of the interstices of the sponge with a cer-
tain amount of fibrinous lymph ; subsequently, cicatricial or organ-
izing tissue invades this, displaces the fibrin and destroys it. The
fibrinous lymph, when examined microscopically, is seen to
consist of a delicate network of fibrin, containing within its meshes
many blood leucocytes, all more or less in a state of disintegration.
This disintegration, both of the leucocytes and of the fibrin, be-
comes more obvious as we approach the area of cicatrization. This
latteradjoins the area by which the sponge is adherent to the intes-
tine itself, it may be said that it remains unchanged in all parts
except its peritoneal covering, and it is in this that the earliest
changes ensue, and from that subsequent organization proceeds.
The earliest change noticed in the serous coat is distension of its
blood-vessels ; at the same time they become tortuous ; the fibrous
tissue around them then becomes oedematous.

As Dr. Hamilton holds views of his own on this point, we will
transcribe what he says : " On examining these distended vessels
in other parts, long straight offshoots could be seen arising from
them, and running directly upwards into the cicatrizing layer. The
large number of these was in some parts very remarkable, forming
a dense bundle in certain places. For a considerable distance after
they left the parent trunk in the peritoneal or sub-peritoneal tissue
they gave off only a very few divisions.

56 SPONGE GRAFTING.-

** Nearer the fibrinous layer, however, they could be seen to give
ofE branches enclosing wide meshes, and at the extreme internal
limit of the cicatricial layer they ended in a network of wide loops.
Now, the convex side of these loops was, without exception, always
towards the distal extremity of the vessel, the concave towards the
proximal, and in no instance could I find anything but loops in this
situation." The blood-vessels are the primary cause of the vascu-
larization of the sponge, and they bear into its interior actively
dividing connective-tissue corpuscles derived from neighboring
connective-tissues, and it is not of the latter that the new cicatricial
is evolved. The blood-vessels are the primary, the connective-tissue
elements the secondary, factors in the organizing process.

Here our readers will observe that Hamilton is at variance with a
widely accepted doctrine as to the growth of new blood-vessels by
budding out, first advocated by Arnold. It is no intention of ours,
in this place, to criticise the work now before us; our readers must
study for themselves. Suffice it to say that the cicatricial layer is
that in which the new blood-vessels are formed and forming, and
that its vitality depends on this formation of vessels. It increases
gradually in extent, and, by invading the fibrinous layer, as grad-
ually destroys it until nothing is left but organized material.

The practical outcome of this interesting work appears to estab-
lish the principle that a porous body may become vascularized, and
be used for the purpose of facilitating the cicatrization of wounds.
It would seem especially applicable to those cases where there is
great loss of substance, but in which there is, however, healthy
action.

AVhether a wider experience will confirm Dr. Hamilton's views
remains yet to be seen. The original article, from which we have
taking the foregoing particulars, is worthy of careful study, for it
contains many points of histological interest besides the clinical
one to which we have chiefly alluded. — Med. Times and Qazetfc.

Prof. Neumann has been definitively appointed to the chair of
** Syphilodoligie" in the Vienna Medical Faculty.

OBITUARY. 57

Compulsory J^eeding of Phthisical Patients.— M. Debove has
recently laid before the Societo Mcdicale des Hopitaux in Paris
s me facts relative to tlio advantages of compulsory feeding for
]>hthisical patients. Under the inllnencc of this method by Fauch-
fi's oesophageal tube, which all \v% in the first instance, washing
out the stomach if necessary, then introducing into it nourishing
iMid easily assimilable foods, such ;is milk, eggs, and raw meat, the
]iatients are seen gradually to recover appetite, strength and plump-
ness, whilst fever, sweats, and vomiting disappear. The tolerance
of the stomach for nourishment introduced in this way, sometimes
in considerable quantities, is a remarkable fact. The cough no longer
induces sickness, and the restoration of the gastric functions puts
an end to the anorexia. Thus M. Debove's researches are of great
interest from the physiol ^uical, as well as the therapeutical, point
of view. Pulmonary phtliisis is not the only disease in which his
method might be used with advantage ; it is clearly suitable to the
majority of cachetic conditions to all diseases produced by defective
nutrition. It may be noted that ISl. Dujardin-Beaumetz has re-
lieated M. Debove's experiments in his hospital wards, and confirms
M. Debove's statements as to the favorable results obtained by the
therapeutic method under consideration. But it is obvious that it
can only have a limited, temporary, and occasional usefulness. —
British Medical Journnl.

OBITUAEY.

C. TATE MURPHY, M. D.

The death of Dr. Murphy, at his home in Clinton, on the 8th of
January, was not entirely unexpected. For several years he had
been afflicted with a rodent ulcer (.Jacob's Ulcer). At one time it
was quite under control, but for long weary months ho suffered
trreatly. Notwithstanding all this he went about his business, mak-
ing professional visits at long distances.

Dr. Murphy is so well known that a sketch from our pen would
add nothing to the fame he had won. lie was a diligent physician
and a successful politician. lie had attained high position in the
State Medical Society, having been for six years Examiner in Ma-
teria Medica and Therapeutics. Ho was a member of the State
Senate, Chairman of Committee on the Penal Institutions of the
State. He defended his poor stricken Carolina when she was in the

58 BOOKS AND PAMPHLETS EECEIVED.

hands of her malignant enemies. Ho stayed tlio dastard hand of
the enemy of tlio Board of Examiners, who, hut for him, would
have dashed this humane and wise law in fragments, llis was a life
of hattles, foes within and foes without, — were constantly harrass-
ing him. Nothing but his ardent nature, and his resilient spii'its
that enoblcd him to maintain ilie battle of life so long against such
odds. Ptace to his wearv bodv I Honor to his nams !

BOOKS AND PAMPHLETS EECEIVED.

Biennial Ecports of the ]3oard of Directors and the Medical Su-
perintendent of the Western Lunatic Asylum of Virginia. For the
Fiscal Years 1879-80. 1880-81. Eichmond : E. F. Walker, Sui)er-
intendent of Public Printing. 188L

Obstetric and Gynecological Literatnic, 187G-18S0. By James
E. Chadwick, M. D. , Boston, Mass. Eeprinted from Boston Med-
ical and Surgical Journal of September 8, 1S8L Cambridge :
Printed at the Eiversidc Pres.s. 1881. Pp.17.

The Prevention of Syphilis. An Address Prepared at theEequest
of the Philadelphia County Medical Society, and Eead Before it De-
cember 14, 18SL By J. William White, M. D. Eeprinted from
the Philadelphia Medical Times, Jan. U, 1882. Pp. 20.

The International Scientists' Directory. Containing the Names.
Addresses, Sjiecial Departments of Study, etc., of Amateur and
Professional Naturalists, Chemists, Physicists, Astronomers, etc ,
etc., in America, Europe, Asia, Africa and Oceanica. Compiled by
Samuel E Cassino. Boston, U. S. A. : S. E. Cassino, Publisher.
1882.

The Nurse and Mother. A Manual for the Guidance of Monthly
Nurses and Mothers. Con)prising Instructions in Eegard to Preg-
nancy and J^reparatinn for Ciiild-birth ; with Minute Directions as
to Cue Luring Confinement, and for the Management and Feeding
of Infants. Bv Walter Coles, M. D. .J. H. Chambers & Co., Chi-
cago. 111., St. Lonis, Mo., Atlanta, Ga. 1881.

The Opium Habit and Alcoholism. A Treatise on the Habits of
Opium and its Coinjxninds ; Alcoliol ; Chloral Hydrjite ; Chloro-
form; Bromide nf PninscJiuni ; and Cannabis Indicus. Including
their Therapeutical Indications ; With Suggestions for Treating
Various Painful Compl'cations. Bv Dr. Fred H'. rmati Hubbard.
A. S. Barnes & Co., Ill and 113 William Street. New York.

Dedication of the New Building and Hall of the B(;ston Medical
Library Association, 19 Boylston Place, December o, 1878. Order
of Exercisi s. Address by the Presidait. Dr. Oliver Wendell Holmes.
Eeport of the l^uilding Committee. Eemarks by Dr. J. S. Billings,
Prof. Justin Winsor, Dr, George IJ. Lyman, Charles W. Eliot,
LL. D., Dr. David P. Smith, Dr. Cnlvin Ellis, Dr. Henry I. Bow-
'""ifch. Li«t of Loan Exliiliition of Mt'il'cal Pjrtraits. Cambridg':
J 'rioted at; the Eiverside Press, 1881.

NORTH CAROLINA

MEDICAL JOURNAL.

THOMAS F. WOOD, M. D., Editor.

Number 2. Wilmington, February, 1882. Vol. 9.

ORIGINAL COMMUNICATIONS.

OCCLUSION OF THE CANAL OF THE OS UTERI OPE-
RATED ON WITH THE KNIFE— SUCCESSFUL— CASE
OF HYPOSPADIAS CURED BY OPERATION— CONGENI-
TAL ATRESIA OF VAGINA SUCCESSFULLY RELIEVED
BY THE KNIFE.

By T. B. WiLKEUSox, M. D., Young's >< Roads, N. C.

OCCLUSIOX Ol- THE CANAL OF THE OS UTERI OPERATED ON" WITH
THE KNIFE — SUCCESSFUL.

Mrs. E. L , a wealthy lady of Roxborough, N. C, married, set.
3 i years, tbc mother of two children, of a nervous temperament,
with a hereditary tubercular diathesis on the mother's side, con-
sulted me in May. 1880, in regard to a uterine deformity. She suf-
fered from all the nervous phantasia that the female system is heir
to, dating the^Degiuning of her troubles from the birth of her last
child, six years ago, at which time there was a rupture of the left
side of the external os uteri. Soon after the termination of her
confinement the following symptoms commenced, and from that

60 OCCLUSION OP THE CANAL OF THE OS UTERI.

time to the date of operation ecarcely an hour out of the twenty-
four during each day had she been free from pain: These paroxys-
mal attacks were liable to take place at any moment, beginning with
a premonitory darting pain in the lower portion of the pelvic region,
extending through to, and along the middle of the sacral region.
There were also a slight hacking cough, intense dyspnoea, with a
troublesome smotheriog sensation, as if a heavyweight was resting
on the thorax, excruciating pain in the pra?cordial region, nausea
and headache. To quiet these attacks, heavy doses of nervous seda-
tives and opium were necessary. These phenomena were greatly
heightened at the commencement of each menstrual period, attended
with gevere bearing down pains at the bottom of the abdominal
cavity— closely imitating the throes of labor; and notwithstanding
these strong and expulsive efforts on the part of the womb, hardly
a stain of the monthly flow could be discerned.

The patient was placed in Dr. Hims' position and with his specu-
lum introduced, a good view of the parts was given. The cervix
presented an appearance as if it had been cleanly excised leaving no
lips, and the cervical canal was thoroughly occluded. On the outer
left side, about one quarter of an inch above the marginal edge of
the cervix uteri, was a very minute fistulous opening that, with
care a small sound — the size of an ordinary pocket probe — could be
made to enter for one and a quarter inches ; beyond this point, the
instrument could not be passed. The probe, when in position,
formed an angle a little short of a right angle with the centre of
the cervical neck. The uterus and vagina were exceedingly sen-
sitive— there being a morbid hyperesthesia of the whole track.
After a careful examination of the parts, finding that there had
been vicarious menstrual efforts from the lungs and stomach, and
being fully convinced that these grave symptoms were traceable, in
the main, to the abnormal deformity of the womb, and that the
existence of this disease was imperiling life. The patient was made
aware of the dangers likely to arise during, and after the comple-
tion of the proposed operation. Being an intelligent lady, well-
posted in regard to her condition, she readily agreed to risk the
result.

On the first day of June, 1880, assisted by Dr. J. T. Fuller, the
patient lying on thcleft side, a duck-bill speculum was introduced

OCCLUSION OF THE CANAL OF THE OS UTEKI. Gl

under a good sunligbt witlioiit the use of aoEesthetic (patient being
averse to the use of chloroform). After having given a good dose
of brandy with ten grains sulphate quinine, a long teDaCuluni was
engaged in the upper anterior surface of the neck ; a small grooved
director was then carefully passed into the fistulous track on the
left side, until its point was arrested on the opposite surface ; then
a narrow conical shaped knife was passed along the groove of the
director to its terminal point. The knife and guide were then car-
ried to the right, a little beyond the central point of the neck, the
knife dividing in its passage the intervening tissue of the cervix, in
a transverse median line — making an incision one and a quarter inch
in length, and three quarters of an inch in width at its lower part.
AVhilst the knife was held stationary, the director was carried
onwards to the fundus. This was done in order to be certain that
the incision corresponded with the normal canal. The director then
being slightly withdrawn, the knife and guide were passed up until
the cavity of the womb was reached — slightly nicking the constricted
canal. These instruments being withdrawn, and their positions
reversed the left side was treated in a similar manner. This left a
straight cone-shaped' canal leading to the uterine cavity. After
arresting haemorrhage, an intra-uterine stem, two inches in length,
and about the size of a large gum male catheter, was inserted into
the male canal — the stem being held in position by one of Fowler's
pessaries, with a piece of black silk cemented on the under surface
of the cut — these instruments being first coated with carbolized
glycerine. The patient was confined to her bed on her back for ten
days. The stem was allowed to remain in six days, and a large sized
gum catheter was passed every third day afterwards until the time
of the next monthly period. Internally, immediately after the
operation, she was given thrice a day, the following pill :

H.

Carbolic acid, gtts, xij.
0 Pulv. opii, grs. vij.

Quinioe sulph., grs. xij,
M, Make twelve pills.

The Vdgina was thoroughly washed out twice a day with Cirbolized
lead and opium water. Xo unpleasant inflammatory symptoms su-
pervened to endanger the final result, but an entire subsidence of

62 CASE OF HYPOSPADTAS CUKKD P.Y OPERATIOS".

the nervous phenomena, together witli a quietude of mind and body,
ensued. The new outlet remained pntulons witliont any contrac-
tion in its calibre.

This lady had been under the care of a number of distinguished
medical gentlemen, amongst them the late Dr. J. P. Mettauer
Dr. Watkins, now of Rochester, N. Y., and my distinguished
friend Dr. Hunter McGuire, of Richmond, Va. This case was one
of a rare group of deformities met witli in this organ. A partial
agglutination of the lips of the os uteri is frequently met with, but
an entire obliteration of the normal canal to the extent mentioned
in this case, in a married lad}- — one who has borne children — is sel-
dom met with. The great morbid irritability of the womb and va*
ginal track, together with the nervous excitement engendered in the
general system, render a prognosis exceedingly doubtful : but
thorough quietude of the body in a recumbent position, and the
fixing of the womb by means of a properly adjusted cup-pessary so
as to prevent any to and fro movement of the intr.i-uterine stem
against the side of the wounded canal, add much to the chances of
a favorable result ; for upon the proper maintenance in situ of this
intra-uterine instrument, depends the future hope of a patulous
condition of the organ.

CASE OF HYPOSPADIAS CURED 15Y OPERATIOX.

Charles H., aged 2H year?, a wealthy farmer of Charlotte county,
Virginia, of healthy parentage consulted mo in April, 18TG. He
had been under the care of several distinguished surgeons, among
the late Dr. Q. P. Mettauer, of Virginia, without deriving perma-
nent relief. His disease was congenital, and from his earliest recol-
lection he had never been able to pass a stream of urine. After a
careful examination of the penis, I detected two minute orifices,
one at the natural outlet of the canal, the other about half an inch
back of the corona glandis, — a slit-like cleft in the under portion of
the organ with everted edges. It required a patient effort of nearly
ten minutes to introduce the smallest size pocket probe into either
one of these orifices. There was considerable morbid excitability
about the parts and the manipulatory efforts on my part brought on
frequent spasms of the bladder. As soon as voluntary effort at
urination was made the penis would erect itself, completely closing

CASE OF HYPOSPADIAS CURED «Y OPERATION. G3

the minute oritices so that not a drop of urine coukl escape ; butas
soon as rhe attention of the patient was directed toother matters, a
discharge of urine commenced to How guttatim. After bringing
the patient under the inlluence of chloroform, his limbs being held
by assistants, I passed a small grooved fn-obe, about the size of an
ordinary sewing needle, in the meatus, through the constricted por-
tion of the urethra, extending about an inch in length. I then
passed a narrow-bladed bistoury down the groove of the probe, and
divided the urethra upwards towards the dorsum of the penis, mak-
ing the incision large enough to admit a No. 11 catheter. The
probe and knife were then removed, and a silver catheter was passed
into the bladder which was allowed to remain in ten minutes and
was then withdrawn. The urethra was cleared of all blood by the
uec of the syringe. The catheter was then repassed and secured in
the bladder. Having dipped a silver probe of the smallest size into
strong nitric acid, it was passed through the fistulous track on the
under surface of the penis, completely cauterizing its surface and
the everted edges. The fistula was then accurately closed by a
small piece of tissue paper saturated with contractile collodion, and
an extra layer of the latter applied after the first had dried. The
catheter remained in the bladder four days, when it was removed
and introduced every morning for two weeks. The fistulous orifice
closed entirely. The patient has had no trouble in passing a full
stream of water. There has been no tendency in the urethra to
contract (and now nearly eleven years since the operation the canal
maintains a normal calibre) — an unfortunate result so often noticed
in these cases. Hypospadias has been subjected to various plans of
treatment. Amongst the most prominent are passing the edges of
the fistula and causing their union by sutures, caustics, and galvano-
causlics ; but any plan of treatment in the hands of the most skil-
ful surgeon will sometimes fail. One point particularly necessary
for a successful termination is to have a non-irritable urethra — one
that will bear well the retention of a catheter — for the fistulous
track can be much more accurately closed over a firm resisting rod
than it can without, and the catheter prevents any urine from pass-
ing over or entering the abnormal opening. Should caustics be
used, select that one which will prove sufficiently powerful to destroy
the pyogenic membrane along the fistulous track, and at the same

04 COif<;EXlTA]. ATRESIA OF VAGINA.

time not produce any undue excitement in the urethra. In cases of
this kind, nitric acid is highly to be lauded. It will seldom fall to the
lot of any surgeon to meet with a urethra so nearly obliterated as in
the ease above reported. All voluntary efforts, before the opera-
tion, to empty the bladder failed, and the frequent vesical tenesmus
noticed in the case, was due in part to the retention in the bladder
of residual urine. The constant trickling away of the iiuid had
produced so much irritation and excoriation as to render life a bur-
den, and caused such an offensive odor as to render his presence ex-
ceedingly disagreeable.

COXr.KNITAL ATKKSIA OF VAGIXA SUCCESSFULLY KELIKVED BY

THE KNIFE.

Bettie C, colored, set. 13 years, consulted me in April, 1879 for
gome malformation of the external organs of generation. Placing
the i)atient on her back and opening wide the thighs, the full exter-
nal abnormality was plainly visible, the labia majora imperfectl}'
developed and between these folds there existed a rudimentary trace
of the median raphe extending from the clitoris to the fourchette
making the line where the normal vulvar outlet should have been.
There was complete closure of the meatus urinarius, noticing a
prominent teat at the edge of the anus, a probe was passed in, the
instrument taking an upward course in the median line to a point
where the urethra probably opened, through this fistulous tract the
urine was discharged. The history as given by the patient, evi-
dently showed that there must have been a considerable distension
of the bladder, and a forming abscess for its relief between the labia
in foetal life, for immediately after birth this swelling was noted and
for thirty-six hours after no urine was passed, at the expiration of
this time the abscess opened at the most dependent point near the
anus giving exit to matter having a distinct urinous odor — the con-
stant tricklingof urine along the fistulous duct had existed, consid-
erable vesical irritation frequently giving rise to painful tormina
and the tenesmus of the bladder, and the act of expulsion being an
incomplete one, created a constant desire to urinate. Passing a
finger into the rectum, the neck of the womb and a trace of the
upper portion of the vagina could be distinctly felt. Th.e girl was
well developed for her age, mammae prominent, but no evidence
that the menstrual molimen had commenced.

COXGEXITAL ATRESIA OF v■AGI^"A. 65

On the fifteenth day of April, 1879, tjie patient on a firm table in
the lithotomy position, feet and hands secured, the rectum well
emptied, and under the influence of chloroform, assisted by Graham
Royster, a medical student, a grooved director was passed into the
fistulous track from the anus to the supposed proximal termination
of the urethra, and feeling for'the groove with the forefinger nail
of the left hand, a narrow bistoury was pushed through the tissues
at the posterior commissure to the groove of the director, the knife
was then carried upwards dividing the external part in the median
line for an inch and a half in length and a quarter in depth. The
meatus having been found, a female catheter was passed into the
bladder giving exit to a quantity of turbid urine, the instrument
was then given into the hand of an assistant with a finger in the
rectum; the incision was continued inwards with a scalpel-r-using
the blade of the knife as little as possible, depending mainly on the
handle and grooved director to break up the intervening parts.
This dissection was carried to the depth of two and a half inches,
carefully avoiding the wounding of the urethra and bladder ante-
riorly, or peritoneum above, or the rectum below. At this point the
cul-de-sac of the vagina was reached, this being opened it was lace-
rated by the dissector, and the forefinger of each band back to
back were introduced and the wall put on the stretch, this gave
a canal readily admitting an ordinary sized cylindrical speculum.

The hemorrhage was jiretty free, several small arteries requiring
the ligature. After all oozing had ceased, an ordinary cone-shaped
glass vaginal dilator, was introduced, well annointed with carbolized
glycerine, and secured in position by a T bandage. The patient
reacted well. The pill that had been given prior to was continued
after the operation, viz :

xicid, carbolic, gtts xij.
Quinia?, sulph., grs. xij.
Pulv. opii, grs, iv.
M. Pills xij. S. One thrice a day.

Given a liquid diet, mainly milk and a little lime water. Uowels
moved oii the eighth day — vaginal phig removed on the fifteenth
day. A large tallow candle coated with carbolized glycerin was intro-
duced into the vagina twice a day for one month after the operation.

66 COXGENITAL ATRESIA OF YAGINA.

This patient made a p;oocl recovery, no pelvic troabk and is now
over two 3'ears since perfectly well. There has been no perceptible
contraction of the canal.

Occlusion of the vagina presents many points of interest to the
surgeon and general practitioner. Operative means for its relief are
frequently of vital importance to the future welfare of the patient,
Before attempting its radical cure an accurate anatomical knowl-
edge of the parts concerned is actually necessary ; this will impress
upon the mind of the surgeon the close proximity to the line of in-
cision of the urethra and bladder anteriorly, the peritoneum above,
and the rectum below. The time for intervention is an important
item. Most surgeons advise waiting for the age of puberty to bo
reached. Wait until the menstrual molimen has begun, and the
evident symptoms that the flux is accumulating in the womb ; but
unfortunately this period is the one most dangerous for the patient
on account of the known tendency to septic degeneration of the
liquids contained in the uterus when brought in contact with the.
external atmosphere, this zymotic action producing septic endome-
tritis ending in partial pelvic peritonitis. When the womb becomes
distended with this liquid, regurgitation of the fluid may take place
back through the Fallopian tubes into the peritoneal cavity or a-
rupture of the uterine fibres discharging its contents into the blad-
der or rectum thus rendering life miserable if not finally ending
fatall3\ It is a maxim well taught that the operator should be well
satisfied that there are ovaries and womb pre8ent,aud that some por-
tion of the vaginal wall exists ; for if the latter is entirely absent
the septum between the bladder and rectum is nearly obliterated;
these organs lying in close apposition, in this cise a perpendicular
dissection would certainly result in the wounding of these viscera,
lateral incisions would be required. Hut the absence of this canal
is 110 effectual bar to the operation, for in 1835 Amussat performed
his celebrated feat for occlusion in which case there was an entire
absence of the vagina, but by laceration and pressure he divided the
intervening septum and reached the womb successfully.

The point of discharge for the urine in this case is a rare anomaly
but one of the most interesting cases of malposition of this duct i.?
the one mentioned by Dr. Gross in which there was complete occlu-
sion of the vagina in a young kdy eighteen years of age, the bladder

BROMIDE OF POTASSIUJl IN" YOMITIXG. 67

discharging its Contents at Llic umbilicus througli the imperfectly
closed urachus. From a statistical standpoint it is fair to assume
that the time of election for these operations is the period prior to
to the ago of puberty, before the menstrual nisus has begun. By this
course we avoid the dangers from septic decomposition of the re-
tained menses and we escape that morbid hypera3mia, and irritable
hyperiBsthesia of the organs of generation so likely to be present at
the age of puberescence; for so long as this nervous condition exists
any gynfBCological surgery is dangerous. From the date this abnor-
mality is discovered by the female the mind is constantly harrassed
by this condition, she is fully cognizant of the fact that whilst in
this state she is forever debarred the matrimonial tie, that she is
never to be the fond wife or loving mother; this idea so strongly im-
pressed on the mind may start a train of ills that a life time can
never eradicate.

Effervcsciufj Draught of Bromide of Potassium in Vomitimj. —
Dr. Cheron {La Franco Medicate, vol. ii., 1881, p. 404), having
tried various remedies in that form of vomiting which accompanies
ovaro-uterine complaints in women, finally settled u])on the fol-
lowing :

No. 1. I^.

Potass, bicarb., 3 ss;
Aqua3, fsij;
Potassii bromidi, 3 ss.
M.

No. 2. ^.

Acidi citrici, 3 j;
Aqua?, f 3 iv;
Syrupi simplicis, f 3 x.
M.
Pour a teaspoouful of No. 1 into a glass, and add a tablcspoonful
of No. 2 ; stir them together, and drink while effervescing. The
dose may be repeated every hour or every half-hour, but the amounts
given above in Nos. 1 and 2 represent the total quantity to be taken
in twenty-four hours. — Phil. Med. Times.

68

ELEPHANTIASIS-RADICAL CURE OF HERNIA-EPITHE-
LIOMA— DISLOCATION AND MULTIPLE FRACTURES
—SUSPECTED FRACTURE OF THE HEAD OF THE
HUMERUS.
A Clinical Lecture Delivered at the Philadelphia Hospital, Decem-
ber 7, 188L •
By George McClellan, M. D., one of the Surgeons to the

Hospital.

Reported by Wm. H. Mokrisojs", M. D,, for the Noetii Cako-

LiKA Medical Journal.

ELEPnANTIASIS.

Gcntknicn : — The first case which I shall bring before you this
morning, is one which I show you on account of its rarity and
interest. It is a case of elephantiasis. This a very rare disease and
3'ou will probably not have many opportunities of seeing it. The
affection is in this case, limited to the foot. It is very often con-
fined to the lower extremity although it may attack other portions
of the body as the scrotum. The disease receives its name from the
peculiar character of the integument, which bears some resemblance
to that of the elephant. The epidermis is rough and scaly and all
the other tissues are in a state of hypertrophy. They are all greatly
enlarged but of normal form.

The pathology of this disease is not at all clear. We do not know
the causes or the real pathology of elephantiasis. There are curi-
ous instances where, after the disease has affected the leg, it has by
a process of metastasis, left the leg and attacked the scrotum or
some other part of the body, but these cases occur very seldom.
The affection is very common in some eastern countries and is sup-
posed to be akin to leprosy of ancient times.

Nothing has yet been found to relieve the condition or restore the
part to its normal state. The pain which is due to the pressure
upon the nerves, may sometimes be alleviated by the use of morphia,
iodine and belladonna.

A number of years ago, Dr. Campbell performed in this institu-
tion an operation for the relief of this affection. This consisted in

RADICAL CURE OF HERNIA. 69

the ligation of the*femoi-al artery with the object of diminishing the
supply of blood* to the part. After the operation, the case pro-
gressed very well, so far as the ligation was concerned, but the ele-
phantiasis remained the same and although the case was kept under'
observation for eighteen months or two years, no change occurred.

After a limb has been amputated, for elephantiasis, it has always
been found that the arteries are very much enlarged and that the
collateral circulation is very free. Hemorrhage is the great danger
after this operation.

Some relief is afforded by rest. Pressure, will, of course, be of
no service. In this case the elephantiasis gives this woman trouble
only from its weight and she finds that being on her feet for any
length of time, increases the inconvenience.

The case in which ampntation has been performed, have always
done well. There is no remedy but ampntation, but it is only justi-
fiable when the limb becomes so ponderous and unwieldy that the
patient cannot move about on accotmt of it.

RADICAL CURE OF HERNIA.

The next case has had a number of complications. I think tjie
last one was a skin aEfection. Previous to that he had a fistula in
ano. This was laid open by a free incision by one of my colleagues,
but the man has not been entirely relieved. For some reason or
other the fistulous track has not healed. It has been washed out and
is now plugged with a tent to induce the formation of granulation
from the bottom.

The trouble to which I desire to call attention is this which you
recognize as a rupture. I wish to make a few remarks upon the
radical cure of hernia.

Operations for the radical cure of hernia have been performed
time and time again and many different methods have been devised
but so far no method has been found reliable, that is to say, no
method has been permanently successful.

It is proper to consider the subject of radical cure in a case where
the bowel cannot be retained by a truss and the patient is in con*
stant danger of strangulation, which is, as you know, a very fatal
accident. In ninety-nine cases out of a hundred, strangulation
means death, for the operation for tlic relief of a strangulated hernia

70 RADICAL CURE OF HERNIA.

js only successful, as a rule, when performed immediately. How
few of us see cases so early ?

In this case. Dr. MacDonald, a former member of the surgical
staff of this hospital and a sliilful anatomist, tried to effect a radi-
cal cure ; but the operation was, as in a number of other case?,
where be tried it, unsuccessful. Yon can see here the line of inci-
sion, extending from about one inch from the anterior superior spin
ous process of the ilium above Poupart's ligament down to the
median line. The operation consisted in making the incision as I
have described. The tissues were next laid open down to the fascia
transversalis and then with strong catgut ligatures,soaked in chromic
or carbolic acid, the fibres of the conjoined tendon were brought
together occluding the opening of the external ring. After all these
operations it is necessary that the patient should be very careful
and that a truss should be worn to retain the bowel in the abdomi-
nal cavity until the adhesions are sufficiently strong. Dr. Mac-
Donald may justly claim that in many of these cases through the
ignorance or indifference of the patients, the treatment was not
properly carried out. When we remember the importance and the
relations of the parts concerned in this operation. I can not con-
sider it an advisable one.

In some notes on this subject which I was reading. I saw described
an operation performed by Dr. John Wood, of Glasgow, who is a
very practical man. His operation consists in raising the skin and
subjacent tissues over the external ring,then passing a strong curved
pin and around it a ligature, producing temporary strangulation.
He has in four or live cases succeeded in having the bowel retained
for a number of years.

The notes to which I have referred were those of an operation
performed by Dr. George Buchanan, of Glasgow, and in his paper
he mentions the cases of Dr. John Wood. He describes an opera-
tion which he has recently adopted for the radical cure of inguinal
hernia in the child, i. e., those between tlie ages of fifteen months
and two years. lie has operated on six or eight cases, so far suc-
cessfully. Surgeons are in the habit of reporting those cases as cases
in which the bowel is retained for three of four months. Dr. Buch-
anan makes a curvo-linear incision, running down the scrotum. He
then dissects down until he comes in contact with the sac. The sac

EPITHELIOMA. 71

is laid open by a longitudinal incision and then transverse incisions
are carried around until they reach the posterior part of the cord.
The edges of the sac below arc then stitched together so as to form
a tunica vaginalis testis and the remainder of tlie peritoneum pushed
up as a plug and included with the conjoined tendon in a stitch of
strong wire. This operation is particularly applicable in the cases
of infants with inguinal hernia which cannot be reduced or kept
reduced by a truss. Frequently, cases of this kind present them-
selves to you, in which the rupture cannot be retained by a trus?.
If in such a case, a truss is applied, there is a double danger of
strangulation, for the bowel may slip out beneath the truss. In
such cases it is proper to consider the radical operation. Dr. Buch-
anan apparently has good claims for advocating his operation.

There is another operation to which my attention was called in a
paper by Dr. Allis, of this city. In this paper, Dr. Allis describes
an operation performed by Prof. Dowell, from the south, who came
to this city during the Centennial for the purpose of advocating his
method ; but his operation did not succeed beyond a few weeks or
months. The operation consisted in passing a double pointed
needle, with an eye at each end, armed with a thread, in such a
manner as to form a double ligature subcutaneously. Dr. Allis
suggests that the needle used in the operation might bo modified so
as to have the eye in the centre.

In all these operations most delicate anatomical knowledge is re-
quired. As Professor Agnew has so often said in his lectures, the
knolwledgc of anatomy required is so great, that very few men
possess it and can tell with their finger pushed up through the ex-
ternal ring, what they have between the needle and their finger.

EPITHELIOMA.

This case is one which I think I had the opportunity of bringino-
before you some six or eight weeks ago. The disease was at that
time not nearly so extensive as it now is. It is a case of so-called
epithelioma, a very bad name for a very bad thing. It is a fungous
growth, which, in this case first showed itself in the cicatrix of a
wound made for the purpose of examining the tibia, which was
thought to be necrosed. It embraces the skin, subcutaneous tissues
and also the bone. How far the bone is diseased, it is impossible to
say until it has been examined by the eyes. In other respects the
woman seems to be health v.

72 DISLOCATION AND MULTIPLE FRACTURES.

There is no possible relief to be afforded by internal treatment.
This growth has extended very rapidly. In all these cancerous
affections attacking the limb where the patient has to be on his
feet, the superincumbent we'ght causes a stasis of the blood which
favors rapid development.

The only relief *to be expected is from amputation above the dis-
ease. I have carefully explained to this woman, that it may be
necessary to^amputate at the knee, or even above the knee for
the medullary structure cannot help but be invaded to a great
extent. This disease [is very painful, very offensive, and very an-
noying to tho'patient. It is often difficult to convince patients of
the necessity for amputating. They hold on to the limb until the
disease has undermined the primae via3 and all the forces of life are
diminished by its poisonous products. In such cases, the dangers
of amputation are, of course, much increased.

Case II. — The next case is one of a similar character. I bring
her before you to show you how this disease will affect the system
and the ravages it will make on the patient's general health.

This poor old woman, the resident doctor tells me, has been in
the hospital for three or four months with this foul, horribly smell-
ing, rapidly spreading ulcer, involving a large extent of the left leg.
This disease has been going on rapidly and in four months it has
reached the condition which you now ece. No application that wc
can make will prevent its development.

Her advanced age as well as her general condition would certainly
prevent any one from resorting to the knife. If she were young
and her general health could be built up and she desired the opera-
tion, it would be justifiable, I think, to amputate, even where the
disease is so far advanced as this is.

The peculiar smell of a cancer of this kind is noticeable over the
entire house. I have on several occasions, when attending patients
with cancer of the vagina and neck of the womb, noticed this
smell immediately on entering the front door.

DISLOCATION AND MULTIPLE FRACTURES.

This case presents some interesting features. The man while
under the influence of alcohol was struck by a railway train which
caused a dislocation of the right shoulder and multiple fractures in

SUSPECTED FRACTURE OF THE HEAD OF THE HUMERUS. 73

the left arm. By multiple fnictures, I mean fructures in more than
one place. He was brought to the hospital and the dislocation re-
duced under ether and the fractures temporarily dressed. As the
case was so complicated the resident physician sent for Professor
Pancoast. When the doctor arrived, he found the man suffering
from delirium tremens. When a man under the influence of alco-
hol, is submitted to a violent injury there is apt to occur a form of
delirium tremens, known as paralysis agitans or shaking palsy.
Professor Pancoast not having the proper appliances at hand for
treating the case, was at first afraid that he would have to ampu-
tate the arm. He, however, extemporized some splints and the case
did well. When I came on duty, I applied a felt splint (Ahl's) and
a rectangular splint to the arm.

The man also received an injury of one of the fingers which re-
quired amputation, this Prof. Pancoast did according to his favorite
method of taking the flap from the dorsal surface, instead of from
the palm as is done in the old method. Dr. Pancoast's method has
the advantage of retaining the natural covering of the knuckle.

The case has progressed wonderfully well. He had a fracture of
the humerus, one of the radius and one of the ulna. The man has
a tolerably useful arm and the continuance of the proper treatment
(passive motion judiciously applied, and frequent friction) will give
the man a very good limb. In a case of this kind you must act
with decision, taking the responsibility at the time.

SUSPECTED FRACTURE OF THE HEAD OF THE HUMERUS.

My attention^vas called to^this man as';a case of suspected intra-
capsular fracture of the humerus. It is, of course, utterly impos-
sible at tbis^late period (three weeks) to decide as to the nature of
the case. Even at the'time of the injury, it would have been very
difficult to say whether or not there was an intra fracture. All in-
tra-capsular fractures are hard to diagnose. We have no conclusive
definite signs by which we can judge of them. They are matters
of inference and can only be positively diagnosed when there is an
external wound.

Fractures in this region are divided into intra-capsular and extra-
capsular. I suppose that you know the difference between the ana-
tomical and surgical neck of the humerus. The surgical neck is that

74 SUSPECTED FRACTURE OF THE HEAD OF THE HUMERUS.

below the tuberosities, while the .inatomical iicek is the constriction
nbove the tuberosities. Iiitra-capsular fractures are those that in-
volve the head or that portion of the bone which lies within the
capsular. Extra-capsular fractures arc those which occur below the
tuberosities ; the fracture may take phico at the surgical neck, the
tuberosities may be fractured or the epiphysis separated from the
shaft. The latter injury is seen only in young children.

Intra-capsular fractures are either fractures of the head of the
humerus, (this has never been proven to result from any other than
gunshot injuries), or else they are fractures of the anatomical neck.
This injury has very rarely, even by the most skillful surgeons and
practical anatomists, been diagnosed before death.

The difficulties in the diagnosis of these fractures are very great.
There is always, after an injury of this kind, marked swelling.
This causes tension of the ligaments and muscles and thus mark
the symptoms.

In regard to the differential diagnosis between intra-capsular
fracture and dislocation. In all forms of dislocation, the sub-
■ acromial fossa is enlarged and you are able to introduce two fingers
into it. In some healthy individuals you can introduce one finger,
and in all lean subjects it is possible to insert the little finger in the
snb-acromial fossa.

In dislocation, the elbow protrudes from the side. This does not
occur in intra-capsular fractures.

The fracture cannot be detected with any certainty by crepitus.
You can easily see how the effusion and swelling will produce thick-
ening and bursal enlargement of the capsular ligament and thus
prevent the sound of crepitus from being heard. The crepitus is
usually of a moist character. If you place a patient under ether
and examine the joint carefully, by placing your hand over the
shoulder and manipulating the arm, you will be liable to detect
the crepitus where no fracture could pointedly exist. Crepitus is,
therefore, not a conclusive sign, in these cases.

The symptoms which would make you sus2)cct an intra-capsular
fracture, would be besides crepitus, severe pain and the absence of
symptoms of dislocation. "Without these indications you must con-
clude that you have a contusion or sprain of the shoulder joint and
even then such may be the case. I am inclined to think that in

CARRIER PIGEONS AS DOCTORS' ASSISTANTS. 75

many cases where there has been said to be a fracture, there has
been a sprain ; but a sprain is often as bad as a fracture. You know
the old saying is : "A sprain is worse than a break." A contusion
of the shoulder joint leads to thickening of the tendons and other
tissues around the joint, thus impeding motion. The treatment
tnust be founded upon a conjectured diagnosis. The proper treat-
ment of an intra-capsular fracture, is to keep the head of the bone
in position by applying Velpeau's bandage. A pad should be placed
in the axilla and nothing makes a better pad than a pair of woman's
stockings rolled one into the other. Velpeau's bandage, if the bone
is broken, brings it into position, and also secures rest and quiet
which are essential to recovery.

This man may have had an intra-capsular fracture, but I think
it more probable that this was a sprain.

CARRIER PIGEONS AS DOCTORS' ASSISTANTS.

We learn from reports in the papers that carrier-pigeons are
being made very useful by country doctors in this State and Penn-
sylvania. One doctor in Hamilton County, New York, uses them
constantly in his practice, and considers them an almost invaluable
aid. After visiting a patient he sends the necessary prescription to
a dispensary by a pigeon, or any other instruction the case or situa-
tion may demand. He frequently, also, leaves pigeons at places
from which he wishes reports of progress to be despatched at speci-
fied times or at certain crises. He says that he is enabled to attend
to at least a third more business through the time saved him by the
use of pigeons. In critical cases he is able to keep posted up by
hourly bulletins from the bedside between daylight and nightfall,
and he can recall case after case where lives have been saved* that
must have been lost if he had been obliged to depend upon ordinary
means of conveying information. — New York Medical Record, Oc
tober 29, 1S81.

7r,

SELECTED PAPERS.

SELECTIONS FROM CLINICAL LECTURES, DELIVERED

AT THE LONDON HOSPITAL.

By Jonathan" IIutchinson, E. R. C. S.

THE PUE-CANCEKOUS STAGE OF CAXCER, AXD THE IMPOKTANCE
OF EAPtLY OPERATIONS.

Goillciucn : — Tlie patient who has just left the theatre is the sub-
ject of cancer of the tongue in an advanced stage, xis I demon-
strated to you, the lymphatic glands are already enlarged. It is
hopeless to think of an operation, and there is nothing before him
bflt death, preceded and produced by a few months of great and
continuous suffering. His case, I am sorry to say, is but an exam-
ple, of what is very common. J^ot a month passes but a case of
cancer of the tongue presents itself in this condition. The cases
which come whilst the disease is still restricted to the tongue itself
are comparatively few ; nor does this remark apply only to the
tongue. " Too late ! Too late!" is the sentence written but too
legibly on three-fourths of the cases of external cancer concerning
which the operating surgeon is consulted. It is a most lamentable
))ity that it should be so ; and the bitterest reflection of all is, that
usually a considerable part of the precious time which has been
wasted has been passed under professional observation and illusory
treatment. In the present instance, the poor fellow has been three
months in a large hospital, and a month under private care. I feel
free, gentlemen, to speak openly on this matter, because my con-
science is clear that I have never failed when opportunity offered,
both here and elsewhere, to enforce the doctrine of the local origin
of most forms of external or surgical cancer, and the paramount
importance of early operation. I have tried every form of phrase-
ology that I could devise, as likely to impress this lesson. Nearly
twenty years ago, I spoke to your predccissors in this theatre con-
cerning the " successful cultivation of cancer ; " telling them how,
if they wished their patients to die miserably of this disease, they
could easily bring it about. The suggestion was, that all suspicious
sores should be considered syphilitic, and treated internally by

THE PRE-CANCEROUS STAGE OF CANCER. "i"?

iodide of pctassium, and locally by caustics, until the diagnosis be-
came clear. More recently, I have often explained and enforced the
doctrine of a pre-cancerous stage of cancer, in the hope that, by its
aid, a better comprehension of the importance of adequate and
early treatment might be obtained. According to this doctrine,
in most cases of cancer of the penis, lip, tongue, skin, etc., there
is a stage — often a long one — during which a condition of chronic
inflammation only is present, and upon this the cancerous process
becomes engrafted. I feel quite sure that the fact is so. Phimosis
and the consequent balanitis lead to cancer of the penis ; the soot-
wart becomes cancer of the scrotum ; the pipe-sore passes into can-
cer of the lip ; and the syphilitic Icucoma of the tongue, which has
existed in a qniet state for years, at length, in more advanced life,
takes on cancerous growth. The frequency with which old syphi-
litic sores become cancerous is very remarkable ; on the tongue, in
particular, cancer is almost always preceded by syphilis, and hence
one of the commonest cau-ses of error in diagnosis and procrastina-
tion in treatment. The surgeon diagnoses syphilid, the patient ad-
mits the charge, and iodide of potassium seems to do good; and
thus months are allowed to slip by in a state of fools' paradise. The
diagnosis which was right at first, becomes in the end. a fatal blun-
der, for the disease which was its subject has changed its nature. I
repeat that it is not possible to exaggerate the clinical and social
importance of this doctrine. A general acceptance of the belief that
cancer usually has a prc-caucerous stage, and that this stage is the
one in which operations ought to be performed, would save many
hundreds of lives every year. It would, lead to the excision of all
portions of epithelial or epidermic structure which have passed into
a suspicious condition. Instead of looking on whilst the' fire
smouldered, and waiting till it blazed up, we should stamp it out
on the first suspicion. What is a man the worse if you have cut
away a warty sore on his lip, and, when you come to put sections
under the microscope, you find no nested cells ? If you have re-
moved a painful, hard-based ulcer of the tongue, and with it per-
haps an eighth part of the organ ; and, when all is done, and the
sore healed, a zealous pathological friend demonstrates to you that
the ulcer is not cancerous, need your conscience be troubled ? You
have operated in the pre-cancerous stage, and you liave probably

7S j^^ EMPIRICISM AND SPECIFICS.

effected a peimanent cure of what would soon have become an in-
curable disease. I do not wish to offer any apology for carelessness,
but I have not in this matter any fear of it.

EMPIRICISM AND SPECIFICS : PEMPHIGUS CURED BY ARSENIC.

The patient whom we are about to discharge from Talbot ward,
cured of severe pemphigus, was admitted for a special purpose. lie
was sent in by my friend and former pupil. Dr. Tom Robinson, in
order that he ni'ght be cured. You will say that the hope of cure
is the motive vviiich brings most of our patients to us. True ; but
in this instance there was something more than this. Dr. Robin-
son could easily have cured him hmself, but he sent him here in
order that I might do the miracle of cure under your eyes, and thus
claim your belief in the efficacy of drugs. You will remember his
state when admitted ; he was covered from head to foot with bulla};
the trunk was less severely affected than his limbs, head and geni-
tals ; on these, there was nowhere a space as large as the palm free
from bulla?, and on the trunk also there were a considerable num-
ber, lie was in a miserable condition from pain and irritation. The
eruption had been out about ten days, and it affected the rau-
cous membrane of his mouth as well as the skin. You may remem-
ber that we kept .him in bed for a few days before we used the ma-
gician's wand, in order that all might see that there was no natural
tendency to amelioration. More bulla} came out; then without
making the slightest change in diet, wc ordered a few drops of
a tasteless solution of arsenic to be swallowed three times a day.
The result was that, at our next visit, most of the bulla} had dried,
and there were no fresh ones. He continued to improve greatly
for ten days, when suddenly a few fresh small bullfe seemed to
threaten a relapse. "We doubted the dose of our remedy, making
the dose eight instead of four drops ; and, from that day, with the
most trifling exception, the recovery has been uninterrupted. With
such a fact before you, let me beg of you, gentlemen, to believe in
drugs, and to treat empiricism with respect. In the prescrij)tion
which I ordered, I availed myself solely of empirical knowledge ; I
presciibed, just as any old woman might prescribe, that which I
knew would do good. Concerning the nature of pemphigus, I
knew nothing; of its cause, absolutely nothing; of its clinical

EMPIRICISM AND SPECIFIOe. 79

reiatioiifhip, Imt litile ; of tlie inodiis opei-andl of arsenic, I knew
scarcely mure ; but this I did know as a fragment of assured con-
viction, that arsenic would cause the pempliigus eruption to disap-
pear, and ti.e patient to regain his health. Far be it from me to
speak tflightingly of scientific work ; let us by all means wor^ as
hard as we can in the laboratory and microscope-room, and pene-
trate as far as we possibly can into the mystciies of disease ; let ns
never weary in our search after causes or in our endeavor to find
practical a])plication for the facts of physiology. But, whilst doing
this, let us remember that, as regards the relief of suffering, much
of our nsefuhicss is based u])on knowledge which is nowise scientific,
but simply a matter of experience and memory. We have many
specifics fur many maladies, or rather for many symptoms, and he
is the most successful practitioner who has stored in his memory the
largest numbrr of them. As years go on, we shall add many more
to our list ; and I doubt not that there arc those who now listen to
me who are destined to give help in their discovery ; for discoveries
in this direction are rarely ma'de by single observers, but rather by
the concuri'ent woik of many ex|)erimenters, all keeping their eyes
open. Willing to try new things, and resolute to store faithfully the
results of their observations. Iodide of potassium for tertiary
syphilis, the bromide for epilepsy and as an anaphrodisiac, iodoform
for phagedena and specific ulceration, balsam of Peru for scabies ;
so silently have these invaluable specifics been introduced into
practice, that it would puzzle most of us to say who first recom-
mended them. I inention this fac^ in order to show how important
is the honest labor of all in the pursuit of tlierapcutics. We all
])rescribc, and we ought all, on system, to observe and record the
results of our observation as to the effect of drugs. Five-and-
twenty years ago, I believe that the case of i)omphigus which you
have seen cured would have been found incurable in all the medical
institutions of the world, with one single exeception. Much more
I'ccontly than that, the disease was pronounced by llebra to be in-
variably fa.'al. So. indeed, it would have to this day, if we had not
found out arsenic. I know (.f nothing else (hat will cure it. Our
])aticntwas already beginning to emaciate, and, in the course of a
few months — possibly of a few weeks — he would have had to die,
worn out by the constant discharge from his skiii, had we not put

80 CAN A MAN HATE SYPHILIS TWICE ?

the arsenic into his blood. Never shall I forget seeing a poor
wretched child carried on in a bed between Mr. Startin's out-pa-
tient room at tlie Blackfriars Hospital for Skin Diseases. It had
been brought straight from the wards of one of our largest hospitals,
where, during three months, all had been done for its help that be-
nevolence, aided by the science of the day, could sugges'. Yet it
was emaciated to skin and bone, and so covered with sores, that it
was impossible to put its clothes on. A few minims of arsenic were
prescribed, and in a -few weeks the child was well. So much for
drug specifics.

CAN A MAN HATE SYPHILIS TWICE ?

The man whom we have just seen offers a remark;iblo example of
the occurrence of a chancre soon after the first. His second sore
has been, as I have repeatedly demonstrated, characteristically in-
durated, lie is cpiitc candid, and makes no doubt that this sore was
tlic result of contagion. Yet it is barely a year since he had his
first chancre, and this was followed by an eruption, of which he
had scarcely got clear when this second sore occurred. The case is
proof that a man may have an indurated sore on the penis within a
a year of a former one, but it is not proof that he may have syphi-
lis twice, for this patient has not as yet had any constitutional
symptoms as the result of the last chancre. If, however, you ask
me for an answer to the general question, Can a man have true com-
plete syphilis twice ? then I must reply clearly that he can. Such
cases are rare — as, rare, perha))S, as examples of second attacks of
small-pox — but they do occur. I am at present attending a gentle-
man who has a terrible phagedenic chancre and rupial eruption, and
who unquestionably liad complete syphilis, chancre, sore-throat, and
i-ash seven years ago. I have also a second case under care, very
much milder, but illustrating exactly the same fact, with almost
precisely similar dates. St?cond chancres are, however, far more
common than second attacks of constitutional syphilis. Many of
tl'.em arc the result of fresh contagion, but seem to have no power
to produce constitutional symptoms : but others arc not from con-
tagion at all, but form in connection with a taint still remaining
from the llrst attack. It is a most important fact that indurations
may form in the penis in every respect like Iluntcrian chancres, not

IS MARSH POISOX A MYTH ? 81

distiiiguisluiblo in any way, ami yet that they may be merely re-
curred sores, aud the products of constitutional taint. I have seen
this over aud over again ; and M. Alfred Fournier, of the St. Louis
Hospital, has written a very instructive paper on this form of sore.
In the case of our patient, it is obviously impossible to say, after
the statement wliich I have just made, whether or not his present
sore is the result of fresh contagion. It may be simply a relapse, or
it may be a gumma, lie, however, confesses to exposure ; and, as
the sore followed in due course, it is probably true that he was
afresh inoculated. Second attacks of syphilis are sometimes, as in
the case just mentioned, very severe. The same has, I believe, been
occasionally noted in recurred attacks of variola. As a rule, how-
ever, they are mild, or even abortive. Third attacks may even
occur ; and so may, as we are told, third attacks of small-pox. We
must explain such facts, I expect, by reference to individual pecu-
liarity and idiosyncrasy, but it is important that they should be
known. The belief that syphilis can occur but once in a lifetime
is very widely spread amongst a certain class of the public. I have
watched with amusement the change in expression in many a young
gentleman's face when he got my reply to his smiling suggestion —
"A man cannot, I suppose, have the disease a second time ?" —
British Medical Journal.

IS MARSH POISON A MYTH ?

The transitional progress of the medical agnostic from the point
at which, having emerged from the darkness of plausible theory, he
struggles honestly, cautiously, aud laboriously forward, through
the twilight of speculation aud experiment, into the full dawn of
perfected discovery, is deeply interesting to all true men of science.
Nevertheless, sympathy with the doubter is liable to be suspended
whenever we observe that, in a blind struggle for change, he blun-
ders into some new darkness, imagining it to be light, and is satisfied
to prefer a shallow new theory to a well-grounded old one. None
"can be more willing than we are to admit that those physicians who,

82 IS MARSH POISON a myth ?

in the present day, refuse to adhere to the old belief in the exis-
tence of a tnarsh poison as a true entit}', are doing good, if it be
only in promoting discussion upon an unsettled question of vast
practical importance ; but we consider it to be undeniable that,
when they endeavor to convince us that the paludal influence ia sim-
ply the combined effect of climatic causes, such as cold, heat, damp,
and extreme vicissitudes of temperature (which used to be recog-
nized, not as the true causes, but merely as the excitinrj causes of
marsh fever), they do no more than conduct us into new obscurity,
offering us doctrines which arc quite as theoretical as those held by
Moore, Lancisi and Macullocb, and very far less probably. The
profession are indebted to Deputy Surgeon-General W. J. Moore for
a monograph* in which he sets forth the steps by which he has suc-
ceeded in ])ersuading himself that such a thing as marsh poison has
no existence. The compilation of opinions which Dr. Moore ad-
duces, as leading him up to this conclusion, is long and careful. Wo
regret that we cannot accept it as a perfectly full and fair exposi-
tion of all the facts at issue. Any one who may desire to enter into
a thorough investigation of this question will find it useful, but its
practical value would be enhanced ten-fold if it could be reedited
by two other. scientists, one an advocate of the old views, the other
a practical investigator of the germ-doctrine ; or perhaps we should
rather say, by one who, having in mind the observations of the
Maculloch school, follows diligently in the path of microscopical
research thrown open by Klebs, Tommasi-Crudeli, and Sternberg.
We think it especially to be regretted that men who, like the pro-
pounders of the climacteric theory of paludal influence in America
and India, dwell in the very hotbeds of that influence, whatever it
may be, with every facility for practical observation in their hos-
pitals and at their very doors, sliould, at this very critical stage of
inquiry, prefer theory to physical research, employing the pen in-
stead of the microscope and test-tube in their attempts to elicit new
truth. Dr. Moore is by no means the only clever advocate of the
Climatic theory, who, without, as it would appear, having attempted
to follow practically the researches of V(\q savants of Austria, Rome;
and New Orleans, puts aside the whole doctrine of paludal micro-

*" Malaria r. Recognizable CUmatic Influences" {Indian Medical Gazette tor '^a-
vember 1, 1881.

IS 5IAKSH POISON A MYTH ? 83

phytes with easy incredulity. It is by no means impossible that fu-
ture research may dismiss the at present much vexed Bacillus 7na-
larim, as a detected pretender to the status of a specific virus "to
the base mud from which it sprung — unwept, unhonored, and un-
sung." Still it is, just now, a very substantial little entity, which
will not allow itself to be reasoned into space, any more than the
hind leg of a sagacious domestic quadruped admits of being resolved
by argument into its elements. We should occupy unnecessary
time and space in attempting to combat the reasonings upon which
Dr. Moore has succeeded in convincing himself that marshes are not
the source of a specific poison, but that arid sandy wastes and dry
mountain ravines are the natural halitats of ague and remittent
fevers. We have merely to remark (1) that a sandy desert, desti-
tute of trees and hill-ranges, capable of arresting the course of ma-
laria, is no defence against winds laden with the emanations of very
distant terais, jheels, and jungles ; and (2) that, although Dr.
Moore has been rather cautious in citing the authority of William
Fergusson (who, true man of science as he was, was not strong upon
the doctrine of microphytes), those who deny that there is a marsh-
poison attach the greatest weight to Fergusson's narrative of a re-
mittent fever which arose among troops encamped in "the half-dried
ravine," " which had lately been a water-course," " from the stony
bed of which (as soil never could lie for the torrents (the very ex-
istence even of vegetation was impossible."* Upon this we have to
suggest that botany has made some progress since the year 1809,
and that " the half-dried ravine" and " the stagnant pools of water
that were still left among the rocks" are, we apprehend, precisely
the localities in which our microscopists would expect to discover
the Bacillus tnalaricB in its highest perfection.

Dr. Moore further argues, " It is stated that the Bacillus pre-
vails in the greatest quantity during the heat of the summer, while
we, in India, know that malarial fevers are most common in the
autumnal season, and for some time after the commencement of the
cold weather. It is therefore believed that Bacillus inalaricB will
not account for the universal prevalence of malarious disease."
Upon this we have to remark that the autumnal and cold seasons
of India are what may be termed the drying up time, at which the

■ *"Notes and Recollections of a Professional Life," page 187.

84 ASPIKATIOX OF THE fJALL-BLADDER.

leaves of deciduous plants die and rot, and the water of tauks,
jheels, and mountain torrents either disappears or becomes "thick
and slab" with the products of organic decomposition. This au-
tumnal and cold weather follows immediately, with little or no
break, upon that terrible hot season which immediately suc-
ceeds the rains, and which leaves every one more or less debilitated
and prone to suQ'er from the diseases of that climate. Again, would
it not be better to search for the Bacillus in the marshes which lie
only too cIojC to the Bombay Club, to inoculate monkeys (which
are not subject to ague and remittent fever), as Dr. Vandyke Car-
ter did with the SpirUInni, and then to discuss this question
further? We thank Dr. Moore for his thoughtful memoir, which
is a very well-assorted ])ieceof medical mosaic work ; but its subject
is one upon wb.ich, in our present state of mind, we should prefer
one observation by, say, Burdon-Sanderson to any number of argu-
ments, however elaborate. An Indian anecdote will fairly illus-
trate our opinion of this narrative. A high official, having received
a report which containe i a great deal of showy argument, handed
it to his Hindoo clerk, saying, ''Read that. Baboo, and give me
your opinion upon it." The reply was, "Very fine report, 0 pro-
tector of the poor, hut vonclicrs not got T' The sensible Indian
practice being not to look at a bill unless the voucher be attached
to it. — Medical Times and Gazette.

ASPIRATION^ OF THE GALL-BLADDER.

Dr. P. H. Kretzschman reports a successful case and says :
Five times has the gall-bladder been aspirated; thirtij-f our ounces
and a luilf of bile have been removed within one month. At every
operation the patient felt much relieved, and since the first with-
drawal of bile the constitutional symptoms diminished in severity.
At no time did the operation itself place our patient in danger, and,
generally speaking, there was no pain attached to it.
The following generalizations he appends to his paper :
]. The operation can be })erformed with safety without taking
particular precautions in uniting the walls of the gall-bladder with
those of the abdomen.

ASPIRATION OF THE GALL-BLA.DDER. 85

2. The operation can, thei'efore, be done as soon as the diagnosis
of a dilated gall-bladder has been made, if from its size, there seems
to be danger of rupture, or if the patient suffers much pain. Aside
from these conditions, when aspiration should be resorted to with-
out hesitation, the question presents itself whether it would not be
good practice to evacuate the contents of a distended gall-bladder
under all circumstances, simply to remove the superfluous bile,
which, being cut off from its natural destination, is bound to be
reiibsorbed by the lymphatics, carried back into the circulation and
produce, to a greater or less degree, a condition which is generally
known as '*' cholasmia."'

3. A fine trocar can be employed, and by means of suction even
a tenacious fluid can be removed from the gall-bladder.

■i. The insertion of a small trocar or an aspirating needle is al-
most a painless procedure.

5. In cases of doubt as to the presence of gall-stones, a flexible
probe can be passed through the canula and used as a sound.

G. Aspiration being a safe and painless operation, it can be em-
ployed for the purpose of aiding diagnosis.

The rules for performing the operation are thus formulated :

1. Aspiration should not be delayed, but resorted to as soon as
the diagnosis of distended gall-bladder has been made.

2. A good-sized aspirating needle or a fine trocar should be used.

3. The instrument should be introduced into the gall-bladder at
a point as high up and as near to the border of the liver as possible.

4. On withdrawing the instrument, the punctured v/ound in the
abdominal wall should at once be closed by some kind of plaster, or
by the introduction of a stitch.

5. The operation should be repeated as often as the gall-bladder
becomes distended again.

6. The common rules of surgery as to cleanliness, etc., should be
strictly adhered to, — Proceedings Kings Counfg.

A Xeio Alkaloid From Cinchona. — A cinchona bark known as
C. ciqjrea, which for the last two years has been imported from
South America in large quantities, contains a hitherto unknown
alkaloid. The name " ultra-quinine" has been proposed for it.

86

CORRESPONDENCE.

■ A CASE OF EXTKA-UTERINE PEEG NANCY OF NINE
YEARS DIJEATION.

On the 17th day of November, 1881, I was called to see Mrs. D.,
ffit. 37. Iler history is brieliy as follows : She was married in 1870.
In January, 1872, she became pregnant. In August, 1872 pseudo-
labor came on, and she called a physician. He told her she was de-
livered of a piece of the after-birth, that it was not yet time for her
confinement, and gave her laudanum to quiet the pains. She re-
mained in bed four weeks, and the tumor, which has always rested
high up in the right side, began to subside. Lochia continued the
usual length of time, catamenia returned, and she enjoyed tolerably
good health, and continued to live with her husband, but was never
pregnant again.

In 1880, she was taken with what was diagnosed and treated as
dysentery. The discharges were very fetid, and. the disease did not
yield to treatment. However, in the course of three monfhs she
was better, the evacuations becoming normal in character and con-
sistency. She again enjoyed tolerably good health, till six weeks
before I saw her, when again she was taken as before, and received
similar treatment ; but she became weaker and weaker, and I was
called.

When I saw her she was unable to sit up in bed, was very much
emaciated, with a rapid and feeble pulse. In the face of such a
history, I proceeded to examine her, feeling almost confident that
these purulent discharges emanated from a cyst, the result of extra-
uterine foetation. Introducing my finger into the rectum, I discov-
ered on its anterior surface the opening through which these dis-
charges were coming. Inserting the index finger into the opening,
it at once came in contact with some flat sharp bones, evidently
the cause of this trouble.

With the patient anesthetized, I proceeded to remove them by the
following operation :

Introducing Thomas Cusco's bivalve speculum into the anus, it
very nicely exposed the opening, which proved to be too small to
allow the bones to pass. Passing a pair of cervical dilators into the

EXTRA-UTERINE PREGNANCY. 87

opening, I stretched it, and the next moment using the same as
forceps, I withdrew the cranial bones separately. Then seizing the
spine by the cervical vertebra, it was found to be in tact, and was
partly drawn through the opening, but the ribs prevented further
passage through the speculum, and the latter was removed, when
the spine one upper,and one lower extremity were delivered together.
The remaining bones were afterwards delivered with the forceps, the
speculum having been replaced. The cyst was then washed out with
a carbolized solution, and the patient placed in bed.

After Treatment. — Two hours after the operation morphia was
administered by hypodermic for pain. Five hours after the opera-
tion the temperature was 103°, with nausea and vomiting. Carbolic
acid was given in drop doses for five hours, every hour. Tempera-
ture began to fall and this was discontinued.

At 8 o'clock on the following morning, temperature 101°. Cyst
was again washed out. On the evening of the same day, the tem-
perature was 100°. Cyst again washed out. The temperature con-
tinued to fall until the third day following the operation, when it
was normal, and the nausea and vomiting had disappeared, and ap-
petite returned. Her diet consisted of milk, eggs and beef, wine
and iron ; the latter was given teaspoonful doses every hour. The
catheter was used twice after the operation. On the fourth day her
bowels acted. She only complained of a little soreness. ^

Uer recovery is perfect, being able within one month to visit her
friends, and says she feels better than during the nine preceeding
years.

With all due deference to those who would trust to nature under
such circumstances, I think this will prove conclusively, that arti-
ficial aid in certain cases is essential. And may we not ask if this
was not one of those cases, since nature had made two ineffectual
attempts to relieve, and in the latter had not only failed, but had
completely exhausted herself.

Thomas M. Jordan, M. D.

Hillsborough, N. C, January 4th, 1882.

88

CASE OF TEIPLETS.

Editor Xorth Carolina Medical Journal :

Dear 8ir :— On the night of December 29th, 1881, 1 was called
to attend Mrs. Appa C, who, so stated the messenger, " had had
one child "and looked as if she would have another, that the mid-
wife in attendance had done all she knew and wanted a doctor." I
went as fast as possible over eight miles of rough country roads,
reaching the house ^about eleven and a half o'clock. Found the
woman in a b^dly frightened and exhausted condition, she having
been in labor twenty hours when the first child was delivered at 7
o'clock P. M., by a foot presentation, the midwife stating "that
one foot was born a long time before the other." She was so sore, the
labia being swollen to about the size of my wi-ist if not larger, that
it was necessary for me to administer chloroform before an exami-
nation could be made, and^on making the examination I found the
OS fully dilated, the breech of the child being the presenting part.
As she was not having pains sufficient I gave her thirty drops of
Tilden's fl. ext. ergot. Ten minutes later I repeated the dose. The
pains soon assumed an expulsive character, and in tv/cnty minutes
after the last dose of ergot the child was delivered. Still there was
no apparent diminution in the size of ^her abdomen. The pains
continuing, the third child was born, (vertex presenting) by the
time I could tie the cord and hand the child to the nurse, on the
expulsion of^the third child the pains ceased and to this time, the
woman has not had a pain. After waiting some fifteen minutes I
attempted to remove the sccundines when I found that the womb
had made an hour-glass contraction, the placenta being above the
constriction. Introducing my hand, I gradually, with my four
fingers dilated the constriction sufficiently to allow me to grasp the
placenta, when I found it firmly attached to the fundus, which,
after some trouble, was carefully detached and removed. I found
theie was^only one placenta, the three cords being aboutiwo inches
apart in a triangular position. The cords were about 12, 15 and
20 or 22 inches long. The children were girls, and I suppose would
have weighed 54-, 4 and 7 pounds. The smallest being the second
one and that died on the following day, the others lived and done
well on butter and sweet potatoes. This was the third pregnancy

ACTION OF THE ASCLEPIAS CURASSAVICA. 89

of the mother, who, for some two weeks after the birth of the

triplets was troubled with general dropsy. She is'now doing well.

Very respectfully,

Richard J. Noble, M. D.
Selma, Ts\ C, February Sth, 1882.

OX THE PHYSIOLOGICAL ACTION OF THE ASCLEPIAS
CURASSAVICA.

We read in a recent number of the UniCio Medico, of Rio Janerio,
that Dr. Guimaraes has made a series of experimental investigations
on the physiological action of the Asclepias curassavica — a com-
mon plant in Brazil, and known to European botanists under the
name of hadanl ipecacuan. Dr. Guimaraes made twenty-flve ex-
periments on various animals, such as dogs, rats, guinea-pigs, etc.,
and he obtained some well-marked results, among which were the
following : — The active principle is a cardiac poison, resembling
digitalis in its action ; and, like almost all such poisons, the asclc-
pias affects all the striated muscles, and causes them to lose their
contractility. It does not exercise any injurious action on the ner-
vous centres presiding over the life of relation, nor on the sensitive
or motor nerves. An alcoholic solution of the roots, injected into
the veins, immediately causes a great constriction of the small ves-
sels, resulting in a considerable increase of blood-tension in the
large ones, and a more or less rapid reduction of the normal tem-
perature. It is an excitant of the vaso-motor centres. Besides
these primary effects, the asclepias produces others which are
secondary, among the most notable of which are disturbances of
respiration, from a state of slight dyspnoea to great orthopnoea ;
and disorder of the digestive system, marked principally by vomit-
ing and diarrhoea. The solution obtained by maceration from the
stems and the roots acts on the heart and the vessels, but with un-
equal intensity — that from the stalks exercising a more marked and
rapid action on the heart than the solution from the roots ; but the
reverse takes place when the action is exerted on the vaso-motor cen*
tres. — Medical Times and Gazette.

90

EDITORIAL.

NORTH CAROLINA MEDICAL JOURNAL

A MONTHLY JOURNAL OF MEDICINE AND SURGERY, PUBLISHED
IN WILMINGTON, N. C

Thomas R Wood, M. D., Wilmington, N. C, Editor.

1^=" Original communications are solicited from all parts of the
conntry, and esjjeciaUi/ from the medical j^rofession o/'The Oaro-
LiNAS. Articles requiring Ulustrations can he promptly s^tjJlMed hy
previous arrangement with the Editor. Any s^ilscriler can have a
specimen number sent free of cost to a friend whose attention he
desires to call to the Journal, by sending the address to this office.
Promp)t remittances from subscribers are absolutely necessary to
oiaUe us to maintain 07ir worh with vigor and acceptability. All
remittances must be made \myal)le to Thomas F, Wood, M. D.,
P. 0. Draiver 791, Wilminqton, N. C.

PROGNOSTIC PRECISION OF THE CLINICAL THERMOM-
ETER IN PHLEGMASIA DO LENS.

The successful conduct of a case of phlegmasia dolens, depends
greatly upon the judgment of the physician in permitting the pa-
tient to resume the upright position. If this is permitted before
the subsidence of active inflammation, the return of phlebitis, with
all the serious train of symptoms, is very sure.

Accumulating experience shows the great value of the clinical
thermometer. First, In determining the early onset of the disease.
Second. In the precision with which it marks the diurnal fluctua-
tions. Third. In furnishing an absolute guide to the complete snb-
sidence of febrile and inflammatory action, thus indicating the be-
ginning of convalescence.

The temperature in phlegmasia dolens is apparently capricious.
A lying-in patient may bo seized during the night of any day from
the eighth to the fourteenth day after delivery, with a chill and
fever. This may not be preceded by any marked degree of pain

CLINICAL THERMOMETER IX PHLEGMASIA D0LEX3. 91

about tlie iiulvis or the tbigli, but is usually rullowoa by it. The
temperature in two hours not infrequently runs up to 104.5° to
105°, passing nearly off by a copious sweat, the mercury not falling
below 101° for days. Indeed, it may be safely relied upon, that if
a woman in child-bed has an initial chill, occurring during the
night, with a temperature running up to 104° or 105° followed by
rapid defervescence until the mercury reaches 101°, and there is no
tenderness of the abdomen, no tympany, no dry tongue or delirium,
phlebitis may be prognosticated confidently. The pain and swell-
ing come iu due time, probably not perceptibly until three days after
the initial fthill and fever. It is not unusual for these night chills
to recur, at intervals of a day or so for many days, and after each
recurrence, a new area of pain, denoting extension of phlebitis,
results.

In the first week of phlegmasia dolens the evening temperature is
seldom less than 103°, and the morning temperature 101.5°. This
condition of things sometimes continues through the second week
unless the temperature is reduced by daily large doses of quinine. In
the third week if the case is progressing favorably and there is no
extension of the phlegmasia to the other limb, the temperature will
reach 102°, dropping to 100° or 101° in the morning. Finally in the
fifth week the highest temperature will barely be 100°, and so it will
remain some days and then diminish to 99.5°. Should the unfor-
tunate patient now be advised to sit up before the mercury has
fallen to 98.4° the inflammatory processes will be speedily lighted up
again, the unfavorable change being denoted by a deciled chill.

The last week of phlegmasia dolens i§ a most anxious time. The
patient has been greatly exhausted by fever, less of appetite, and
confinement to the bed for weeks, superadded to the drain upon her
by [larturition. It is very desirable that she should be pushed for-
wards towards convalescence. But here the thermometer is onr sure
guide. As long as the temiierature runs above the normal point
there is danger, and indeed there is danger until the temperature
has been at or helow 98.4° for three days. A careful study of the
iliermometry of phlegmasia dolens, will guard the physician against
the many times fatal mistake of allowing his patient to assume the
erect posture too early. There is nothing new in these observations,
but there is a reason why we should direct special attention to the
use of the thermometer in this disease, especially to that small num-
ber of physicians who are not in the habit of using the thermome-
ter as a means of diagnosis and prognosis.

93

REVIEWS AND BOOK NOTICES.

Eighth Annual ItEPOiiT of the Seceetaky of the State
Board of Health of the State of Michigan. For the
Year Ending Sept. 30, ISSO. Lansing : W. S. George & Co.,
State Printers and Binders. 18S1. Pp. 510.

Reading this hirgo volume, the work of a Liborioua and pains-
taking Secretary we arc more and more impressed that the
Secretary of a State Board of llealtli shoiikl b^ a man of good at-
tainments, he should be a good organizer, he should have a fertile
brain, he should be possessed of untiring industry, he should have
political sagacity in a sufTicient degree to obtain such legislation as
would promote the regulation of the public health, and above all,
he should be a good ph3'sician in that broad sense, which presup-
poses an education in physics and chemistry, as well as the ripe ex-
perience of a good clinician ; but he should no longer have to do
the drudgery of a practitioner, but devote all his time to the difficult
task of an oflfice for which there is no precedent as to the minuticB
of its details, and no text-books to lead him to success. In no one
officer do all these qualities reside in such an eminent degree as in
Dr. Baker, Secretary of the Michigan State Board of Health. In-
deed, no fewer qualilications would have enabled him to have
brought out such a volume, and the volumes (some of them better
than this) which have preceded this. It is true that the papers
brought together here, are from many workers, but the guiding
hand and the inspiration of the movement are largely due to the
chief executive officer.

The subjects here presented in the new experimental science of
sanitation are numerous, as follows : '' Contamination of Urinking-
Water by Filtration of Organic Matter Through the Soil," by Vic-
tor C. Vaughan, ]\I. D. ; " Texas Cattle," by Alexander J. Murray,
V. S. ; "Methods of Study in Sanitary Science," by John S.
Caulkins, M. D. ; "Light in Public Schools," by C. J. Lundy,
M. D. ; " The Prevention of Pulmonary Consumption," by Henry
F. Lyster, M. D. ; " Sanitary Rewards and Punishments," by Hon.
Henry W. Lord ; " The Use of Household Filters for Potable
AVaters," by Prof. A. B. Prescott ; " Sanitary Progress and Venti-
lation," by J. S. Billings, M. D. ; "General Sanitation, — Its

REVIEWS AND BOOK NOTICES. 93

Impoi'tauce, and Plea for Better Methods," by Henry B. Baker,
M. D. This list selected from many more, shows the broad range
of subjects connected with public health, selected as studies by
IMichigan sanitarians.

The extraet given below from Professor Prescott's paper on "Tiio
Use of Household Filters," to several communities in tlie State is
well worth the space wo give it.

First. A good portable charcoal filter, such as described, when in
good order, removes from eighty to ninety per cent, of the putres-
cible organic matter, from rain-water.

Second. Such a filter, in good order, supplied with unj^oiluted
rain-water, collected and stored with due cleanliness, and with
strictest seclusion of ground drainage, furnishes a very pure water
(containing an average of only three-tenths and at most seven-tenths
of the maximum safe quantity of nitrogenous organic matter.)

Third. A good filter, in good order, cannot be at all depended
. upon to make polluted water safe for drinking. (Any water con-
taining the free ammonia found in filtered waters Nos. 5 to 10,
especially with the albuminoid ammonia of Nos. 5 and 0, would be
rejected by a chemist as unsafe.) A polluted water, probably con-
taining animal excreta, is liable to carry specific poison, as that of
typhoid, and no filtration can bo at all trusted to make it safe.

Fourth. In case of any potable water not decidedly bad and yet
containing such traces of organic matter as to make its use of doubt-
ful safety, the danger from its use is very greatly lessened by its
filtration through a good filter, in good order.

Fiftli. A good charcoal filter, used for clean rain-water, and not
l-e2)t si(bmcrr/ed o\cv half or two-thirds of the time, but left with
the filter-bed drained oS a part of every day, will remain -in good
order for considerable time, and may be relied upon for at least a
year. Air is far better than the purest water to cleanse a good char-
coal filter. The better the filter, the more readily is it cleansed of
organic matter by atmospheric oxidation. Due care of a filter re-
quires that all suspended matters should be removed before the
water reaches the filter-bed. This is well accomplished by the
sponge interposed between the reservoir of unfiltered water and the
bed. Of course, water that is loaded with impurities (especially
dissolved impurities) will far sooner clog a filter-bed and make it
worthless. It is only when supplied with approximately pure water
that the slight organic residues can be removed by atmospheric oxi-
dation, and the filter be considered an almost permanent means of
purification.

Sixth. AVater should not be stored after it is filtered. Filtered
water is like the manna of the Hebrews ; it must be obtained fresh
every day. Organic growths, alga^, multiply in even pure water.
These bodies are highly nitrogenous ; perhaps taking nitrogen from
the air ; and they should be removed. Filtration does it.

Filtration includes three distinct operations :

04 REVIEWS AKD BOOK NOTICES.

First, — Stralninn. The mccbanictil removal of solid particles,
suspeuded in the water. It is tliese that, when abundant enough,
render water turbid, or cloudy, and tliat are deposited by standing
in perfect quiet, as in the sedimentation of waters for cities. Fil-
tration upward is sometimes adopted, to obtain sedimentation in
the filter without clogging the filter-bed. But a finely porous sep-
tum, such as sponge, effectually I'emoves all solid particles. In the
use of rain-waier, it is a great advantage if at least some degree of
straining, the closer the better, can bo effected before the water
enters the cistern. By straining is usually meant the removal of
solid particles" large enough to make some degree of cloudiness,—
particles largo enough to bo seen by the unaided eye or with a ham!
magnifier. Microscopic particles are not removed by ordinary
straining : though they are, in greater part, by a good filter.

Second, — Adhesion. The retention of dissolved matters in the
filter-bed. A solution of organic coloring matters, though so ])er-
fectly free from suspended solids as to show no particles under a
microscope, when passed throuoh certain porous substances, leaves
the coloring matter behind. The capillary attraction of the poi'ous
surfaces for the dissolved solids takes them out of solution. Dis-
solved gases are to some extent withdrawn from solution in the
same way. The more minutely ]K)rous a filter-bed is, the more effi-
ciently it removes oi'ganic matter from water. The best filter-bed
for this purpose is bone charcoal, perhaps the next best is wood
charcoal. But whatever the material, it should be so disposed that
the water must all be subjected to capillary attraction, as long as
possible, in going through the bed. If there are interstices, so as
to permit currents of water, just so much of the water fails to bo
filtered. And the retention of dissolved solids depends upon finer
pores than are needed to take out suspended particles. A good filter-
bed must be fine and close enough, so that at any given ]ioint the
liquid does not pass through faster than by drops; and if, in a sec-
tion of the bed, of two inches diameter, the water does not pass
faster than five to twenty drops in a minute, so much the better.
Filters of bone charcoal, in large fragments, put in a box which is
sunk in water and from which water is drawn out, have been tried
for public water supplies, and have been found to remove far less
organic matter than we find these wood charcoal and gravel filters
to do. Of course, the close filter-bed works too slowly for ready
adaptation to public Avater. The filter-beds used in these experi-
ments are stated to contain about one volume of gravel to three vol-
umes of charcoal. But the result is governed largely by the degree
of fineness and compactness. The structure of the bed must be
even, so that no channels can be made, and then the rate of flow is
the criterion of suitable fineness and compactness. A bed of sand,
it has been found, does but little more than remove suspended mat-
ters, including organic growths too fine and too light to be removed
by sedimentation, The .sand particles are not porous, and their
surfaces have weak adhesive attraction.

REVIEWS AXD r.OOK NOTICES. 05

Third,— Oxidation. It h;is been stated for some years past, that
the organic matters withdrawn from water by a filter-bed are to a
degree oxidized away by the air, so that the lilter-bed does not clog
up. (The analyses liere submitted, showing the efficiency of filter-
beds long in use, prove that a great deal of oxidation of organic
matter nuist have occurred. Otherwise, as is often assumed, the
filter-beds would soon get saturated with the organic matter, and
then do as much or more harm than good. For No. 1, the filter,
which was small, had been in use, for two or three pails of water
each dav, for eight months ; for No. 2, the filter had been longer
in use f Numbers 13 to 19, inclusive, were filters which had been
sometime in use in families, and No. 25 h had been in use two years.
Yet the efficiency of these filters was found not very much lower
than that of the new filters used for Nos. 3, 5, 10, and 11. The
filters which had been in use and kept filled and covered witii water
constantly, did the poorest work, viz., Nos. 4, 12, and 20 ; notably
No. 4:, though it had been in use only four months. Also No. 2-4 h,
a charcoal cistern filter, long submerged, only removed 27 per cent,
of the matter indexed as albuminoid ammonia.) Filter beds need
the air to be let through them every day for due exercise of atmos-
pheric oxidation. And it is by this, here named as the third func-
tion of filtration, that household filters with charcoal beds become
practically useful in purifying water.

Transactions of the Medical and Chirurgical Faculty of

THE State of Maryland. At its Eighty-Third Annual Session.

Held at Baltimore, Md., April, 1881. Baltimore : J. W. Borst

& Co. 1881. Pp. 398.

We should have noticed this volume at an earlier day. It includes
many excellent papers, one of which by Dr. Goodell on ''The Dan-
gers and Duty of the Hour," appeared in the November Journal.
The " Invited Papers" are of special interest as coming from the
pens of two active and original physiologists of the Johns Hopkins
University— Prof II. N. Martin, M. D., and Mr. Sedgwick., The
first paper by Prof. Martin is on " A New Method of Studying the
Mammalian Heart," and the second conjointly by Prof. Martin and
Mr. Sedgwick, "A Study of Blood-Pressure in the Coronary Arte-
ries of tiie Mammalian Heart." The diSiculties in the last
studies are obviously great. The difficulty of introducing a
canula into the arteries of the living beating heart, seems hitherto
to have failed physiological experimeutprs, and these gentlemen un-
dertook the task without any very great hope of success. The re-
sults of their experiments are : The blood pressure in the coronary

90 REVIEWS AND BOOK NOTICES,

arteries is comparatively very great ; being in a small branch very
little less than equal to, or greater than that in the carotid trunk.
The coronary and carotid pulses are practically synchronous. The
sphymographic tracings from each artery is in its variations an ex-
act duplicate of that obtained from the other. Their results show
that under changes of pressure or rate, that the most complete
synchronism prevails, and they think by the sum of their observa-
tions that the semi-lunar valve of the aorta does not close over the
openings of the coronary arteries during any portion of the cardiac
period, a theory first advanced by Thebcsius and afterwards revived
by Biiicke.

There are several papers of local intcrest,chicily historical accounts
of the profession, medical journals, and medical colleges in the
State of Marvland.

A Treatise [on the] Diseases of the 'Eye. By Henry
D, Notes, A. M., M. D., Professor of Ophthalmology and
Otology in Bellevue Hospital Medical College. New York : Wm.
Wood & Co., 27 Great Jones Street, New Yorlc. Pp. 3G0. Illus-
trated by numerous woodcut engravings, and chromo-lithographs.
Specialism in medicine when pursued with a due amount of pro-
fessional honor and scientific research, is a higher plane of profes-
sional dignity than can be obtained in the multifarious duties of a
general practice. Specialists in the United States have not enjoyed
an enviable position. Their ranks have been crowded by the
greediest of all doctors, and by the most brazen pretenders. Young
men unwilling to attain to a degree of ripened knowledge prepara-
tory to entering upon the special fields, or to do the unpleasant
drudgery which falls to the lot of general practitioners, have taken
up specialties to coin money by the shortest processes. This day is
fast passing away though, and the most famous physicians in this
country are among the specialists. The good of their special study
is now being felt by the general profession in thejiew books being
produced on the different specialties. Of no special branch can
greater praise be given than to that of ''Diseases of the Eye."
This book is an example of the ability of specialists to bring their
high science within the jiractical comprehension of a general prac-
titioner. It will be received with decided favor by the subscribers
to Wood's Library we have no doubt. It is the December number
of the '81 series.

MEDICAL .rOURlSrAL PREMIUMS. 97

Illustrations of Dissections in a Series of Original Col-
ored Plates the Siz» of Life. Eepresenting the Dissec-
tion OF THE Human Body. By George N. Ellis, and Ct. H.
Ford, Esq. Vol. I. Second Edition. New York : William
Wood & Co., 27 Great Jones Street. New York. 1882.
This is the reproduction on a reduced scale, of the English work
above mentioned. How it compares with the original, we have not
the means of knowing. The illustrations arc original, drawn by
Mr. Ford from dissections made by Mr. Ellis, only such dissections
were j)rcpared for the drawings as are usually seen in the practical
anatomy room. AVhile the human figure has not changed in its
anatomical structure since Chescldon's Anatomy was written, there
is still room for improvement in the pictorial elucidation of its
structure far above anything given us by the old masters. Mr.
Ellis has succeeded in adding new interest to anatomical design,
which is very pleasing after looking at a stale set of stock designs
for a score of years.

The Library of Standard Authors has made a good beginning for
1882, and by the way, this enterprise of the Messrs. Wood leaves no
room for the doctor to grumble at the prices of medical works.

The North Carolina Medical Journal offers as a premium
for the best prepared and complete herbarium of the medicinal
plants of the State, the following works, or their equivalent, in vol-
umes the successful competitor may choose :

Curtis' " Wood)/ Plants^' and ''Catalogue of Indigenous^Plauts"
in one volume.

" Fluclcigcr and Hanlurifs rharmacographia,^' one volume ; and
'■^ Flora Amcricm _ tieptentrionalis ; or a Systematic uirraiujemcnt
and Description of the Plants of North America^'' By Frederick
Pursh, two volumes.

The collection must be prepared by the person presenting it.
Each specimen must be neatly mounted on stout white paper 9x14
inches, (two or three specimens can be put on a sheet when they are
small) and the name marked on each. This offer is made^to'mem-
bers of the State Medical Society, and to licentiates of the Board
of Examiners who may not be members.

Herbaria must be sent in on the 2d Tuesday in May, 1882, at the
Concord meeting. For further particulars address Editor of the
Journal.

98

TRANSLATIONS FROM THE FRENCH AND ITALIAN.
By Wm. G. Eggi-iESTon, INI. D., Hampden Sidney, Va.

DIAGXOSIS OF DIABETES— A NEW SYMPTOM.

M. Magitot says :

1. The examination of tlie moutli furnislics a constant sign for tlie
diagnosis of diabetes.

2. Tliis consists in tlie lesion known as alveolar osleo-penostUis

3. This manifestation of diabetes, which appears at the onset of tiie
disease, and persists during its whole course, acquires, under some cir-
cumstances the importance of a revealing srjmptoin.

4. The alveolar affection is characterized, as an initial sign of dia-
betes, by a first period, or period of simple deviation of the teeth ; a
second, or period of looseness of the teeth or alveolar catarrh ; which
corresjionds to the general state of the patient. A third, or period of
falling of the teeth comes on in a more advanced stage of the disease.

5. After this, if the disease continues, the alveolar borders become
the seat of osseous re-absorption, possibly followed by gangrene of the
gum. This indicates a near and fatal termination of the disease. —
lievue Med. Franc et Etrang.

ECHINOCOCCHI OF TIIE ABDOMINAL CAVITY ; DIAGNOSIS A.MD TREAT-
MENT.

Dr. Rossijii [in Oazatla Med. di Roma'] thus sums up :

1. The method of differential diagnosis, or we may say of elimination
hardly amounts to a ivise prohahility,

2. The more certain, and therefore indispensable, diagnostic means is
diagnostic puncture or exploration, which is perfectly harmless.

3. The diagnostic puncture enables us to know the nature of the con-
tents of the tumor, and at the same time opens up a means of complete
cure.

4. As soon as an hydatid tumor is diagnosed, surgical treatment
should begin at once. Medical treatment is useless.

5. Among the many methods of surgical cure proposed, that which
requires less time, with less pain, and a greater number of recoveries,
is simple punctures, and evacuating the contents through a canula ;
and the wound should be immediately closed.

6. A purulent condition of the liquid only requires, after evacuation,
leaving a permanent canula (drainage tube) and practicing tlie ordi-
nary washing of cavities. One case has shown the possibility of re-
covery under similar circumstances.

7. Ordinarily, ^yhen the liquid contains a great many vesicles, and is
purulent, it is better to leave a large canula (or drainage tube). By
snch means, whilst there is gradual evacuation of the liquid, assisted by

APPLICATIONS OF THE RUBBER BANDAGE. 99

au aspirator, we obtain, after a few days, tlie necessary adiiesions. We
can then, if a canula lias been kept in the cavity, substitute a drainage
tube, using, as a wasli, a dilute solution of carbolic acid, alcohol or bile.

APPLICATIONS OF THE RUBBER BANDAGE,

Outside of incarcerated hernia, where the results of its use are un-
satisfactory, and in eczematous affections of the limbs, in which its effi-
cacy is most remarkable. Prof, See also used the Rubber Bandage under
following circumstances :

1. In oedematous Infiltration of the limbs from whatever cause — car-
diac aflections, hepatic troubles, the various caehexife, i^ressure from
abdominal tumors, etc., as well as in the erysipelatous redness, so fre-
quently following partial mortification of the skin, is specially effica-
cious in infiltrations of the upper limbs, and in mammary cancer affect-
ing the axillary glands ; also in persistent oedema after the cure of
phlebitis or angioleucitis,

2. Sero- plastic infiltration, following diffuse phlegmon, articular
rigidity and loss of, or pain on motion, due to a rigid state of the skin
and subcutaneous connective tissue. Friction and massage are to a cer-
tain extent useful in those cases, but the elastic bandage is of great ser-
vice applied in the intervals between the sittings.

The rigidity due to swelling of the fingers, following j^hlegmon of
the hand and forearm, is efficaciously treated by the same means.

3. The infiltrations and bloody eff"usions, following contusions, sub-
cutaneous lacerations and ecchymoses of every kind. The elastic band-
age favors and j)romotes re-absorption of the extra vasated blood.

4. Serous effusions in the joints, hydrartheosis of the knee, of the
elbow, and of the dorsum of the foot, occasionally resisting all other
means of cure.

o. Circumscribed or diffuse phlegmonous inflammations, at any
period of their evolution. It is preferable to a soft catajDlasm in mode-
rating the afflux of blood and compressing the tissues.

G. Ecthyma of the limbs, and the ulcers remaining after desquama-
tion of the crus'ts ; atonic ulcers on the lower limbs, callous ulcers, and
varicose ulcers. In all these, the elastic bandage causes a rapid disap-
])earance, and favors cicatrization.

7. Recent wounds, accidental or surgical, united by sutures. The
elastic bandage apiilied under "Lister" greatly favors immediate re-
union. By its impermeability it completely shuts out the organisms
from the air, thus constituting a valuable auxiliary to antiseptic medi-
cine.

By its elasticity we get equal j^ressure at all i^oints. These two jn-op-
erties it should possess in a high degree.

It should be applied so as to press only ver}j lightly ; should be re-
moved and re-applied two or three times daily, after being washed in
carbolic acid water. — An Abstract from Qaz. Med, di Roma.

100

CURRENT LITERATURE.

BEATON'S OPERATION FOR TJIE RADICAL CURE OF

HERNIA.*
By George W. Gay, M. D., Surgeon to the Boston City Hospital.

The Ileaton method of treating inguinal hernia for a radical cure
consists in moistening the fibrous tissues of tlie inguinal canal and
rings with a preparation of \vhite oak bark, and applying pressure
by means of a compress and bandage to keep the canal closed, and
prevent the descent of the hernia until the contracted tissues be-
come strong enough to support the strain imposed upon them. The
originator of the treatment claimed that by this method of "tendi-
nous irritiition," a permanent contraction of the fibrous structures
was produced, which resulted in a lasting cure of the affection.

The fluid recommended for injection is composed of fourteen
grains of the solid extract of white oak bark, thoroughly rubbed up
with half an ounce of the fluid extract of the same drug by the aid
of gentle heat. The mixture is thick and muddy, and requires
thorough shaking before using.

The operation is perfarmed as follows : The hernia having been
reduced, and the sac also, if possible, an instrument resembling the
hypodermic syringe, charged with the astringent, is thrust directly
down through the skin into the external abdominal ring, and the
point of the needle carried up the inguinal canal in front of the
spermatic cord to the internal ring. The fluid is deposited slowly
while Avithdrawing the instrument, the point of which is to be
moved about in all directions, in order that the astringent may be
distributed as evenly as possible throughout the canal. A com-
press and bandage are a2)i:)lied at once, and worn for a few weeks,
when, in the successful cases, the rupture is cured, and requires no
further support.

Twenty-four hours after the operation there is usually present
some effusion and tenderness in the inguinal region at the seat of
injection. The former may remain for an indefinite period ; tlie

*Read before the Surgical Section of tlie Suffolk District Medical Society, Novem-
ber 19, 18S1.

RADICAL CURE OF HERNIA. 101

latter cominouly subsides in a few days, except in those unfortunate
cases which terminate in suppuration. In some instances no thick-
ening or effusion can be detected after the operation, while in other
cases complete absorption of the exudation takes place after a time,
and the i:»arts return to their former condition. At the end of a
fortnight, in the favorable cases, when the patient is allowed to
leave the bed, the external ring will be found much reduced in size,
and it is with ditliculty that the finger can be introduced into the
canal, where, previous to the operation, it passed easily.

Should any of the fluid be allowed to escape into the areolar
structure outside the canal, it is apt to produce a mass of indura-
tion in the loose tissues, which may persist for some time, but which,
from its location, size, mobility and gradual absorption, can seldom
serve in any degree to prevent the hernia from coming down. Fur-
thermore, cellulitis and abscess may result from this cause. Sup-
puration occurred in two of our patients. The abscesses were deep
seated, apparently extending through the anterior wall of the in-
guinal canal. The resulting infiltration entirely disappeared in a
few weeks after the abscesses closed, and in one case the hernia re-
turned. These complications increase the suifering, prolong con-
valescence, and, in our opinion, add nothing in the success of the
operation.

Dr. Davenport, who edited Dr. Heaton's book, and who was a
careful and conscientious observer, always strongly insisted to the
writer upon the importance of setting up only a very moderate local
action by the injection ; anything like severe inflammation was to
be avoided if possible. lie believed that white oak bark had a
mild yet persistent astringent effect upon fibrous tissues, which was
more lasting and less violent than that resulting from ordinary in-
flammation. Hence, it is the fibrous, and not the cellular struc-
tures which require the application of the astringent.

Where is the fluid deposited, in this operation ?

This is an inquiry that has often been made, but to which, in the
absence of any examination upon the cadaver, it is difficult to give a
satisfactory answer. Theoretically, it should bathe the fibrous
structures in contact with the neck of the sac. Practically, the sur-
geon, depending largely upon his anatomical knowledge of the
parts, carries the needle up to the vicinity of the internal ring, and

102 RADICAL CURE OF HERXIA.

slowly empties the syringe during its withdrawal. Whether the sac
is penetrated or not is probably largely a matl^er of luck, rather
than of skill for in cases of old hernia it would seem hardly practi-
cable to guide a needle between the sac and walls of the canal with-
out penetrating one or the other. In some cases the needle moves
above in the canal with great freedom, giving one the impression
that it has entered the cavity of the peritoneum ; yet in twenty-
seven operations I have never seen anything like peritonitis. With
few exceptions, there has been only a moderate local disturbance,
which did not require treatment, and which subsided in a few days.
Although the pain of the operation is not severe, yet in children an
anesthetic is required to prevent the struggling and straining from
forcing out the contents of the rupture before the bandage is
applied ; timid and nervous people also need it to enable them to
keep still. Opiates are not usually called for during the after-
treatment.

Below will be found a brief report of all the cases operated upon
by me, both in hospital and private practice, with the exception of
two, which have been under treatment but a few weeks. The re-
sults are stated as fully as possible, and no patient is reported cured
who has not remained well for at least a year after discarding all
support to the rupture.

Case I. — A waiter, aged twenty-four years, entered the hospital
suffering from an inguinal hernia of moderate size on the left side ;
a truss had been worn. September 9, 1877, the patient was ether-
ized, rupture reduced, and ten drops of the Ileaton mixture in-
jected into the inguinal canal. A compress and bandage were ap-
plied, and the patient remained in bed two weeks. He was dis-
charged, wearing a bandage, at the end of five weeks. The exten-
nal ring has been reduced to one-half its former size by the opera-
tion, and the rupture had not returned.

Case II.— K sailor, thirty-four years of age, with a reducible in-
guinal rupture of seven months duration, was operated on at the
same time, and in the same manner as the previous case. He was
discharged in four weeks, wearing a truss ; the ring was contracted
somewhat, but not sufficiently to control the hernia.

Case III.— A harness-maker, aged forty-five, subject to asthma
and bronchitis, had a right inguinal hernia of some years duration :

KADICAL CURE OF HERNIA. 103

the ring was large, and rupture uncontrolled by a truss. Operation
June 10, 1878. Although the size of the ring was somewhat reduced,
the intestine came down during an attack of severe coughing, and
he was discharged not relieved.

Case IV. — A policeman had an omental rupture of two years'
duration, which extended half-way to the bottom of the scrotum,
and could not be controlled by a truss. The operation by injection
was performed twice in as many months, with the result of reduc-
ing the ring to the size of a pipe-stem, but a strand of the omentum
still came down, though it could easily bo kept up by a truss. Being
very anxious to obtain a radical cure, he afterward submitted to an
operation for the removal of the protruding omentum, but with
only a partial success. He is now wearing a truss.

Case V. — A boy, a year and a half old, with a double inguinal
hernia, was operated upon in 1878, in the out-patient department of
the hospital. The after-treatment was neglected, as the mother
failed to bring him back to have the bandage readjusted. The ope-
ration did no good, and the child now wears a truss.

Case VI. — James, twenty-one months old, right inguinal hernia*^
injected with three drops of the oak bark ;^wore bandage only a
week ; remained well at the end of fourteen months.

Case VII. — Michael, two and a half years of age, had a right in-
guinal hernia which had lasted six months ; the ring was large, and
two operations were performed. Three years later the rupture came
down, only after great straining; he had]worn no support.* It
seems fair to consider him much relieved by the injection.

Case VIII. — A house painter, aged twenty-four, subject to con-
vulsions, was injected for an inguinal rupture. The fits returned
three days after the operation, when he jumped out of bed, pulled
off his bandage, and the rupture returned. No benefit was received
from the operation.

Case IX. — Daniel, aged twelve,Vthin, spare boy, had a scrotal
hernia with large rings, and loose pillars. Was injected twice within
two months. He remains well at the present time, and has not
worn a support for nearly two years.

Case X. — A boy, four years of age, was operated upon for an
omental hernia running into the scrotum, with little if any relief.

*I have lately repeated the operation upon this child.

104 RADICAL CURE OF HERNIA.

Case XI. — John, six years old; inguinal rupture, which had
come down only a few times ; it was reduced under ether about a
week before the operation by injection. The ring was small, and
hence peculiarly adapted to this operation. The little fellow' was
running about in a week, and has had no return of his rupture. It
is now nearly two since the operation. This patient would very
probably have recovered by wearing a well-fitting truss.

Case XII. — For a year Miss , aged thirty-eight years, had

suffered a good deal from an omental hernia, which came down into
the right labium in spite of any truss she could apply. The opera-
tion was performed as in the male, and she remained in bed about
a month. The resulting inflammation in this, as in all the cases
narrated thus far, was very moderate, never threatening suppura-
tion. She wore an abdominal supporter for several weeks. Four-
teen months after the operation she remained well.

Case XIII. — A man, fifty-eight years of age, entered the hospital,
suffering from the early symptoms of strangulation of an inguinal
hernia. It was reduced under ether, and the operation for a radical
cure performed some weeks later. When he left the hospital, at the
end of three weeks, the hernia had not returned, and the little fin-
ger could not be passed into the external ring. As the rupture was
intestinal, the operation promises to ba successful.

Case XIV. — A baby, ten months old, was brought to me with
double inguinal hernia, which trusses did not keep in place. Both
were operated upon for the first time over a year ago ; aa the child
has since had measles and whooping-cough, without bringing down
the left rupture, we may safely call that one cured. Suppuration
followed the injection upon the right side, and the operation has
been rejieated twice without success. The rings are large, the in-
gninal canal is short, and thus far no truss has been found to con-
trol the hernia. The operation is to be repeated after the child has
fully recovered from whooping-cough.

Case XV. — Mr. F., aged twenty-three, suffered a good deal from
inguinal herniae, which could not be controlled by trusses. The
rings were large, pillars]^thiu, and abdomen flat. Both ruptures
were operated upon without ether a year ago. Large effusion fol-
lowed the injection, resulting in an abscess on each side, which was
a long time in closing. Neither hernia has returned ; the patient
wears a double truss, and has been greatly relieved by the operation.

RADICAL CURE OF HERNIA. 105

Jlecapilulatioii. — Number of patients, fifteen ; cured, four ; re-
lieved, eight ; not relieved, three. Number of ruptures, eighteen;
cured, five ; relieved, eight ; not relieved, five. Number of opera-
tions, twenty-three.

With two exceptions, the above eases seemed to be favorable ones
for the operation. That it was not more successful may very likely
be due, in part, to the lack of skill and experience in the operator;
in part to the imperfect after-treatment, especially in several in-
stances, occurring in the out-patient department of the hospital ;■
and finally to the fact that a second operation could not be obtained
in several cases, in which not quite sufiicient contraction resulted
from the first.

While, I do not feel justified from my limited experience, extend-
ing over only four years, in expressing a decided opinion as to the
real value of the oak bark treatment of hernia, yet my impression
is, that in the inguinal variety^ of the affection it is often a good
method, and is worthy of further trial and study at the hands of
compe'ent sni'geons. It would seem peculiarly adapred to cases
with small rings, and to cases occurring in children, when Nature
herself is making a constant effort to correct the deformity, and
requires but little assistance to enable her to accomplish the result.

I know nothing of the merits of the operation in other kinds of
hernia ; but in the one under consideration lean but conclude that
it is safe ; it is not very painful ; it is not very difficult to perform;
it docs little harm; even if it docs no good ; it will cure a certain
number, and will relieve others. — Boston' Medical and Surgical
Jonrnal.

Corporcd Examination Without Assent. — It may not be general-
ly known, but we are struck with a recent statement made in the
British Medical Journal, (January 7, 1882) tliat the inspection of
one's person without his or her consent, as in the instance of the
examination, by a physician of a woman for illegitimate birth, at
the instance of magistrate, renders that physician liable to proscu-
tion for assault.

lOG

ON TAPPING THE BLADDER FROM THE PERINEUM
THROUGH THE IIYPERTROPHIED PROSTATE.

By REGi]!fALD Harriso:n', F. R. 0. S., Surgeon to t])0 Liverpool
Royal Infirmary.

Tapping tlie bladder is an operation which is not often necessary;
I believe it may occasionally be resorted to even when a catheter can
be passed. Assuming it to be required, how is it to be done ?

Tapping with tlie aspirator-needle above the pubcs is a safe pro-
ceeding, and for affording temporary relief is to be recommended.
A surgeon who finds himself in difficulties with a distended bladder,
a large prostate, and false passages, is likely to do less harm with the
needle than with the catheter, and is sure to give relief. Taking
off the tension by withdrawing the urine generally permits tlie in-
strument to pass on the next trial. This method, however, can only
be used for temporary purposes.

Tapping the bladder above the pubes with a trocar for the pur-
pose of establishing a more or less permanent drain is very much
like opjening an abscess at its least dependent fpot. Urine ascends
the canula against gravity, and the products of inflammation of the
bladder, usually present in some degree, remain behind in the pouch
undischarged. Tapping through the rectum requires the retention
of the canula in the intestine, and is thus an obstacle to defecation.
Forcing the end of the catheter through the enlarged prostate is an
unsurgical proceeding not to be entertained. Tapping the membran-
ous urethra leaves us in the position of having the obstructing
prostate behind the opening. There is a point in the wall of the
bladder unconnected with the peritoneum through which a trocar
and canula may safely be passed. I refer to the prostate gland,
which, in old men, where paracentesis is more frequently required,
often affords a considerable area for the operation. I will illustrate
this method by the following case, only premising that over twelve
months ago I recognized its propriety, and tested it on the dead
subject. I then had the instrument made for the purpose ; but
though having considerable opportunity far dealing with retention
of urine under all circumstances it was not until quite recently that
a case in point presented itself. I mention this as explaining how

TAPPIXG THE BLADDER. 107

I came to be prepared itiatrumentally for doing that which I will
briefly describe :

X. D., aged eighty-fonr, was admiltcd fco the Liverpool Royal Iti-
firriiary at 2 A. M., on 4th of Xovember, 1881. My liouse-surgeon,
]\lr. Laimbcer, found him bleeding from attempted catheterism with
a large prostate, and a distended bladder. Recognizing the urgency
of the case, and finding catheterism impracticable, he emptied the
bladder with the aspirator above the pubes. I saw the patient a few
hours afterward, and found that he had not passed urine since, and
that no catheter could be introduced. His tongue was brown, and
he much exhausted. Later on, I again visited him, when the blad-
der had become fully distended. I then had him placed under ether,
and succeeded in passing a gum-elastic prostatic catheter. Beyond
demonstrating that the ditBculty had been overcome I declined
letting any more urine be drawn off for a reason arising out of
recognizing that either the catheter must be retained or re'in-
troduced when required ; neither of which proceedings I was dis-
posed to recommend.

Retaining a catheter in the bladder of an old man somewhat
childish, and disposed to remove any appliance if not closely
watched, is not easy, and when it is done it often ends with death
from cystiti?, pyelitis, and exhaustion. This was a case where, in
my judgment, it was wisest to establish a permanent drain ; and to
do this in the manner on 'which I had Jetermined required a tense
and not a flaccid bladder. Taking a trocar which had been made
for the purpose, with a silver canula I introduced it in the median
line of the perineum, three-quarters of an inch in front of the
anus, and pushed it steadily through the prostate into the bladder,
at the same time retaining my left index finger in the rectum for a
guide. On withdrawing the trocar a large quantity of ammoniacal
urine escaped. The canula. being, provided with a shield, was se-
cured in its place by tapes much in the same way as a tracheotomy-
tube. A piece of India-rubber tubing was attached to the i)ortion
of canula which projected beyond the shield, and conveyed the urine
into a vessel placed at the side of the bed. The urine continued to
dribble through this tubing. The patient was at once made com-
fortable by this arrangement, and in forty-eight hours he was up,
sitting in an easy-chair — an important tnatter with old persons. To

lOS TAPPING THE BLADDER.

permit of this the rubber tubini; is shortened daring the day-time,
the end of it being tucked through a light abdominal belt, where it
is compressed by a small pair of bull-do^ forceps, which are re-
moved when the patient desires to pass urine. He is quite as well
as most men of eighty-four years of age are. lie gets up daily,
takes hisfood, and sleeps comfortably, either on his back or his side,
without any narcotic, and is quite free from any urinary inconve-
nience other than wearing his tube. During the night his sleep is
not broken by calls to micturate or pass catheters, as his urine runs
off by the tubing as it is excreted ; while in the day-time when he
is up and about his act of micturition practically resolves itself into
something equivalent to the turning of a taj). His urine, which
had been fetid and ammoniacal, is now neaily normal, the bladder
being readily washed out by applying a syringe to the canula twice
a day. On two or three occasions the canula has accidentally
slipped out while the tapes were being changed, but has been readily
replaced by the nurse. The somewhat enthusiastic manner in which
the patient compares his present with his past condition can not be
passed by entirely unnoticed.

The operation was devised much on the same lines I endeavor to
take in commencing my lithotomy incision — namely, the selecting
of a point in the perineum which endangers no vessel of importance.
My object in planning the operation was to obtain what I can best
describe as a short low-level urethra, adapted to the altered relations
of the bladder to the prostate when the latter becomes enlarged, for
the purpose of socuring the most complete drainage. I shonld add
that since the tapping, as far as we are aware, the patient has only
passed a few drops of urine by the urethra. — British Med. Journal.

I)rs. n. C. Wood and Formad desire to know of the existence of
an epidemic of malignant diphtheria, in order that they may con-
tinue their research upon the nature of the diphtheritic poison. Dr.
Formad will go to any locality within eight hundred miles of I'hil-
adelphia. Letters may be directed to the T^niversity of Pennsylva-
nia.— r]iih((lcl}>]iia MriL Tiini's.

lot)
WHAT IS BIJIGHT'S DTSEzVSE ?

It is, we believe, currently reported and geuerally believed that
an old fcgv by the name of T>righf, who was connected with <iny's
Hospital some years ago, asserted that lie had seen a number of pa-
tients all having drops)', with albumen in their urine, whilst after
death their kidneys were commonly found to be diseased. These
symptoms and conditions he grouped together, and to them cer-
tain iudividuaU still more silly than himself gave the name of
Bright's disease." But it is evident that this Dr. Bright had no
gift of imagination, for he actually worked long and hard before he
came to the trifling conclusions above referred to ; beyond all, he
could never invent his facts, nor had ho the gift of twisting tt.em
about so as to prove anything. In short, he is what Americans
would call a " very or'nary cuss'' after all. But sec what has been
done since his day I Why, his disease, though it is by the weak-
minded still supposed to kill a large proportion of our fellow-mor-
tals, has actually been improved off the face of the earth ! First
it was found that the same CDudition of kidney would sometimes
give rise to dropsy, and sometimes not : especially this was noted —
that in the same individual, dropsy mightexist at onetime, and not
at another ; so the dropsy was dropped as one of the necessary
symptoms. Then it was found that albumen was not always plen-
tiful in the urine ; yea, that it was sometimes absent altogether : so
the albuminuria has been got rid of as an essential feature in
Bright's disease. Only one thing more remained, and that was tlie
kidney disease, which has now apparently gone the way of all the
rest; so that we have the pleasure of contemplating a disease which
no longer possesses any oithe characters by which it was originally
distinguished. These are great achievements, doubtless; but de-
struction comes naturally to mankind. Look at the new theories
constructed I Some of the wicked ones, we fear, would, with re-
gard to these, say that the zeal which comes not of knowledge
might be better employed even in coining words than in building
hypothesis on hypothesis— a kind of tower which has little chance
of reaching to the heavens, or, indeed, attaining to any greater
height ijian other fungoid growths similar to itself. — Medical Times
and Gaxelte.

110,

NO'JES.

Xahiral Deposit of Epsom SaUx. — In the iSouthein ]iart of I'olk
County, Ga., there is reporlcd to be "an undeveloped mountain
of Epsom salt," The latter, it is said, crops out all over the ground,
and an ounce of the earth put into a glass of water will give a good
solution of salts. — Xeic Ih'niedt'es.

A Xew Kymograph. — Dr, Edward T. Iieiehert, of Philadelphia,
has invented a new and cheap kymograph. [Midical Times, Jan-
uary 28th, 1882.) lie says that the want has been long felt to get
an instru ment cheap enough to bo within the reach of the many
students of phys-iology. Tiiis apparatus graphically records the
etfects of drugs on the circulatory and respiratoiy systems. Dr. II.
C Wood says the teachings by this instrument are as clear as any he
has seen in this country or Europe.

ChinoU/ie. — This propo-sed new substitute for rpiinine is an oily
liquid of peculiar odor. It is insoluble in water, but readily solu-
ble in alcohol. With acids it forms soluble salts. With tartaric
acid we get a salt of beautiful silky crystals, soluble in water, hav-
ing an odor resembling bitter-almonds, and a taste similar to pepper-
mint. This is the preparation best adopted for internal use. It is
one-fifth the price of quinine. Wo welcome it to the unenviable
stage of probation, and wait to see if it can rival (luinine.

Discs of tlte Alkaloids ■for Hypodermic Use. — It will at once
strike the practitioner that if a disc of soluble material for^liypo-
dermic use, containing carefully divided doses of the more dangerous
alkaloids, such as morphip, apomorphia, atropia, and strychnia,
could be devised, it would be a matter of great convenience. Solu-
tions do not keep for any length of time. Such a disc has been
made, the vehicle being sulphate of soda, and it is found that the
alkaloids keep well this way, and are very convenient. We have
been usinjr them recently with entire satisfaction.

Emmdt on Hypodermic Use of Morphia. — Ot aW modes, [of the
administration of opium] that of the hypodermic syringe is the

XOTES. Ill

most dangerous, since it can be so I'cadily cmplojed. The invent{>r
of this method has given, I fear, a curse to the human race instead
of a blessing. I may be deemed prejudiced, but I have long felt
that the medical profession is largely responsible in the abuse of
this instrument, for the wide-spread existence of the opium habit.
This vice is increasing so rapidly all over the country, that we shall,
to our sorrow, at no distant day. rival the Chinese in the consump-
tion of this druff.

liifainmahiUtii of Ether. — An accident is narrated in the Xash-
ville Jonv. Mccl. and Surr/crj/, showing how careful a surgeon must
be in using ether as an anesthetic. The warning is especially
necessary to Southern physicians, as they seldom use ether, and
might overlook this danger. In the case reported the ether diffused
in the atmosphere of the room was ignited by the spirit lamp of
the a'omizer, and the patient undergoing surgical operation barely
escaped a serious accident by fire.

Xose-]>Jeid. — Dr. George M. Leffeits {Mediral Xews, January 2S)
gives a good practical hint about nose-bleed. Frequently recurring-
attacks are many times treated unsuccessfully by means of ergot and
iron internal]}', and by plugging, syringing, &c., &c. In such cases
an examination of the mucous membrane of the anterior nares
should be made. It is easily done with a suitable light and specu-
lum, even without the latter in many instances. This examination
will reveal an erosion of the mucous membrane of the cartilaginous
septum, just above the point of the former's junction with the skin.
Thq^erm ulcer cannot be applied to the lesion, as there is no marked
excavation. The secret in the success of treatment lies in the care-
ful, direcf treatment of the eroded point. Prevent the patient from
removing the crusts of inspissated mucus and blood which form,
and also by the unremitting use of vaseline or cosmoline. Astringent
solutions of copper are then useful. Xiti-ute of silver should be
avoided.

Hot 7/ater in the Treatment of Hemorrhoids. — Landowski
{Chi. f. Chir., 188], Xo. 38 ; from Jour, de Ihcrap.) suggests hot
sitz-bath in bleeding piles, together with enemata of hot water.
These not only check the bleeding, but diminish the size of the

112 NOTES.

turgescent tumors to ;i marked degree. In ordinary hemorrhoids
three sitz-batlis per diem may be employed. In bleeding piles the
baths shonld be more frequent,, and the enemata should be given as
hot as the patient can bear (usually about 101°). — riiilndclpliia
Medical Tunes.

Cov)piIalio7i of Facta Ahuvt a Xeio Medicine {PoioelVs Beef Cod
Liver Oil and I'epsin) — A Superior Tonic and Nutrient — by Lead-
ing Practitioners. Dr. Jloward S. Inline, Alhanij, N. Y. : I have
tried it on myself ; good results. I will recommend it profession-
ally. Dr. Edward A. Alcorn, nustonville, Kij. : I gave it to my
daughter ; disease, phthisis; great wasting away. She took it with
impunity, and received great benefit from its use. Dr. A. M.
Pojvell, Catawda, JV. C. : I tried Beef, Cod Liver Oil and Pepsin
(Powell's) on myself. I was broken down — nervous and liver tor-
pid ; results and relief beyond my expectation. I unquestionably
recommend it. Dr. C. II. Hejjhurn, Sapcriniendent Lidian T'rai)i-
ing tSchool, Carlisle, Pa. — My patients derive great benefit from its
use. — Exchanges.

Violin Strings as Bougies, — Dr. Daniel (Jackson, Miss.,) in the
Transaclions of Mississippi Medical Associa/ion, relates two cases
of very tight strictures of the urethra, where, failing to pass the
smallest bougie, in the emergency he used a fiddle-string. This
passed easily. Being withdrawn in a few minutes,it had swollen near-
ly twice its previous size ; u string was passed and allowed to remain
fifteen minutes. Tiiis being withdrawn, the urethra was dilated
Bufiiciently to allow the passage of a No. 4, and then of a Iv). 0
bougie, and finally, a flexible Nelaton catheter, threaded on a fiddle-
string, was introduced. Dr. Daniel claims for the fiddle-string
cheapness, simplicity, availability, harmlessness, strength, and rapid
expansion. — J. B. 31., in Vichshurg Herald.

The Management of Fever in Children. — The antipyretic treat-
ment of fever in children by cold water, quinine and salycilic acid,
IS the subject of some remarks by Dr. Forster {Jalirh. f. Ivinder,
xvi.) The indication for their employment may be stated to be
when danger supervenes from either the heiglit or the duration of

NOTES. 113

the pyrexia. Accurate observations are still wanting on the effects
of cold baths, but their therapeutic value is greater than in adults,
and their action more intense, since the body-surface is greater in
proportion to the body-volume in [^childrcn. There appears to be
considerable difference between rectal and axillary temperatures
after cold baths, and a marked fluctuation for sometime afterwards.
In cases where baths are not applicable, cold-packing, sponging, or
spraying may be employed : but the effect is not so marked. Qui-
nine and salicylic acid have a more permanent effect than cold water,
and should be given to children in doses much larger relatively to
their body-weight than is the case in adults. Their use is frequently
followed by vomiting ; and in those diseases attended by failure of
the heart's action, as diphtheria, quinine is to bo preferred. — Lon-
don Med. Eecord, Dec. 15, 1881.

Hilpodcriaic Injeriions of Ilijdrocliloratc of Morpltia in Insanili/.
— Dr. Yoisin, of the. Salpetriere, has published twenty seven cases
of insanity so treated, in addition to those which he published in
187-t, and repeats the statement then made, that these injections
have furnished the most satisfactory results. In this second me-
moir he calls attention to the importance of combating the neuralgic
pains met with in the insane, experience having shown that a
good number of these patients called hypochondriacs become, after
a period of more or less years, the subjects of organic cerebral or
spinal affections, the evolution of which would have been prevented
had the pains been effectually treated. The new cases are almost all
examples of lypemaniac insanity. They are the depressive forms of
insanity, and especially those which have been preceded by antemia
and asthenia, that are most amenable to the morphia treatment,
which is also very eflicacious in hysterical insanity. It is not suit-
able for acute cases unless no secondary changes have occurred in
the vessels and cells, and when the cerebral substance and the mem-
branes are not hypcra?mic. The doses required are very variable,
for while in some patients very large doses may be given without
any physiological or therapeutical effect being produced, in others
very feeble doses are not tolerated. Thus one patient received
daily in two injections two grammes without any ill effect ; another
could not receive the tenth of a milligramme without vomiting dur-
ing the whole day. It is of importance to know that any patient
improving under tliis form of treatment becomes less andlcss tole-
rant of the remedy, the intolerance thus becoming a favorable
symptom. — Gaz. dcs Hop., September 24-.

114

BOOKS AND PAMPHLETS RECEIVED.

IllnsLrations of Dissections in a Series uf Original Colored Plates
the Size of Life. Piepresenting the Dissection of the Human ]?ody.
By George N. Ellis and Cf. H. Ford, Esq. Vol. I. Second Edition.
New York: William Wood c't Co., 27 Great Jones Street, New
York. 1882.

A Treatise [on the] Diseases of the Eye. By Henry D. Noyes,
A. M., M. D., Professor of Onhthalmology andOtology in Bellovno
Hospital Medical College. New York : Wm. Wood & Co., 27 Great
Jones Street, New York. Pp. 3G0. Illustrated by numerous wood-
cut engravings, and chromo-lithographs.

Eighth Annual Report of "the Secretary of the State Board of
Health of the State of Michigan. For the Year Ending Sept. 30,

1880. Lansing : W. S. George & Co., State Printers and Binders.
1S81. Pp. 510.

A Study of the Tumors of the Bladder with Original Contribu-
tions and'Drainage. By Alex. W. Stein, M. D. New York : Wm.
Wood & Company, 27 Great Jones Street. 1881. Pp. 94.

Small Pox : Restriction and Prevention. Issued by Connecticut
State Board of Health. Copies may be had by applying to the Sec-
retary, Hartford, Conn.

Tlie Fourth Annual Report of the Presbyterian Eye and Ear
Charity Hospital, No. 79 East Baltimore Street, Baltimore, Md.
For the Year Ending December 1, 1881. Baltimore : Hugh S.
Oren, Printer, 11 North Street. 1882.

Chronic Club-Foot Successfully Treated Without Tenotomy, by
Continuous Extension and Stretching. By James S. Green, M. D.
Reprint from the New York Medical Journal and Obstetrical Re-
view, November, 1881. Pp. 9.

Some Remarks Upon National and International Sanitary Juris-
prudence. By Thomas J. 'Turner, A. M., M. D., Ph. D." 1881.
Read before the American Public Health Association, November,

1881. At its Annual Session in the City of Savannah, Ga. Boston :
Franklin Press : Rand, Avery & Co. 1882. Pp. 40.

Transactions of Medical Association of Georgia. Edited for the
Association by A. Sibley Campbell, M. D., Secretary, Augusta, Ga.
Augusta, Ga. : Printed for the Association by Joseph Lovcday,
Reynold Street, mdccclxxxi. Pp. 314.

Vaccination : Advice on the Necessity of Vaccination ; The
Value of Vaccination ; The Tests of Successful Vaccination ; How
Often Re-vaccination Should bo Done ; The Quality of Vaccine ;
The Best Way to Use Vaccine ; How to Prevent and Exterminate
Small Pox ; The Construction of Small Pox Hospitals, ttc. Issued
Gratuitously by the North Carolina Board of Health. Raleigh:
Ashe & Gatling, State Printers and r>indors. 1882. Pp. 13.

NORTH CAROLINA

MEDICAL JOURNAL..

THOMAS F. WOOD, M. D., Editor.

Number 3. Wilmington, March, 1882. Vol. 9.

ORIGINAL COMMUNICATIONS.

HYPNOTISM.

A Clinical Lecture Delivered at the Philadelphia Hospital, Decem-
ber 21, 1881.
By Charles K. Mills, M. D,,
Neurologist to the Philadelphia Hospital, and Lecturer on Mental
Diseases and Electro-The'rapeutics in the University
of Pennsylvania.
Repor'ed by Wii. H. Morrisox, M. D., for the North Caro-
lina Medical Journal.

Gentlemen : — I will devote my hour, to day, to the considera-
tion of hypnotism. This is one of the fashionable subjects of the
day ; it is one that is of great interest to the neurologist, and one
which, I think, should have a certain amount of interest for the
general practitioner of medicine. The whole question of what is
called hypnotism, involves many points in the physiology and
pathology of the nervous, system. It may also have a certain
amount of practical application in the diagnosis, prognosis, and

116 HYPNOTISM.

even in the treatment of certain forms of diseases of the nervous
system.

I have no interest in this subject, except, of course, a legitimate
interest, one based upon the considerations to which I have just
alluded. I did not at first have much faith in the production of
the hypnotic condition ; I do not know that I have now as much
faith as some in the extraordinary phenomena of hypnotism; but
from what little clinical experience I have had, and the few experi-
ments that I have performed, I am convinced that it is quite possi-
ble to produce in the human subject, and also in animals, a certain
peculiar condition which, for want of a better name, is called
hypnosis.

Of course, in atten)pting to perform any experiments of this
kind, and particularly before a class, we run a certain amount of.
risk of failure. We may fail in certain cases, in which, uoder other
circumstances, we would bo successful. If we are successful, we
run a risk of being charged with deception. Certainly no one who
knows me, would, for a moment, imagine that I would have any
collusion with a patient. I have, however, no doubt that simula-
tion and collusion do often, enter into exhibitions of hypnotism.
They enter into many public exhibitions, for the operator charges a
certain price for admission, and it is necessary that the experiments
should succeed in order that he may be financially successful.

My own experiments have been chiefly on cases of hysteria.
This, in itself, might, at first sight, make you suspicious of the
genuineness of the peculiar phenomena ; but, if you think .for a
moment, there is no reason for such a suspicion, unless hysteria
means malingering on the part of tha patient, or collusion on the
part of the operator.

Many sources of error are to be guarded against. The subjects
may deceive you. They may deceive me this morning unless I am
on my guard. They may intentionally deceive, or they may unin-
tentionally deceive in reference to some things. You may deceive
yourself. Of course, it is possible for the operator to intentionally
deceive, but that source of error, of course, is thrown out in the
case of a responsible operator of good character.

I have not succeeded in producing this condition in many sub-
jects. I have experimented on a number of healthy. individuals,
and have failed in all but two, or at the most, three instances ; and

HYPNOTISM. 117

in these the success was only partial ; i. e., I produced a certain
degree of the hypnotic state ; for there are degrees of this condition.
I have experimented on a few insane people, but as yet without suc-
cess. I have experimented on feeble minded children, with one
success. I have also experimented on animals. As long ago as 1G-4G
Father Kircher discovered that if he tied a hen's legs together, and
then put her beak down to the floor, and draw a chalk line forward
from it, that the chicken went to sleep and when she was untied did
not attempt to move. Kircher thought that this was due to the
imagination of the chicken, which seeing the line thought that it
was the string with which it was tied. Some of you have doubtless
performed similar experiments upon chickens. I have performed
them with some success. I remember well one old rooster, which if
his head was placed to a black-board and a chalk line drawn either
from his beak or from each eye, would remain in a stupid condition
almost indefinitely ; but some body present on one occasion when
this rooster was on exhibition suggested that he was a stupid old
fellow anyhow. I have experimented on a guinea hen but she re-
mained for only a minute in this condition. In experimenting on a
rabbit, and on some small birds, the success was only partial.

r)jfferent conditions of the hypnotic state are seen. If you ope-
rate on hysterical patients you can produce two different conditions,
possibly three, as pointed out by Charcot and Richer. In the first
place, you can bring about a condition of lethargy ; secondly, in
some instances, you can produce a cataleptoid state. Sometimes the
cataleptoid passes into the lethargic state. Certain phenomena are
usually present in this state of hypnosis. As a rule, the pulse,
respiration and temperature change, as the patient passes into this
condition. The patient, of course, cannot simulate these changes.
A loss of sensation to pain, or analgesia,is produced. You can pass a
needle into the skin without exciting any pain. Let me here guard
you against one error; often in these cases where the sense of pain is
abolished, the sense of touch is not. They will feel the contact of
the needle, while they are not conscious of pain. An increase of
reflex irritability is another marked effect. It is necessary in per-
forming these experiments to preserve perfect quiet.

Case I. — This patient has been in the hospital for some time and
represents one form of hysteria. She has had both hysterical and

118 nYPNOTISM.

epileptic attacks, a trouble sometimes spoken of as hystero-epilepsy,
with distinct crises, i. e., with attacks of true hysteria and of true
epilepsy.

In producing hypnosis, I simply use a faceted glass button, or a
crystal with faces, phiced on a dark ground. This is the method
employed by Mr. Hansen. Hansen is a mesmerist, who lead Heid-
enhain to take up the subject. The latter used, passes, as I do my-
self, if I find that gazing at the button alone is not successful. It
sometimes takes several minutes to produce this condition.

(The patient was then seated in a chair, while Dr. Mills held a
faceted glass button secured to a piece of black cloth, about six
inches from the eyes and above them, causing the patient to look
upwards and inwards. The button was then gradually brought
nearer the eyep, until it was not more than three inches distant.
In about three minutes the patient's eyes closed, and the button was
removed. The doctor then began to make passes from the middle
of the forehead down each side of the face, and also down each
arm. The left arm was then placed at right angles to the body and
stroked for a few moments. I: then retained this position for a
short time. The lecturer then continued,)

I wish to call attention to three points as we progress. If you
were watching the patient closely, you saw the convergence of the
eyes caused by gazing at the button, a convergence inwards and
upwards. You also noticed, if you were near enough, a change in
the pupil, the pupil contracting and dilating. This was to my mind
a manifestation that she was beginning to pass into the condition,
A little watering of the eyes could also be observed, but this is
sometimes more marked than it was here. You certainly noticed
the closing of the eye?, and the rapid oscilliation of the eye lids.
These are nearly always present. You observed another thing,
always present, in this particular case, which has a certain amount
of physiological bearing ; i. e., as she passed into the lethargic state,
the left arm began to tremble. It did not do so before. I placed the
arm in certain positions and it remained for a short time. It will
commonly stay in any position, in which it is placed for a considera-
ble length of time.

I now produce what is sometimes produced in these cases of hys-
terical lethargy, that is, a condition of contracture. The arm has
been flexed at the elbow and at the wrist.

nYPNOTISM. 119

The pulse, respiration and temperature usually increase consid-
erably as they pass into this state. and then often settle down to a
certa'n level not quite the normal.

The temperature before she was brought in was, in the axilla,
97.3°. It is now 100°. The respirations are 2G in the minute. The
pulse is about 100. These you recognize as above the normal.

(The doctor then took hold of her hand and said, " como."' She
immediately arose from the chair, keeping her left arm in the posi-
in v-^hich it had been placed. She then, with her eyes closed, followed
the doctor as he walked around the table in the amphitheatre. The
doctor made a distinct noise at each step. When he sto])ped the
patient stopped, and again followed when she heard the doctor con-
tinue his walk. She was then conducted to a cbair and told to "sit
down," which she did. A needle was then passed for a distance of
a quar er of an inch into the back of the hand between the fore-
tlnjier and the thumb, without the patient appearing to feel it m
the least ; not a muscle of her face moved.)

Case II. — This patient was a girl 20 years old who had just re-
covered from an attack of hysterical paralysis. She was brought in
and was hypnotized in the same manner as Case I. The button had
not been held in front of her eyes for more than a minute, before
they closed. It was then removed ; but on again putting it before
lier there was a strong contraction of the orbicularis muscle. Ex-
periments similar to those performed on Case I were then shown.

Case I was then awakened by the doctor placing his baud upon
her shoulder,and saying "wake up," "all right." The woman imme-
diately opened her eyes, looked around in a bewildered sort of a way,
and walked out of the lecture room.

Case III. — This patient was a woman about 50 years old. She
was brought in and the button given to one of the resident physi-
cians to hold in front of her.

The doctor continued : We have in this patient a case of true
hystero-epilepsy and, I think, that possibly we may be able to pro-
duce the cataleptoid condition before she passes into the lethargic
condition. The first patient, if I am correct in my supposition,
passed into a condition of altered consciousness; there was a diminu-
tion and change of consciousness. She passed into a state of som-
nolence, lethargy, or artificial sleep. The various changes in the

120 HYPNOTISM.

pulse, respiration and temperature, which in this instance, was not
so marked as they sometimes are, were also manifested. I have
known the respirations^to go up to 44, and once np to 50 in the
minute. Thave seen the pulse reach 140. You saw also the anal-
gesia. In Case II you saw a somewhat^similar condition. She was
in a reiictionless sleep as wag shown by the change in the pulse,
etc., and by the analagesia.

Other experiments in hypnotism are sometimes performed ; these
are spoken of by] various names, as automatism by command,
hallucinations, etc'^^You wilPor will not be successful in these
experiments according to the depth of the state, which is pro-
duced. Our first case passes so deeply into the lethargic state that
it is impossible]^to perform many imitation experiments. In
some cases the patient'passes' into an almost comatose condition.
In thelighter degrees of hypnosis it may be possible that experiments
like those lately exhibited by Dr. Hammond can be performed. He
proposes for this condition the came "suggignoskism," which comes
from Greek words'meaning'to'agree with the mind of another. It
is a word hard to pronounce, but has a pretty good application in its
etymology. In these experiments, a man was made to believe that
he was lugersoll, then an exhorter, and then an individual of an ex-
tremely different character. I am not preparad to speak from expe-
rience in regard to these matters. I have seen and taken part in
such experiments as a spectator, and I am satisfied that there may be
a certain amount of genuineness in phenomena of this kind. (Case
II was now awakened.)

(Case III being now hypnotized, the arms were elevated and re-
mained in this position for a few seconds. The arms were then flexed
at the elbow and wrist, and remained so until the position was
changed by the doctor. Tlie woman was directed to stand up and
both arms were extended at right angle to the body. While in this
position a needle was stuck into both hands as in the previous cases,
the woman manifesting no knowledge of the fact. She was then
seated and the doctor awoke her as in the preceding case. The re*
turn to consciousness was marked by rapid vibration of theeye-lids.
For a few moments the woman did not seem to realize where she
was.)

Dr. Mills then resumed : In 'reference 'to the cases that I have

LIATRIS ODORATISSIMA. 121

shown you this morning, I^believe^that the'phenomena .have been
genuine. You may ask how do yon explain these cases ? Why do
we produce these effects so easily in hysterical subjects and can they
be produced in others ? I believe that the phenomena can be mani-
fested in others. I believe that very many can be'affected to a certain
degree. The condition is not due to the passage of fluid^from you
to the patient, not to^the]^transference of force, nor, in the^strict
sense of the term to one will predominating over that of another.
It is largely a subjective phenomenon ; its production depends upon
the patient, but that does not mean simulation.

The brain is divided into different levels, and these different levels
have different regions. I shall make my explanation as short as
possible. These experiments are other illustrations of the great
doctrine of localization. The surface of the brain is a great per-
ceptional and volitional region. We have near the fissure of Rolando
a great motor region, which governs voluntary motion. In other
regions are other centres for conscious sensation, and so on. In this
condition ef hypnosis, the upper volitional regions are thrown out
of action, and the lower automatic centres have full sway. These
patients only illustrats what you often see'in hysteria independently
of hypnotism.

LIATRIS ODORATISSIMA WILLD. (DOU TONGUE,
HOUND'S TONGUE, VANILLA)— BOTANICAL AND
CHEMICAL NOTES.

^ By Thomas F. Wood, M. D.,' Wilmington, N. C.

A handsome annual plant, with perennial roots, belonging to the
natural order Composifce.

Botanical Descriptmi. — Entire plant smooth. Stem branched
above, and varying from green to purplish at time of maturity.
Root leaves arranged in a circle, from four to fifteen inches long, by
one to three inches wide; smooth, entire ; varying in color from pale
green when grown in damp, rich soil) to a deeper green (when

1'2'Z LIATRTS ODORATISSIMA.

grown in dryer soil) ; often glaucons, tliickisb, obovate-spatnlate ;
three to five ribbed. Stems two to five feet high. Leaves of sttin
clasping, diminishing in length to the corymbs, which are leafless ;
obtusely dentate.

Heads usually seven-flowered, in many cymes, constituting a
large, loose corymb. Flowers bright jiurple ; corolla five-lobed,
lobes ovate ; achenia tapering to the base; pappus minutely bearded,
not plumose.

Root not tuberous, as in many species of this genus ; perennial.

History. — Yov'^mviwy'yQ^xB L. odoratissima has been commonly
used, on the southern seaboard, by housekeepers, for the prevention
of moths, and by smokers for aromatizing tobacco. It was first
collected in quantity near Wilmington, N. C, by M. Giard, a
French teacher, in 18J9. No accounts of the collection of large
quantities have reached us, until after the end of the late war. Its
employment by smoking-tobacco manufacturers gave great reputa-
tion to certain brands, and attracted attention to the plant, so that
for several years it has been a commercial tonka bean.

The distribution of Liatris odoratissima is quite abundant, but
peculiar. From North Carolina to Florida, in the savannahs, and
moist, pine lands, it is found in greater or less amounts. It disap-
pears for miles in some regions quite similar — where other species
of Liatris grow, and where one would expect, by nature of the soil,
etc., to findjt. It grows in circular clumps, among the wire-grass
(Sporobulus ]wnct\xs_K%mt]i) and in open spices, the largest clumps
of leaves usually not sending up a flower-stalk. The soil is a thin,
moist, sandy loam, 'quite dense while moist. The] earliest appear-
ance of leaves3,is in May ; it^flowers in'September and October.
Drainage^'of land causes it_to"^disappear in a few ^seasons.] ^The
leaves reach their greatest maturity just after the flowering season,
and after a hard frost lose their fragrance. ]^The leaves are often
depredated upon'_by insects, but seem'to be^avoided by cattle. "; The
gay purple heads of flowers are very attractive, but entirely in-
odorous.

Ijiatris has no ascertained medicinal properties. It has for a long
time had a reputation for the prevention of moths, and housekeepers
formerly employed it largely for this purpose. Since the war, ex-
periments with it were made in the Quartermaster's Department at

LIATRI8 ODORATISSIMA. 123

Washington, showing conclusively that woollen clothing packed
carefully with well-cured leaves were not in the least protected from
the ravages of moths. The demand now for the plant is confined
to tobacco manufacturers and perfumers. A most delightful per-
fume, resembling the odor of quinces, results from the diatillation
of an alcoholic tincture, giving a basis for a series of new odors, if
skilfully managed.

Properties.— 'The leaves are rarely very slightly odorous when
green, but drying develops a very pleasant odor, quite like that of
the tonka bean, likened by some also to the odor of vanilla ; from
this latter fact it gets one of its local names, vanilla.

Shining acicular crystals are sometimes formed on the surface of
the leaves in the green state as the plant reaches its greatest matu-
rity. When dried, even partially, matured leaves have deposits of
crystals upon their surfaces, but the matured leaves, when dried,
yield them more"abundantly.

In the early season, the leaves are very succulent, losing sixty to
seventy per cent, in drying ; but in September the loss hardly ex-
ceeds twenty per cent.

The odor of the leaves resides in the crystals, although not ex-
clusively. The appearance of these surface crystals was years ago
noticed by Donald McRae, Esq., of Wilmington, who brought it to
the attention of the late Mr. Wm. H. Lippitt, an apothecary. Up
to that time the crystal deposit was believed to be a potash salt. Its
character was determincd^by^Mr. Wm. Proctor, Jr., in 1859, at the
request of Mr. Lippitt. Mr. Proctor found it to be identical with
coumarin, the crystallizable odorous principle of tonka bean.

The leaves retain their fragrance for many years after they are
gathered, a damp atmosphere developing it for months after all ap-
pearance of activity has disappeared. The odorous exhalation from
the leaves is volatile, being more perceptible in the upper stories of
warehouses where it is kept.

Collection and Preparation for Market. — The root leaves are
almost exclusively collected, both on eccount ofjheir size and the fa-
cility of gathering a clump of leaves in one handful. The roota are
not generally disturbed, and it is currently believed that a better
yield, both as regards quality and quantity,*is secured on ground
that has been previously picked over the year before."" j^ Women and

124 LIATRIS ODORATISSIMA.

children work together in the savannahs, one set gathering leaves,
which the same day are spread ont to dry in the snn, while another
set takes them to market. When the bundles are received at the
store of the luirchaser, the leaves are in half dried or wilted condi-
tion, and are there selected and spread out for more thorough dry-
ing in the shade, preparatory to bailing for shipment. An active
young person can gather daily, in a good territory, leaves amount-
ing in weight, when dried, to from eigliteen to twenty-five pounds ;
most of them do much less.

Cltcnustry. — From my examinations, it seems that the odorous
principle is not confined to the coumarin, for after the leaves
have been exhaustively treated by boiling dilute alcohol, and all
the coumarin separated, the remaining extract is still distinctly
odorous.

Coumarin can be separated as follows : Boil the leaves witli the
dilute alcohol, filter off the fluid ; then pack a percolator with the
same leaves, and pass enough boiling dilute alcohol through until
there is but little color obtained. Distil off the alcohol until slight
iridescence appears on the surface of the liquid then pour it off in
a shallow vessel to cool. When cold, coumarin crystallizes iu acic-
ular tufts. Drain the crystals, re-dissolve in hot water, and re-
crystallize, and they become nearly whito.

Several rough experimental assays of the quantity of coumarin
to a given weight of leaves gives the following result :

One pound dried leaves one year old yielded two drachms of pu-
rified white crystals. One pound of recently-cured loaves yielded
about two and one half drachms.

The odor of the older leaves was quite as conspicuous as that of
the more recently gathered, and the discrepancy on the yield of
coumarin was due to the dropping of surface crystals.

Coumarin sublimes at about a temperature of 225°. It first
melts, and after the water of crystallization is driven off, the crys-
tals are made to reform on a cool surface. This statement of the
temp^erature docs not seem to agree with that made by other ob-
servers ; but, after repeated trials, I failed to effect sublimation at
a lower degree.

Coumarin has a pungent, slightly bitter taste, is partially soluble
in the saliva, and when swallowed in small quantities causes a glow

REGARDING IODOFORM: TREATMENT. 125

of heat in the stomach. Iq five-grai:i doses, it quickens the puhe
and causes fulness in the head.

Experiments for the production of coumarin from Liatris point
to the fact that it is formed in the process of ripening of the plant,
and that it exists in exceedingly small quantities before maturity.
Several attempts to procure coumarin by dry distillation of the
leaves failed, although it is very likely that it can be procured in
this way when a proper process has been devised.

FURTHER CONCLUSIONS REGARDING THE IODOFORM

TREATMENT.

Mosetig-Moorhof, in a recent communication in the Wiener Med.
Wochensclirift, comes to the following conclusions regarding the
iodoform treatment : 1. It is almost a speciBc against local tuber-
culous processes. 2. Fungous granulations should be removed be-
fore it is applied. 3. Iodoform placed upon non-fungous surfaces
is the surest antiseptic. 4. It is absorbed and excreted through the
kidneys. 5. It excretes a painless and rapid granulation process and
prevents septic absorption. 6. The heating process is general
afebrile ; the powder sprinkled on the surfaces of the wound does
not prevent primary healing. 7. Drainage is necessary. 8. Red-
ness and swelling occur rarely, and then from retention of secre-
tions. 9. No other disinfectant is necessary. 10. The iodoform
treatment is the cheapest and surest of any ; iodoform keeps for
a year. 11. Iodoform is the antiseptic for operations in cavities — ^
i. e., the mouth, bladder, rectum, etc. 12. It can be deodorized
with tonca bean. — N. Y. Med. Record.

Medical Candor. — Tlie following is not so cad as a story : — A
famous surgeon advises one of his patients to undergo an operation.
"Is it very severe ?" asks the patient. "Not for the patient,"
says the doctor ; " we put him to sleep ; but very hard on the ope-
rator." "How so?" "We suffer terribly from anxiety. Just
think ! — it only succeeds once in a hundred times." — Med Times
and Gazelle.

126

SELECTED PAPERS.

SALICm AND THE SALICYLATES IN ACUTE RHEUMA-
TISM.

The discii3sion at the Medical Society oE London on the Value of
Salicin and the Salicylates in Acute Kheumatism, though it has
given us nothing that is absolutely new, has not been without its
value and uses. There remain still a good many points which we
should like to see further elucidated, but one great fact comes out in
a clear and distinct light — we mean, the salicyl compounds in rheu-
matic fever. * # * *

There arc few diseases more generally prevalent than rheumatism,
very few common diseases which are so painful, and probably none
which, not being directly and immediately fatal, so often leave be-
hind them a legacy of suffering and death. These facts, together
with our apparent helplessness in dealing with it, have led
men at all times to seek some remedy which shall have a
powerful controlling effect on the disease, not only as regards
lessening its violence, but also as giving us some means of
obviating the fatal heart-complications which so often result
from it. And it must be confessed that our search has for
the mos'' part been in vain. When, therefore, Dr. Maclagan an-
nounced that he had found a specific for rheumatism in salicir,
many eagerly grasped at the means of relief thus afforded, whilst
many remained sceptical. This is probably the best frame of
mind for the reception and investigation of any new line of treat-
ment. All of U8 know the multitudes of remedies which have been
introduced, vaunted to the skies, found awanting, and quietly
dropped. All of us have heard of wonderful cures where only
the processes of nature have been at work. Nevertheless, it
is well that there should be enthusiasts to take up and try every-
thing new, just because it is new ; but it is quite as necessary that
there should be cool heads and careful investigators to test any won-
derful results thus obtained. Well, salicin met the usual hap, but
not with the accustomed consequences. From the hands of enthu-
siasts it passed into those of men who had the skill and the means
of testing the value of the drug. It was found in many cases,

SALICIN" AND THE SALICYLATES IX ACUTE EHEUilATISM, 127

though not in all, to be highly beneficial ; but it could hardly be
said to come into universal use until the rare and not-easily-obtained
salicin was to a great extent superceded by salicylate of soda — a
substance first introduced as an antiseptic, but speedily turned to
other uses, in the treatment of pyrexia, and then of rheumatism.
Salicin itself, and the ordinary willow bark whence it is derived,
had long been known in this country, and used — especially in do-
mestic practice — as a tonic, and sometimes as an antiperiodic. In
the latter respect, however, it has always been held as far inferior to
quinine, though in certain cases agreeing better with the stomach,
and not giving rise to the unpleasant symptoms produced by quin-
ine in large doses. Salicylate of soda is a purely laboratory product.
From this and the fact that the two have similar properties as re-
gards rheumatism, it is plain that it is the fundamental principle,
if we may use the expression, that possesses the efficacy, which is
not limited cither to the vegetable or the purely artificial product,
which, chemically speaking, are not identical.

The first real discussion, which took place, as regards the value of
these two remedies, was at the Clinical Society, and arose on the
reading of a paper by Dr. Greenhow, narrating the results of his
own practice. Since that time more material has been collected,
and the ideas in men's minds have taken more definite ehape. But
the great merit, as it seems to us, of the recent discussion at the
Medical Society, is that most of the results have been given in
figures. It is quite true that figures, like edge-tools, are awkward
things to play with, especially when no uniform system of statistics
is adopted ; nevertheless, if they go in accordance with the matured,
but unnumbered results of men's experience and study, the one
strongly tends to confirm the other, and gives to both a weight
which neither could possess apart from the other. It must not,
however, as we have said, be conceived that every point has been
settled with regard to the influence of salicyl compounds on rheu-
matism. Hitherto we have vainly sought an answer to some of the
questions which have arisen in our own mind. Perhaps we might
summarize what stem to us to be the chief questions which require
settlement in connection with the effects of the salicyl compounds
in rheumatism, and cur views as to how far men are agreed with
regard to them. And to the very first question we would ask, we

128 SALTCIN AND THE SALICYLATES IN" ACUTE RHEUMATISM.

are obliged to give a most unsatisfactory answer. We know that
both salicin and salicylic acid are useful in rheumatism, but are
they equally useful, and do they both act in the same way, or rather,
we should say, are their effects identical ? It must be borne in
mind that salicylic acid has been much more widely used, and so its
effects must be better known, than salicin. But, apart from this,
it has been alleged that certain phenomena, especially deafness,
headache, and even interference with the heart's action, do occur
with acid, whilst they are said never to occur with the vegetable
product., Of the former series of these we should think as little as
we do of the similar effects of quinine. "VVe should think that the
remedy was being pushed too fast and too far, but that would
probably be all. The second allegation, if true, is a much more
serious matter. On the other hand, we have it asserted, on good
authority, that the efficacy of salicin is not nearly so great as that
of the acid. At all events tliis is clear — that the vegetable requires
to be given in equal if not larger doses than the artificial product,
even when combined with soda.

The second question we would put, and the answer to which is
again doubtful, is, whether or no the salicyl bodies are true anti-
rheumatics— that is,specifics for rheumatism — or anti-pyretics only?
Tliis question must be answered in various ways, for no one single
thing or circumstance can be taken as a test of the cure of rheuma-
tism. That salicyl substance do in most cases speedily relieve pain
and reduce temperature is now, we think, generally admitted ; but
can we call this curing the disease ? Wc have said above that even
thus much cannot be invariably predicated of it, but it is true in
the great majority of instances, and some of the cases where the
drug Ecems to fail may, according to Dr. Fagge, be overcome by in-
creasing the dose. But it is by no means clear how this improve-
ment is effected. Thus, Dr. Coupland has shown very fairly that
pyrexia and pain are not of necessity associated in the relapse of
rheumatism, for in some relapses there was pain alone, in others,
pyrexia alone ; but he also showed most effectually that in the pri-
mary attack, as many had held befcre, the temperature comes down
before the pain abates. Hence it is tolerably clear that we cannot
well attribute the influence of salicyl either to an anti-rheumatic
property alone or to an anti-pyretic property alone. At all events,
the patient is relieved.

SALICIN AND THE SALICYLATES IN ACUTE RHEUMATISM. 129

There are, perhaps, in all, four points which, if we could deter-
mine, we should arrive at something like a correct estimate of the
value of salicin as an anti-rheumatic. These are — 1. Does it shorten
the whole duration of the disease ? 3. Does it diminish or in-
crease the chance'of relapse ? 3. Does it tend to foster or avert
the recurrence of similar attacks ? 4. Has it any marked infiucnco
over heart complications. Xow, the first of these is notoriously a
difficult question to answer. We say that it is generally admitted
that the acute symptoms of rheumatism, especially the pain and the
fever, are speedily relieved by salicyl. And many hold very strongly
to the opinion that when it has done this it has done all that it can
or ought to be expected to do. But as rcgards]^the ultimate cure,
only one thing seems capable of affording any clue, and that is, the
time which a judicious and careful physician would allow to elapse
before he would discharge a patient as cured. The first day of
getting out of bed is worse than no criterion, and even the period
of discharge must be taken with important modifications. Weighed
by the period over which risks extends, we find little reason to
boast of the salicyl treatment. With regard to relapse the case is
still worse, for with salicyl the number of relapses would seem to be
greater than under almost any other plan of treatment. But this
cannot fairly be attributed to that drug; the patient, feeling so much
better with its use, cannot be persuaded that he runs any further
risk, and all kinds of liberty are taken. Xow, any one familiar
with rheumatism knows how apt relapses are to occur ; what slight
errors may give rise to a second attack, which may be even more
serious than the first. Nevertheless, with all this, there is a suspi-
cion— a kind of thing that cannot well_be]^proved^,by^^figures, yet
sufficient to bias men's minds — that the treatment !_by][salicyl alone
rather fosters>elapse than otherwise. With 'regard] to 'recurrence
we are in a still worse position than as regards relapse, and briefly
it may be said_that sufficient time has]not yet elaspsed to enable us
to say more than that^salicyl certainly does not 'prevent the'recur-
rence of the disease. In hospital practice the relationship of heart-
mischief to rheumatism is not easily studied ; it is well known that
in the great majority of cases — which, by the way, commonly make
their appearance from the second to the seventh day after the com-
mencement of pain — heart-disease is either begun before application

130 CUKIOUS CASE OF LEAD-POISONING.

is made to the hospital, or it is not likely to show itself afterwards.
But whea it has begun, of this we are assured, that ealicyl has little
or uo control over it. And if it be true that in some cases salicylic
acid has given rise to dangerous hoart-symptoms where there was
no apparent mischief, we should surely beware, where the heart's
action is already irregular, and consequently imperfect, of giving
anything further to embarrass it. It is better that the patient
should suffer from some pain in his joints than that his life should
be imperilled.

How then to give salicyl to the best advantage ? To this question,
fortunately, there seems, to our mind, to be no difficulty in reply-
ing. We know, as a matter of experience, that if salicyl is to do
good at all, it will do so within a day, or two at the outside. When
once the pain has gone and the temperature fallen, we can see no
farther use for it until they return, should that ever be the case.
But there are remedies on which we have been accustomed to rely,
and not in vain, which may now well take its place. Chief among
these are quinine and alkali. Nay, some give alkali from the very
first, even with the salicylate, and with apparently good results.
But uo medicine will suffice without good nursing and careful atten-
tion to diet; these are of the utmost importance. Whilst finally,
before discharging the patient, it is advisable to have him so far con-
valescent that he can take with advantage such a mild preparation
of iron as, let us say, the ammonio-citrate. — Med. Times and Gaz.

Curious Case of Lead-Poisoning. — Dr. Churton reports a curi-
ous case of a dress-maker, who was attending the Leeds Dispensary,
and who was found to have a distinct blue line upon the gums,
which disappeared in the course of a few weeks under iodide of
potassium. An investigation of the case revealed the fact that silken
thread, being sold by weight and not by length, is sometimes
adulterated with sugar of lead ; and upon questioning the patient
it was found that it had been a common practice with lier, when at
work, to hold silk (and also other kinds of thread) in her mouth,
and that she had done this the more readily with silk inasmuch as
it often had a sweeftaste. Upon further inquiry, it was learned
that the silk thread of the best makers is tasteless, whereas some
inferior thread is sweet. — British MedicalJournal.

131
ANTI-VACCINATION.

Mr. Henry Bergh is a violent anti-vivisection'sts and an ardent
homcepatb, and is therefore almost of necessity a man with a very
impulsive heart and a very feeble intellect ; but what excuse the
editor of the North A^nerican Revicio has for printing his peculiar
diatribe against vaccination we know not, unless he considered it
worth while to sacrifice to an itching desire for notoriety the repu-
tation of his journal as a vehicle for sober sense, and also the lives
of some foolish readers. To amuse our readers, and to show what
kind of intellect dwells in the cranium of Mr. Bergh, we print the
following extracts :

* * * '"That hideous monstrosity, vaccination, was first in-
troduced to the public on the 14th day of May, 1796, by Dr. Ed-
ward Jenner, who originated it. * * *

*'In the period of less than oii3 hundred years that has elapsed
since the introduction of this practice, millions upon millions of
sound and healthy human beings have been inoculated with the
most loathsome pestilence, doomed to carry to the grave, bodies
wasted by consumption or marred and deformed by scrofula, can-
cer, and innumerable other ills. What is worse, they have trans-
mitted these diseases to posterity. * * *

" Now, the purpose of the writer is not only to convince the
reader of the truth of this admission, but to go farther, and to prove
that vaccination never has afforded, and never can afford, immunity
from small pox, and that the unnatural practices of so-called scien-
tific physicians have simply resulted in changing the ruby stream of
life into a filthy current, in comparison with which the foulest
ditch water is pure. * * * *

" According to Dr. Spinzig, the eruptive character of small pox
is the outward manifestation of a process of decomposition of the
blood, produced by a disproportionate quantity of urea. Hence this
disease is, in fact, the effect of the reiiction of urea on the blood.
Normal blood, as we learn from the exhaustive experiments made
by Goze and Feltz, contains not more than from .01 to. 02 percent.
of urea, while in variolous blood the percentage is .08 or more. The
specific action of urea on the blood consists in a deoxidation of the
corpuscles. Hence small pox is a phase of blood-poisoning. * *

132 CYSTITIS.

" The writer is himself an example of the utter futility of vacci-
nation. In his youth he passed successfully through the loathsome
process. Nevertheless, some years afterwanls, he presented one of
•the most clearly defined cases of varioloid. According to Mr. Wil-
liam Jebb, of London, in his statement presented to the American
Anti-Vaccination League, eighty per cent, of the mortality from
small pox comes from vaccinated cases.

'' Thus, though it is proved by statistics that the loathsome
practice is void even of a mitigating effect upon the progress of
small pox, nevertheless the dreadful work goes on of wilfully im-
planting in the healthy bodies of the human beings the germs of
disease, from which are developed scrofula, consumption, cancer,
and by which the very continuance of our race on tiie earth is im-
perilled. Doubtless, in the estimation of that large portion of the
public who are, through their intellectual sloth, the dupes of the
medical profession, the writer's words will pass for the ravings of •&
lunatic when he affirms that the human race is gradually rotting
away by reason of this deadly practice of vaccination. But so it is ;
and the prucess of decay is accelerated by the consumption of flesh
that has been rendered unfit for human food, and actually poison-
ous, by the barbarous and unnatural treatment to which animals are
subjected. * * * *

*' Professor Simonds, of the Eoyal Veterinary College, Camden
Town, England, states that in the course of his long experience he
never saw a case of cow pox. Who ever heard, he asks, of bull pox?
And if there be no bull pox, and yet cow pox really exists, it is an
anomaly among zymotic diseases : for no other disease of that class
is limited to one sex of a species." — Philadelphia Medical Times.

Cystitis. — I^. Acidi benzoici, sodii biboratis, fui. gr. x. ; Inf.
buchu, 3 ij. Th's amount three or four times a day, — A. J. C.
Skene. This may almost be called specific in its influence in the
earlier stages of cystitis, affording rapid and lasting relief. The
diet should be carefully regulated, and the skin and bowels kept in
active condition. — JSfew York Medical Record.

133

THE INFLUENCE OF OPERATIONS UPON THE PEO-
LONGATION OF LIFE AND PERMANENT RECOVERY
IN CARCINOMA OF THE BREAST.*

By Samuel "W. Gross, A.M., M.D.

The convictions are steadily gaining ground that carcinoma of
the breast is curable, and that it is primarily a local affection, and
not the expression of a constitutional taint, dyscrasia or diathesis.
In favor of these views — which are held by Virchow, of Berlin,
Billroth, of Vienna, Fischer, of Breslau, Esmarch, of Kiel, Nuss-
baum, of Munich, Volkmann, of JIalle, Kocher, of Berne, Erichsen,
Hutchinson, Sir William Gull, Simon, Moxon, Bryant, Arnott,
Payne, Green, and formerly by De Morgan and Moore, of London,
and by Gross, Parker, Peters, Neftel, Eichardson, Moore, and
McGraw, of the United States — the course of the disease shows
that visceral tumors are preceded by signs of extension of the cel-
lular elements of the growth into the adjacent tissues and by in-
fection of the associated lymphatic glands ; and they are, moreover,
sustained by the results of surgical interference, the latter of which
furnish the motive for this paper.

In view of the inevitably fatal progress of carcinoma of the breast
when uninfluenced by operation, the great questions to be consid-
ered from the standpoint of pathological histology are, whether
the knife prevents, first, local dissemination ; secondly, lymphatic
involvement ; and, thirdly, the development of metastatic tumors ?

1. The answer to the question — does surgical intervention prevent
the invasion of the skin, connective tissue, muscles and walls of
the chest ? — should be affirmative in a certain proportion of in-
stances. Observation during life and during operations indicates
that the adjacent tissues are infected in 90.82 per cent, of all in-
stances ; while of 395 cases in which this point could be traced,
there was local recurrence, after removal, in 315, or 79.74 per cent.
Hence extirpation precluded continuous invasion of the surround-
ing tissues in 10.08 per cent, of all cases, a proportion which ap-
proximates that of the permanent recoveries, as we shall see
presently.

2. In regard to the second question — does extirpation prevent

*Read before the Xew York Academy of Medicine January 19, 1882,

134 RECOVERY IN CARCINOMA OF THE BREAST.

infection of the associated lymphatic glands ? — the reply must be
that it certainly does. Thus, of 657 cases, glandular implication
was witnessed in 422, or G4.23 percent., when the patient first came
under observation. In all the axillary glands were enlarged, and
along with these the supraclavicular glands were involved in 27, the
infraclavicular in 5, and the cervical in 3. Of 114 operations in
which this point is noted, the recurrent disease wa3 seated in the
glands in 46, or 39.31 per cent., or in 24,92 per cent, less than
when the aEfection was not influenced by interference ; and the fact
is noteworthy that the glandular recurrence was more frequent by
19.64 per cent, when the breast alone was removed than when it
was extirpated with the glands.

3. In replying to the third question, it should be remembered
. that metastatic tumors are not always developed. Thus, of 740
patients dead of carcinoma, in whom the disease pursued a natural
course, or who had submitted to operation, contamination of the
viscera was discovered in 303, or in 40 per cent., so that more than
one-half succumbed from the intensity of the local disease and the
pernicious effects exerted upon the general nutrition through the
loss of blood, offensive and exhausting discharges, and suffering.
Of the entire number, in 252 the case was not influenced by opera-
tion, and metastatic growths were found in 157, or 62.30 per cent.,
while of the 4S8 subjected to the knife, the disease had extended to
the viscera in only 146, or 30 per cent. As the course of the dis-
ease when left to itself shows that metastases are absent in 37.70
cases out of every hundred, and as they are wanting in 70 out of
every hundred of the patients dead after operation, it follows that
operations prevent implication of the inner organs in 32.30 cases
out of every hundred.

Having thus seen that local extension, reproduction in the glands,
and the formation of metastatic tumors may be obviated by the
removal of the breast, we are justified in inferring, first, that life
maybe prolonged, and, secondly, that a permanent recovery may be
effected by surgical intervention.

1. In regard to the first deduction — namely, the extension of
life — an analysis of 67 cases which pursued a natural course, indi-
cates that the average life was 27 months. Of 224 patients, on the
other hand, who died after interferecce with local or general repro-

RECOVERY IN CARCINOMA OF THE BREAST. 135

duction, the average duration of life was 39 months ; so that extir-
pation adds one year of life.

2. The question of permanent recovery after operation must be
based upon the study of the typical course of the affection, which
demonstrates that certain events which happen at certain times
should determine the date at which a cure may be regarded as being
assured. Volkmann* states that " if a year has elapsed after ope-
ration, and the most careful examination fails to detect evidences
of local recurrence, enlargement of the glands, of visceral implica-
tion, we may begin to hope that a permanent result will be attained;
and that a cure is generally assured if two years have elapsed,
while it is rendered almost certain after the expiration of three
years." As I have pointed out elsewhere,f the average date of
death from metastases is 31.2 mouths ; and that local reproduction
is witnessed in only one case out of every two hundred, after the
expiration of three years. Hence, I assume, with Volkmann, that
the result may be said to be final if the patient survives over three
years without local or general recurrence after the last operation, or
has died of some intercurrent malady under the same conditions.
Of 52-i cases of scirrhous, medullary, colloid, and atrophying car-
cinoma, in which the result is known, 57, or 10.87 per cent., or 1
in every 9.10, fulfilled these requirements, 53 being still alive at
the date of the last reports-. The average duration of life after
operation was six years and five months, and the disease had existed,
on an average, for seventeen months and a half before surgical in-
tervention, so that the average duration of life was seven years and
ten months. Of the cases which ran a natural course, only 1 5 per
cent, survived six years ; while of the cures, 31.57 per cent., or
nearly one-third, were free from disease after the expiration of six
years. In speaking of the duration of life after operation. Sir
James PagetJ says : " I am not aware of a single clear instance of
recovery : of such recovery, that is, as that the patient should live
for more than ten years free from the disease, or with the disease
stationary." Applying this severe test, I find that 10, or I in 5.7,
fulfilled this requirement, 4 being free from recurrence for between

*Beltrage zur Chirurgie, 1875, p. 325.

tA Practical Treatise on Tumors of the Mammary Gland, p. 161.

JLectures on Surgical Pathology, 3d ed., p. 619.

IW RECOVEKY IN CARCIN:o:irA OF THE BREAST.

ten years and one month and ten years and ten montlis, 2 for be-
tween eleven years and two months and eleven years and nine
months, 1 for twelve years, 1 for thirteen years and ei^ht months,
1 for fourteen years and seven months, and 1 for fifteen years and
seven months.

In connection with the 57 cures, there are several interesting
points which are of the first importance in influencing the progno-
sis after operation. Iq 9 instances there was repullulatiou. In 6
there was one recurrence; in 2 there were 2 reproductions, re-
spectively, in twelve months and four years ; and in 1 there were
three recurrences in four years. In these three cases the subjects
were free from disease for three and a half, four and a half, and
twelve years after the last operation ; so that, as in sarcoma of the
breast, recurrent tumors should be freely extirpated as soon as they
appear.

Another practical point is that glandular implication is not a bar
to operation. In 18, or nearly one-third, of the 57 permanent re-
coveries, infected axillary glands were removed, and in several of
these cases there were nodules in the skin, and the upper layer of
the great pectoral muscle was excised. Even if the glands be per-
mitted to remain, it does not follow that the progress of the disease
may not be arrested, as their enlargement may be due to irritative
hyperplasia and not to carcinomatous degeneration. In three cases
in which they were not interfered with the patients were free from
recurrence, respectively, for five years and nine months, six years
and one month, and ten years and ten months. Other interesting
points in regard to the prognosis after operation are that recurrence
is more frequent in the axilb, by 11 per cent., when the breast
alone is amputated, than when the glands are simultaneously re-
moved, and that reproduction takes place fcur months earlier after
the former than after the latter procedure.

In this connection I may call attention to the fact that absence of
glandular implication does not afford an absolute guarantee that
secondary deposits are not already present in the viscera, since in
one example out of every eight metastatic tumors are formed with-
out the intervention of infected glands.

In the final cures the operation was practiced when the affection
had already existed, on an average, for seventeen months and a

RECOVEKY IN CARCINOMA OF THE BREAST. 137

half, or when the skin, the connective tissue, and the lymphatic
glands are usually implicated. IleKce, it was not performed early,
or at a period which is best fitted for insuring immunity from repro-
duction ; nor was it by any means always complete. Thus, of 53
cases in which the extent of the operation is noted, the brekst was
amputated in 25, the breast was amputated and the axilla was
cleaned out in 16, the tumor alone was extirpated in 10, and extir-
pation, with the removal of infected glands, was practiced in 3.
The disease had been observed for twenty-six months, and the
recovery averaged six years one month and fourteen days, for the
amputations of the mamma; it had existed for seventeen months,
and the cure had lasted for five years and eight months, for the am-
putations of the mamma and removal of the glands ; and its dura-
tion before operation was nine months and thirteen days, and the
average life afterwards was five years, eight months, and seven days
for the partial operations. Of the 53 cures, the IG in which both
the breast and the glands were removed are alone to be regarded as
having been subjected to radical operations, since every possible
source of local and general recurrence should be gotten rid of to
constitute a thorough operation ; and T now make it a rule to am-
putate the mamma with its investing fat and skin, search for any
outlying lobules, dissect the fascia off the pectoral muscle, and open
the axilla with a view to its thorough exploration, and the removal
of any glands that may have^escaped observation previous to inter-
ference. If the muscles are infiltrated, they^should be cut with a
bold hand, and the wound especially in the vicinity of vessels, along
the lymph sheaths of^which extension of the disease not infrequently
takes place, should be seared with thejhot iron.

If such unexpected results, namely, one cure out of every nine
operations and one-fifth, are attainable by procedures of which
seven-tenths must be regarded as inadequate to remove all affected
tissues, what degree of success may we not reasonably expect from
early and radical measures ? As soon as women have learned that
a permanent>ecovery may be anticipated when the^disease is in its
incipiency, they willapply sooner^o the surgeon^ for relief, and
there is every reason to believe that the ratio of cures will be greatly
increased.

The results that I have indicated — and they are derived from tbe

138 RECOVERY IN" CARCINOMA OF THE BREAST.

recent and trustworthy statis.ics published by Winiwarter,* Olde-
kop,f Henry,J aad E3tlander,§ have not been attained without a
very considerable mortality, since of the G02 operations, 104, or
13.27 per cent., were fatal from the immediate effects of interfer-
ence. The rate of death is about 10 per cent, for partial opera-
tions ; 7.G9 per cent, for amputation of the breast, and 23.10 per
cent, for amputation of the mamma and extirpation of the glands.
Hence partial extirpations should be discarded, as they are more
fatal, possibly from aiming at primary nnion, than removal of the
entire breast, and as they hold forth little prospect for permanent
recovery. The reason for the excessive mortality when the mamma
and axillary glands are removed is to be found in the defective man-
ner in which the axillary wound was managed in a large proportion
of the cases. Thus of 187 operations of this description — and they
constitute 68 per cent, of the entire number — Billroth! lost not less
than 40, or 65 per cent, of the entire number of deaths, of which
25 were due to pyaemia and septicaemia, which were frequently com-
bined with hemorrhage from the axillary vessels, 3 were due to
haemorrhage alone, 11 to erysipelas, and 1 to pneumothorax from
opening the pleural cavity. Instead of trusting to ligation of the
divided veins, against which his early teachings had prejudiced
him, he resorted to plugging the wound ; but he states that since
he has found that veins may be tied with impunity his results are
improving. In the future I believe that the mortality from radica'
procedures will not reach 10 per cent., since of 17 cases — 15 of
which occurred in hospital practice — in which I amputated the
entire breast and its entire coverings, removed the pectoral fascia,
and opened the axilla, I have lost only one, tlie subject having been
a fat woman, who was impressed with the idea that she would not
recover. In 14 of these cases infected glands were extirpated, and
in 3, large portions of the pectoral muscles were cut away.

From all the data contained in the paper, I believe that I am
warranted in framing the following practical conclusions :

1. That surgical intervention in carcinoma of the breast tends to

♦Beitrage zur Statistik der Carcinome, Stuttgart, 1S7S.
fLangenbeck's Archiv., Ed. xxiv, pp. 536 and 693.
JStatistiche Mittheilungen tiber den Brustkrebs, Breslau, 1879.
gRevue MensueUe de Medicine et de Chlrurgie, 1880, p. 5S5.
iChirurgische Klinik, Wien, 1871-76, p. 263.

EXTIRrATION OF GOITRES. 139

retard the progress of the disease by preventing local dissemination,
implication of the associated lymphatic glands, and the development
of visceral tumors.

2. That local reproductions do not militate against a permanent
recovery, provided they are freely excised as soon as they appear ;
and that Jymphatic involvement does not forbid operation, since
infected glands were removed in more than one-third of the exam-
ples of final cure.

3. That the subjects are almost without exception safe from local
and general reproduction if three years have elapsed since the last
operation.

4. That the risk from operation is outweighed by the benefits
which accrue from them, since they not only add twelve months to
life, but also cure more than one-half as many patients as they
destroy.

5. That all carcinomata of the breast, if there are no evidences of
metastatic tumors, and if thorough removal is practicable, should
be dealt with as early as possible by amputating the entire mamma
and its integuments, dissecting off the subjacent fascia, and open-
ing the axilla with a view to its exploration and the removal of any
glands which were not palpable prior to interference. — P7iiIadel2)Jiia
Medical News.

EXTIEPATION OF GOITRES.

Dr. Wolfler contributes to the Wien. Med. Wocli., No. 1, 1882,
some statistical details of the cases in which Professor Billroth has
performed the operation for extirpating goitre. He commences his
short paper with the remark that one of the most interesting and
profitable of surgical inquiries consists in casting a critical eye over
the results, obtained by skilful hands, in surgical operations which
but a short time ago were never thought of. Not only does the
surgeon call to mind the interesting clinical points in each case,
but he impresses on his memory the valuable experience which each
case afforded, out of which gradual improvement in the modes of

140 EXTIRPATION OF GOITRES.

operating is derived. The author on this occasion has already re-
marked, keeps strictly to statistics, reserving for a future occasion
the detailed history of the cases. Thanks to antiseptic surgery,
Professor Billroth has felt himself justified in resuming this ope-
ration and of developing it during the past five years. Within this
period he has performed 58 operations on 55 patients (in t^liree cases
a second operation wa? necessitated in consequence of recurrence).
Of the 55 patients, 48 were cured and 7 died. This gives a mor-
tality of 12.7 per cent. In two of these fatal cases death resulted
from causes apart from the operation ; in one in consequence of
bursting of an aneurism of the aorta : in another from peritonitis.
Among the remaining 53 cases, there were five of malignant disease
of the thyroid. Of these 5 cases 4 recovered from the operation,
while the fifth died after tracheotomy had been performed, of
asphyxia, dependent on extensive recurrence. All these cases,
indeed, might be excluded, as extirpation of the thyroid, on account
of malignant growths, differs both in the method of operating and
in prognosis from cases of goitre. Thus, 48 patients remain, of
which 44 were quite cured. Comparing the results (of the goitre
cases proper) with others obtained in the pre-antiseptic period, the
following facts are shown : — From ISGO to 1876 there was a mor-
tality of 36.1 per cent. ; while during the years from 1877 to 1881
the mortality was 8.3 per cent. As regards the performance of
tracheotomy in these 48 cases, in 5 only was it called for, either
before, during, or after the operation. Of these 5, 3 died and 2
recovered. Thus of the 43 cases in which tracheotomy was not
necessciry only 1 died, which is a percentage of only 2.3 per cent.
for non-tracheotomized patients. From this it. may be concluded
how much more severe those cases are in which at the time
of the operation there is tracheal stenosis. Of the 48 cases,
15 were males, 33 were females. Among the latter the operation
was undertaken in several instances on " cosmetic" grounds. The
oldest patient was sixty-Gve, the youngest (a girl) only twelve. Age
seemed to exert no unfavorable influence. Concerning the mode
of operating it may be stated that in two cases the gland was
shelled out of its capsule, 1 of which was fatal ; in 24 cases only
one-half of the gland was removed, with 1 fatal case ; and in 22
cases the entire gland was removed, with 2 fatal cases. The average

CEREBRA.L PATHOLOGY. /41

duration of the after-treatment in the favorable cases was 21.8
days. The recurrent laryngeal nerve seems to have been interfered
with (as shown by larygoscopic eximination) in 11 cases on one
side ; in 2 cases on both sides ; and in 31 not at all. Of these cases
of one-sided paralysis of the cords, it must be mentioned that the
patients recovered perfectly in the course of time, and that in 3 of
the 11 the paralysis existed before the operation. In 1 of the 2
cases of double-sided paralysis of the cords, which died of tetanus
three months after the operation, a post-mortem examination failed
to show that the paralysis depended on injury of the recurrent
laryngeal nerve. We shall look forward to the promised details of
these interesting cases, which are apparently so much more frequent
in Vienna than in London. — Medical Times and Gazette.

CEREBRAL PATHOLOGY

The latest general pathological propositions relating to the en-
cephalon have been given by Dr. Seguin (of New York) as follow :

1. Lesions of the base (especially if involving the pons and crura)
give rise to the following symptoms ; paralysis, anesthesia of the
face and limbs, impairment of the equilibrium, and changes within
the eye. There are no psychical symptoms.

2. Lesions of the great basal ganglia probably produce no symp-
toms unless encroached upon by the internal capsule which passes
near them.

3. Lesions of the white centre of the hemisphere produce no
symptoms when they do not involve the parts composing the inter-
nal capsule. If the anterior portion of this capsule be injured, we
observe paralysis ; if the posterior part, anaesthesia

4. Lesions of the cortex cerebri produce, when located anteriorly,
psychical symptoms ; when located in the median regions, paralysis
of an imperfect kind ; and when situated posteriorly, no symptoms
at all.

5. Lesions of the cerebellum produce no symptoms except by in-
volving afijacent parts containing important motor and sensory

142 MEDICAL JOURNAL PREMIUMS.

tract?, thus giving rise to irregular paralysis, changes in the optic
apparatus, symptoms of irritation of the vagus nerve, etc.

6. Lesions of one-half of any part of the encephalon produce
motor and sensory symptoms in the side of the body opposite to the
lesion. When the lesion is in one half of the basis cerebri some
symptoms are found on the side of the face and head correspond-
ing to the lesion, others on the opposite half of the body.

7. Lesions on the median line cause symptoms to appear on both
sides of the body.

8. Any intracranial lesion which acts in such a way as to increase
the intracranial pressure, may produce, in addition to other symp-
toms, the condition known as choked-disc or neuro-retinitis. —
Louisville Medical News, January 7.

The North Carolina Medical Journal offers as a premium
for the best prepared and complete herbarium of the medicinal
plants of the State, the following works, or their equivalent, in vol-
umes the successful competitor may choose :

Curtis' " Woody Plants" and ''Catalogue of Indigenous]_Plauts"
in one volume.

" FhwJcigerand Hanburi/s FharviacograpJna" one volume ; and
"Flora Americce Sej^leiitrionalis ; or a Systematic Arrangement
and Description of the Plants of North America." By Frederick
Pursh, two volumes.

The collection must be prepared by the person presenting it.
Each specimen must be neatly mounted on stout white paper 9x14
inches, (two or three specimens can be put on a sheet when they are
small) and the name marked on each. This offer is made to mem-
bers of the State Medical Society, and to licentiates of the Board
of Examiners who may not be members.

Herbaria must be sent in on the 2d Tuesday in May, 1882, at the
Concord meeting. For further particulars address Editor of the
Journal.

143

EDITORIAL.

NORTH CAKOLINA MEDICAL JOURNAL.

A MONTHLY JOURNAL OF MEDICINE AND SURGERY, PUBLISHED
IN WILMINGTON, N. C.

Thomas F. Wood, M. D., Wilmington, N. C, Editor.

Original comimuiications are solicited from all jjarts of the
country, and especially from the medical profession o/'The Caro-
LiNAS. Articles requiring illustrations can le promptly supplied hy
jjrevious arrangement with the Editor. Any sulscriler can have a
specimen number sent free of cost to a friend ivhose attention'he
desires to call to the Journal, % sending the address to this office.
Prompt remittances from subscribers are absolutely necessary to
enable us to maintain our worlc with vigor and accep)tability. All
remittances must be made payable to Thomas F. W^ood, M. D.,
P. 0. Drawer 791, Wilminc/ton, N. C.

THE DANGERS OF THE HYPODERMIC USE OF MORPHIA.

Much has been written lately on the abuses of morphia employed
hypodermically. and still we are satisfied that the alarm has not
been distinctly enough sounded. The cases of conBrmed morphia
habit are fast iucreasing, and the profession are largely to blame for
it. It is so easy a matter to allay the anguish of body and mind
by a method grateful to the patient and [time-saving to the busy
physician, that the hypodermic use of morphia is resorted to far too
often, many times with an avowed purpose to gain time to arrive at
a diagnosis. Into this pit-fall many unwary physicians have fallen,
and the strangest and saddest fact of all, (and as we write these
lines we have scarcely recovered from the untimely death of two of
our dearest professional friends) we hear of medical men here and
there, who, themselves are yielding to the temptation of allaying
pain of body or mind by tha same dangerous means.

In the great cities we hear of busy men, who, in order to carry on
their complicated and exciting speculations, resort to hypodermic

144 DANGERS OF HYPODERMIC USE OF MORPHIA.

morphia ; so wide-spread is this habit, that it is not unusual to hear
of their relating their experiences to friends similarly addicted, dis-
cussing the quantity that can be taken without risk, the best
syringe to get, the most favorable places to insert it, and the remedy
for the obstinate constipation produced by it.

In fact the time has now come, when, not only hysterical women,
but sturdy men are falling a prey to the ill-advised use of morphia,
and we are probably at the beginning of a reaction that will go
farther than we desire it. But at the risk of helping forward a
troublesome reaction we ought to warn those over whom we have
any infinence that the danger of becoming addicted to morphia
hypodermically is far greater than by any other mode of adminis-
tration, and should only be resorted to by a physician in those times
of. necessity which are unmistakable. On no account should a
syringe be allowed a patient with instructions how to use it. The
worst cases of morphia-habit are the results of this very reprehensi-
ble custom.

While it is not easy to lay down any fast rules for the guidance
of physicians as 'o the occasion when morphia should be resorteS
to hypodermically, still there are those amongst us whose experience
has not yet led them into difficult places on account of it.

For instance, it is a growing fault to prescribe morphia hypoder-
mically for headaches, and extensive experience contraindicates it
in such cases, even in those of the most formidable and agonizing
character, namely, such as result from syphilis. What else is it
but entrapping our patient in a snare, to hold out the seductive ease
from headache by morphia, when it is apparent, or will be sooner or
later that we are putting him in the midst of a vicious circle from
which there is no escape except by death, or by enduring the untold
torture which the effort at extrication from morphia surely entails ?
To give morphia for headache we only allay pain for a time, by
surely preparing our patient for a worse headache, which requires
increasing doses of drug. Seme of our readers will think that is
useless to point out a matter so obvious, but still an interview
recently with an eminent neurologist, satisfies us that the morphia
treatment for headache is gaining ground with the people, and this
surely must be because it is practised by the profession.

We stand face to face with a great difficulty. By favoring a

THE INSPECTION OF VACCINE STABLES. 145

loose and indiscriminate use of the hypodermic syringe we precipi-
tate an universal opposition to its use, and so practically bar our-
selves of the aid of this valuable adjunct. If it was necessary to
collect every case of death from chloroform to emphasize the warn-
iag of the dangers of careless ansesthetization, how much more
imperative is it that we conscientiously point out the great dangers
from the use of morphia hypodcrmically ; and above all, we ought
to be extremely guarded how we trifle with so powerful an instru-
ment for good or evil, undertaking any amount of trouble for our
patient, rather than be even a remote ngent in enslaving his body
and soul by morphia.

THE INSPECTION OF VACCINE STABLES.

At the last meeting of the American Medical Association, Dr.
Martin, of Boston, introduced a resolution looking to the appoint-
ment of a committee to investigate the condition of the various
animal vaccine establishments in this country. The resolution was
virtually killed by the resolution of Dr. A. C. Post, providing
that not more than one hundred dollars of the money of the Soci-
ety be expended for the purpose. Whether this provision was in-
tended to counteract Dr. Martin's resolution or not we do not know,
we only know that Dr. Woodward, the President of the Association,
did not think it necessary to appoint a committee upon such a
foundation. Of course no one can question his wisdom in this.

Since the last meeting of the Association, there has been renewed
interest excited in the subject of the supply of vaccine virus, and
the record made for animal vaccination during these few months
just passing will maks a lasting impression for or against the
method.

The force of the resolution above inferred to, was not lost, but
had the effect of inducing a few pliysicians interested in the con-
duct of extensive vaccination, to examine for themselves the nature
of heifer vaccination at the various stables at which it is produced.
Whether or not there will be any systematic report made for the in-
formation of the public, or whether the material gained will only

146 THE INSPECriOX OF VACCIXE STACLES.

be used for the guidance of tlie medical ofEcers of health in the
State, where these gentlemen belong we do not know.

At a risk of wearying our readers with anything more on the
subject of vaccine supply, we will wrice duwn a few of our observa-
tions on the metliods practiced in the different vaccine stables,
learned for tlio most part by actual inspection.

It is now tlie case that the original vaccine stock which is in use
by the various propagators of virus in the United States, came from
the stables of Dr. S. C. Martin, or his predecessor, Dr. H. A. Mar-
tin. There is no authentic account of the introduction of any other
stock in this country, excepting the Wohassec stock discovered by
Dr. H. A. Martin, and now being propagated by his son, Dr. S. C.
Martin. Hardly an establishment in the country has not lost its
stock, and been obliged to have recourse to the original stock from
the Brookline Stables of Dr. Martin. It was with interest there-
fore that we observed very closely the methods of the originator
of the American system. That Dr. Martin has gone on from
year to year without any lapse in the succession of vaccinated ani-
mals, is due to the personal care and study the elder Dr. Martin
has given to the subject, and to the long experience of his trained
assistants. He has never been urged on by the great demands for
virus, to resort to questionable methods to increase his supply. As
far as we can learn, upon this very point, the danger to the interests
of animal-virus propagation is greatest.

In several parts of the country, vaccine stables have been estab-
lished, the proprietors having no sufficient knowledge of the method
of conducting the business, and failures must overtake such ven-
tures sooner or later. IE these failures only alTected those pecuni-
arily interested, it would be a slight matter as compared with the
serious detriment it will give to the cause of animal vaccination.
Very few consumers know any difference between the virus of one
producer and another, the cost price to them behig the chief mat-
ter'to be considered. ^

In reality there is a great differencj in the methods employed at
the various vaccine stables. These consist essentially (1) in the site
of the inoculations, (2) in the method of the inoculation, (3) in the
quality of the animal inoculated. Since speculators have engaged in
the business, the one object to be gained seems to be the production

THE INSPECTION OF VACCINE STABLES. 147

of the largest amount of virus, to enable the producer to fiu-nish
it at a price so low as to bring him thegreatest number of customers.
So that while the anxiety of the scientific and conscientious pro-
ducer has been to furnish material so pure and reliable as to place
animal vaccination on a sure foundation in the confidence of the pro-
fession, there arc others who are surely laying the foundation of a
serious disaster to this valuable system as introduced and pracliccd
by Dr. Martin.

Every season new discoveries are claimed to be made as to the
method, and last season, one producer claimed that he had discov-
ered that oW animals yield the test virus; and another that by
making deep incisions through the chorion, of great length, that his
yield was enormous, and yet in both these instances these operators
have been obliged to have recourse to fresh virus from the original
sources to start them up again.

Now as to the use of old cows as vaccinifers, there could not be a
graver fallacy. Multiparous cows could only bo preferred on ac-
count of the greater area of skin-surface allowed for inoculation,
and consequently the greater yield of virus; but, it is very well
established that cows that have calved, are mucli more likely to
have tubercular disease, especially on account of their artificial
lives in the stock and dairy stables. Practically, the vaccine derived
from old cows gives a considerable proportion of phlegmonous
sores, and irregular results as regards the course and duration of
the vesicle in the human subject.

The method of increasing the quaatity of virus by long deep in-
cisions was introduced by a, western producer. The result was a
copious flow of a straw colored serous fluid, requiring several assis-
tants to work briskly to save it as it flowed from the incisions after
the crust was removed ; but this very fluid which appeared to
be so precious was for the most part entirely inert. Sometimes it
did " take" in the human subject. But when it is remembered that
a fluid containing one fortieth of virus is capable of producing good
vesicles, and furthermore when we consider that there may have
been many groups of vesicles along the line of the deep incisions,
and that being broken probably emptied some of their contents into
this doubtful fluid, its potency may be accounted for in this way.

The demand on the part of the profession for crusts has cre.Ued

MS THE INSPECTION OF VACCINE STABLES.

a new abomioation known as ^'' lympli concs.'^'' Wo qnotc from a
recent pamphlet by Prof. C. A. Lindsley, M. D., of Yale College :

'^ ' Patent solid lymph cones' is another form of vaccine virus
found for sale by instrument dealers, druggists, etc. The state-
ments made in the circular publishing the virtues of these ''patent
cones" are so much at variance with the real facts representing
them, as revealed by a careful examination of them, that it would
seem to be within the lines of the legitimate and proper duty of the
State Board of Health to openly caution the citizens of the State
regarding their fraudulent and dangerous character.

" The said circular, Avhich lies before me, describes them as being
* consolidated lymph/ and as ^ solid Ipmj^li made into a tJiick mass.'
These re?narkable statements are alone snflicient to excite the sus-
picions of any one having any practical knowledge of the business
of producing lymph. The writer is informed by experts that an
amount of ' consolidated, solid lymph,' enough to make one of these
cones could not be produced for more than one hundred times the
])rice named in the advertisement. One gentleman, who is among
the most eminent vaccinographers in this country, and who has been
a large ])roducer of animal vaccine, writes me, that, if every par-
ticle of the little tears of dried lymph which could be obtained from
two hundred heifers could be carefully collected, it would not be
enough to make one ' solid cone' of the size which is advertised by
the New England Vaccine Company to sell for three dollars. In
the same veracious (?) circular, it is asserted that ' these cones are
entirely free from any trace of pus, debris, or epidermis,' thus at-
tempting to impress still more forcibly the previous statement that
they are only ' solid lymph.'

The writer submitted for examination one of these cones to Dr.
T. Mitchell Prudden, Director of the Physiological and Pathologi-
cal Laboratory of the College of Physicians and Surgeons of New
York, and Lecturer on Normal Histology in the Medical Depart-
ment of Y^ale College. The following is a copy of his written re-
port of his examination :

" *Neav York, July 1, 18SL

" ' Dear Doctor : — I enclose the report of the examination of the
cone of virus, and send you a slide for examination with a pocket
glass of low power, which shows some of the hairs, &c., taken from
the portion which I examined.

" ' Sincerely yours,

" ' T. Mitchell Phudden.
" ' To Dr. Chas. A. Lindsley."

THE report.

"'The mass consists largely of larger and smaller clusters of
epithelial cells and cell detritus, together with a large number of

THE IXSPECTIOX OF VACCINE STABLES. 149

hairs, some broken off and others torn out by the roots. Besides
these things there are fragments of vegetable substances of various
kinds, fibres, bits of seed., etc., shreds of connective tissue fibres,
starch granules, and considerable colored amorphous material
whose nature I am uuable to determine. A few lymph cells and
fragments of the same are also present.

" ' Quantitative results were not sought for ; but from about half
of the single cone I picked out seventy-four fragments of hair
which were readily visible to the naked eye, and many more were
left, which were readily seen by low powers of the microscope.'

" Such is the wretched mixture that the patentee offers to the
public as ' solid lymph.' It seems to be constructed on the same
idea that masons make mortar, to be held together with hair.

"x\ny physician with an appreciable sense of the dangers of septic
poisoning would never venture to inoculate a patient with such a
compound of animal and vegetable matter, liable at any moment,
under favorable conditions, to take on putrefactive changes, which
might render it fatally poisonous.

" In the proceedings of the Medical Society of the County of
Kings, N. Y., for April, 1S81, is an account of a death after using
one of the. cones obtained from the New England Vaccine Com-
pany, occurring to an officer in the U. S. Navy, and reported by
the surgeon.

"The following are extracts from the sliip's medical journal,
" ' March 2d. Whittaker, Chief Engineer. Left arm very much
inflamed from recent vaccination.'

"*' March 3d. Whittaker, Chief Engineer. No fever ; headache
and lumbar pain much moderated ; left arm very inflamed and pain-
ful; inflammation erysipelatous in appearance.'

"'March -ith. Whittaker, Chief Engineer. Not much consti-
tutional disturbance; condition of arm no better; erysipelatous
inflammation extends from elbow to shoulder ; whole circumference
of arm involved ; surface of skin exteriorly covered with blebs."
" ' March 5th, Gth, and 7th. At home ashore.'
" ' March 8th. Whittaker, Chief Engineer. Febris — sick leave.'
" ' March 9ih. Whittaker Chief Engineer. Erysipelas. No im-
provement in the condition o£ the arm. He is under the care of
Dr. S., of Brooklyn.'

" ' March 10th. Whittaker, Chief Engineer. Erysipelas. In-
formation was received this morning that Mr. Whittaker grew worse
the early part of the evening, and died about 10 o'clock, P. M.'

" The above record leaves little doubt that the virus used in the
vaccination was the cause of the erysipelas and deatli.

" The surgeon making the report writes that ' this is the only
case of erysipelas or disease of any kind which ho has observed
from vaccination, * * * but the Powhatan lying near us had
one fatal case some weeks ago.'

" All the bad results of impure vaccination do not get into print.

150 SMALL POX IN MACON COUNTY.

But it needs but very few such sad events as the above to maintain
and inter.sify the popular prejudice against all vaccination, however
prudently and scientifically done."

Dr. Lindslcy's article is illustrated by a microscopical drawing
from a solid lymph cone, showing hairs, part of a leaf, vegetable
fibres and amorphorus matter entering into its composition.

The National Board of Health Bulletin (March 4, 1882) contains
a brief report of inspection of Vaccine Stables made by Drs. IIos-
mer F. Johnson, of Western and W. P. Whitney of the Eastern.
There is no doubt that these inspections will tend to make honest
producers more than ever careful as to their work. We notice
though one statement made by Dr. Whitney that very clearly shows
his superficial knowledge of the process of collecting virus from
vesicles. He says that Codman and Shnrtleff collect virus without
pressure, this lymph is put in a bottle and the quill dipped in the
lymph. This we affirm to be impossible. It would be easy to get
a flow of str.xw-colored serum having in it a little accidental pure
vaccIriC lymph, but to get virus from a vesicle on the heifer, pressure
must be used.

Xothing but good can come out of thorough investigation of this
subject, and we trust the National Board of Health will prosecute
it, by the aid of acknowledged experts.

SMALL POX IX MACON COUXTY.

Dr. J. M. Lyle reports to the North Carolina Board of Health the
existence of two cases of varioloid about a mile from the town of
Franklin in Macon county. The town is thoroughly vaccinated.

The cases have been quarantined and no fear is apprehended of
its spread. They were brought from Richmond, Va.

These are the only cases of small pox known to exist in North
Carol in it.

Dr. Lewis, a Chicago opponent of vaccination, has died of small
pox. — Ketv Yorh Sun.

151

REVIEWS AND BOOK NOTICES.

Illustrations of Dissections in a Series of Original Col-
ored Plates the Size of Life. Representing the Dissec-
tion OF the Human Body. By George Yiner Ellis, ;ind
G. 11. Ford. Volume II. William "Wood & Co., ;iT Great Jones
Street. New York. 1882. Pp. 225.

We noticed the first volume of this work in our February issue.
In quoting the title-page, which is a literal production of the origi-
nal, we conveyed the impression that the work itself was an exnct
life-siz3 re|-)roduction. It is though, the usual octavo volume, u.'ii-
form with the excellent series so long and favorably known as
Wood's Library of Standard Medical Authors. This volume con-
tains 30 lithographic illustrations of oi-iginal dissections and at a
price within the reach of every one.

A Practical Treatise on Materia Medica and Tuerapeu-
Tics. By PiOBERTS Bartholow, M.A., M.D., LL D. Fourth
Edition Revised and Enlarged. New Y'ork : D. Appleton & Co.,
1, 3, and 5 Bond Street. 1882. Pp. GG2.

This volume is devoted more especially to therapeutics, materia
medica holding a very subordinate position. Indeed it seems neces-
sary at this stage of the science and ait of therapeutics to separate
it from materia medica. The arrangement of the volume is very
different from that of the old classical works, and far simpler and
more helpful to the student.

Part I is devoted to the modes in which medicines are introduced
into the organism. The Action and Uses of Remedial Agents, and
topical remedies.

Part II to The Actions and Uses of Remedial Agents : — those
used to promote constructive metamorphosis; those used to promote
destructive metamorphosis or increasing waste ; agents used to
modify the functions of the nervous system ; remedies which dimin-
ish or suspend the functions of the cerebrum after a preliminary
stage of excitement; agents having the power to arrest septic pi-o-
cesses and to destroy minute organisms; remedies used to cause some
evacuation from the body; urino-genital remedies; and topical
rejiedies.

152 REVIEWS AND BOOK NOTICES.

This arrangement and classification of the subject is doubtless
better than the cumbersome attempts which for so long a time re-
pelled the student. Whether we approve the arrangement of the
work or not, we can unhesitatingly recommend this volume as being
clear, concise, accurate, and fully abreast with the present state of
this very progressive branch of medicine. In five years this volume
has reached its fourth edition, and the present one is thoroughly
revised and in many places re-written. It is a sterling work, and
cannot fail to establish the author's reputation at home and abroad.

Fourth Annual Report of the State Board of Health of
THE State of Connecticut. For the Fiscal Year Ending No-
vember 30th, 1881. Printed by order of the Legislature. Hart-
ford, Conn. : 1882. Pp. 396.

We congratulate the State of Connecticut upon the work her
Board of Health is doing. Through the arduous efforts of Dr.
Chamberlain, the Secretary, and his confreres, the present report
is a credit to him and them and will undoubtedly give a new impe-
tus to sanitary work and sanitary legislation.

The (leneral Report of the Secretary shows that the Board has
received the endorsement of the medical societies in the State, and
that his work goes on with promising activity. Dr. Chamberlain
notes that there are twenty-seven State Boards of Health, a fact
quite significant, when we remember that only a few years ago there
were only three or four in active existence. We wish that the num-
ber of the Boards of Health was as significant as it appears to be, of
an energetic sanitary movement. We must no^ leave out of sight the
painful fact that some of these Boards are only in name.

The presence of malarial diseases and their spread along the
water courses in Connecticut has been the subject of studious in-
vestigation. One article especially deserves more extended analysis
than we are able to give it, it is an article entitled " Malaria in
Connecticut" by Dr. Chamberlain, Secretary, and another, a "Re-
port on Malaria in Western Connecticut" by Egbert L. Viele. It is
accompanied by a map of the State giving the drainage areas of
rivers in Connecticut.

Dr. Noah Cressy contributes an illustrated article on the ''Natu-
ral History and Pathology of the Trichinous Infection of Man and
Animals."

REVIEWS AND BOOK NOTICES. 153

A very opportune and timely paper is by Dr. C. A. Lindsley, on
" Vaccination," giving some material liigbly useful as to the quality
of vaccine, and especially as to the impurities in animal virus, an
cxtrj^t from which is made in this number.

A System of Surgery, Theoretical and Practical, In Treatises
by Various Authors. Edited by T. Holmes, M. A. Cantab.
First American from Second English Edition. In Three Vol-
umes. Volume III. Pp. lOGO.

This volume completes the Americanized Holmes' Surgery. The
whole work is an improvement on theEuglish volumes, both as to
matter and mechanical execution. ^The American work is more
compactly bound, and while the size of the type is reduced, the
pages are set up in double columns compensating in some measure
for the large clear type of the original.

We have purposely avoided saying anything about the rights of
the English publishers of these volumes, because it is a business
transaction with which we have no concern. If reputable and re-
sponsible publishers can conscientiously reproduce such volumes for
us at a price within our reach, all they ask is that we sustain their
venture, and we can leave the adjustment of copyright differences
to them.

In a literary point of view, the additions made by the American
contributors, are for the most part valuable, but make a very un-
pleasant break in the original in many places, a feature not at all
new to American reedited works.

The revision by Dr. Hunter McGuire of Part IV on " Gunshot
Wounds" by M. Thomas Longmore, is_ done in'good^taste. Dr.
McGuire had a large surgical experience during the war, and has
inserted at the proper places manyj^paragraphs relating to the sur-
gery on the Confederate side, of which otherwise there would be no
proper record. We call attention'to one]'point^ which is even now
too little meted upon, viz. : The use of chloroform in surgical shock.
*' So far from adding to the shock * * *j|the use of chloroform
seemed to support the patient^during the ordeal."

The next section on " Ansesthetics" originally by Mr. Joseph
Lister, is revised by Dr. J. C. Eeeve, and it is, upon the whole, the
best digested chapter on the subject that has yet appeared.

We have not attempted a review of Holmes' Surgery. We only
desire to say that it is a work without a superior, and that the
American edition enhances its value for physicians in general practice

154

CURRENT LITERATURE.

NATIONAL BOAIID OF HEALTH AND VITAL ST A-

TISTICS.

The Federal structure of ihe nation somotitnes perplexes science,
as well as politics, seeking a desirable end. Jnst now the National
Board of Health, acting in cooperation with the American Public
Health Association and with the American Association for the Ad-
vancement of (Science, is trying to devise a practical method of es-
tablishing a general and efficient system of vital statistics. The
collection of these incidents — that is, of births, marriages and
deaths — serves two objects : first, they are social statistics, identify-
ing the individuals for judicial purposes — that is, for purposes of
record; and then they have a scientific value, in that the individuals
appear simply as units, and being discussed in the aggregate, illus-
trate the great vital and economic curves of national progress.
With registration for identification the general government has no
concern : that only affects the States and their subdivisions. But
it is of national interest to preserve the other phase of those facts,
and to have them arranged for intelligible comparison, not only re-
ciprocally, but with similar figures collected in other lands. Dr.
Billings, charged with the study of this matter for the National
Board of Health, has reported to that body his conclusions, as fol-
lows : That it is best to use the State machinery by paying to the
States at the rate of '^2,bOO per million inhabitants for such statis-
tics as are required. This be estimates to bo about half the cost of
collectiDn — the States now bearing the whole cost. He would not
pay for imperfect work, the receiving authority being the jndge.
He would make the National Board of Health, or a permanent
branch of the Census Buieau, the recipient, and he regards 125,000
as sufficient to begin the work if Congress vvill authorize it. One
great difficulty is that only about half a dozen States have anything
like satisfactory registration laws, and for a long time to come the
returns cannot be national. But as it is the first step that costs, it
is the first step that begins a great work. Nothing will bo accom-
plished if wo wait until a perfected system can be applied. There
is every rca3:>n to believe tlial the American and British registrars

CHIiS^OLIN AS A SUBSTITUTE FOR QUININE. 155

are in substantial accord as to the nomeriClature and classification
of diseases, and that a report now in preparation when published
will supply a uniform plan to be used by the English-speaking and
ultimately by the Continental nations. Of the value of trustworthy
vital statistics to sanitary and political science nothing need be said;
and if the general direction of the project remain with the gentle-
man whose name has been mentioned, it is pretty certain that the
most intelligent and at the same time most practical scheme will be
evolved. — The Nation.

CHINOLIN AS A SUBSTITUTE FOR QUININE.

If all that is asserted of chinolin be true, it certainly has advan-
tages over many of its competitors for public recognition as a cheap
substitute for quinine, in the abundance of its source and its anti-
septic and antiperiodic properties. It was first prepared from Dip-
pel's animal oil, nearly forty years ago, by Eunge, and it is now
recognized as a component part of coal-tar. Later it was obtained
by distillation of quinine, cinchonine, and other alkaloids, and it
may also be prepared synthetically by repeated distillations of a
mixture of seventy-six parts of aniline, forty-eight of nitro-benzoic,
two hundred and forty of glycerin, and two hundred of sulphuric
acid. It is an oily liquid, of peculiar odor ; but when combined*
with tartaric acid as tartrate of chinolin, it forms silky crystals,
closely resembling sulphate of quinine, and is soluble in water.

Chemically, as well as in its physiological action, chinolin is
closely related in the cinchona alkaloids. Experiments conducted
by Dr. Donath* and others go to ])rove that it has a noticeable
lowering effect upon the temperature of the body, and tliat even in
weak solutions it retards decomposition, whilstin stronger solutions
it entirely prevents it. It also prevents the coagulation of egg-
albumen and the formation of yeast-cells, and is an active poison to
bacteria or fungous growths.

*Trans]ation, Monthly Review of Medicine and Pharmacy.

150 TIMIDITY IN THE USE OF NITRITE OF AMYL.

The effect of ehinolin on mucous membranes is somewhat irritant;
but it may be taken in doses of thirty grains or more without harm.
The mode of elimination of ehinolin is still under investigation, it
having been proved that it does not pass off in the urine, at least
unchanged.

In regard to the therapeutic value of ehinolin there remains
much to be demonstrated, as hitherto its use has been limited to a
few experimental cases. Dr. Harrington, of this city, reports the
results of a trial of ehinolin in the wards of the Jewish Hospital.*
He employed the tartrate in four cases of intermittent, in doses of
from ten to twenty grains dissolved in water. He states that the
administration was not followed by emesis, except in one case, in
which there was gastric irritability previously, the same patient re-
taining it well. It did not in any case produce ringing or buzzing
in the ears : but the exhibition of the drug was followed by a lower-
of the temperature and a partial cessation of the other attending
symptoms. Judging from the limited number of case?, it would
appear that ehinolin tartrate has some antiperiodic action, bat does
not as yet fulfil all that is claimed for it. — -Vi. N. W., in FhiladeJ-
pJiia 3Icdical limes.

TIMIDITY IN THE USE OF NITRITE OF AMYL.

In relation to General Burnside's death from angina pectoris, the
editor of the Boston Medical Journal (December 22) calls attention
to the too general timidity in the use of the nitrite of amyl in this
disease. Danger is erroneously supposed to attend its use simply
from its sudden, often somewhat startling, effects. Its good effects
are indeed instantaneous, and why any fear should be entertained as
to its use is a mystery, as there are no authenticated cases in which
it has done harm.

" Indeed, in a selected case, when the physician has fairly assured
himself of the dose required, he may safely leave it in the hands of

*Mcdical Bulletin, Monthly Review of Medicine and Pharmacy.

TIMIDITY IX THE USE OF NITRITE OF AMYL. 157

the patient if he has not been prepared for its almost electrical
effects. We have seen such cases. It does frequently create a head-
ache, but if the patient has been prepared for the rush of hot b'ood
to the skin, aud for the rapid increase of the cardiac pulsations, to
mental disturbance will take place. As for the headache, which
arises only occasionally, it is of no consequence in view of the re-
lief we are giving the patient. But angina pectoris is not the only
complaint in which the nitrite is a valuable aid. In the chill stage
of malaria, the symptoms being extreme, we have checked the chill
in forty seconds, the drug relaxing the spasm of the cutaneous ves-
sels, and admitting warmth to the surface of the body. The febrile
stage was correspondingly shortened. In the chill which often
attends dysmenorrhoea we have heard it pronounced a 'perfect
blessing.' In asthma — not always in old subjects, in whom it is
apt to fail, but in cases under fifty years of age — it will clear up
rales which can be heard twelve inches from the chest, within five
minutes, and often they do not return. It will arrest spasms of
the diaphragm. In all these cases, especially in angina pectoris,
we have found it not only invaluable, but harmless. It is the
remedy of all remedies for chloroform syncope. In partial drown-
ing— indeed, in any case of cardiac failure — it is the whip of whips
for the flagging heart. In the convulsions of strychnia-poisoning,
in tetanus, in the early stages of epilepsy, in short, in spasm of an\
nature, this drug is capable of accomplishing great good. If physi-
cians would but use it in appropriate crises, they would soon see that
it can be easily controlled, and moreover that it can be used with
impunity. It is necessary only to watch the pulse and the face, and
as soon as the former reaches 130, or when the nasal flush appears,
stop the inhalation. It sometimes happens that the nasal flush does
not at once show itself. In such an event the pulse is a reliable
guide. When used even with ordinary care the drug never causes
insensibility. As to tl:e dose, two drops would be the quantity for
an adult as a beginning. If this prove ineffectual, it should be in-
creased boldly, especially as the specimen used may have lost
strength. The drug may flush the face, and yet not relieve the pain.
This is an indication of its weakness. A fresh, strong specimen
would flush the face and relieve the pain as well. It is impossible
to keep the drug on hand, and expect it to do its legitimate work.

15S TIMIDITY IN THE USE OF NITRITE OF AMYL.

unless it be sealed with the greatest care. It would be better to
procure a fresh specimen for each case. Again, the remedy fails
because the quantity inhaled is insuflicient. Each patient is his own
law in regard to the dose necessary to relieve his particular case. A
drachm has frequently been administered without harmful effects.
But it should be borne in mind that some individuals are more easily
affected than others by equal doses. At the outset, therefore, the
do^ should be small, and increased until the desired result has been
reached. A convenient form of administration is a pledgetof co*ton
wool, upon which the liquid may bo dropped. It may then beheld
between the patient's teeth until the characteristic effects appear.''
Quoting Dr. Balfour's statement that '' this remedy is perfectly
safe, and may be entrusted to the patient with the certainty that he
will not injure himself by its use," the writer says :— "This is the
course we have followed for some years, and in no instance has there
ever been cause to regret it. Indeed, there are cases which can be
managed in no other way. As an example we may mention a gen-
tleman who for many years had suffered daily attacks of angina
pectoris. In this case we advised that the patient should procure
a small tin box (salve or percussion-cap box), fill it with cotton-
wool, moisten the wool with the drug before leaving his house, and
that if pain came on he should inhale from the box. He was
directed to follow the same course in case of attacks at home. A
short trial of this plan proved its efficacy. In any case of frequently
recurring attacks of the disease the remedy should be kept in the
house, or be procured at once when needed, and administered by one
of the family while waiting for the physician. Valuable lives might
thus be saved. We sincerely hope that these facts may influence
physicians in favor of the nitrite of amyl. At present it is a neg-
lected ^x\^g.^''— Medical Times and Gazette.

The death of 8iu Robert Christison, author of the Dispensa-
tory, &c., is announced. He had reached the advanced age of 85
years. His funeral in Edinburgh was one of the most remarkable
that has been seen there.

159
PAROXYSMAL H.EMOGLOBINURIA.
By Robert Sauxdbv, M.D., Eilin., M.R.C.P., Lond.

[This is an interesting account of a disease of which we have in

the past year seen two examples. We desire to elicit enquiry on the

subject among- our correspondenls. — Ed.]

********

Description of Attack.— li^ clinical features vary somewhat, but
the following may be taken as a typical example of what occurs: A
young man, in fairly good health, while undergoing considerable
bodily exertion on a cold winter's day, is suddenly seized with shiv-
ering, lassitude, and great sense of weakness, followed by a desire
to make water ; on voiding urine he is astonished to notice that it
appears to contain blood. He takes to his bed, and continues for
some days to pass dark-colored urine, but with careful nursing and
rest he gradually recovers, but is henceforth liable to relapses, espe-
cially during the winter months.

The previous general health is usually good, but there is not in-
frequently a tendency to digestive derangement ; and in some cases
follicular stomatitis and pharyngitis, hepatic derangement, and con-
stipation have been noted, with sometimes vomiting at the com-
mencement of the attack.

The attacks are sometimes preceded by a distinct rigor, at others
by yawning, formication, and headache ; the temperature occasion-
ally falls below the normal, in one case being 1)0.1° Fahr. in the
axilla, with lividity of the hands, feet and ears.

Synqjtoms. — The skin and conjunctivae have been observed to be
of a peculiar dusky color ; some patients have been described as
jaundiced. The body temperature varies very much in the different
cases recorded. The earlier descriptions said nothing of any rise
in temperature or denied it. But Greenhow records a temperature
of 103.2° in his first case ; Beale records a similar temperature.
Druitt, in his careful descriptions of his own case, says that he suf-
fered on several occasions from feverish attacks, with a rise of tem-
perature to 103° Fahr., and splenic enlargement, but that on all
other occasions, even during the passage of ha3moglobin, the tem-
perature was quite normal. In two cases which have come under
my observation the temperature has been elevated during the

160 PAROXYSMAL HEMOGLOBINURIA.

attacks, in one reaching 102° Fahr., in the other 105.2° Fahr.
There is often perspiration, though this may not be general, but
confined to certain localities ; thus in Rosenbach's case the sweating
was chiefly in the forehead, and in one of my cases the patient com-
plained chiefly of the profuse perspiration of his hands.

The observations on the temperature variations in these cases
are still incomplete ; it is probable that differences exist. In my
cases there was no complication to cause the rise of temperature,
nor was there the least reason to suspect the fever to be of ma-
larial origin. In one of my cases there is reason to belive that the
temperature reached a daily maximum of over 104:° Fahrenheit
for at least a week, during the whole of which period the urine was
dark.

Headache and a tendency to sleep are the only nervous phenom-
ena hitherto described, but in one of my cases the attacks have been
at times associated with mental aberration, bordering on acute
mania.

The heart and lungs usually present no abnormal physical signs,
but in my first case the heart's apex was to to felt in the fourth in-
tercostal space, with a loud systolic rnur.nur at the base, propagated
into the neck, and a loud hruit de dlable in the jugulars.

The liver and spleen have been described as enlarged. In the case
just referred to the spleen was enormous, the limits of percussion
dulness in its long axis being ten inches and a quarter ; it reached
beyond the umbilicus, was round, tense, and tender. In another
case no hepatic or splenic enlargement could be detected, nor any
tenderne:s in the hypochondria.

The state of the blood has been recorded in a few cases, generally
with a negative result, tliough in a few an increase in the white
corpuscles is recorded ; in my first case, in spite of the anremiaand
splenic enlargement, there was only a slight relative excess of leu-
cocytes over the colored corpuscles.

As the examination of the blood is very much a matter for ex-
perts, it is satisfactory to be able to quote the report or Professor
Hayem on the case recorded by Mesnet. The blood was examined
before, during, and after the attacks, and he states that it presented
the appearances of the blood from a case of slight anjemia, while
the tendency to the rapid formation of fibrinc in the blood taken

PAROXYSMAL H.^AIOGLOBINURIA. • 161

during the paroxysm, recalled the characters of the blood of pa-
tients suffering from some inflammatory disorder ; but this has been
seen in other haemorrhagic diseases, such as purpura and scurvy.
The examination of the corpuscles gave results such as are met
with in all anaemic blood. During the paroxysm there was a slight
increase of white corpuscles, and a relative diminution of the red;
and two days after the attack there appeared a crop of hsematoblasts
and dwarf globules, indicating a degree of activity in blood forma-
tion which was greater than would be looked for after a haemor-
rhage apparently so inconsiderable in amount.

More recently, M. Ilayem has stated that he has assured himself
that the plasma of the blood extracted by cupping during an attack
contained a certain quantity of haemoglobin.

The state of the urine is necessarily the point ujion which obser-
vations have been most minute. Great variations appear to exist as
to the time during which the hfemoglobin persists in the urine.
Thus, in a case recorded by Gull, although the attack lasted for
several days, the morning urine was always dark, but after 1 or 2
P. M., it became clear. It is quite possible that guaiacum and
ozonic ether would have revealed a certain amount of blood-color-
ing matter in this apjoarently clear urine. In other cases the urine
may remain dark for weeks together.

In two cases which I see from time to time, there is always a cer-
tain amount of blood-coloring matter present, quite readily discov-
erable by the guaiacum test. The mother of .these patients says she
never knew their urine to be clearer than certain specimens which I
have seen, and which undoubtedly contained haemoglobin, but no
albumen.

The color of the urine varies from porter-color to mere smokiness;
or it may be, as above suggested, and as I have seen it, apparently
clear, yet giving a distinct reliction with the tests for bloed-coloring
matter. It deposits, on standing, a variable amount of brown
iioccnlent matter, which, under the microscope, is seen to consist of
urates, oxalates, blood-casts of the tubules of the kidney, granular
and hyaline casts, and what looks like the detritus of blood cor-
puscles. Oxalates are i:ot always present ; Gull found crystals of
haematin, but this is exceptional. In Rosenbach's case, already
alluded to, the urine contained albumen before it became dark.

162 PAROXYSMAL H.EMOGLOBINLtRIA.

The reaction of the urine is almost invariably acid ; its specific
gravity varies. Gschleiden was the first to show, by means of the
spectroscope, that the coloring matter present is really hasmoglobin;
and this has been confirmed by other competent observers, although
dissented from by Dr. Thndichum.

With the microscope, either no blood corpuscles or only a few
have been found. Dr. Wickham Legg states that in one case un-
der his observation there was no difficulty in recognizing many red
blood corpuscles in the urine when recently passed, but that on the
following day after standing not one could be found.

The earlier writers maintained that the albumen present was pe-
culiar, by dissolving readily in excess of nitric acid, and Gull sug-
gested that it was globulin. This suggestion appeared to be worth
investigating. I have endeavored to do so by precipitating the urine
with sulphate of magnesia, so as to get rid of all the para-globulin
present. The results of several experiments showed conclusively
that serum albumen was present in addition to para-globulin.

In Forest's case the albumen persisted in the urine in spite of the
absence of any amount of ha3moglobin, and in one of my cases
albumen has persisted, more or less, for years, without other signs
of kidney-disease. Professor Jacobi, of New York, has observed a
similar persistence of albuminuria in a case under his care.

The question of the persistence of traces of albumen and haemo-
globin during the intervals is of interest, and should be looked for.

During the paroxysm the urine contains blood casts, hyaline, and
granular casts, and sometimes epithelial casts, but these disappear
rapidly and are not found during the inlervals.

According to Dr. Wickham Legg the amount of urinary water
passed during twenty-four hours is sliglitly increased, while the urea
is a little below the average.

Indican tias been found, and is probably often present in excess,
as Virchow found a large quantity of blue pigment in Dressler's case.

Etiology. — The cause of this disorder is obscure. Age and sex
seem to have only slight influence. It has been met with as early
in life as two years, and as late as fifty-four. It is most common
perhaps in young adults. When Dr. Wickham Legg wrote, only
one case had been described in a female, but I can add at least two
others — one published by Dr. Adam and one of my own.

PAROXYSMAL H,^MOGLOBINURIA. 163

The only ins'.ance of heredity is that furnished by my own pub-
lished cases, in which the father and at least two children have suf-
fered. Occupations seem to have no special influence, except as
they expose the individual to cold. No rank in society seems to be
exempt from the predisposition.

The exciting cause is almost invariably a chill, by wet feet or
some such common mode ; hence Mesnet'd proposal to designate it
a friqore, and from its greater frequency in winter the justice of
Hassall's title, winter hematuria. An apparent exception to this
rule is to be found in Rosenbach's case, as the attacks were more
common in summer than in winter ; but it turned out that the
parents kept the boy in a warm room in the winter, while in sum-
mer he was allowed to go about and play.

Sir William Gull has stated that bodily exertion by walking too
much, or lifting a weight, seems to increase the disorder. The in-
fluence of ir juries is of interest. Sir Wm. Gull has described the
case of a young lady, who fell and hurt her back on getting into a
railway carriage, and shortly afterwards passed bloody-looking urine,
containing only disintegrated granular matter. Rosenbach's case
supports the notion that the disorder may have a traumatic origin,
as a fall from a waggon was apparently the exciting cause of the
first attack, although when the predisposition was fully established,
the attacks were readily induced by exposure to cold. Botkin also
has published a cise in which a fall from a horse preceded the first
attack.

In several of the cases there has been a history of ague preceding
the urinary derangement, but it is exceptional. A few cises have
resided for a length of time in a hot climate.

It is stated on doubtful authority to be common in India, but no
evidence has been afforded of the truth of ttiis statement. As in
this climate the disease appears to be so dependent upon cold, it
would be of great interest, to know whether it does occur in India,
and if s"", what is the cause.

The con-cction which appears to exist between this disorder and
liver de:angemeut has struck most observers. Jaundice has been
present in many of the cases, and other evidences of hepatic
derangement and disturbarces of the digestive system are very
common.

164 PAROXYSMAL H^^MOGLOBINURIA.

Syphilis an! ihenmatism have been noted iu the liistory of a few
patients.

********

Prognosis. — The prognosis as to recovery from each attack is
good, and as already stated, no case has been known to terminate
fatally ; but the liability to relapse is infinitely great, in spite of all
possible care. M. Bucqaoy has, however, re[)orted a c.jse which un-
derwent a spontaneous cure.

Dr. Druitt has recorded the history of his own long struo;glo with
the disorder, and tells us how, after in vain sought help from drugs,
and from temporary residence on the South Coast and in Italy, he
finally gave up the contest and went to India, where he remained
well up to the conclusion of his account. Ic would he of interest
if he wculd inform the profession of the subsequent progress of his
case.

Treatment. — We have Dr. Druitt's authority for saying how
fntile were the various recommendations he adopted as to warm
clothing, wash leather socks, flannel from head to foot, etc., in
arresting the attacks.

Following his experience, and from what I have seen of the dis-
ease, I believe the best advice we can give our patients is to seek a
home in a warm and equable clima'e, if they wish to secure them-
selves against relapses. As these cases are frequently young male
adults, this advice may often be followed.

With regard to drugs, none has proved of any service in pre-
venting the relapses; but during the attack?, quinine, in relatively
large doses (up to ten grains), has been most serviceable in the
cases already published, and in my own experience. Dr. Warburton
Begbie had the good fortune to observe disappearance of the
ha3moglobin from the urine after the administration of chloride of
ammonium in scruple doses ; but this good fortune has been so far
unique : in one case in whicii I tried it, it ajipeared quite inert.

The facts recorded in the preceding pages atford a ba^is for cer-
tain general conclusions in which I have triel to sum up our pres-
ent knowledge of this affection.

1. Paroxysmal hasmoglobinuria occurs at all ages, but nmst com-
n.only in young persons.

'Z. It affects both sexes, but males more frequently than females.

3. It is in some cases distinctly hereditary.

PAROXYSMAL n^MOGLOBIXURIA. 105

4. The exciting cause of an attack is almost invariably a chill ;
though in a few cases the firstattack has undoubtedly been induced
by a blow, yet the subsequerit attacks have betn brought on by ex-
posure to cold.

5. Its relation to ague is exceptional and n )t well made ou^

6. It is not specially associated with any known diatlietic ten-
dency (e. g., rheumatism, gout, scrofula), or with any specific dis-
ease (e. g., syphilis).

7. There is strong reason to believe th it funct'on:il disturbance
of the liver is present in maiiy cases.

8. Enlargement of the spleen has been noted, but is exceptional.

9. During attacks the temperature may vary from normal, or even
subnormal, to a high degree of fever (105° Fahr.).

JO. The skin may be covered by profuse persp'ra'ion, or this may
be restricted to certain parts, or it may be dry.

11. The skin may be jaundiced, or of a peculiar dusky hue, dur-
ing and after the attacks.

I'Z. The serum of the blood during the attacks has been shown
to contain haemoglobin (Hayem).

13. The microscopical characters of tiie blooJ are those of slight
anaamia.

14. The urine during the attacks always contains hajm globin or
met-bcemoglobin, serum, albugxen, paraglobul n, granular and hya-
line casts, and urates.

15. The urine between the attacks may contain traces of albumen
or haemoglobin, or both.

16. The prognosis as to lecovery from each attack is good, no
fatal case having occurred.

17. While a spontaneous cure has been recorded, as a rule the
liability to relapses persists.

18. No drug influences the liability to relapse; but during the
paroxysms quinine has seemed of most service.

19. Eesidence in a tropical climate affords the best prospect of
wardincf off future attacks. — Medical limes and Gazette.

166

CONCORD MEETING OF THE STATE MEDICAL SOCIETY.

We desire to remind Chairman of Sections on the Progress of the
Medical Sciences, that their work is looked forward t»by members
of the Society with great interest. The reporters are gentlemen of
ability, and much is expected of them.

The President of the Society also desires that the captions of
volunteer j)apers to be reaii will be sent to hitn at an (arly day, so
that they may be placed in the printed programme.

The subject of the address of the regular E-;siy'st will hi an-
nounced in the Jourxal of April.

QUANTITIVE CHANGE OF BLOOD CORPUSCLES IN

FEVERS.

The results of Ab»lph Boekman's investigation mav be summed
up in the following statements :

In febris recnrrtns the number of red blood corpuscles undergoes
a sudden diminution, which loss increases more and more as the
fever progresses and reaches its maximum during or immediately
after the crisis.

In febris intermittens the number of red blood corpuscles de-
creases with every attack cf intermittent. Likewise in Boekman'd
experiments there became evident, coincident with the rise of tem-
perature, a decrease in the number of red blood corpuscles and an
increase in the number of white coi-puscles.

In pneumonia, also, a diminution of the red blood corpuscles
takes place during the febrile period, tlio less being especially marked
after the crisis. A case of severe ara3mia demonstrated in like
manner a very considerable decrease in the number of red corpus-
cles during the febrile stagr-.

In intermittens quotidiana the white blood corpuscles appear in
greater quantities during the entire period, while any attacks were
experienced. Kelsch noticed a multiplication of the white cor-
puscles only in the pernicious malarial infection?, while Fuhrman

PELLAGRA. * 167

claims that this process occurs also in simple intermittent although
in a slighter degree. Bookman's observations harmonize conse-
quently witii the result obtained by Fuhrman. Both pneumonia
and ana?mia were accompanied during the febrile period by a mul-
tiplication of white corpuscles.

The failure to count the number of white corpuscles in the blood
of those suffering with febris recurrens. compels us to resort to the
investigations of Laptschinski and Ileydenreich. According to
these two observers there appears in recurrens, during the fever, a
considerable increase in tiie number of white corpuscles, v.hich
makes its appearance suddenly and reaches its maximum on the
day, when the temperature falls, but during the intervals between
the febrile attacks returns gradually to its former state.

If reviewing these observations, we compare the conduct of the
red and white corpuscles with one another as well as with the body
temperature, the conclusion is reached, that in the acute febrile
affections, the number of red blood corpuscles undergoes variation-
ontrary to the changes in the temperature, while the number of
white corpuscles, on the other hand, undergoes changes parallel to
the range of temperature, i. e. — that between these two organic ele-
ments of the blood their exists during the fever a certain antago-
nism in this respect a decrease in the number of red corpuscles,
corresponding to a higher temperature is always accompanied by
a corresponding multiplication of while corpuscles. — Deutsche Med-
izinal Zeitung, G. A. F., in Cincinnati Lancet and Clinic.

PELLAGKA

M. Hardy showed to the French Academy. of Medicine {Ann. de
Derm et de SyphiL, 2me sere, vol. ii. No. 4 p. 719) the hand of a
patient who had died of pellagra. The man bad been a drunkard,
and had never eaten maize. M. Hardy believes that alcoholism is
a cause of pellagra ; MM. Th. Roussel, Lancereaux, and Noel
Gueneau de Mussy, on the other ban 3, stating their belief that pel-
lagra is a specific malady always due to altered maize.

108

TRANSACTIONS OF THE MEDICAL SOCIETY OF VIR-
GINIA.

The January number of the Virginia Medical Monthly coutaiued
the Transactions of the Medical Society of Virginia, after a custom
established many yaars ago. The literary work of this Society on
the occasion of its last meeting did not suffer by the obstruction
placed in its way, by what appears to us, a small and noisy opposi-
tion. The matter of numerical strength at a given meeting is not
alwajsa fair index of the solidity of a Medical Society, for many
times sight-seers and pleasure seekers are quite numerous in such
a body, and a great show like a Yorktown celebration would lead
away all those seeking recreation and pleasure.

The contributions to the Transactions are as follows : Annual
Address by Dr. Hunter McGuire, " Clinical Remarks on Cancer of
the Breast ;" Report on "Advances in Anatomy" by Dr. Christo-
pher Tompkins, of Richmond ; Report on "Advances in Surgery,"
by Dr. M. C. Kemper, of Goshen ; " Advances in Practice of Med-
icine, by Dr. Bedford Brown : " Catarrhal Deafness," by Dr. Jas.
A. White, Richmond ; " Emetic Effect of Chloroform," by Dr. G,
Wm. Semple, Hamptom ; " Case of Abscess of the Liver," by Dr.
J. A. Alexander ; "The Physiological and Therapeutical Action of
Sulphate of Quinine," by Dr. Otis F. Manson.

The paper by Dr. Manson we desire to review in particular in our
next number.

Effect of Cultivation upon Belladonna. — A recent analysis per-
formed by A. W. Gerrard {Boston Medical and Siirgical Journal,
March 16th, 1882, page 243) upon cultivated and wild belladonna
plants, shows that wild plants yielded in every part the greatest per-
centage of alkaloids.

Wild Plant. Cultivated Plant.

Root 45 per cent. .35 per cent.

Stem..... 11 " " .07 " "

Leaf 68 " " .40 " "

Fruit 34 " " .20 " "

169
NOTES.

Pilocarpiyie in Diplitheria. — Dr. W. Lewin, of Friedrichsberg,
contributes bis experience of this drug in diphtheria to the BerJinex
Klinische Wochenschrift, Nr. 32. He was induced to try the treat-
ment in consequence of Dr. Guttmann's report of its virtues (an ab-
stract of which appeared at the time in this journal). Dr. Lewin's
experience is much less extensive than Dr. Guttmanu'd. As far as
it goes it does not seem to confirm Dr. Guttmann's eulogies, for he
considerd that, far from being a specific, it is not even a constant or
sure remedy in diphtheria. lie gives a series of thirteen cases, in
two of which it acted marvellously ; in two others fairly well, but
other drugs had also to be employed ; while in the severe cases,
"like all other previous remedies, the pilocarpin left us in the
lurch." Dr. Lewin has never seen collapse follow its use, although
he has prescribed it in good doses. He regards the drug as a useful
addition to our list of remedies against diphtheria, but cannot give
it any very high place among them.

Treatment of Amygdalitis and Tonsillar Hypertrophy hy the Bi-
carbonate of Sodium. — Dr. Arracngue reports seven cases of angina
tonsillaris cured in less than twenty-four hours by the bicarbonate
of sodium (?). This, therapeutic measure was known to Professor
Gine, who employed the remedy both in the form of a powder and
as a local application. The authorasserts that frequent applications
in tonsillitis and tonsillar hypertrophy will produce immediate
amelioration in the majority of cases, while, in other instances, cure
results in a little while. It is most efficacious when applied during
the decline of the inflammation, although Dr. Armengue has suc-
ceeded with it in aborting the morbid process. The bicarbonate
does not diminish the predisposition to angina, but arrests its devel-
opment, Amygdalotomy the author believes to be a useless opera-
tion.— Gazz. Med. di Roma.

Impure Chloroform. — In the Progres Medical of December 31,
Dr. Yvon refers to certain tests of the purity of chloroform pub-
lished some time since by Prof. Regnauld, which the surgeon may
resort to himself. These are : — 1. The sweet odor of the chloroform.

170 NOTES.

2. It should not redden litumus-paper. 3. It should give no pre-
cipitate, nor even produce turbidity, when shaken with a solution
of nitrate of silver. It should not becime colored when carried to
boiling point with concentrated solution of caustic potash. 5. Sul-
phuric acid should not be blackened when brought in contsct with
chloroform. Other tests can only be practised by the chemist, such
as the determination of the density and boiling-point; but Prof.
Regnauld states that no chloroform can be regarded as pure which
does not satisfy the above-named conditions. But, however pure
chloroform may be, it is continually in daqger of undergoing spon-
taneous changes, so that its purity requires verification from time to
time ; and when it is kept in a bottle incompletely filled, more or
less imperfectly corked and exposed to the light, this is soon
diminished. For the detection of the changed condition, even be-
fore it becomes dangerous, M. Yvon employs, as a test, permanganate
of potash one part, caustic potash ten parts, and distilled water 300
parts by weight, which form a solution of a beautiful violet red.
This, brought into contact with chloroform that has been rectified,
does not change color ; but if the rectification has been incomplete,
it is more or less rapidly reduced, its reduction being preceded by a
change of color to green. This permanganate in solution, therefore,
supplies the p?iarmacien with a most delicate and rapid test of the
purity of the chloroform furnished to him, and employed from time
to time, ascertains whether the original purity is still maintained. —
Medical Times and Gazette.

Nocturnal Incontinence of Urine in C'lildren. — Few practition-
ers escape the care of frequent cases o' children's nocturnal incon-
tinence. It is one of the least dangerous, but at the same time one
of the most annoying and persistent disorders of childhood, and any
help we may get of a practical sort, especially in the way of pre-
vention, will be welcome to our readers. A recent paper read before
the Harveian Society, by Dr. Tom Robinson, has two homely hints
that are of value, and to which we desire to call attention. "There
is no doubt," he says, " that nurses and mothers are' frequently to
blame for this troublesome vice. Young children ought to betaken
out of bed during the night and placed on a chamber, so as to ex-
cite their bladders to act." And again, " Fear will frequently

NOTES; 17i

prevent youns; pooplj frjm lising in the dark to relieve them-
selves." If we instruct our patients to take up their children when
they go to bed themselves, we shdl do much, even in quite young
children, to arrest the natural incontinence of infancy. And no
parent should allow children to sleep without a dim but sufllcient
light, not only that they may readily lind the chamber, or the water
closet, but that in case of fireor sudden illness darkness may not
add its unknown terrors as a hindrance to their seeking aid, or the
means of escape. If they sleep at a distance, or in diflerent stories,
the halls also should be lighted.

Inoculation of lubercuhsis.—T)r. Orlando Robinson, in an arti-
cle in the Philadelphia Medical Times-, Decembers, based on a prize
thesjs of the Medical Faculty of the University of Pennsylvania),,
arrives at the following conclusions : 1. Tuberculosis artificially
produced in animals is not due to a speeifie virus. 2. To produce
it in animals inoculation with tubercular matter is not necessary,
a. Failures to produce tuberculosis by inoculation with substances-
other than tubercular are in the same proportion as failures with
true tubercular matter. The introduction nnder the skin of any
foreign substance capable of excting an inflammation or any trau-
matic injury can produce tuberculosis, provided that the animal is
of scrofulous habitus, 5. Scrofulosis in animals is expressed by an
inflammation terminating in the production of a cheesy mass. G.
Animals not generally, scrofulous (cats and dogs) may become so,
and then only can tuberculosis be produced in them. 7. Miliary
tubercles are simply compressed aggregations of cells of any simple
granulation tissue, ill-nourished, into small nodes. The arrange-
ment into modes represents a true ante-mortem act of cells, to
which any young inflammatory connective tissue is liable. 8. Under
favorable conditions of nutrition, tubercles in animals may undergo
a higher organization, becoming converted into h u-mless small
fibromata. 0. Tubercles artificially produced in animals nre histo-
logically strictly identical with those occurring in min.

Oil of Winter Green.— Thh important product is obtained in
the largest quantities from the Betnla /c;im (Sweet birch. White
birch) although the manufacturers distil the oil at the same time

172 NOTES.

from Gaiililieria. An interesting account of the distillation of oil
of Gaultlieria is given in the American Journal of Pharmacy for
Febrnary by Geo. W. Kennedy, Phar.G. lie examined a distillery
in Pennsylvania where the oil is obtained from Betulahnta largely
bnt also from G. Procunihens. Ilis examination of the oil there
produced is thus described : It- is entirely colorless, of a strong
aromatic odor, and a sweetish aromatic taste. It boils briskly at
from 4-24° to 43G°, and the boiling point rises to 442° where it re-
mains stationary. Oil of Gaultheria is 431° at boiling. This seems
to I e the only distinguishing difference between the two oils. The
oil sells in New Yoik market at $2.65 a pound, the diit llery above
mentioned producing 30 pounds a week.

Sweet birch abounds in the mountains of this State, and could be
turned to a prolitablo business by our mountaineers.

Death from Chloroform Overstated. — Mr. John Word man,
F.R.C.S., writes in the British Medical Journal, Feb. 25th, show-
ing how fallacious reports of deaths from arresthetics are. In a re-
port by Dr. Jacob the following statements arc made of deaths :
From chloroform, 9; from ether, 4 ; from chloroform and ether
(mixed) 1 ; from ethidene 1 ; total 15. This is fallacious like so
many of such reports. The number of times the different anes-
thetics have been used is not stated. For instance if chloroform
has been given twice as often as ether, the death rate is nearly equal.
Mr. Wordman suggests that a sub-committee of the British Medi-
cal Association be chosen to collect the statistics of total adminis-
trations of anesthetics in British hospitals and their results. We
want the whole truth.

Analysis of PincTcneya Pubens {Georgia Bark) — Through the
courtesy of our friend, Dr. J. II. Mellichamp, of Bluffton,
S. C, we are enabled to give some further information of the
chctnical characters of Georgia bark. The analysis was done by
Peter Coll'er, Esq., Chemist at the Department of Agr.'culture.
He says : ■

I find no alkaloids whatever, upon which the virtues might de-
pend, but a very large proportion of ah extremely bitter resin, dark
brown in color. An alcoholic extract in which were found a smaU

NOTES. 173

quantity of gum and a slight trace of sugar, was 32.20 per cent.
of the bark. This extract was nearly all composed of this bitter
resin, with the exceptions above named. An ether extract of 1.53
per cenf. contained a very little resin, and asubtarice which in alKa-
line solution, gave a blue green fluorescence, resembling that of
quinine in acid solution. But as ihis substance was present in so
email proportion it was deemed best not to proceed farther with its
examination. As the bark contains no alkaloid differing wholly in
this respect fiom cinchona, it is probable that whatever virtue it
may possess is dependent upon the large amount of bitter resin.

Cinnamic Acid as an Antiseptic. — This acid which gives to th
gum of Liquidanilar Stijracijlua (Sweetgum) its peculiar balsamic
odor, has been made artificially, recently, and deserves to come into
geceral use. It dissolves in 1,000 parts of water, GO of oil, and is
moie soluble in borax and phosphate of soda solutions {Boston
Medical and SurgicalJournal). Two grains of cinnamic acid pre-
served four ounces of urine from decomposition, and the same
quantity preserved an albumen solution seventeen days.

Prof. Jos. Decaisxe the illustrious botanist of Paris is dead.
He was for many years I'rofessor of Culture in the Acadeniie des
Sciences, lie was exceedingly courteous and willing to assist young
botaniits. His works are numerous, but the one on systematic
Botany in conjunction with La Maout is the best. lie is one of the
very few persons who ever succeeded in Fi-ance in raising D.'onea
muscipula from the seed.

Testa on the AUe/jed Antagonism Betiveen Amyl-Nitrite and
Chloroform. — In this paper Dr. Testa {Gaz. Med. Ital., October 29
and November 5, 18S1) gives the results of forty-four carefully con-
ducted experiments on the action of amyl-nitrite in presence of
chloroform in animals. The subjects of the experiments were
rabbits, and ihe experiments themselves are divided into four series
of eleven each. In the first series the action of chloroform alone
is studied ; in the second, the influence on the anaesthetic condition
of amyl-nitriie ; in the third, the influences of varying doses of
chloi'oform ; in the fourth, the influence of the amyl-nitiite on ar-

174 OBITUARY.

toiial pressiiio. From iheee experiment?. Dr. Testa concludes that
the action of amyl-nitrite is to lower arterial tension, to increase
ithe heart-boats, and to render respii'ation irregular. lie believes
Ihat its action in chloroform poisoning is not only iiselCfS, but posi-
itively pernicious, inasmuch as it inten ifies the very risks to which
•chloroform itself is liable. There is, therefore, n i true antagonistic
or antidotal action belwedn the two substances. — Lilton Forbes, in
London Medical Record.

Dr. 'I'heodur Schwann, Professor of Physiology i i (he Univer-
s'ty of Lioge, died at Cologne on January 11th, at ilie agd of 71.
He was celebrated as the first exponent of the doc I'ine of the cell-
formation of animals.

71ie Case of Guiteav — A Psycliological Sludij. — Ttiis a reprint of
an article from the pen of Dr. Geo, M. Ceard to prove the insanity
of Guiteau. The newspapers have in ailvancc satiated the ]>ublic
•wiih this matter of theianityof this miserable culpi'it, but still
ihere may be nudical students curious enough to hear an argument
of this kind, and lo them we com.nend J)r. Beard's pamphlet.

CoiiASSET it should be instead Wohassccon p. 14G, lllh line, this
^B umber.

OBITUARY

HANSON r. MURPHY, M. D.

Dr. Murphy died at his residence in Pender county, January
31, 1SS2 in the sixty-ninth year of his age. He was born in New
Hanover county in 1813. He was the oldest son of Cornelius Mur-
phy uho emigrated from Scotland to Korth Carolina at the age of
12 years. He received an academic education at the Donaldson
Academy ; studied medicine with Dr. Benjamin Robinson, of
Fayetteville, N. C, and afterward with Dr. Austin Flint, at Spring-
'field, Mass. He attended lectures at the University of Pennsylva-
nia, and graduated at the National Medical College in Washington,
D. C, in"l841, being the first physician of iNew Hanover county
outside of Wilmington that ever received a medical dip'oma. He
married the only daughter of the late James Simpson Esq , and
settled in Duplin county. He returned to his native county in 1S61
and represented New Hanover in the State Constitutional Conven-
tion of 1865-6.

OBITUARY. ITJ^

' Dr. Murphy belonged to that sturdy class of self-reliant physi-
cians, so well suited to hard work in an agricultural community.
Before he undertook the laborious duties of practice he had stored
up an unusual amount of worldly wisdom, and had been schooled by
literary methods that gave tons such honored men as Robinson and
Flint. He was nevertheless impatient of the servile following of
the most gifted ma-ters of medical science, relying rather upon his
trained powers of observation, than the inflexible rule of the art as
taught iu the books. lie was therefore seldom at a loss in emer-
gencies, and his means -were many times original.

For feveral months he was a great sufferer from an aneuli^m
which finally closed his useful career. In all the multifarious work
which fell to his lot, he vigorously strove to fulfil the measure of
his duty. He will be greatly lamented by the large community in
which he lived, for he had officiated at the bedsides of scores during
two generations.

ROBERT BRIDGES, II. J).

Dr. Robert Bridges, Emeritus Professor of Chemistry iu the
Pennsylvania College of Pharmacy, died at his residence," Xo, 119
South Twentieth Street, February 23d, 1882, in the seventv^-sixlli
year of his age. Dr. Bridges was a native of this city, and"^a con-
stant resident during all the years of his active" and useful
life. He graduated at the University of Pennsylvania, both in the
depariment of arts and in that of medicine ; the latter m 1828, sx
years after the establishment of the College of Pharmacy, an insti-
tution to which he was afterward to render £ervices so valuable,
faithful, and so long continued. His services were held in such
high esteem by all aesociated with the College of Pharmacy that
when increasing years and infirmities warned him to tender his
resignation, he was at once elected Emeritus Professor of Chemistry,
and so continued during the brief remainder of his life.

^Dr. Bridges being a physician, as well as a chemist, was a fellow
Ox the Philadelphia College of Physicians and Surgeons, and for
many years, in addition to the duties of his professorship, discharged
those of librarian to the last-named institution. He was a man of
active mental constitution, a patient and systematic thinker, and a
polished and lucid writer, and the scientific journals of the country
were enriched by many contributions from his pen. Jle was also
the American editor of Foioie's Cheviisiry, which, by its extensive
circulation, made bis reputation national.

For the last two years Dr. Bridges has been a sufferer frcm a
complication of diseases, which, as became plainly evident some
weeks since, could have no other than a fatal termination. In pri-
vate life Dr. Bridges was a gentleman of high intelligence and
kindly manners, proceeding from genuine goodness of heart and
innate benevolence. To his immediate relatives he was tenderly
attached, and his house was as a home to those near and dear to
him ; but, singularly capable as he was of appreciating household
happincs?, he never married ^Mediccd and Surgical Beporter.

17G

JOSEPH PANCOAST. M. D.

On March 7th, 18S3, Joseph Pancoast, M D., Emeritus Professor
of Anatomy in Jefferson Medical College, died, at his residence, No.
1030 Chestnut Street, of pneumonia, having reached his seventy-
seventh year. His illness was of very sliort duration. He hecame
prostrated, and his suffering from congestion of the lung was acute"
His condition steadily grew worse, death finally coming to his relief.
He was attended by his son. Dr. Wm. H. Pancoast, and Dr. Da Costa.

He filled for a period of thirty-six years, successively, two of the
most important chairs in Jefferson Medical College. He also edited,
at sundry times, " Manee on the Great Symnathet'c Nerve," and
the " Cerebrospinal System in Man," by the same author, and sub-
sequently " Quain's Anatomical Plates." He was a voluminous
contributor to the American Journal of the 3Iedical Sciences, the
American Medical Intelligencer, and \.\\q Medical Examiner, besides
publishing various monographs, both pathological and surgical, and,
at the time, the novel department of plastic surgery. He also pub-
lished sundry essays and introductory letters to his class ; the one of
18G5 is entitled "Professional Glimpses Abroad." He was a mem-
ber of the American Philosophical Society, of the College of
Pharmacy and other scientific institutions. He was an eminent
surgeon, bold, rapid, and skillful with the use of the knife, and in
diagnosis almost invariably correct.

Among the many- new operations devised by him was one for soft
and mixed cataracts upon the eye ; in ISll, a new process for re-
moving cystic tumors ; a quick process for correcting strabismus.
He afterwards demonstrated that after the eyebrow had been de-
stroyed a good looking substitute could be made by raising a flap of
the scalp, with the soft, drooping hairs of the temple, and giving it
a long pedicle, to run in a bed cut for it up to the brow. He four
times performed, with success, a lumbar operatiDn for large ab-
scesses lying in the connective tissue between the colon and ctecum
and the front of thequadratus muscle. Later, he found that by
cutting the posterior muscles of the velum palati atacertain point,
a voice that was unintelligible could often be restored. He was the
originator of the operation for the relief of exstrophy of the bladder;
performing it first in 18G8, and it has since been followed here nnd
in Europe. Amputations at the hip joint or even high up on the
thigh, were farmerly very fatal operations, from the excessive loss
of blood. Far more patients died than recovered from these ope-
rations. Dr. Pancoast devised a plan to prevent this by using the
abdominal tourniquet, with a large roller compress over the lower
end of the aorta, so as to shut otf all the arterial blood from the
lower limbs. — Medical and Surgical Reporter.

177
BOOKS AND PAMPHLETS RECEIVED.

Illustrirte Monatsschrift der iirztliclicn Pulytechnik. Heft 3.
IV Jahrgang. Miirz 1882.

Descriptive Circulars on Now Drugs, and Specialties, Intraducad
by Parke, Davis & C^., Detroit, Mich.

Fifth Annual Report of the Board of Health of the State of New
Jersey. 1881. Mount Holly, N. J. : 1881. Pp.344.

An Address to the People of Maryland. By the Civil Service
Reform Association. Baltimore : The Sun Book and Job Prim-
ing Office. 1881. Pp. 7. . ,

Annual Report of the Health Officer of the City of Burlington
to the City Council. January 1, 1882. Burlington, Vt. The Free
Press Association. 1882. Pp.25.

The Use of Constitutional Remedies in the Treatment of Ear
Diseases. By Samuel Theobald, M.D, (Reprinted from the Med-
ical News, February 4 and 18, 1882.) Philadelphia: 1882.

- Preliminary Observations on the Pathology of Sea-Sickness, (Re-
printed from the Lancet.) By J. A. Irwin, M.A.. Cantab; M.D.
Dub. Philadelphia : P. Blakiston, Son & Co. 1881. Pp. 13.

The Thirty-Ninth Annual Report of the Mount Hope Retreat,
for the Year 1881. By William H. Stokes, M.D. Baltimore :
Printed by John Murphy & Co., 182 Baltimore Street. 1882.

Homoeopathy, What is it ? A Statement and Review of Its Doc-
trines and Practice. By A. B. Palmer, M.D., LL. D. Second Edi-
tion. 1881. Detroit, Mich., U. S. A. : Geo. S. Davis, Medical
Publisher.

An Introduc ory Lecture delivered at the Opening of the Penn-
sylvania School of Anatomy and Surgery, October 4, 1881. By
George McClellan, M.D. Philadelphia: W. H. Hoskins, 913
Arch Street, Philadelphia. 1881.

Report on the Geology and Resources of the Black Hills of Da-
kota with Atlas. By Henry Newton, E.M., and Walter P. Jenuey,
E.M. Department of the Interior. Washington .Government
Printing Office. 1880. Pp. 566.

Vascular Tumors of the Female Urethra. With the Description
of a Speculum Devised to Facilitate their Removal. A. Reeves
Jackson, A.M., M.D., Chicago, 111. Reprint from Vol, IL Gyne-
cological Transactions, 1878, Pp, 9.

Contributions to Orthopoedic Surgery. By Charles F. Stillman,
M.D., of New York. (Reprinted from the Transactions of Ameri-
can Medical Association for 1881.) Philadelphia : Collins, Printer,
705 Jayne Street. 1881. Illustrated, Pp. 14.

17.8 BOOKS AND PAMPHLETS RECEIVED.

Vaccination. By Prof. C. A. Lindsley, M.D., Medical Depart-
ment, Yale College, December, 1881. From the RMiort of the
Secretary of State Board of Health. Hartford, Conn. : The Case,
Lpckwood & Bi'ainard Co., Printers. 1882. Pp. 30.

The Study of Trance, Muscle Reading and Allied Nervous Phe-
nomena in Europe and America, with a Letter on the Moral Char-
Mcter of Trance Subjects, and a Defence of Dr. Chare )t. Bv Geo.
M. Beard, A.M., M.D. New York : 1882. Pp.40.

Illustrations of Dissections in a Series of Original Plates the Size
of Life. Representing the Dissection of the Human Body. By
Geo. V. Ellis and G. H. Ford, Esq. Vol. IL Second Edition.
New York : AVilliam Wood & Oompinv, 27 Great Jones Street.
New York. Pp. 226.

Fourth Annual Report of the Connecticut State Board of Health,
for the Fiscal Year Ending Nov. 30, 18S1, with the Registration
Report, 1880. Relating to Births, Marriages and Divorces. Printed
by Order of the Legislature. Hartford, Conn. : Pi ess of The Case,
Lpckwood & Brainard Company. 1882.

A Brief Historical Notics of the Origin and Progress of Interna-
tional Hygiene. A Paper Presented at the Ninth Annual Meeting
of the American Public Health Association. 1881. By James L.
Cabell, A.M., M.D., LL.D., University of Virginia. Boston :
Franklin Press : Rand, Avery, and Company. 1882.

A System of Surgerv, Theoretical and Practical. In Treatises
by Various Authors. Edited by T. Holme?, M.A.Cantab. First
American from Second English Edition, Thoroughly Revised and
Much Enlarged. By John H. Packard, A.M., M.D. Assisted by
a Corps of the Most Eminent American Surgeons. In Three Vol-
umes. With Manv Illustrations. Volume III. Philadelphia :
Henry C, Lea's Son'& Company. 1882. Pp. lOGO.

NORTH CAROLINA

MEDICAL JOURNAL.

THOMAS F. WOOD, M. D., Editor.

Number 4. Wilmington, April, 1882. Vol. 9.

ALEXANDER ON THE CURE OF EPILEPSY BY LIGA-
TURE OF THE VERTEBRAL ARTERIES.

In a short paper in the Medical Times and Gazette for November
19th, Dr. William Alexander, Liverpool, called attention to three
cases where the carotids had been ligatured, and he promised to give
further results at a future time. This he intended to do after the
lapse of a year from the commencement of these operations ; but the
results have been so striking, and so many enquiries have been made
about the cases already operated on that he finds it necessary to re-
port at an earlier period.

The three cases reported have remained free from fits ever since.
Tlie first is engaged in a tea-ware house. The idiot boy has become
obedient-, observant, and intelligent, and efforts are being made to
get him iuto an idiot asylum as a most promising pupil. The third
case an old liospital bird, has been in an out of hospital on various
jiretences ever siacc. He almost regrets his cure, as it lessens ma-
terially the facility with which he can obtain admission to hospital.
He is at present in with a swollen leg.

The case referred to by Dr. Alexander, where maniacal symptoms
appeared after fits, and sometimes in place of them, and where the
maniacal symptoms subsided as well as the fits after ligature of one

180 CURE OF EPILEPSY.

vertebral, is still in hospital. A relapse took place in this case in
regard to both symptoms. The fits, however, were much fewer and
less severe, and the maniacal symptoms never rose above an excited
manner, whereas before they were homicidal in their tendency. In
this case he has since ligatured the other vertebral artery, no bad
effect followed the operation, and both epilepsy and mania quite
disappeared. He has lately had one or two slight fits without the
loss of consciousness, and his mental and physical condition are so
much improved that he would not be taken for the same individual.

The hopes then held out in regard to the possible effects of liga-
ture of the carotid were speedily succeeded by disappointment,
and the cases thus operated on are waiting until the cerebral circu-
lation has been fully accustomed to its altered circumstances before
the vertebrals are interfered with. Dr. Alexander was not previ-
ously aware that the carotids had been ligatured for epilepsy. H s
researches have not discovered to him that any person had ever sug-
gested ligaturing the vertebral for epilepsy. He believes that liga-
ture of the vertebral was only done once before he performed it, and
in that case for innominate aneurism, where the carotid and sub-
clavian were ligatured at the same time.

He gives the following record of cases where the vertebrals have
been ligatured :

" Case I. — Nicholas M,, aged seven years, a slobbering, howling
idiot, was brought into the Liverpool Workhouse Hospital by a
drunken, nervous emaciated mother, on November 3, 1881. His
father is also dissipated in his habits, but otherwise strong and
healthy. The family consists of ten children, another of whom is
mentally weak. His fits began when he was a year and eight months
old, and have continued with increasing frequency ever since. From
his admission on November 3 until November 23, when the left
vertebral artery was tied, he had twelve fits (probably some more
that were not noticed). The operation was performed by making a
linear incision outside the sterno-mastoid muscle and outside the
veins that converge to the lower third of the outer border of that
muscle. The subcutaneous tissues were next cautiously divided
until the finger could be inserted into the loose, fatty tissue that
lies inside the scalenus anticus muscle. Upon retracting the sterno-
mastoid, with the subcutaneous veins and the internal jugular vein,

CURE OF EPILEPSY.

181

towarJs the middle line, the sulcus towards which the vertebral
artery runs were exposed. A littte scratching with a director ex-
posed the vessel, and ligation was a matter of routine. No bad
symptoms followed, although the patient frequently displaced the
dressing, as the valvular wound that I now practise in ligature of
the artery keeps the depth of the incision undisturbed and unex-
posed to the air, in spite of the disturbance of the dressing that
often takes place in epileptic, and especially jn idiotic, patients.
On December G he had a slight fit, and on December 20, 21, and 22
he had several fits. On December 28, as a few more fits had oc-
curred since the 22d, the right vertebral artery was also tied. The
wound healed up well, and in a week the boy was running about,
with only a small sore at the seat of incision. Up to January 23 he
continued free from fits. His drunken mother then refused to pay
for him any longer, and took him out. A fortnight after I saw the
mother. The child had no more tits, but he was evidently living
in a very neglected condition, and I am afraid his mental state will
not improve by reason of the deteriorating influences of his envi-
ronment. The case was appaiently a most hopeless one for opera-
tion, and the results obtained in stopping the fits and in clearing
the boy's mind are to me as astonishing as they are gratifying.

*' Case II. — Margaret O'D., aged seventeen years. She has been
an inmate of the epileptic establishment at Dingle Mount, in con-
nection with the Liverpool Workhouse, for some years. I have been
unable to obtain any particulars of her family history or of the
cause of her fits, but Dr. Irvine, the medical officer to Dingle
Mount, has supplied me with the subjoined record of the fits that
liave been observed during the year 1881 : —

a

cS

1-5

6
2
2
4

14

c3

1
1
0
15

17

<

2
2
9
5

18

0
5
2
11

18

a
a

1-5

0
0

1

7
8

>>

s

t-5

3
0
0
3

6

S
<

. 02

o

O

>

o

P

1

•2
3
6

12

2
5
3
0

10

3
4
0
4

4
3

7
4

0
4

2
27

57

67

Sent to

w'k house

Total

18

33

121

Tot

aldi

irin^

' yea

ir, 28

9.

The right vertebral artery was tied on December 21, and from her
admission until the ligature she had a great number of fits. The
wound healed without the slighest rise of temperature, and up to

182 CURE OF EPILEI'SY,

the present time (Febiuary 21) she has not had a single fit. Be-
sides the freedom from the fits, her temper wliich was very bad, has
enormously improved, and except for alittle (lightiness and '^might-
iness' of manner, her character has changed remarkably.

" Case HI. — George II., age 3 eighteen years was admitted iiUo
the medical wards of the Liverpool Workhouse on June 17, 1881.
His father was then alive; his mother was dead from heart-disease.
He suffered fioni 'hydrocephalus' when eighteen months old, and
when at school he was struck by a ' ruler.' These are the only
causes to which the disease can be ascribed. lie ha) his first fit at
fourteen years of age, and has had them ever sine. No recoid was
kept of their number in the medical waids, where eviry medicinal
means was tried. Ue was admitted to the surgical wards on Octo-
ber 1, and from that until October 12, when the left vertebrrtl
artery was tied, he had thirteen fits. The wound healed without
ftnv circumstance occurring tliat calls for remark, ilis first fit after
operation occurred on October 28. On November o he had anothei-,
and during November he had altogether thirteen fits (about half
the nutnber that occurred in the same time previous to the opera-
tion). On December 8 the right vertebral artery was fed, and on
January 14 he was discharged to his home, as no fits had occurred
since the operation. Next day, on leaving the hospital, news reached
him of his father's death — the only person he had to go to— and the
shock was consequently great. During the next few days he had
some sli'^ht fits. At the present time these weaknesses do not
trouble him, and have not for over a fortnight. He expresses him-
self confidently in the belief that a cure of the fits has taken place;
and it is a remarkable fact that the patients have a feeling that a
cure has taken place before time has proved it. They tell me
'something has left them,' or that ' they feel quite different from
what they did before.' The physical and mental improvement are
us marked in this case as in the previous ones.

'' Case IV. — Mary S , aged 31, single, of temperate habits was
admitted to hospital from Dingle Mount on July 30, 1881, suffering
from pneumonia and epilepsy. The fits began at the ago of two
years, after an attack of whooping-cough. They then ceased dur-
ing childhood, to reappear again at puberty, when she was fourteen
years old. Iler mother died from fits No record was taken of the

CL^HE OF EPILEPSY.

183

number of fits during the summer, as her chest was in such u doubt-
ful condition that opci-ative interference was considered out of
the question. At the beginning of the 3ear her pulmonary disease
had completely disappeared, and observations were then made upon
the number of fits, when she was found to have as many as six in
the week on an avercjge. On January 18 the right vertebral artery
was tied. 8he had one Lit the evening after the operation, and no
more until January 30. Up to February 20 she had had four fits
altogether since the operation. She was Iheji sent back to Dingle
Mount, because she did not wish to havetheother vertebral tied, on
the ground that she believed the fits wore leaving her. I did nat
press the o|)eration, as I believe the fits will gradually disa])pear
afier ligatnie of one vessel, and in her case full opportunities will
be afforded for testing this belief.

" Case r.— Mary E. W., aged twenty-one, admitted to hospital
January 27, 1882. Iler father and mother are botli alive and in
g od heal'h. Of the family, four children ditd of fever, one of
' water on the tjrain,' and one of convulsions. Two girls are alive
and healthy. The patients has had fits since she was eight vears
old, through a fight during play. She was, however, sensible until
she was eleven years of age, when she fell in the street and cut her
forehead. After this she became imbecile, and did not recoo-nize
any one belonging to her. Dr. Irvine sends me the following record
of the fits observed during the year 1881 : —

a

CS
>-5

a)

1

3

14

7

25

o

cS

5

9

14

17

45

<

10

10

9

21

50

a

11
12
9
21

53

a5

C

9

19

6

7

41

1^

13
14
6
29

"62*

3
<5

8

5

G

18

17

13
10
11
15

49

o

O

5
16
10
22

53

>
o

^

18
10
11
Id

55

V

P

First week

4

4
5
12

25

15
23
21

28

87

Second week

Fourth week

Total

Total during 1881, 582.

From January 27 until the ligature of the left vertebral artery
on February 2 she had nine f"ts. The patient was a stout, flabby
person, with a very short neck, and the operation of ligaturino- the
vertebral artery was one of no mean diDTiculty. The wound healed
up without any unusual inci'case of temperature, and she had no
fits for a week after the operation, and during the ne.xt fortnight
she had only seven fits — a decided improvement upon the previous

184 OURH OF EPILEPSY.

ten montli3. She is decidedly brighter-looking, and although she
does not talk much, jet she looks around hor more intelligently. A
more hopeless case than tins could not bo imagined, and yet I be-
lieve I shall make something of her."

lie has ten more patients under treatment, a report of whose
cases will be observed to a future i)aper. In three of them he has
tied both vertebrals simultaneously, without any bad effecis, and in
none of these have any fits occurred fcince. In all, without ex-
ception, the amelioration has been decided, whether we have regard
to the reduction of the fits or the improvement of the mental
ppwers. No lesions referable to the diminished supply of blood to
the spinal cord have been observed, and no deaths have occurred
from the operation in any of the cases under his charge.

It has been objected to ligature of the vertebrals that the opera-
tion is merely psychological in its effect?. "The mind of the pa-
tient is fortified by the idea that a cure has been cfTected, and hence
can restrain the fits. On this ground a milder operation would bo
as effectual." To such an objection he would reply that the idiots
operated on had no knowledge cither that they had fits or were
operated on for them. Many cases of severe burns have been under
my care in epileptics, and the fits have occurred in spite of the
burns. This fact disposes of another objection, that epilepsy and
severe wounds do not coexist. In some of my most successful ver-
tebral operations the wound healed by the first intention, and he
can trace no relation between the efilcacy of the cure and the
wound-trouble, but decidedly the reverse.

Then, again, it is difllcult to understaiul how ligature of the
vertebrals can effect any change, considering the free anastomosis
in the cerebro-spinal circulation. This theoretical difficulty is not
of much force when arrayed against opposing facts. Hut, even
theoretically speaking, the vertebral arteries have few anastomoses,
and mentions a paper of Mr, Moxon's somewhere, in which ho
attempts to show how lesions of the cord may depend on deficient
supply of blood through the vertebrals. llis operations, bethinks,
prove that Moxon was in error, and that the lesions he refers to de-
pend more on venous congestion than on spinal anaemia. Within
the last few days two observations have confirmed this view. lie
operated on a hopeless epileptic with a partially paralyzed right

CURE OF EPILKTSY. 185

arm, luul u deformed and iinmovublo luuul and wrist. A few days
after, he called my attention to his haod, which he could move with
a facility such as he had not done for years. Another patient upon
whom he operated with my friend Dr. MacDonncll abouta fortnio;ht
ago, was afflicted with a peculiar stiffness of articulation and a
slowness in getting out the words. He saw him on the same day on
which ho witnessed the mobility of the wrist. The ituprovemetit
in his articulation was so decided as to have already attracted the
attention of his attendants and follow patients. Now, to what
could this have been due but the relief of the pressure of passive
congestion. The suggestion here offered he intends to follow up in
his wards in the treatment of chronic diseases of the spinnl cord
in other than epileptic cases, but further notice here would be
premature.

Dr. Alexander rcierves a physiological observation in this connec-
tion to the last. When the vessel is ligatured the pupil on that
side becomes contracted. In the majority of cases this contraction
maintains ; in Mary S.'s case (case 4) it is still distinct. When the
opposite vertebral artery is ligatured, the opposite pupil always
contracts and the pui)ils again become equal. No interference in
sight occurs, and in some unilateral ligatures the contraction passes
off. The inferior cervical ganglion rests upon the carotid, and
sends branches along these vessels. These branches are included
in the ligature, and somehow affect the pu[)il. Or, he asks, is
the pupil affected by a change in the circulation at the base of the
brain ?

Dr. Alexander with his present experience is able to say that
ligaturing the cerebrals has a decided effect ui)on the mental con-
dition of epileptics and upon the number of (its in epilepsy and he
strongly recommends it where other means have failed. lie has
now tried it in hereditary cases, in epilepsy following scarlet fever,
blows, fright, and in cases where no cause could be ascertained. In
all tl'.e effect was beueficial, and mostly curative as far as time has
allowed him to judge.

186
ADMINISTKATION OF BELLADONNA TO CHILDREN.

Dr. Jules Simon, iu a lecture delivered at the Ilopitul des Ea-
fants-Malades {Gaz. des Hop., January 5 and 10), observes that
belladonna is a medicine that is often employed with success iu
children, who in general bear it very vvell, just as adnlts for the
most i)art tolerate it badly. The doses which he recommends are
the result of the almost daily use of the drug, either in his hospital
or private practice. As examples of its cfficac}', he alludes to its
use in four cases, one of them occurring as far back as 1871, so that
the employment of belladonna is no new thing with him. This
case occurred in a boy three years and a half old, the subject of in-
tense whooping-cough, to whom he gave, on March 7, thirty drops
of the tincture of belladonna to l^e taken in the twenty-four hours.
On the 8th he ordered forty drops, and next day sixty, always in the
same space of time. This last dose was continued daily until the
lOth, not only without any accident, but with great improvement
in the cough. In two other cases, in boys four and three years old
respectively, the dose given varied from fifty to sixty drops in the
twenty-four hours; and in a girl thirteen years of age, with bad
paroxysms of the cough, beginning with <cn drops per diem, he
gradually increased the dose to l::iO, without the slightest accident
arising.

The powder and extract of belladonna are two prejxiralions that
may be very well associated so as to make very small pills, each con-
taining a centigramme of extract and one of powder ; and these
pills are found very useful in combating the tendency to constipa-
tion in chlorosis. The dose of the tincture may be graduated as
follows : From two to three years of ago, five to ten drops ; three
years, ten to twenty drops; and above three years, thirty to forty
drops per diem — always, however, at this last age commencing with
ten drops. The dose should in all cases be divided into two por-
tions. Below the age of two the tincture is given only quite ex-
ceptionally, and then at a year old in doses of five drops per diem.
Of the syrup the daily dose is one or two teaspoonsful (i. e., five to
ten grammes) for a child two years old, and two, three, or even four
teaspoonsful for one of three years. To the adult are generally
given two taolespoonsful, or about thirty grammes. AVhen the

ADMINISTRATION OF BELLADONNA TO CHILDREN. 187

neutral sulphate of atropia is employed, half a milligramme per
diem should be given to a child two years old, gradually increasing
the daily dose to two milligrammes. Belladonna may also be em-
ployed externally, as in arthritis and coxalgia, when a liniment may
be formed of four parts of extract of belladonna and six of extract
of henbane with q. s. of oil of henbane. Sometimes also the extract
of belladonna is added to mercurial ointment ; and an ointment
composed of neutral sulphate of atrophia twenty to thirty centi-
grammes and benzoinated lard thirty grammes is very useful in re-
lieving or even removing muscular pains in certain cases. Bella-
donna is, then, a very active and in general well-tolerated remedy ;
and of all the preparations we have referred to, the tincture in me-
dium doses of ten drops for a child two or three, years old is tho
most employed, as also the syrup in doses of one or two teaspoons-
ful for a child of the same age. I much prefer these two prepara-
tions to the neutral sulphate of atropia."

Turning toils physiological properties and therapeutical indica-
tions belladonna may be described as an irritant substance to the
parts upon which it is deposited. Taken internally, it, induces
thirst, drynessof the throat, with bitterness, and a certain acridity.
Sometimes it gives rise to a semi-paralysis of the pharynx, and
sometimes even to a kind of dysphagia. In poisonous doses it
gives rise to nausea and vomiting, like opium itself. But while tho
action of this last on the intestinal canal is characterized by con-
stipation, belladonna on the contrary, produces hypersecretion from
the mucous membrane of the canal, and slight painless contrac-
tions— that is, diarrhoea. Belladonna has a sedative action on the
circulation, producing in a therapeutical dose a diminution of the
pulse and calorification ; while in a poisonous dose it gives rise to
febrile accidents and a notable elevation of temperature. Prepara-
tions of belladonna produce on the skin almost a scarlatiniform
eruption of uniform redness. Their action on the respiration is to
diminish the secretion of ihe respiratory mucous membrane, the
rapidity of respiration, and the play of the thorax, diminishing also
the sensibility of the nerves. But when given in large doses, at the
same time that these induce vomiting and fever they increase the
movements of the thorax. Transpiration is not increased by bella-
donna, which again in this differs from opium ; and it is the same

188 AUMINISTIIATION OF BELLADONNA TO CHILDREN.

with the urine, whicli is increased in quantity. It is a nervine lyar
excellence, exciting the central nervous system. In a somewhat large
dose it produces cephalalgia ; in a stronger dose, vertigo, intoxica-
tion, subdelirium, with great loquacity ; and in a poisonous dose
the delirium becomes more intense, and even furious. Opium is
the opposite of this, depressing the nervous system. It acts on the
pupil by " decongestioning" and dilating it — again the opposite of
opium. On this ground it is supposed to render the brain antemic,
while opium seem rather to produce its congestion. Finally, in a
therapeutical dose it diminishes the susceptibility of the nerves of
sensibility, and in a poisonous dose it gives rise to the phenomena
of tetanism. To sum up : the principal action of belladonna is to
produce diarrha3a, to diminish calorification, to increase the renal
secretion, to maintain the nervous system aroused, while rendering
the central nervous system ara?mic.

As to the diseases in which belladonna is indicated, Dr. Simon
states that in simple acute laryngitis, in stridulous laryngitis, in
intense laryngitis with spasms, raucous cough, etc., he prescribes a
mixture of equal parts of the tincture of the roots of aconite and
belladonna, giving ten drops per diem to children two or three years
of age. In spasmodic and paroxysmal bronchitis, in bronchial
adenopathy, in whooping-cough., and in iniluenza, he also orders
belladonna in combination with aconite. If the child is nervous
and very excitable, he associates with the syrup of belladonna (ten
grammes) syrup of codein (ten grammes) and eight or ten drops of
tincture of aconite, obtaining thus the benefit of both opium and
belladonna, their antagonism not being so complete as to prevent
their advantageous association in some forms of disease, especially
such as are attended with respiratory spasm. Belladonna is also of
service in emphysema, in asthma, and in suffocative paroxysms. On
the other hand its employment is absolutely proscribed in pneumo-
nia or broncho-pneumonia. In affection of the digestive organs,
especially those met with in nervous little girls, already almost
hysterical, with their intellect developed beyond their age, and who
are already little actresses, who have anaesthesia of the skin, com-
plain of severe pains without obvious cause, and who suffer from
gastralgia, dyspepsia, and sometimes vomiting — in such patients,
after trying laudanum, blisters, douches, and ice,he gives belladonca,

t

ADMINISTRATIOX OF BELLADONNA TO CHILDREN. 1S9

in spite of the cerebral irritation which exists, in doses of a tea-
spoonful of equal parts of syrup of belladonna and syrup of codein.
When children are arrowing up and suffer from constipation, which
accompanies abdominal neuralgia, he gives before meals a pill con-
sisting of a centigramme of powder and one of extract of bella-
donna. In tenesmus, ointments combined with belladonna generally
succeed, and they are also of use in appropriate cases of nocturnal
enuresis. In young girls of thirteen to fifteen, in whom the estab-
lishment of menstruation is difficult and is accompanied by erratic
pains, a liniment composed of four grammes of the extract of bel-
ladonna, six of the extract of henbane, and thirty of the oil of
henbane may be applied to the hypogastrium, and then covered
with a cataplasm. The pains are by this relieved without l»he ill
effects produced by opium enemata on the menstrual process.
Belladonna, formerly much employed in epilepsy, has of late been
superseded by the bromides ; but in some cases in which these last
have been found to fail, advantage has been derived from giving for
a fortnight one or two milligrammes of powder of the neutral sul-
phate of atropia, and following this up for another fortnight with
strychnia. In zona and in facial neuralgia of rheumatic origin
belladonna may bo employed for the relief of the severe pains. In
affections of the eye it is of use in diminishing the contraction of
the pupil, as also in catarrhal or purulent conjunctivitis, especially
when followed up by quinine. It is an errcr to regard it as a pre-
servative from scarlatina.

" Belladonna, then, is a means which may be very usefully em-
ployed in the affections of the respiratory organs already indicated,
in diseases of the digestive canal (when neither enteritis nor
diarrhoea exist), in affections of the nervous system, in zona, in
facial neuralgia, and in diseases of the eye." — Medical Times and
Gazelle.

In matters of ethics yonr first duty would be for each to work
after his- own ethic?, before he gives himself much trouble about
the ethics of his neighbor.— Z?/-. BiUinfja lo Bellevue Graduates.

190

THE EXCISION OF THE CANCEROUS UFERUS.

Statislics as to opcraLions, compiled from the practice of maiiy
different pci-sons, represent not tlie ])ossibIe results, but what may
be called the average result only, b;cause they inc'ude operations
done by men of very different knowledge, skill, and experience.
They tell us what has been done, but we cannot judge from them
what miv I e dour, nor always what ought to bo done. The results
obtained by one surgeon of experience are of much greater value
for the guidance of others. Professor Schroeder, of Berlin, has
recently published in the Zcilscltrift filr Gehurtshillfc nnd Gyn-
dkologie the results obtained by him from the partial and complete
excision of the cancerous uterus. The first group of cases which
ho gives comprises those of removal of the hody of the vferns, the
cervix bein'i^ left. Ho ha^ done this live times — three times for
carcinoma, twice for sarcoma. Four recovered, one died fi-om
sceptica3mia. In one, a case of carcinoma, four months after the
operation there was no sign of I'elapse. In another, a case of sar-
coma, five months after the operation, the disease had recurred.
The subsequent history of the other two is not given. The next
o-roup is of cases of FreuniVs operation, of which Dr. Schroeder
o-ives eight cases, six of which were operated on by himself, one by
Dr. Veit, ando:.e by Prof. Freuud. Of the eight, three recovered,
five died. Of the three recoveries, one had relapsed eleven months
afterwards, one died six months afterwards from recurrence of the
disease ; the other, four.een months after the operation, was as yet
without relapse. Dr. Schroeder then gives his experience of the
supra-vaginal excision of the whole cervix; i. <?., dissecting off up-
wards the mucous membrane, connective tissue, and peritoneum,
and then cutting through the cervix high up. Of this proceeding
he gives thirty-seven cases, with four deaths. In one, the disease
was not completely removed. Of the remaining thirty-two cases,
successful so far as recovery from the operation was concerned, in
fourteen recurrence took place ; in three within two months, in
three within three months, in three within six months, in three
others within seven, eight, and nine months respectively, in the
other two the date of recurrence is not given. Seven are reported
as continuinc^ well, having been watched, in two cases two months

JUXTA-EPiniYSAL SPIIAIX. 191

onl\', ill the rernuining (ivo cases three, four, five, six, and seven
months respectively. The subsequent course of the remaining
eleven cases is not stated. The last operation for uterine cancer of
which the results arc given is the total extii'patiou of the litems
tlirovfjlt the vagina. This, Professor Schrceder has performed eight
times, with only one death, whicli took ])lace from- internal hemor-
rhage, the result of a laceration of the broad ligament. The suc-
cessful cases were at the time Professor Schroeder wrote too recent
for him to make any statement as to the frequency of relapse. So
far as these statistics go, the latter operation would seem the most
promising. But it is one difficult of performance, in which imme-
dia'e success, must depend largely uj)on the manipulative dexterity
and experience of the })erson who performs it ; miscellaneous sta-
tistics cannot show wluit results may be obtained by an exception-
ally skilful and c;irerul operator. — Mediral I'inies and Gazette.

OLLIER ON JUXTA-EP1PHY8AL SPRAIN.

In a contribution to the Revue de Cliinigie, No. 10, 1881, on
juxta-epiphysal sprain, and its direct and remote results with regard
to inflammation of osseous structure, M. Oilier describes the lesions
that may be produced in a long bone, near one of its extremities,
by violent movements of the contiguous articulation, or by violence
applied to the bone itself. In the adulr, the usual results of violent
movement of an articulation are stretching and laceration of its
ligaments, with or without separation of the osseous processes to
which some of the ligaments are attached. In young children, on
the other hand, particularly those under the age of three years, the
ligaments and cartilages offer resistance ; and it is beyond the artic-
ulation, and at the weakest, and most yielding part of the long
bone, that the lesion is produced. This lesion consists, in some in-
s'ances, in epiphysal sej)aration in its first degree; in other instances,
in incom[)lote fracture near the epiphysal line. The following
lesions arc mentioned as the probable results of the so-called, of
the e]iiphysal sprain ; crushing, compression, and fracture of the

192 JUXTA-EPIPIIYSAL SPRAHST.

spoDgy bonetissne; indentation unci partial fracture tf the thin
peripheral layer of compact tissue ; and, as consequences of these
lesions, squeezing one of the medulla, and effusion of blood into the
medullary spaces and under the periosteum. These injuries are
more likely to result from violence to the contiguous articulation,
when the consistence of the bone has been impaired through rickets
or any other condition of acute or chronic disease, that has a ten-
dency to interfere with the nutrition of the osseous structure. As
these lesions usually affect the interior parts of the bone, and do
not involve the periosteum, v/hich membrane remains intact, they
lire liable to be overlooked by even the most experienced surgeons.
The absence of displacement and of readily appreciable anatomical
lesions, will account for the slight importance that has hitherto been
attached to the disturbances caused by sprain of a joint in a young
patient. According to Professor Oilier, the so called growing pains,
which affect some infants at the period when the growth of the
skeleton is most active, are often the result of falls and of excessive
movements, and may be explained by the feeble consistence of the
recently formed juxta-epiphysal portions of long bones. The atten-
tion of M. Oilier was firs: directed to this point, about eighteen
years ago, by a singular case of arrest of growth in the humerus,
without suppuration or violent inflammation, which had followed
a fall on the arm.

Juxta-epiphysal sprain may give rise to a more or less painful
swelling, restricted to the part of the long bone near the epiphysal
line, whilst the neighboring articulation remains quite free. There
is, in most cases, slight tenderness, which ceases spontaneously in
the course of a few days. Tissue-repair, in young children, is
extremely rapid ; the periosteum swells at once, and, when thus
swollen and thickened, restricts the abnormal mobility in the juxta-
epiphysal region, which, in the more severe form of sprains, is the
immediate result of compression and crushing of the spongy bone-
tissue, of laceration of the peripheral layer of the compact tissue,
and of loosening of the subchondroid spongy layer. Even in the
most severe forms of juxta-epiphysal sprain, the periosteum soon
attains sufficient thickness and resisting power, to enable it to form
a kind of splint, and to render diaphysis and epiphysis quite im-
movable. Speedy recovery usually takes place in children that are

JUXTA-EPIPHYSAL SPIIAIX. 193

healthy and well-nourished ; but in those that aio not well cared
for, and are scrofulous, and have a hereditary predisposition to
tubercle, and especially in those with swollen and caseating lymph-
glands, the prognosis is less favorably. In this latter class of pa-
tients, the trabecular fracture, or the effusion of blood into the can-
cellated tissue, is very likely to become the origin of chronic and
painless osteo-myelitis, a condition usually regarded as an immedi-
ate or direct result, or rather as a spontaneous product of scrofula.
As a cutaneous affection may give rise to swelling of the neighbor-
ing lymph-glands, and as irritation of a raucous membrane may be
the origin of deep-seated adenitis and of splanchnic tuberculosis,
so, in a case of trabecular fracture, the crushed medulla may be-
come the starting point of a neoplasm, lymph-cells may accumulate
in the medullary spaces, pass into acondition of fatty degeneration,
and form caseous foci, which, progressively infecting the bone, will
lead, in a predisposed subject, to any of the varying forms and con-
sequences of osseous tuberculosis. In order to prevent any danger-
ous results from juxta-epiphysal sprain, the surgeon has only to
keep the injured limb at complete rest for a certain time, and, if
there be much swelling and effusion of blood, to apply compression
at the seat of injury. The necessity is pointed out of carefully ex-
a»ning any infant, any of whose limbs has been the seat of violent
movement, or has been injured in a fall. If, on examination, a
juxta-epiphysal swelling, whether painful or indolent, bo made out,
then the little patient should be kept at rest, and watched until the
bone has returned to its normal size.

In conclusion, Professor Oilier writes of the relations of juxta-
epiphysal sprain with the lesion observed frequently in the forearm
of infants, and known by the name of painful pronation, and with
regard to which many theories have been put foith. Many surgeons
have sought in the^articulations forHhe cause_of this injury, some
regarding it as a lesion of the wrist, others as a lesion of the elbow.
Goyrand, who attributed it at one time^to forward luxation of the
upper extremity of the radius, subsequently regarded it as due to
luxation of the triangular cartilage of the radio-carpal joint. Pro-
fessor Oilier, from both clinical observation and experimental re-
search, has been led to regard this lesion of painful pronation as a
juxta-epiphysal sprain of the lower end of the radius or ulna, ac-

lO-t FIlACTUItE OF THE NECK OF TUE FE.MUK.

companies by iiioi'C or less stretching of ligiiments, muscles, and
other external structures, but consisting essenlially, in children
below three years of age, in the lesions already mentioned, such as
torsion of bone-structure, inllexion or indentation of })eripheral
compact tissue, trabecular ruptures in the spongy tissue, aud de-
tachment of periosteum — W. Joiinsox Smith, in London Medi-
cal Record.

WIGHT ON FRACTURE OF THE NECK OF THE FEMUR.*

When we had admitted the uncertainty and the not unfequcnt
impossibility of making a diagnosis of fracture of the femoral neck,
wc may asiv the following question: 'Are there any signs by
which we can be reasonably sure that there is a fracture of the neck
of the femur, on the supposition that crepitus is absent, and that it
is not good practice to try to find crepitus ?'

In order to bring some points to bear on tlic settlement of this
r|uestion, I have tabulated the records of twenty-one cases of
fracture of the femoral neck that I have seen, some with other sur-
geons and some in my own practice. The records that I have tabu-
lated contain the following measurements : 1. Inside measurements
from the superior anterior spines of the ilia to tiie lower ends of the
internal malleoli ; 2. Outside measurements from the superior an-
terior spines of the ilia to the lower ends of the external malleoli ;
3. Measurements from the tops of the great trochanters to the
lower ends of the external malleoli ; 4. Measurements from the
bases of the tibia3 to the lower ends of the internal malleoli ; 5.
Measurements from the superior anterior spines of the ilia to a line
drawn transversely in front between tlie tops of the great trochant-
ers. This is the transverse femoral line.

The object of all these comparative measurements is to de'.ermine
the possibility of original symmetry of the two limbs, and to 11 nd
out, as far as possible, if the injury to the hip have caused any

♦Proceedings Med. Society County of Kings.

FRACTURE OF THE NECK OF THE FEMUR. 195

sliorteiiing of the limb on the injurecl side, so that we can infer the
probability of their being a fracture of the femoral neck. Let mc
repeat, in this connection, some of the points constituting reliable
surgical measurements. 1. The instrument of measurement should
be an accurate steel tape-lino, with feet and inches on one side, and
metres and centimetres on the other side. This tape-line will not
elongate under tension, and the ordinary tape-line will elongate
under tension. 2. The measurements should be made independently;
that is, when one is made, the points of the tape-line should be re-
moved from the surgeon's hands, and new points for the other side
of the body should be determined without any reference to the
measurement of the first side. 3. In all ordinary cases, the leg
may be measured quite accurately by semi-flexing it on the
thigh, for this position brings the anterior edge of the base of the
tibia markedly under the integument, so that it can be made quite
as accurate a point of measurement as the superior anterior spine of
the ilium. 4. In most cases, the tops of the great trochanters can
be so accurately compared, as to make the measurement from them
to the external malleoli of considerable value. 5. In all cases the
personal equation of the surgeon should be most carefully excluded
from any measurement. G. The lower limbs should be put parallel
with the pelvis ; for in the ordinary measurement, adduction elon-
gates and abduction shortens the lower limb.

1. In all the twenty-one cases above recorded, there was more or
less obliteration of the abdomino-femoral — or inguinal — fold on the
side of the injury. This was probably due to two causes ; a. Effu-
sion in front of the injured femoral neck; l. Contraction of the
soft parts in front of the femoral neck. 2. About one-half of the
patients were examined standing up ; and when the foot of the in-
jured side was brought down to the floor, the glutco-femoral fold
on that side was seen to be lower than the gluteo-feraoral fold on
the uninjured side. 3. There was out rotation of the injured limb
in all of the above cases. In Cases' I and II the out rotation was
not marked. 4. In all the cases of impaction of the base of the
femoral neck, the upper end of the femoral shaft was materially
enlarged. There were probably eight such cases. 5. In all of the
cases of impaction of the top of the femoral neck into the femoral
head, the upper end of the femoral shaft was not enlarged. There

196 FRACTURE OF THE NECK OF THE FEMUR.

were probably five such cases. 6. The other eight cases could not
probably belong to either of the above classes. 7. In all of the
above cqses, there was more or less prominence of the outside of
the dip, but the gluteal region was somewhat flattened ; and
generally there was a fusiform enlargement of the upper part of the
thigh. 8. In fourteen of the twenty-one cases there was more or
less asymmetry of the lower limbs : and this point is important for
two reasons. First, it was determined by measuring from the tops
of the great trochanters. Second, it agrees with the general fact,
that about two persons out of ever} three have asymmetry of lower
limbs. Hence, the above measurements from the tops of the great
trochanters to the external malleoli were probably correct. Hence,
such a measurement may be recommended as a valuable aid in mak-
ing a diagnosis of fracture of the neck of the femur.

1. The average shortening after fracture of the neck of the
femur, as shown by the inside measurement, is about .02 of an inch;
as shown by the outside measurement, is about. 55 of an inch ; and
as shown by both measurements, is about one-half an inch, .58. 2.
The greatest shortening was one inch and one-half — in Case V. 3.
The least shortening was zero — in Case XVI ; but in that case there
was an actual shortening of three-fourths of an inch. 4. The
average normal asymmetry of the lower limbs in the above twenty-
one cases was .4- of an inch. 5. The average shortening of the
measurement from the superior anterior spine of the ilium to the
transverse-femoral line was about one-lialf inch, again showing that
the top of the trochanter major is an approximately accurate point
from which to measure. 6. In the four following cases the injured
limb appeared to be shortened one-fourth of an inch by a compari-
son of the inside measurements.

In no case of fracture of the femoral neck do I use force to find
crepitus. I consider the other evidences of fracture, such as I have
above enumerated, as sufficient to come to a practical conclusion.
Nor do I give an anfesthetic in order to make an examination. In
this connection, I would make the following statements : 1. Mov-
ing the outer fragment when it is in contact with the inner frag-
ment, will generally carry the inner fragment with it, and there will
be no crepitus ; and when there is impaction, ordinary manipula-
tion will not cause crepitus to be felt. Yet crepitus may at times

ANTI-VACCINISM. W7

be felt, when there is impaction of the neck of the femur. 2.
Moving the outer fragment when it is not in contact with the inner
fragment, of course will not give crepitus. 3. Hence, unwarranta-
ble force will be required in order to get crepitus in many cases of
fracture of the neck of the femur may be broken up by severe ma-
nipulation, and a patient who would have had a useful limb maybe
quite completely disabled for life ; for an impacted fracture of the
neck of the femur is the best setting of the bony fragments that the
surgeon can have. 4. In a suspected case of fracture of the neck
of the femur, I examine all the witnesses of fracture except crepi-
tus ; and if these witnesses agree substantially, I pronounce a ver-
dict in favor of fracture of the neck of the femur. And if there
be a doubt as to the correctness of such a verdict, I give the patient
the benefit of that doubt, by treating the case as if there were
fracture of the neck of the femur ; and then the surgeon receives
a benefit from that doubt. But if there be no fracture, the patient
has had some days of needful rest, and has had a contused hip well
treated. — London Medical Record.

REPLY TO BERGIl'S INSANE TIRADE AGAINST VACCI-
NATION.

We publish some paragraphs of the tirade by Mr. Bergh in our
last issue, and take pleasure in asking our readers attention to some
extracts from a reply to Bergh, taken from the Xorth Americcin
Review for April. The original paper was too long for the North
American Revieiv, and contained much statistical material as to the
prophylactic value of vaccination, and we hope to see it in print.

Two charges are made by anti-vaccinators which include all
their utterances worthy of a moment's consideration : (1) That
vaccination does not protect from small-pox ; (3) that the opera-
tion of vaccination is the means of introducing into the human
system a large number of diseases and diseased conditions and pre-
dispostions, almost, if indeed, not quite all known to pathology and
some known to no pathology but that of anti-vaccinism. If these

198 ANTI-YACCINISM.

two charges can be proved utterly false — and notbinw is easier to
any candid, impartial, competent, Ijona fide seeker for truth, — no
rational person can pretend for a moment that there is any ground.
for anti-vaccinism, whatever there may be for reform and improve-
ment in the practice of vaccination.

To meet the first charge, it is evident that statistics of the mor-
tality from small-pox in vaccinated and unvaccinated populations,
of epidemics of small-pox before and since vaccination, and of the
well, imperfectly, and not at all vaccinated in masses of population,
in armies, and particular in hospitals for the treatment of small-
pox, must afford conclusive evidence. Such statistics exist to an
amount practically inexhaustible, and are recorded with the greatest
possible care, honesty and accuracy in reports of the proper officials
of every civilized government, of boards of health, and, above all,
of small-pox hospitals. They all invariably and perfectly sustain
the doctrine that a simple "good vaccination" in the earliest in-
fancy, even when made with virus of moderately long humanization,
though it may, and docs frequently, fail to prevent small-pox after
adult age, wonderfully modifies the total adult severity, and reduces
the total adult mortality and disfigurement from the disease. These
statistics also perfectly agree in proving that effectual re-vaccina-
tion or even primary vaccination in adult life protects so completely
that cases of small-pox, after either, when done with virus not too
far removed from the cow, are as rare as second attacks of small-,
pox, while no case of small-pox after either primary or effective
secondary vaccination in adult life with true animal virus, has yet
been reported. It is fully believed by those by far the most compe-
tent to judge, that small-pox after perfect primary vaccination, fol-
lowed by effective re-vaccination after the tenth year, with true ani-
mal virus, will prove to be as rare as third attacks of small-pox, of
which perhaps a score are recorded in the whole history of medicine.
This belief is based on observation of the typical perfection of the
vaccinia induced by true animal vaccination, and its entire freedom
from those irregular and unprotective developments, the tendency
to produce which is one of the serious and frequent defects of virus
of very long humanization. I cannot spare enough of my brief
space to give even a few items of the statistics to which I have al-
luded, and which are easily accessible in almost innumerable publi-
cations. * * * *

ANTI-VACCINISJr. 199

In 187:2-3, au epidemic, the most malignant and destructive in
livi'.ig memory occurred in Boston. Its average mortality
among the entirely unvaccinated v;as considerably over tifty per
cent. The population was about 2(jb,000. The number of cases
during the thirteen months, January 1, 1872, to February 1, 1873,
was 3,187 ; the deaths, 1,015. A very peculiar condition of things
existed, the causes of which I have not space to explain. There
were, practically, no means of isolation. In no way had the people
of the Boston of 1872 any advantage against small-pox over their
ancestors of 1721, except that yielded by vaccination, and even that
most tardily afforded. But how immense that advantage ! With-
out vaccination, the epidemic of 1872-3 in J5oston would have been
terrific iu its destructiveness. Let it be remembered that the dis-
ease, in the most malignant and contagions form, was present in
every part of the city; that small-pox is a disease to which, with
hardly an exception, every unprotected person is liable on exposure
to its contagion. Were it not for vaccination, there would have
been in these thirteen months at least 150,000 cases in Boston, and
little less than 25,000 deaths, even if the epidemic had been no
more contagious and fatal than that of 1721. It must be remem-
bered, however, that it was very much moi-e malignant and conta-
gious, and that the rate of mortality among the quite unvaccinated
was much more than threa times as great. What was true of Bos-
ton in 1872-3 was true of every city and large town of Europe and
America during that dread visitation. None but the grossly igno-
rant will sneer at these assertions, for a very superficial study of the
history of small-pox before the eighteenth century will afford the
authentic narrative of variolous epidemics far more destructive than
my hasty approximative estimate. Thei-e is hardly a year in which,
among some of the barbarous and quite unvaccinated populations
which Mr. Bergh considers so enviable in their immunity from the
twin scourges of humanity, physic and physicians, small-pox does
not rage and destroy with far greater destructiveness. I have said
that nothing can possibly be more conclusive than the statistics in
favor of vaccination, even as practiced before the wide adoption of
the great reform to which I have already alluded. Even the anti-
vaccinist must admit this, if they are accepted as honestly and
truly recorded. If, after studying a few of these statistics carefully.

200 ANTi-VACcmisjr.

any doubt remain in the miud of the student, let him obtain, by
application to Mr. \Yilliam Young, London, the anti-vaccine
answer and refutal of what he has read, for, eacli and all,
anti-vaccinism has essayed to answer and refute. If lie care-
fully analyzes these answers and still lias any learning to anti-vac-
cinism, his case is indeed hopeless. Nothing can be more contempt-
ible and transparently dishonest and sophistical, well calculated,
indeed, to convince poor, illiterate, credulous people by appealing
to their prejudices and to the always present jealousy, suspicion,
and even hatred which the poor entertain against the wealthy, the
ignorant against those who are better informed, but laughably inad-
equate to satisfy any rational, educated, and unprejudiced person
save of the truth of the doctrines of vaccination. IIovv do the
anti-vaccinists pretend to answer these thoroughly convincing sta-
tistics ? One great and leading trick is to show that, in a certain
epidemic, more of the vaccinated than of the nnvaccinated died,
utterly ignoring the accompanying fact that perhaps ninety-five per
cent, of the population had been nominally vaccinated. Another
is, to state the entire mortality of some epidemic before vaccination
in which it was very small, say fifteen or even ten per cent., and
compare it with that in the same city since vaccination, largely in-
creased in population, during an epidemic of terrible contagious-
ness, malignancy, and consequent fatality. Another still, to take
the mortality of all (vaccinated and nnvaccinated) in some terrible
epidemic like that of 1SG9-74, and compare it with that of some
exceptionally mild epidemic before 1798, when, of course, all were
nnvaccinated.

When these and many other precisely similar and quite as dis-
honest trumpery subterfuges are, even to their contrivers, most evi-
dently insufficient, comes the inevitable dernier ressort, the ultima
ratio stitltorum, to deny the truth and good faith of the statistics
themselves. Every old wife's tale, every rascally charlatan's
slanderous lie, every idiot's exaggeration, is repeated and accepted
as ''confirmation strong as Holy Writ" ; but the most authentic,
elaborate, consistent, scrupulously exact statistics of great armies,
Government bureaus, composed of the assembled returns from a
thousand sworn officials, or of great public hospitals, open to daily,
hourly insj^ection and criticism, are "doctored" statistics, "cooked"

ANTI-VACCINISM. 201

statistics — in other words falsehoods, and masses of falsehood, the
work of a conspiracy of thousands of the noblest, most self-sacriGc-
ing, truthful men in existence. A conspiracy so well organized,
that from every hospital, from every civilized government, are pub-
lished statistics of precisely the same character, thoroughly corrob-
orative of the inestimable value of vaccination. A conspiracy for
what ? To retain a little longer the loaves and Cshcs, the paltry in-
comes which accrues to a part of the medical profession from the
practice of vaccination,— an income so small, so precarious, so
insignificant compared with the labor it involves, that all physi-
cians of any eminence, who are not actuated by a sense of duty,
notoriously avoid and refuse the practice that wins it ! The men
who utter these villainous, wicked absurdities are not all so utterly
ignorant as Mr. Bergh. Some of them know better. They have
studied the history of small-pox and vaccination, and are well
aware that when the profession of medicine, almost to a man,
adopted inoculation, the adoption involved the loss of that practice
in small-pox which was by far the most lucrative source of profes-
sional income. They know, too, that when the same profession
adopted vaccination, its doing so meant the abandonment of a far
more profitable practice. Before either inoculation or vaccination
were introduced, small-pox w-as as common among the wealthy and
noble, as fatal to royalty itself, as it is now in those back slums of
London, in which are the citadels and strongholds of squalor, vice,
ignorance, and anti-vaccinism. The greatest income ever earned by
a physician before the present century was that of the famous Dr.
Eatcliffe, and was mainly, if not entirely, due to his repeated great
skill and success in treating small-pox. Every city and large town
in England then had physicians famed for their peculiar skill
in treating that dreaded disease, and winning fame and fortune
from the reputation. If a single physician in the mighty metrop-
olis of the world, with its teeming millions, were now to confine
himself to the treatment of small-pox, that specialty which once,
when that city held not one-third of its present vast population,
enriched scores of his profession, he would starve. It would be
rarely that he would have a paying patient, for small-pox is practi-
cally unknown among the most civilized, enlightened, and, of
course, best vaccinated classes, and, for the occasion, I will include

202 ANTI-VACCINISM.

with them the leaders of anti-vaccination, who are, almost to a
man or woman, very thoronghly vaccinated.

All the sophistry of anti-vaccinators, all the shallow, hnseless
theories evolved from the inner conscionsness of visionary pre-
tenders to science among them, are utterly and absurdly inadequate
to meet the one simple fact, patent to all, requiring no laborious
I'escarch to ascertain, that precisely as they are well vaccinated are
people exem])t from danger of small-pox, while those who are the
best vaccinated as a class, doctors and nurses, may be said to enjoy
perfect immunity even during epidemics so intensely malignant and
contagious as to attack all the unvaccinatcd, and many of the im-
perfectly or improperly vaccinated, exposed to their contagion. The
favorite anti-vaccine theory is that small-pox is merely a- result of
bad drainage and neglect of ordinary sanitary precaution, and that
the immunity of the belter classes is mainly due to improvements
in plumbing, utterly ignoring the fact that long within the periods
of written history small-pox was unknown in Europe and America,
although all the conditions and causes which the sages of anti-
vaccinism assure us are alone necessary and competent to the crea-
tion of the disease dc novo existed to a far greater degree than now.
Few things of the sort could be more amusing than the enumera-
tion and analysis of the small-pox anti-vaccine theories of Spinzig.
Both, Nightingale, and the rest ; but I must forbear, with the sim-
ple statement that every anti-vaccine attempt to invalidate this en-
tirely magistral and conclusive fact in favor of vaccination involves
the denial of the contagiousness of small-pox — a denial as selfcvi-
dently absurd as would be that of the law of gravitation.

********

In regard to the second charge, let me say, at once, that it has
been long alleged that syphilis was liable to be, and had been trans-
mitted by the operation of vaccination with humanized virus. The
reports, however, were not made with such exactness, or by such
authority, as commanded credence ; and the accident has been of
such prodigious rarity in all countries in which vaccination is
properly done, that it was not until very recently, and by a most
distinguished surgeon, pathologist, and ardent advocate of vaccina-
floii, — Mr. Jonathan Hutchinson, of London,— that a demonstra-
tion of the sad truth was at last made, which commands the implicit

ANTI-VACCINISM. 203

belief of even those most desirous not to be convinced. It is also a
fact that a form of erysipelas, almost always slight, but always an-
noying and sometimes fatal, has been observed about once in five
hundred vaccinations as generally done, and occasionally even after
the most careful performance of the operation with the best hu-
manized virus. These two sometimes inevitable results of even care-
ful vaccination with humanized virus can be perfectly avoided by
the use of that obtained by exclusively bovine transmission of origi-
nal cow-pox, such as at this time is, or has very recently been, em-
ployed to the amount of probably at least one hundred thousand
vaccinations daily, in the tardy but very successful effort to control
and arrest a most threatening and wide-spread epidemic in America.
In the use of such virus, the first terrible accident is impossible,
and, quite contrary to my first apprehensions, erysipelas has never
been reported, — the few, very few cases, which deceived not very
competent observers having been invariably of simple erythema, a
trivial affection due to friction of the vaccinated surface from un-
duly active work or exercise.

These two are the only diseases of which it could be truly said
that, in certain instances, they would not have occurred but fot" vac-
cination. There remain, however, a considerable number of dis-
eased conditions liable to complicate and follow vaccination. Some
of^these are the result of the effect of the slight constitutional dis-
turbance incident to vaccinia bringing to the surface and making
evident an eruption of disease already latent in the system sooner
than would otherwise be the case, but the remainder, without ex-
ception, have no real relation with vaccination whatever, being the
direct consequences of filthy habits oi life, gross neglect of ordi-
nary care, very morbid condition of patient, and, above all, and in
the most severe cases, malpractice, gross and often even incredible,
of physicians ; in improper methods, and in use of virus taken
from improper subjects, at too late a period of the disease, or in a
stage of decomposition. Besides these, there have been a few very
severe and even fatal cases in which, as a result of accident, reckless
imprudence, or drunkenness, the vaccinated arm had, when the
eruption was " at its height," been exposed to intense and continued
cold. It must be evident to the reader that any discussion of these
unpleasant complications of what is, at any rate nominallij, vacci-

5J04 ANTI-VACCINISM.

nation must necessarily b3 technical and, to be instructive, of con-
siderable length. In either case it would be out of place in the
Review. I will, therefore, simply state that none of them have any
but an accidental relation to vaccination. As long, however_, as
every disease except small-pox is as likely to occur after vaccination
as before, so long will innumerable diseases be attributed to its in-
fluence by the ignorant. It is most unfortunate that a body of pre-
tended philanthropists who ought to know better, many of whom
Jo know better, yet see fit to approve the inevi table ^jo.*;/ hoc, xiropler
7iOc reasoning of the common people, and so encourage, not only
antagonism to vaccination, but antipathy, even hatred, toward the
members of that profession to whom the poor have so often to look,
and never in vain, for relief and remedy in their direct misery and
need. The misrepresentation of anti-vaccinism, whether willful or
the result of ignorance, extends to every detail connected with vac-
cinat'on. For instance, a recent prominent authority calls vaccine
virus a '-'disgusting mucus." A still more scientific confrere con-
siders it an equally disgusting "pus" while many others of the
same school are sure that it is nothing but a septic product, in other
words, an animal substance in a state of putrefactive decomposition.
Now, vaccine virus is a perfectly limpid, nearly colorless, and quite
odorless slightly albuminous fluid, having no relation or analogy
whatever with the well-known organic secretions of which Mr.
Bergh and Dr. Both speak so disrespectfnlly, and so far from being
septic that the moment it becomes slightly so, as a result of decom-
position, it ceases to be vaccine virus, or to be capable of inducing
vaccinia. I notice this trifling matter because it gives an excellent
idea of the utterly loose, reckless way in which these people pro-
nounce dicta on purely scientific subjects.

I have seen as many of the cases which anti-vaccinism attributes
to vaccination as most physicians, but not one of these could be
fairly so attributed. I have never seen a c.ise of vaccinal syphilis,
although from my reading I am convinced that such cases have oc-
curred. I have seen many cases of vaccinal crysipelns in my own
practice, but all recovered, and not a single case has complicated or
followed one of the almost countless vaccinations whicli I have made
with true animal vaccine virus.

ANAESTHETICS FROit A ^lEDICO-LEGAL POi:S"T OF VIEW. 205

IIow is it, my eyes being tolerably wide open and having observed
ilie course and result, immediate and remote, of tens of thoiuands
of vaccinations, primary as well as secondary, that I have seen
nothing in all these years, while Mr. ]5ergh, whose eyes are only just
opening to the horrors of vaccination, and who is certainly not very
well educated to appreciate and weigh the value of symptoms ; who
has probably not observed the course and results of ten vaccination?,
if he has of one ; whose study, even of the literature of anti-vac-
cination, is apparently limited to the fifteen-page pamphlet of a
wildly visionary theorist and a four-page London libel on myself, of
whicli both his letter to Professor Chandler and his paper in the
February Xorth. American are little more than reprints without
acknowledgment, — has seen so much ?

T have hcaiil of a rchool that is not

" Any school,
But that where blind aud naked ignorance
Delivers brawling judgments unashamed
On all things all day long."

Is Mr, Bergli, perhaps, one of its recent graduates ?

ANyESTIIETICS FROM A MEDICO-LEGAL POINT OP

VIEW.

Dr. J. C. Johnson, of Brooklyn, presents certain conclusions in
i\\Q Annals of Analomij and Surgery which deserve careful con-
sideration.

Ana?sthetits do stimulate the sexual functions, the ano-genital
region being the last to give up its sensitiveness. Charges made by
females under the influence of an ani3esthetic should be received as
the testimony of an insane person is. It cannot be rejected, but the
corpus delicti aliunde rule should be insisted on. Dentists or sur-
geons who do not protect themselves by having a third person
present do not merit much sympathy.

Death from administration of chloroform after a felonious assault,
unless the wounding were an unmistakably fatal one, reduces the
crime of the prisoner from iiuuder to a felonious assault.

20G ■ EXTERNAL USE OF CASTOR OIL.

The surgeon has no right to use chloroform to detect crime,
against the will of the prisoner.

But the army surgeon has a riglit to use chloroform to detect
malignerers.

The medical expert, notwithstanding he is sent by order of court,
has no right to administer an anfcsthetic against the wish of the
jdaintiff in a personal damage suit to detect fraud.

Gross violations of the well-known rules of administering anaes-
thetics, life being lost thereby, will subject the violator to a trial on
the charge of manslaughter.

A surgeon allowing an untrained medical studeiU to administer
anaesthetics, life being lost thereby, will subject himself to a suit
for damages. What he does through his agent he does himself.

The physician wiio administers an anaesthetic should attend to
that part of the business and nothing else. lie should have exam-
ined the heart and lungs beforehand, lie should have the patient
in the reclining position, with his clothes loose, so as not to interfere
with respiration ; should have his rat-tooth forceps, nitrite of amyl,
and ammonia, and know their uses, and when to use them, and how
to perform artificial respiration.

Chloroform cannot be administered by a person who is not an ex-
pert to a person wdio is asleep without waking him. Experts them-
selves, with the utmost care, fail more often than they succeed in
chloroforming adults in their sleep. — Bosloii Mcdiccd and Surgical
Jonrncd.

External Use of Castor Oil. — The London Medical Journal
gives reports from various practitioners who have found purgative
results follow the inuction of castor oil. One writer states that he
has frequently applied this oil to the abdomen under spongio-piline
or other water-proof material in cases where the usual way of ad-
ministering by the mouth seemed undesirable, and with the most
satisfactory consequences. In a case of typhoid fever, also, half an
ounce of castor oil was applied in this manner, under a hot water
fomentation, the effect of this being, as represented, to relieve the
constipation and lympantic distension that had been present without
undue purging or'irritation of the bowels. — Am. Med. WeeJdy.

207

EDITORIAL.

NORTH CAEOLINA MEDICAL JOURNAL.

A MONTHLY JOURNAL OF MEDICINE AND SURGERY, PUBLISHED
IN WILMINGTON, N. C.

Thomas F. Wood, M. D., Wilminn-ton, N. C, Editor.

Orif/iiial communications are solicited from all parts of the
country, and es2)ecialhi from the medical jrrofessioii of The Caro-
LiNAS. Articles requiriiif/ illustrations can t)e 2)i'oni2)tty s^ipplied hy
precious arrangement with the Editor. Any subscriber can have a
specimen number sent free of cost to a friend whose attention he
desires to call to the Journal, by sending the address to this office.
Prompt remittances from, subscribers arc absolutely necessary to
enable ns to maintain oiir worlc with vigor and acceptability. All
remittances must be made payable to Thomas F. Wood, j\L D.,
P. 0. Drawer 791, Wilminqton, N. C.

THE NATIONAL BOARD OF HEALTH INSPECTION OF
VACCINE STABLER.

We noticed in our March number tlic inspection of Vaccine
Farms made by the agents of the National Board of Health. At
the time we could not analyze them at length, but put them aside
for further examination. We are not informed upon what points
Drs. Johnson and Whitney were directed to examine, but a careful
reading of their reports shows that tiie more important facts en-
tirely escaped them.

Dr. Whitney's report of the Eastern Stables entirely avoids the
important questions in which the profession is most interested.
The information as to the location of stables and the novelties con-
nected with the new practice have been amply described in the il-
lustrated papers, to the satisfaction of the public, indeed more sat-
isfactorily than by such a description as he gives us.

^08 INSPECTION" OF VACCINE STABLES.

But even in the account of the stock, the method of keeping it,
and the sanitary condition of the work, the report made by Dr.
AVhitney does not agree with wliat we saw at the Broukline Farm
of Dr. Martin.

The stable occupied by E)r. Martin are well adapted for the pur-
pose. It is of brick, 52x35 feet and has ample room for 50 calves.
The grounds compose two acres of well drained land. These stables
are well built and ventilated, giving to each calf G30 cubic feet.
The building is finished with hard pine, there are no plastered walls
to absorb effluvia. Dr. Whitney speaks of the animals without
sajing whether the patients operated on were cows or calves, whereas
all the animals in Dr. Martin's stab'.es in March were calves not
more than one-third to one-half tiie size of cows. The drainage*
the ventilation, the general attention in short to the health of the
heifers was all that could be desired, and the quality of the animals
superior. The statement, therefore, that thirty calves were occu-
pying the space which would have been only sufficient for twenty
is not in accordance with what we observed, and what is really true.

We get no information in this report on the following important
points : 1. The method of inoculation. 2. The condition of the
virus employed in inoculation. 3. The day of the maturity of the
vesicles. 4. The character of the vesicles in order to serve as a
means of proving their genuineness. 5. The quality of the cattle.
G. The amount of virus taken from each animal and the relative
quality of that from animals yielding much or little. 7. The
methods employed in securing the vaccine against atmospheric in-
fluences.

These may all seem to be elementary questions, but they are not
answered, and the medical public is left in doubt on them all.

When we consider that there are many forms of cow-jiox (of
course spurious and real) which are constantly mistaken for the
real, the inspector should be able to state explicitly what he saw. It
may not be needed information to the inspectors, but it is for many
seeking after the truth, that the identity of cow-pox requires espe-
cial study. Its recognition was deemed a matter of earnest study
as far back as 1839.* At that time as many a^ ten varieties of cow-
pox were known. These are well illustrated by llering as follosvs :

i^E. Hering, Uebor Kiibpockeii an Ki'ihen (Miteiner colorirtcn Tafel.)

CRIPPLIXG THE CODE OF ETHICS. 209

Variola vaccince, vera {dcJ/ie Knl>2)0cl:en) ; V. vaccincB ccrultm ;

V. vaccinm secundaricej V. vacc. verucosoce ; V. vacc. miliarcs ;

V. vacc. succinim ; V. vacc. nigrm ; V. vacc. herpeticce ; V. vacc.
JjulIrscB : ApJifJtce zo'uticce. These distinctions may not now stand,
(bnt we know nothing to the contrarj) but their existence at the
time when cow-pox was more thoroughly studied than at any time
from 1800 to 18G5, shows that special knowledge was then deemed
requisite.

But we will not pursue the subject further. The National Board
of Health can do good service by making thorough investigation
and study of cow-pox farms. They should not send inspectors who
will bo diverted from the true line of investigations either from a
lack of technical knowledge or from lack of time. We ought surely
be informed how one producer can send out a cone of pure vaccine
lymph sufficient to vaccinate 100 persone, for one dollar, while
another producer declares that many animals could not yield that
much virus, and therefore the price should be many times as much.
Furthermore, one examiner who undertook the examination of
lymph cones for a State Board of Health found that there was gross
fraud in the preparation of " cones of pure vaccine lym])h" ; on
this point the inspectors failed to enlighten us.

CRIPPLING THE CODE OF ETHICS.

The profession of New York have led in many important matters
for a long time, but the change in the New York State code made
in January of this year will cause the more conservative States to
pause and consider the question anew, before they go much further.

The following extract will show the recent change :

" RULES GOVERNING CONSULTATIOXS.

" Members of the Medical Society of the State of New York,
and the medical societies in affiliation therewith, may meet in con-
sultation legally qualified practitioners of medicine. Emergencies
may occur in which all restrictions should, in the judgment of the
practitioner, yield to the demands of humanity."

210 VARIOLOID IN WIL5IINGT0N.

As far as the North Carolina profession is concn-neil, none of the
reasons exist as in Ne^ York fcr a radical change in the code of
ethics. We are not driven by the influence of irregular practition-
ers and their patients to make terms with homoeopaths or eclectics.
The law of this State virtually legalized all persons claiming to be
doctors prior to 1850, but it did not have the effect of putting
th.ese different (and indifferent) specimens of doctors upon any
higher plane than before. Since the law requiring examinations
for licensa to practice in this State has been in operation, disciples
of the irregular school have applied. The question, therefore,
will hardly agitate the profession in this State. There is one
thing certain though in this connection, that the voice of conserva-
tive Xorth Carolina will oppose the innovation set on foot by the
medical society of New York if it becomes a question before the
American Medical Assoc'ation.

Eeally there can bo no such thing as a consultation with a homo^o-
l):ith or eclectic, by reason of the great difforenceof their education
and methods of thought, even if such a thing were desirable. How-
ever smoothly all might go as to the diagnosis, there could be no
agreement as to the treatment without one side or the other should
yield the point.

We can see how in the larger northern cities, where homa3opathy
is somewhat fashionable, that to deny a consultation with gentle-
men of that creed the consultation fees of the regular physician
would be greatly reduced, but the same motives will not impel the
North Carolina profession for many years to come, we hope. So
far we see nothing in the movement but an eye to the mercenary
side of our calling. It is uselessly crippling our code of ethics.

Varioloid in Wilmington. — K. case of varioloid made its appear-
ance in one of the crew of a vessel from New York. The case was
promptly quarantined and vaccination done among all those who
possibly could have come in contact with the sick man. No new
cases (ten days ago) have appeared.

311
LS THE PROFESSION IN THIS STATE OVERCROWDED ?

The question has often occurred to thoughtful men, as to the
effect on the medical profession if those undertaking the responsi-
ble duties of a practice were well trained, and well equipped with
tlie necessary armamentariuni, if it would not lessen the num-
ber of young men rushing into the study of medicine. We have
1,300 doctors in a population of 1,400,000, and nearly all of these
belong to the regular profession. Now, if we were to examine into
the social condition of these gentlemen we would find a small num-
ber of men who were devoting their undivided time to medicine.
It would be found that many have an interest in a small drug busi-
ness, or a farm or both, and in many instances in both. This state
of things is founded in the fact that physicians are insufficiently
and irregularly paid. Taking the average of the best equipped
men, veiy few would be able, in a time of emergency, even among
those who have been more than ten years in the practice, to bring
to a surgical or obstetrical case, such tools as would be necessary to
extricate their suffering patient. In this the doctors are not so
much to blame. The pepole employing them pay such small fees,
on such long credit, that the luxury of new instruments and new
books is beyond the reach of the major part of the profession. '

Notwithstanding this state of things the yearly number of gradu-
ates is increasing, and young doctors have the courage to go out
into the world to gain a livelihood. There is hardly a part of the
State so remote that there may not be found doctors far in excess
of the demand of the location. Nor is this state of things to be
wondered at. The new candidate^ for public practice measuring
what he knows as compared with what he thinks his old-fogy com-
petitor knows, thinks tiie ascendancy will be easily gained. Pretty
soon he finds that the people are not in any hurry for hisunseason-
ed knowledge, and the slow old doctor who has been the adviser of
the family for years is not so easily displaced. He must wait, —
and wait sometimes until he is willing to turn his hand to anything
that will jM'ocure him subsistence. But what can a young doctor
do who has devoted all his time to medicine ? lie will naturally
imagine that his knowledge of materia medica and pharmacy will
be sufficient to give him a start in the drug business, the common

212 TUB UTILITY OF STRYCHNIA AS AN EXPECTORANT,

mistake of most physicians young and old. One disappointment
aftfer another dulls that ambition which first buoyed him up, and he
drops out of the profession into such an obscure corner, pursuing a
calling so far removed from medfcine, that he finds it necessary to
explain how he came by the title.

There are others though, who are quick enough to see that the
prevailing standard is low, and that with the family influence they
can bring to bear, they need not apply themselves to that post-
graduate study they had dreamed of before graduation. And these
soon taking up the current idea, eventually become fossils or drones,
or at best allign themselves complacently with the already well fl'led
ranks of mediocrity.

We must infer tiiat most communities in this State have not de-
manded a higher standjird of professional attainments, for if they
had there would be fewer, but better doctors, and the tendency
would be always higher.

The demand for higher attainments is, however, made by the
Board of Medical Examiners, and the great service being effected
by this agency is already showing itself all over the State. If the
State would enact a law making it a misdemeanor to practice med-
icine without their license, the people would be protected, the pro-
fession would maintain a healtheir growth, and the ends of human-
ity be more completely subserved.

The Utilily of Strychnia aSp an Expectorant. — J. Milner Foth-
crgill {British Med. Jour.) says : The experiments of Rokitansky
have shown that strychnia is a powerful stimulant of the respii'atory
centres, and I have arrived at the same conclusion from experiments
upon rabbits. When the respiratory centre was paralyzed by aco-
nite the injection of strychnia exercised a most potent influence in
restoring the circulation. I have used it clinically with much ex-
cess, when the respiration was embarrassed, in acute bronchitis with
diflicult expectoration, in chronic bronchitis with emphysema, and
when the right ventricle was dilated, it added to the efficiency of
digitalis.

213

REVIEWS AND BOOK NOTICES.

Traite D'IIygiene Publique et Trivee Basee Sur L'Etiolo-

GiE, PAR A. BoucnARDAT. Pdi'is : Germer Ballierc et Cie.

1881. Pp. 109G— clxiii. *

Treatise on Public and Private Uygionp, based on Etiology. By
A. Bouchardat.

The only book with which we are acquainted on the subject of
hygiene that at all approaches this one, is Parke's Hygiene, and
that only in the method of treatment, rather than in the manner.

Here we find practical matter treated with plainness and direct-
ness. The history of alimentation is first considered, — simple ali-
mentary substances such as sugar, fats, fibrine, alcohol, iron, &c.
He attaches the most importance to milk, it being the most re-
markable of a complete aliment. Complex substances are then
considered, that is to say those which are formed by the combina-
tion of many alimentary materials such as bread, meats, fruit?,
vegetables. The question of drinking waters is treated from an
advanced standpoint, especially in regard to the effects of Vi'aters
on the production of endemics of goitre, cretinism, Aleppo boils.

He makes two grand divisions of complex aliments furnished by
the vegetable kingdom : those which approach nearest to a com-
plete aliment, such as seeds and nuts, grammes ; those which are
farther removed, such as fruits, roots, leaves, fungi. He ha^s en-
deavored to show that condiments arc useful in destroying living
and organized ferments, which often trouble digestion.

The author believes that he has done a useful thing in re-uniting
in the same group the modifiers of the nervous system. He divides
them thus : 1st. Those whose action is generally favorable — coffee,
tea. 2d. Those that arc useful or harmful according to the doses
and condition of employment — alcohol, tobacco, coca. 3d. Those
which are harmful-- -opium and hachisch.

He endeavors to show that the liygienist is interested in the study
of the excretions ; for the secretions, neglected, are the sources of
many diseases, bringing its study properly in the domain of pre-
ventive medicine. The employment of baths (hydrotherapy), the
employment of cosmetics, the value of exercise are fully discussed.
He thinks electricity, magnetism, and siderial influence should

^14 REVIEAVS AND BOOK NOTICES.

have a restricted place in positive hygiene. Heat, on the contrary
is so important, that the pages he has devoted to it he considers tlie
most valuable in the book.

The study of putrefaction covers a great number of questions
interesting the hygiene of cities, filth, sewers, latrines, slaughter-
houses, cemeteries, &c., &c. He has also studied moldsand micro-
scopic alga} which are harmful to man : in attacking him — (the
oidium of thrush, achorior. and tricophyton of ring-worm) ; in
ruining his crop, (oidium of the vine, and botrytis of potato ; in
causing special diseases by their ingestion, ergot mucedine of
pellagra, have occupied his particular attention.

The etiology of contagions diseases, successively ; affections
charbonneuse, sui'gical septicaemia, syphilis, small-pox, measles,
scarlet fever, &c.

lie divides general hygiene into two sections. 1. Individual.
2. Public and social. The first comprehends hygienic rules for
age, sex and professions. The second embraces the questions which
are treated in cities, schools, hospitals, prisons, epidem'csand inter-
national hygiene (quarantine.)

The influence of occupations upon life is made a matter of par-
ticular consideration, as also the enormous mortality of infancy.

While this running description docs not give an adequate idea of
the volume, it covers many of those desirable subjects which the
increasing number of sanitary students desire to have information
upon.*

The Transactions of the American Medical Association,
Thirty-Second Annual Session, Held in Richmond, Va. 1881.
Pp. 684.

The Transactions for 1881 is not a very important volume. The
Richmond meeting, if the printed papers be a fair index, was not
successful in a li'crary point of view. The address of Dr. John
T. Hodgon, the President, was entertaining and ins:ructive, and
delivered in a pleasant manner, and being upon the progress of sur-
gery was more acceptable than otherwise.

The Section on the Practice of Medicine was not favored with
fhe best work, and the meeting of this Section was poorly attended;
indeed none of them were as well attended as the Surgical and Gyn-
ecological Sections.

REVIEWS AND BOOK NOTICES. 215-

Tlie most important matters, we are reminded, by reexamining
the Proceedings, is the Journalizing of the Transaction?, and mak-
ing an index of the entire series of volumes. Many important
things le buried in these volumes, and a good index will start them
afresh into the current of thought.

We notice that the number of members at this meeting from
North Carolina was by far the largest delegation we have had.

The Physiological and Therapeutical Action of the Sul-
phate OF Quinine.* By Otis F. Manson, M.D. Ilichtnond,
Va. Pp. G9.

The pamphlet before us comprises the woik of more than twenty
years of an exceptionally good therapeutical student, and it is in
many respects the best treatise on quinine yet given to the public.
It is a little singular that while the medical men who have had the
greatest o]>portunities for studying the medicinal effects of quinine
have been in the southern States, yet there have been very few essays
of importance from this section. Only a few months ago Dr.
Campbell of Augusta, Ga., publshed a paper on the action of
quinine in pregnancy. (North Carolina Medical Journal,
Vol. viii, No. 6, page 381.)

This i)aper had a very wide circulation and may be accepted as
a scholarly presentation of the facts in the case and by an observer
of trained ability, and a writer of great facility and accuracy of ex-
pression.

The paper by Dr. Manson is a second important chapter in the
history of quinine, and having its foundation in extensive observa-
tion in a region where the malarial type is the predominant charac-
teristic of many diseases, it w 11 servo for some time as a master-
piece.

The history of quinine is presented at length, and properly so,
for its discovery was the key to the discovery of that long and use-
ful list of vegetable alkaloids that has been added year by year. It
is hard to realize, that anterior to 1820, quinine was unknown. It
was in this year that MM. Pelletier and Caventou succeeded in
producing a taliGable base from cinchona, announced under the
name of kinine. We regret that Dr. Manson could not have ex

^Read before the Medical Sool«ty of Virginia Session of 1881.

21G KEVIEWS AND BOOK NOTICES.

tended this part of. his essay in describing the attempts previously
made by Sognin and Vauquelin in France in 1803. It is a chapter in
vegetable chemistry full of instruction, and suggestion, and has
been the impelling influence which has moved several generations
of chemists to renewed research.

The discovery of quinine, of course, was hailed with enthusiastic
delight in both hemispheres. The properties of the bark had been
known for more than 200 years, but the objections to it en ac-
count of its bulk and the nauseous bitter, and the liability to cause
vomiting, was a serious obstacle to its general use. This new dis-
covery served to arouse the old controversy on the uses of bark.
The large majority of writers had regarded cinchona as an admi-
rable tonic, possessing excitant and stimulant properties, rendering
its use hazardous in presence of fever and inflammation ; v/hilst a
numerous and powerful minority held it to be endowed with seda-
tive and even antiphlogistic virtues in the same conditions of the
organism.

The study of the question has of late years been carried with re-
newed interest and by more accurate methods. Dr. Manson treats
it as follows :

1. Its action on animals. 2. Its effects on man in health. 3.
Its effects on the human organism in disease. The literature of
experiments showing the effects of quinine on animals is fully tra-
versed, and brings before us in a skilful manner the development of
our present therapeutical status. We have not space to summarize
the physiological action of this drug, but give in the author's words
the " Modus Operandi of Quinine."

" Let us now examine into the })athology of malarial poisoning,
against which it is universally recognized as the most potent remedy.

" It may be regarded as a self-evident proposition, that malaria
is a materies morhi, which being absorbed by the blood and conveyed
throughout the system, manifests a special affinity for the nervous
centres. As we have said this is proven by the vast number of
cases of neuralgia of a strictly periodical character, involving every
nerve in both systems of nerve and every part of their centres, and
giving rise not only to pain, but to disordered function and various
lesions in the parts to which those nerves are distributed. These
phenomena can only be due to the influence of an irritant poison
circulating in the blood and impinging upon those portions of the
nervous centres most readily impressible by the noxious agent. It
is then upon impressibility of the nervous centres, and especially

KEVIEAVS AND I500K NOTICES. 217

of the cerebro-spinal system, that quinine exerts its influence. It
obtunds, stupefies the impressionable centre, and renders the action
of the poison ineffectual. Why any poison should select special
l)arts of the ner.vous centres for its toxic invasion, we cannot ex-
plain, but it is proven by observation of the effects of many poisons.
Need we point to the innumerable localizations of the syphilitic'
poison, as a familiar example, which are all mitigated, or removed
by the same remedial agents. That this theory, that quinine exerts
its remediate power by rendering the nervous centres insensible or
unimpressible, is true, is further supported by the fact that other
agents which have been proven to be remediate in malarial fever,
possess, in common with it the power of impairing or even destroy-
ing the impressibil-ty of the nervous centres. The reputation that
opium for centuries enjoyed, and later the effects of chloroform in
the treatment of malarial poisoning are doubtless due to their
analogous effects on the centres of impressibility.

It is well knovvn to those who have had extensive experience in
cases of malarial poisoning, that many cases are self-limited in their
duration, and terminate in health without remediate measures — the
poison being spontaneously eliminated from the system. Quinine
would then reasonably seem to cure or at least to obviate the perni-
cious effects of the poison by rendering the centres of impressibility
insensible to its action while under its paralyzing influence, and
thus affording time for the noxious agent to be eliminated from the
system. The great tendency to relapse in such affections, even in
those cases in which the system had been saturated with the medi-
cine, seems to prove that its therapeutic effects are not due to any
antidotal or germicidal property. The morbid phenomena return
after the centres have escaped from the stupefying, or we may say
the partially paralyzing effect of quinine on the nervous centres. It
is generally supposed by those who have never resided in regions
where the malarial poisons is most concentrated and malignant in
its character, that the inhabitants universally suffer from the influ-
ence of the poison. It is true that a vast ommher do suffer from its
toxical impression, but it is as equally true that a very large number
do not stifer at all, and preserve their health intict in the poison-
ous atmosphere. They enjoy an iimminitu either partial or perfect,
transitory or permanent, against the power of the poison, and why?
It cannot be denied but they also absorb the blood. In the air
they all breathe the deadly agent floats ; in the waters they drink,
as Hippocrates held, the mortal miasm is held in solution ; from
the soil they till the hidden foe starts up. How can we explain this
immunity, save by the facts that the impressibility is not aroused ;
that the sensibility of the nervous centres does not respond to nor is
affected by the poison absorbed by the blood and circulating through
the substance of its tissues in the same manner as they are not
affected by many other poisons proven to be present in the blood.
The first taste of tobacco sickens with unendurable nausea ; the

218 llEVIEWS AND BOOK NOTICES.

first (IriLk of brandy intoxicates to madness and coma; the first
dose of opium paralyzes the senses, destroys tlio consciousness and
poisons the centres of both systems ; but by habitual use, the im-
2)ressibiUty to these is lost, and the same agent that poisoned before
is now unfelt and innocuous. The poison is still absorbed in the
blood, but the centres do not respond ; the poivcr of imj)rest<iu/j is
in abeyance, because they are no longer capable of being impressed.

" Quinine, therefore, confers immunity from the effects of the
toxic agent by obtunding, stupefying and even imralyzing the cen-
tres of impressibility, and, therefore, so far as the patient is con-
cerned, placing him on the same plane as his healthy comrade, who,
exposed to the same cause, inhaling and absorbing the same poison,
and which, though circulating throughout his entire being and per-
meating every living tissue, is as harmless as the mother's nortnal
milk to the healthy infant.

" All of the secondary phenomena arising from the action of the
malarial poison — pain, fever, perverted sensations, and impaired
function — are evidently due to disturbance of spec'al centres, whicii
cease as if by enchantment, as soon as the impressibility of those
centres is sufficiently impaired or suspended.

" It is well known to the scholar that malaria may concentrate its
action upon any part of the nervous system, and there is every rea-
son to believe that it thereby perverts the functions of every part
to which their nerves are distributed — neuralgia of every nerve,
congestion, irritation, inflammation of every organ, and fever of
every type — may be the consequence of its malign influence ; yet all
these various pathological conditions yield to the same remedy. In
like manner, its beneficial effects in many other diseases may be ex-
plained. It impairs or suspends the impressibility of the sources of
innervation, and gives time for the elimination from the organism
of the various morbific agents from which they originate. We can-
not otherwise explain the salutary action of quinine in diseases
arising from entirely different causes, as, for example, malarial
fever, cerebro-spinal meningitis, rheumatism, erysipelas, etc., in
which its virtues have been attested by so many distinguished au-
thorities.

In the absence of any other satisfactory solution of the modus
operandi oi quinine, wo are justified in declaring that it potently
contributes to the removal of disease by rendering the nervous sys-
tem insensible to the action of the morbific causes of those mala-
dies in which its employment has been proven by experience to be
efficacious. It does not, to use a hackneyed phrase, inhibit reflex
action, for reflex action, requires as its factors an afferent nerve, a
sensitive centre, and an efferent conductor of a reflected impression,
but it impairs impressibility itself, and ' fatal things pass harmless'
by the paralyzed centre. The centre does not and cannot reflect an
impression which it has been rendered incapable of receiving. It
has been ixiralyzed partially or perfectly by quinine, and therefore

REVIEWS AND BOOK NOTICES. 219

placed beyond the pale of daoger. In a word, if we may be ex-
cused for coining a new word, quinine is a paralysant. This may
seem a severe and repulsive designation, as in proper quantities it
merely hemunls, stupefies or narcotizes the nervous centres, but these
rarely are but vnrijing degrees of paresis. The theory here ad-
vanced, based solely on facts, can only lead to safe and certain re-
sults if guided by .the inexorable rule that in its administration the
physician must constantly have in view the end to he attained, viz.,
to render the receptive centres securely insentient to its morbific
assailants, and to hold them in subjection until they have lost, by
elimination or from exhaustion, their power to impress. This can
be only accomplished by increasing the quantity of the remedy un-
til the desired effect is secured. If, as happens in rare instances, its
depressing effects should transcend the normal degree, they may be
speedily removed by the moderate use of brandy or other alcoholic
stimuli.

" Mode of Administration.— "Vhe sulphate of quinine may be ad-
ministered in various modes. "When given by the mouth, we prefer
to administer it simply diffused in water or in pills freshly made
with syrup of gum acacia, or made into a pilular mass and placed
in gelatine capsules. By the latter mode, the patient is relieved
from its bitter taste, and we have always found it as efficacious as
when given in solution. In cases of intense gastric irritability,
immediate danger, or in those in which patients are unable to swal-
low, as sometimes happens in malignant forms of fever, it may be
administered by the rectum, usually an excellent and efficient
method, or injected beneath the skin. From numerous trials of
the hypodermic method, its effects have been found to be prompt
and efficient. For this purpose, the formula of M. Dodeuil, (dis-
tilled water, 20 parts ; sulphate quinine, 2 parts ; tartaric acid, 1
part,) may be used, or of the salt may be dissolved in recently dis-
tilled water, by the addition of a few drops of dilute sulphuric
acid. These methods of administering the remedy render its em-
ployment by other and more uncertain practices of applying it to
blistered surfaces, etc., entirely unnecessary. When introduced by
the rectum, it should be given in at least double the quantity of
the ordinary dose, and in the case of children, when given by the
mouth, it may be disguised in coffee, milk or liquorice."

Lectures on Diseases of Children. A Handbook for Physi-
cians and Students. By Dr. Edward Henoch. New York :
William Wood & Company. 1882.

This is the third volume of Wood's Library for 1882. It is by a
teacher of experience, and written in the form of lectures. Part I
treats of " Diseases of the Xew Born"; Part II the *' Diseases of
Infancy" ; Part III, " Diseases of the Nervous System" ; Part IV,

S^O KEVIEWS AND BOOK NOTICES.

" Diseases of the llespiratory Orf^ans" ; Part V, " Diseases of the
Circulatory Organs" ; Part VI, " Diseases of the Digestive Organs";
Part VII, " Diseases of the Uropoetic Organs ; " Part VIII, '^n-
feetious Diseases" ; Part IX, " Constitutional Diseases ; Part X,
"Diseases of the Skin."

The formulary appended to the volume, is very unwisely written
in the metric system, a mathematical language practically unknown
to the greater part of the profession.

AVe would be unv/illing to place this volume in order of merit
side by side with the classic work of Charles "West, or Meigs and
Pepper. Its proper company is rather that of Day and Tanner.

Illustrations of Clinical Surgery, Consisting of Plates. Pho-
tographs, Woodcuts, Diagrams, &c. Illustrating Surgical Dis-
eases, Symptoms and Accidents, Also Operative and Other Meth-
ods of Treatment, with Descriptive Letter-Press. Fasciculus xiv.
By Jonathan Hutchinson, F.R.O.S. P. Blakiston, Son, «&
Co., 1012 Walnut Street.

The first volume of this work comprised ten fasciculi, mak-
Shg altogether a handsome volume, and a most unique collection of
the rater surgical cases. During twenty-five years Mr. Hutchinson
has gradually formed a collection of drawings illustrating a great
variety of surgical cases, elucidating more especially their relation
to symptoms. From this collection he has selected those he consid-
ered most valuable, and tbey are illustrated in the best chromo-
lithograph y.

In the first volume the articles to which he attached the most im-
portance was as follows : A New Form of Ulcerative Chronic
Rheumatism, Cbeiro-Pompholyx, Vaccination-Syphilis, Stomatitis,
Malformations of the Teeth, Xanthelasma of the Eyelids, The Pa-
thblogy of Phlebitis-Pyaemia, and a considerable series connected
with Injuries of the Head.

Too high praise could not be given for the artistic finish of the il-
lustrations, but the descriptive text is fully equal to it. Mr. Hutch-
inson is the clearest and safest writer on matters appertaining to
surgery, and, in fact, he seems to be at home in so many things that
it 'wotvld be hard to say that he is a specialist at all ; but his state-

MEDICAL JOURNAL PREMIUMS. 22L

mcuts are always trustworthy, his descriptipns Incid, his treatment
convinciog.

The fasciculus before us, has four admirable plates. The one il-
lustrating Cancer of the Tongue and Smokers Glossitis, is excellent,
and illustrates what Mr. Hutchinson has written about recently with
so much force, the "Precancerous Stage of Cancer."

Wo trust that nothing will prevent the completion of this the
last volume, for we believe no book has delighted the heart of the
practical surgeon for years as much as Hutchinson's Illustrations of
Clinical Surgery.

The North Carolina Medical Journal offers as a premium
for the best prepared and complete herbarium of the medicinal
plants of the State, the following works, or their equivalent, in vol-
umes the successful competitor may choose :

Curtis' " Woodi/ Plants" and "Catalogue of Indigenous Plants"
in one volume.

" Fhich'gerand Hanhiri/s Fhan>iacogra2}Ma," j:)ue\o\nnie ; and
''Flora AmericcB Septenti'ionalis ; or a Systematic Arrangement
and Description of the Plants of North America." By Frederick
Pursh, two volumes.

The collection must be prepared by the person presenting it.
Each specimen must be neatly mounted on stout white paper 9x14
inches, (two or three specimens can be put on a sheet when they are
small) and the name marked on each. This offer is made to mem-
bers of the State Medical Society, and to licentiates of the Board
of Examiners who may not be members.

Herbaria must be sent in on the 2d Tuesday in May, 1882, tU the
Concord meeting. For further particulars address Editor of the
Journal.

Dr. Hooper, Litlle Rock, Ark., in the absence of Dr. Woodward
who is now in Europe, will preside at the American Medical Asso^
elation at St. Paul, next June.

222

ORIGIXAL TRANSLATIONS.
By Wm. G. Eggleston, Uampden Sidney, Ya.

PiIocarj)iii in Pleurisy. — Dr. Coriveaud after treating three
ca es of subacute pleurisy with pilocarpin, arrives at the following
conclusions, which, however, must be admitted with reserve as yet:

1st. Nitrate of pilocarpin, given hypodermically in doses of one
centig. to 25 reillig. produces no local action and is exclusively
sialagogue. No abortive property.

2d. Employed in pleurisy, as soon as possible after its onset, pilo-
carpin profoundly modifies the pleural inflammation, arrests effu-
sion, promotes absorption and, to a greater or less extent diminishes
the production of false membranes.

3d. It seemingly acts by a derivative fluxiouary action, which is
more energetic as it is used early in the morbid action,

•ith. It also acts indirectly by subtraction of the liquid, in a man-
ner somewhat analogous to that of purgatives and diuretics, but
which, in virtue of some unknown rela'ions, seerns to bo more
direct when exercised on the salivary glands.

5th. Pilocarpin is incomparably more easily mannged and more
sure than jaborandi. — Revue Med. Franc. Eirange.

[I tried this in a case of pleuritic effusion, left cavity full to the
clavicle — alternating with Epsom salts — result excellent. — Trans.]

Anfisepiic Mineral Liquid. — Dr. Ilorteloup employs the follow-
ing : r^.

Chloride of alumimium, gms. G1.75

" " potassium, " 19.84

" iron, " 15.09

" calcium, " 2.13

M. " " eilica-golatinou-', *' 1.22

This liquid acts somewhat as a caustic on ulcerating chancres,
as chloride of zinc, for example, but its action is less violent. By
regular applications of this liquid rapid recovery can be attained,
and it is to be recommended by reasons of its antiseptic properties.
A teaspoonful added to a glass of urine or pus will prevent its de-
composition for more than a week. The principal advantages are :
absence of odor ; facility of administration ; liarmlessness to the

ORIGINAL TRANSLATIOXS. 223

intact skin ; energetic disinfection, and destruction of vibriones ;
moderate price. — Idem.

Resolvent Action of Alcohol in Inflammations. — M. Ollive has
obtained good results by the topical application of alcohol in in-
flammatory affection, rapid dininution of pain, and diffused swell-
ing ; termination by resolution.

The method is simple : A thick comi)rcs?, or a piece of tarlaline
folded seven or eight times is wetted with alcohol of 30 to 90 per
cent. ; ihen covered over, to prevent evaporation, by some imper-
meable interest. This is applied over the affected part and the
alcohol renewed every three or four hours. This has been tried in
cases of phlegmon, pelvic peritonitis, lymphangitis, &c., and always
with g)od results. — Idem.

[Am^now using this in a very severj case of sprained anklo with
marked improvement in the first twelve hours, — Tra'NS.]

Treatment of Extra Uterine Pregnancy. — Hugo Clan {These
Berlin, 1881), says : One of the first indications when extra-uterine
pregnancy is diagnosed is to destroy the foBtns. To accomplish this
result it w'as proposed to act on the maternal organisms. That un-
certain and dangerous method was soon abandoned. Aiem pro-
posed to destroy the foetus by introducing a trocar through the ab-
dominal wall.

Basedow first proposed to puncture the ovum through the vagina.
This last method gave good results in the hands of Kiwish.

To destroy the fcetus we may

1. Puncture the ovum by means of a trocar introduced through
the abdominal wall or j^er vaginam, and let out the amniotic fluid
surrounding the product of conception.

2. Puncture the foetus itself, and kill it in that manner.

3. Injecting the foetus with morphine and thus destroy it.

4. Destroy it by electro-puncture.

Laparotomy must be performed if indicated. (See next transla-
tion.)

Indications for Laparotomij in Extra-uterine Pregnnncg. — Sachs
(T'/zt'se, Berlin, 1881) says regarding this : According to the old
authorities, laparotomy is always indicated when the fffitus still
lives. If dead, it should not be performed. This doctrine is still

2M' ORIGINAL TRANSLATIONS.

adhered to by many authors. In the preceding article several
methods are proposed with the objects of destroying the fa3tiis, and
arresting further development of the pregnancy.

In a certain number of cases the cyst containing the fa3tus docs
not break, but the contents cease to live and not only is there no
augmentation of volume, but it really shrinks more and more,
finally fatty degeneration attacking the foetus itself, a compact mass
is found in which it is extremely difficult to recognize a foitus. This
is one method of recovery from extra-uterine pregnancy.

But when extra-uterine pregnancy with living foetus is diagnosed
should the child be destroyed, or laparotomy be performed. At first
thought one would actually select the first, as being more easily per-
formed, and at the same time less dangerous.

If the infant is dead it seems best not to interfere. But several
authors iiavc ropo.itcd cases in which, abscesses having been found
aboat the foetus, the mother died. Keller seems to have been the
first (1872) to perform laparotomy for lithopaBdeon. After that
memoirs on the subject were published by Parvy, Litzman, De-
champs, &c., in which it is shown that lithopsBdeon constitutes a
permanent danger for the mother. Hence laparotomy is indicated
in this case. A general summary would seem to show that lapa-
rotomy is always indicated in extra-uterine pregnancy. — Idem.

New Immovalle Apparatus. — Prof. Grenadier has invented a
very aHantageous apparatus for fixing a limb in a desired position.
Place a layer of cotton around the member fixing it, with a few
turns cf a bandage. Cover this with gauze sufficiently large and
resistent. Place the limb in the desired position, and spread over
the above bandage a mixture of alcohol, two pints, gum laquer,
one pint. To facilitate the imbibition of this mixture, first
moisten the apparatus with a quantity of alcohol. In about ten
minutes the b^dagcjs very hard. The advantages are : 1. Easy
application ; soils neither the clothes nor hands of the surgeon. 3.
Lightness permitting invalids to walk without discomfort. 3. It
neither breaks nor scales. 4. Cheapness, such an apparatus for the
calf or thigh not costing over 75 cents or $1.25. 5. Impermeability,
important in fractures, with a suppurating wound, permitting us to
wash, or make any kind of application.— /ii/ew..

ORIGINAL TRANSLATIONS. 225

Iodoform in Sj/philitie Neuralgia. — Zoissl (Vionoa) treats the
symptomatic neuralgia of syphilis with iodoform pills :

Powdered iodoform, 1 gm, 50.
Ext. and powd. of gentian q. s. to make 20 pills.
S. Take two or three everyday.
Both Zeissl and Mauriac have been successful with these pills. —
Mem.

'Treatment of Acme. — M. Hardy uses the following :
I^. Sulphuret of potass.

Tinct. benzoin, tia, 5 gms.

Rose water, 300 "

S. Apply to the face night and morning. — Idem.
M.

Notes of Two Cases of Complete and Spontaneous Rupture of
the Heart. — Klippel.

First Case. — S., female, fet. 59, commencing senile dementia en-
tered I'JIotel Dien in 1870. On April 1st, 1881, complained of
malaise and was put in the infirmary.

April 27th. Left side hemiplegic. Speech is lost, but there is no
trembling of the tongue or deviation. She can put out the tongue.
There is no anesthesia. Memory is intact. AVrites her name
easily. Tendon reflex more marked in the affected side. Con-
tractures appear slowly but progressively.

June 27th. Fingers and forearm of left side strongly flexed ; left
Calf inert. Only a few words Can be pronounced, and that indis-
tinctly. Complained of feeling cold about midday — particularly
in the hands. The face became cold, the head fell to the left side
and the patient died without convulsions.

Autopsy. — Brain weighed 1090 grammes (only 384 + ). Great
quantity of subarachnoid serosity. Placed in a basin the cerebrum
became flat. There were atheromatous plates in all the basal arte-
ries. The meninges were non-observant on the left side. The con-
volutions of the corpus callosum presented no soft spots. No lesion
of the surface of the superior convolutions. Sylvian arteries athe-
romatous. No alteration of the surface of the island on the right
side. Very soft on the left. The third left frontal convolution

226 ORIGINAL TRANSLATIONS.

presented co lesion. On tlie rio^ht that convolution was equally
intact, but in the upper anterior part of extra-ventricular there was
a spot of softening of a dirty red color,

Heart. — The amount of fat entirely concealed the anterior me-
dian furrow. The muscular tissue was yellowish. The valves nor-
mal. Aorta. — Plates of adherence about the level of the first
emergent vessels. Coronary arteries. — Anterior coronary markedly
atheromatous. Contained a clot in its middle portion. Veins. —
The renal cavities of the anterior coronary were tortuous, large and
filled with coagulated blood in the part corresponding to the rup-
ture ; contained thrombi. Tissue. — At the level of the rupture
the tissue of the heart is thin, yellow and dry. The edges of the
opening are sharp on the internal and external walls. Seat of the
Enptu7'e. — On the anterior part of the external wall of the left ven-
tricle, about a centimetre above the apex. Aspect and Direction of
the Opening. — It is irregular and fractuous, Dut the general direc-
tion is vertical. Dimensions. — About two centimetres long, and
stands wide open. Pericadium. — Contained a clot of blood larger
than the fist.

Second Case. — X., female, seL 77, in good general health, was
found dead one morning in bed. There had been no cardiac symp-
toms meriting attention. Had not used alcohol and was not fat.

Autopsy. — The arteries generally were atheromatous, tl:e aorta
presenting atheromatous spots at the arch. No valvular alterations.
The tissues of the breast was yellowish, soft, and easily torn. The
anterior coronary artery was atheromatous ; three centimetres above
the apex it contained two yellow clots. Near the apex the veins
were dilated and full of coagulated blood. The rupture is at the
apex in the anterior part of the external wall of the left ventricle,
close to the interventricular partition. Its direction is vertical, its
length about 5 millimetres. Its lips are thin at the expense of the
internal and external face. Around the opening the tissue presents
a red areola. Pericardium contained a clot weighing 250 grammes.

The two cases are precisely analogous to a case published by
Malnisten iu 1861. In the three cases the order of pathogenic
phenomena seem to have been ihe following :

1st. Atheroma of the anterior coronary arteries. 2d. Thrombo-
sis of these arteries. 3d. Osstructed circulation. 4th. Distrophy

ORIGINAL TRANSLATIONS. 227

of the parts silnateJ below the obstacle to the circulation. 5th.
Enpture of these parts.

These ruptures seem to have resulted not from primitive altera-
tion of the muscular fibres of the heart, but from secondary alter-
ation of that muscle, caused by obliteration of the coronary arte-
ries.— Le Prog res MklicaJe.

, [Bartli collec'ed 24 cases. Lesion in left ventricle in every in-
stance. Beckett reports one in riglit auricle. Lansing one in right
ventricle. — Trans.]

Operative Interference in Transverse Fracture of the Patella
luith Separation. — After a critical analyses of the results obtained
in the past few years by articular puncture and osseous suture, the
author (Georges Poinsot, Bordeaux) draws the following conclu-
sions :

1st. Articular punctu.e should be practiced whenever there is a
moderate amount of effusion — certainly when the effusion is con-
siderable. It should be immediate, and it is unnecessary to follow
it by washing.

2d. After the puncture, in cases in which the ordinary apparatus
are insufficient to produce coaptation, recourse should bo had to
the osseous ligature recommended by Kocher.

3d. In every case the apparatus should be frequently examined
during the first few days until the articular swelling has ceased.

4th. The limb should be protected by an apparatus limiting
flexion for several months after consolidation of the fracture.

oth. Opening of the articulation in rectMit fractures is indicated
in the cases in which articular puncture has evacuated the effusion.

nth. It is indicated in psendo-arthrosis, and also in cases where
secondary distension has compromised the functiorw of the mem-
bers.— L. Union Medicate.

Symptoms of Trichinosis in Man. — Germain See says : It is
impossible to find in any individual case of trichinosis, the ensem-
ble of symptoms is given by the text-books. The disease progresses
piecemeal, by groups of symptoms, and presents different clinical
.aspects in different cases. This peculiarity often prevents a timely
recognition of it. The symptoms may be said to occur in several
forms, best described as (1) gastro-intestinal, (2) rheumatism, (3)
oedematous and (4) typhoid forms.

228 ORIGINAL TRANSLATIONS.

/. Gastro-Intestinal Form. — The affecteJ persons are seized,
without any apparent reason, with grave digestive troubles ; epigas-
tric pain with a sensation of fulness in the stomach, nausea and
vomiting. The time of the vomiting is variable ; sometimes on the
fame day as the trichinosed repast, or the next day ; sometimes they
are later, coming on in three or four days. More often the gastric
symptoms are accompanied by diarrhoea, which may take on a
choleriform character. When the gastric troubles are not pro-
longed, the attack is thought to be one of simple indigestion. If
the diarrha3al stools are abundant and often repeated, complicated
by vomiting and symptoms of abdominal prostration, they may be
mistaken for an attack of cholerine or cholera even if a number of
people are simultaneously attacked. But the error is easily avoided:
the stools of *cholera are characteristic, and the rigiform grains of
trichinosis with diarrhoea are constant. The microscope, however,
will dispel all doubts by demonstrating the presence or absence of
the parasites in the stools. Then, there are two phenomena of
great diagnostic value : (1) Enormous sweats, absent in cholera,
and (2) considerable muscular prostration which appears soon, and
often before the diarrhoea. [This often occurs in cholera also. —
Trans.]

//. Rheumatoid J*or7n. — In this form muscular pain dominates.
Besides a decided sense of prostration the patients have violent
pains with every movement; a sort of feebleness with painful
paresis. About the eighth day the muscles became swollen and
hard, very painful on pressure. The flexors are always more gravely
affected than the other muscles. The forearm may be flexed on the
arm. Any attempt at extension produces great pain. The tissue
is very hard on palpation, even before the contracture is well
marked. The muscles of mastication are affected, and a painful
trismus results; invasion of the pharyngeal muscles produces pain
on deglutition ; when the larynx is attacked there is aphonia or
roughness of voice ; there may be disorders of vision when the
ocular muscles are invaded. The muscles of respiration, the dia-
phragm, intercostals, &c., are always invaded, but sometimes in-
sufficiently to produce respiratory troubles. Dyspna3a, however, is
almost always present and is proportional to the number of the
parasites fixed in the muscles of respiration. All these symptoms

ORIGINAL TRANSLATIONS. 229

are accompanied by violent pains, difPusetl, and not following the
tracts of the nerves, which may lead one to diagnose muscular
rheumatism, neuralgia, syphilitic pains, &c.

Theexistence of gastro-intestinal at the beginning should always
awake the attention of the physician and put him on his guard.
]\ruscular prostration, if marked, is a very valuable diagnostic sign.

The muscles can be harpooned with a Duchenne's trocar or Mid-
dledorpff's harpoon, and find the trichinne in the fragment taken
out. This method is uncertain though, for a perfectly sound frag-
ment of muscle be taken from the side of a piece full of the para-
site. It is better to make a careful retrospective inquest into the
late ingesta of the patient.

///. (EdemUtoiis Furni. — This form is more characteristic. The
'ace of the patient is swollen, particularly if a pauper, and there is
extreaie prostration. IE the oedema is unilateral it is pathogno-
monic; if double and you find no cardiac lesion, no albumen in the
urine there is reason for suspicion. The CBdema of trichinosis is
sudden and with the remarkable muscular prostration and gastro-
intestinal phenomena should lead to a correct diagnosis. The
oedema instead of being local, may be general or may appear on the
extremities. The circulatory troubles may be explained by the
obliteration of the small vessels by the trichinje,

IV. Typhoid Form.—Thcva is an analogy between this form of
trichinosis and typhoid fever. The temperature is elevated and the
fever continuous. The aspect of the patient, 'the muscular prostra-
tion, the respiratory trouble all resemble the beginning of typhoid
fever. The pains may cause it to be diagnosed as typhoid fever of
the spinal form. These phenomena should enable one to diagnose
letwcen the diseases.

1st. The profuse sweats absent in typhoid fever (the skin being
very dry.) 2d. (Edema of the face, present in nine out of ten cases
of tiichinosis. 3d. The rapid decline of the fever, which may have
the same elevation as in typhoid fever, and which does not last in
every case. The other accidents persist whether there is fever or not.

Under the name — nervous form— a fifth class might be made of
the cases in which one observes a series of nervous troubles such as
numbness^ formications, &c., in the limbs.

230. TRAUMATIC, .TETANUS TREATJBD WITH E3ERINE.

In a certain number of cases there will be diverse eruptions, fur-
uncles and miliary pustules.

As to the typhoid form/it is found, as a rule, in those cases which
a-e going to terminate fatally. — V Union Medicale. ■

Coffee as a Disiiifectant. — According to Birbier, coffee has many
advantages of the best disinfectant-% without certainty of their in-
conveniences. It will replace by a pleasant perfume the bad odor
and fcetid emanations which it has to combat. M. B, relates an ex-
perience in Algiers. He had to make a post-mortem during some
excessively hot weather. The odor from the corpse was horrible,
insupportable, in fact, until some coffee in powder was poured over
the body, when the unpleasant smell immediately disappeared.
Two or three times afterward, in similar circumstances, he repeated
the experiment always with the same good result. He has also tried
the powder on old ulcerating sores, causing them to take on healthy
action and heal rapidly. Whether this action is due to the volatile
oil, , the tannin or the alkaloids of coffee, M. Barbit r cannot siy. —
UVnion Medicale.

Traumatic Tetanus Treated with Eserine. — Dr. Thpmas Layton
reports a case of tetanus occurring in a boy, aged eleven years, fol-
lowing, after an interval of three weeks, the wounding of the sole
of the foot with a splinter. Chloral, bromide of potassium, and
cannabis indica were employed without benefit. Eserine was then
administered in doses of 1 G4th grain every hour. Recovery took
place. Dr. Layton calls attention to the following points :

1. The child took a /»/^ adult dose of the sulphate of e-erine
every hour for several days, and not only were there at no time
symptoms of poisoning, but the beneficial action of the remedy was
apparently manifest.

2. There was never the least contradiction of the pupils — on two
occasions as' mentioned in the observation, the pupils were dilated,
at all other times they responded to light in a normal manner.

3. It was noticed that the sulphate of eserine increased either the
secretion of tears and saliva, or defecation ; with regard to the last.
an occasional purgative had to be employed during the progress of
the case. — New Orleans Medical Journal.

231

THE a:ntiuotes for strychnine.

By Robert Barnes, M.D.

Having hud occasion to studj, experimentally' and clinically, the
action of strychnine, I was much interested in the notice of the ex-
periments of Mtssrs. Grevillc Williams and Waters on the antidotal
action of " /J lutidine", (this is prepared by distilling cinchonine
with caustic polash) in tlie number of tKc Journal for March
11th. I eaincstly hope that further experiments will be carried ou%
to test the correctness of their theory, in some country in which
scieniiljc research is not yet paralyzed by the tyranny of ignorance.

My immediate object is to invite attciitijn to the value of nitrite
of atnyl in strychnine-jtoisoning. This agent is not mentioned in
the text- books ; but it is probab'y mucli more efficacious than any
of those which are commonly specified. Antidotes, it must be
premised, are of two kinds : 1. The true antidotes ; those which
destroy the poison by decomposing it, or by annihilating it in
eiscnco, or by pi'oducing inert combinations. These are the chem-
ical or mechanical antidotes. 2. Those, which, not altering the
poison in its essence, counteract its action upon the organism.
These are the physiological antidotes. In our endeavors to regcuea
patient from the action (>f a poison, we have three indications: 1.
To discharge the poison from the stomach, if it have been intro-
duced by that organ^, by the aid of the stomach-pump and emetics;
"Z. To ad,niinister antidotes that destroy or neutralize the poison in
the stomach, or in the system ; 3. To administer means that will
sustain the patient against the action of the poison — in short, keep
him alive until the poison is exhausted.

^o apply these principles to strychnine, I am unable to judge bow
far the.new organic base ,5 lutidine belongs to the chemical or])hysi-
ological class, of antidotes. Strychnine is, unfortunately, a very
stable substance, not easily at'acked in its integrity ; nor is it easily
discharged in substance by vomiting or the stomach-pump. By
the time that symptoms of strychnine-poisoning are developed,
enough may have entered the circulation to lead to a fatal result,
without absorbing more from the stomach. In practice, we shall
commonly be reduced to the use of those mjans which counteract
its toxical influence.

233 THE 'antidotes for strychnine.

There is good evidence to thow that strychnine kills by repeated
violent shocks, exhausting the nervous centres, especially the respi-
ratory and spinal centres ; and that, if these shocks could be mode-
rated or averted, the patient might be kept alive until the dangei-
had passed, by the elimination of the poison. I had the good for-
tune, in the prfe-hysterical epoch of legislation, occasionally to
assist Marshall Hall in his experiments ad hoc. It is well known
now that a frog, poisoned by strychnine, may not exhibit any teta-
nic action if it be kept absolutely quiescent, but that same dose will
kill it, if, by stimulating the diastaltic functions, as by touching its
body, or even by shaking the table upDu which the frog rests, teta-
nic action be evoked.

The first imperative rule to observe, then, is t) avoid every pos-
sible cause uf physical or emotional disturbance. Agents that have
to be adiJiiuiilLTcJ by the mouth contravene this rule ; the attempt
to swallow will excite a tetanic (it. Agents that act by inhalation
do not contravene this rule. Of all the agents with which I am
acquainted, which possess any virtue in stilling the diastaltic func-
tion, and in subduing muscularspasm, not one equals the nitrite of
amyl. In obstetric practice, we are met by the formidable condi-
tions of morbidly exalted, 'diastaltic, and spasmodic action ; puer-
peral convulsions ; and that irregular action of the uterus called
hour glass contraction. Both these conditions are physiologically
allied to tetanus. In my Obstetric Operations (third edition), I
recommended nitiite of amyl to subdue irregular and excessive
action of the uterus. The value of chloroform in counteracting
puerperal convulsions is now familiar; but I believe nitrite of
amyl is even more valuable. By applying this jirinciple, I have had
the satisfaction, as I believe, of saving several lives; and amon^t
them one or two women who had signed antivivsection petitions. I
did not stop to inyire if they were willing to be saved by practice
based upon Ai\i;Lclion; but I should hope to be forgiven. The
means by which tlu necessary knowledge was obtained may, in
their particular cases, be condoned by the end to which that knowl-
edge was applied.

I have had the rare opportunity of treating a casj of strychnine-
poisoning. I was callpd to a gentleman who had inadvertently
swallowed a j)oisonous dose. I saw him within a short time of the

EFFECTS OF DRUGS OX TUB SECREnON" OF MILK. 233

accident. lie was in the most violent tetanic spasms ; opisthotonos
was so marked that his body was arched back, and respiration w.s
i-eaily suspended. Pending the fetching of the nitrite of am)l, the
fits recurred at short intervals with unabated energy. I obtained
the assistance of a young medical friend, who sat by the bedside,
diligently watching, and making the patient inhale nitrite of amyl
the moment the premonitory twitchings or facial expression ap-
peared, and always with the affect of averting or greatly moderating
the fits ; and, to make the evidence complete, when the warning
was not seized in time, the fit appeared in nearly its original inten-
sity. This treatment considered during sixteen hours, resulted in
the recovery of the patient. It was impossible to determine with
precision the dose taken. We had only the physiological test to
satisfy us that he had taken enough to destroy life.

The spasm-subduing virtue of nitrite of amyl has lately been
most happily illustrated, in d case of enchdtonnment of the pla-
centa by hour-glass contraction, by Dr. Fancourt Barnes. This
case was published in the Journal for March 18th, page 377. — The
British Medical Journal.

EFFECTS OF DRUGS ON THE SECRETION OF MILK.

Dr. Max Stumpf draws the following conclusions from an elabo-
rate experimental study of the actions of drugs on the mammary
secretions :

1. Iodide of potassium produces a decided reduction in the quan-
tity of milk secreted.

2. Morphia, alcohol, and lead do not affect the quantity or qual-
ity of milk.

3. Salicylic acid appears to increase somewhat the secretion of
milk in quantity and in the proportion of sugar.

4. Pilocarpice does not increase milk formation.

5. Iodide of potassium causes an alteration m the functional
activity of the gland, and, consequently, a modification in the com-
position of the milk.

G. Alcohol and alcoholic drinks increase only the relative amount

5i3-l TJIE PHYSIOLOGY AXD PATHOLOGY OF THE SPLEEN.

of fat in the milk, and can, therefore, not be used as a dietetic
means of stimulating the gland. ' •...•,.

7. Iodine rapidly appeirs in the milk, and disappears in the wo-
man immediately after stopping the drug; in the hefbivora it lasts
some time after the cessation of administration of iodine. The
quantity of iodine in the milk follows no deCnitc proportion to the
amount of the drug administered, but appears to vary according to
individual peculiarities; " iodized" milk, therefore, cannot be used
as a therapeutic means. Iodine does not exist in milk as iodide of
potassium in solution, but is united with the casein.

8. Alcohol does not pass into the milk in the herbivora.;,

9. Lead passes in traces when s^mall doses are administered, and
persists after the stopping of the drug. ..

10. Salicylic acid, when given in large doses, can be found in
small quantities in the milk, in somewhat larger amounts, however,
in woman than in iho hei-h\yovii.—DeuiscIie Archiv. f. Klin. Mcd.y
Jan. 18, 1882.

KOY ON THE PHYSIOLOGY AND PATHOLOGY OF THE

SPLEEN.

Dr. Roy's observations on the spleen aff.»rd a distinct advance in
our knowledge of the physiology of that mysterious organ, and the
term " discovery" may very properly be used in connection with
these researches, which teach us a novel and hitherto unsuspected
function fulfilled by the spleen. Ic appears that normally (in cats
and dogs, at least) the spleen alternately contracts and expands with
great regularity, presenting systol'c and diastolic phases about once
a minute; and that it thus carries on its own circulation, inde-
pendently^'of Jhe 'general^^lood-pressure. With regard to the
features of this action, we gather from Dr. Roy's paper [Journal of
Physiologii, vol. ili, No. 3) that this subsidiary circulation is com-
paratively sluggish, the ingress to the organ being very narrow, as
is shown by the abicnco of pulse waves from the volume-tracing,
and by the slowness with which the volume diminishes when blood-

THE PHYSIOLOGY AND PATHOLOGY OF THE SPLEEN. 235

pressure is brought down by compression of the aorta. In extent,
the splenic contractions are subject to variations, not only accord-
ing as the contractions are those of a more or less bulky organ, but
also of the actual force of contraction ; there does not, however,
appear to be any constant relation between bulk and extent of con-
traction. The organ is also subject to slow spontaneous changes of
volume, and similar changes can be excited by slightly altering the
chemical constitution of the blood. That the rythmic contractions
are really due to the splenic muscular fibre, and are not merely of
arterial mechanism, is shown by the analysis of curves in which the
" Traube-Hering" rhythm has happened to supervene; the regu-
larly irregular trace which appears under these circumstances, evi-
dently results from the interference of two series of waves at dif-
ferent rhythms ; the one series (that of the specific splenic contrac-
tions) having a slower rhythm than that of the other series (that of
the arterial contractions), which gives rise to the Traube-Hering
waves in the spleen, as in other parts and organs. The reaction of
the splenic muscle to vaso-motor excitation, direct or indirect, is
similar to that of arterial muscle. Excitation of the vaso-motor
centre by dyspncRa, or by faradization, causes strong splenic con-
traction simultaneous with the increased blood-pressure due to arte-
rial constriction ; excitation of the central end of the divided vagus
or of the sciatic nerve causes contraction ; or, if the organ happen
to be in a contracted state, increase in the extent of the natural
waves; and it is noteworthy that such centripetal excitation will
cause splenic contraction after section of both splanchnicsand vjgi,
thus indicating that there is some further efferent channel to the
spleen. Peripheral excitation of the splauchnics or vagi, right or
left, cause strong contraction ; simple section of the splanchnics or
vagi is not followed by expansion, nor is the rhythm altered, facts
which go to prove that the splenic muscle is not maintained in tonic
contraction, and that its rhythm, unlike the Traube-Hering rhythm,
is not of central, but of local administration. With regard to the
vagus, there appears to be some peculiar influence upon the heart's
action proceeding along this channel from the spleen to the me-
dulla, as shown by characteristic " vagus-heart" pulsations during
the splenic systole— by section of the vagi, the character of the
former is abolished, the latter remain unaltered. For details of the

^K^r W5AT IS ACONITINE ?

method^ wc refer our reader to Dr. Eoy's paper; it will sufTice to
state here that the volume of the organ was measured and recorded
from the displacement of fluid contained, with the organ, in a rigid
case.

This important accession to our physiological notions of the spleen
vyill doubtless bo extended, in Dr. Roy's promised communication
of the effect on the splenic circulation of the inJ3ction of various
chemical substances into the blood. The observations throvy light
into an obscure corner of physiology ; and, while deprecating the
building of flimsy pathology upon limited foundations, we may
reasonably expect that these and further observations should help
us to realize pathological aberration and therapeutic rectification of
splenic function. But to judge of the influence < n the economy of
the physical function of the spleen, its bl.od-forming function,
also, must be more precisely known than it is at present. We
know, for instance, that we can, in man, modify, by electrical
ipeans* the bulk and muscular action of the spleen, but we are yet
comparatively ignorant of alteration in the blood which \\*'e thereby
increase or diminish. But whatever our wants may be in respect
to information and speculations upon the relation of the spleen to
the blood-corpuscle, the knowledge of its autonomous circul-tion
is an important addition. — British Medical Journal.

WHAT IS ACONITINE ?

Mr. F. Springmuhl has endeavored to show, in Ittters to the
Times and Standard newspapers, that the term aconitine is properly
applicable to Grerman or comparatively inert, rather than to the
English, or more lethal, preparation, sold under the name of
aconitia or aconitine. He complains that no mention was made ly
the experts who gave evidence at the Ijate trial of Larason, of the
differences in the pro|)ertie3 of the English and German aconitine ;
and that it was never suggested by the defence that the aconitine
might have been administered on the basis of one of the numerous
continental prescriptions, or on the basis of former experiments
made by the condemned criminal with continental — that is, with

WHAT IS ACONITINE ? '437

comparatively inert — aconitine. We must repeat what has been
before said, that the term aconitine, always applied to an alkaloid
extracted from Aconitiim Najjellus, should be preserved for the ac-
tive lethal principle of monkshood rather than applied to a sub-
stance of lesser potency. Moreover, the term aconitia is conse-
crated by the usage of the British Pharmacopcpia to the SLCtiwealka.-
loid of A. NapeUus, wrich produces prolonged tingling and numb-
ness ; and this can hardly be £aid to be a property of the commer-
cial German aconitine. We presume that, had Lamson been in the
habit of prescribing German or any other form of the alkaloid, the
fact would have been laid before the court which tried him. More-
over, his letter stating that he had given nothing to Percy John,
and that, if anything had caused his death, it must have been in
Mr. Bedbrook's sugar, was fatal to the theory that aconitine might
have been administered medicinally by Lamson. Any persons who
were present in court when the experts gave their evidence, and
when Mr. Montague Williams made his speech for the defence, can
speak positively to the fact that Dr. Stevenson did lay stress upon
the difference between German and English aconitine. He said
that German aconitine was a quite different thing from English
aconitine ; and that certain doses of aconitine laid down as proper
by Fiuckiger, applied to the Gorman and not to the English aconi-
tine. lie spoke also of a case in which death resulted from the in-
ternal use of a dose of one-eixteenth of a grain of nitrate of acon^
itine. This is one of the celebrated Tresling cases, where Petit's
French preparation was dispensed instead of German aconitine.
This is, we believe, the only fatal case of aconitine poisoning re-
corded before the death of Percy John. Mr. Springmuhl speaks of
a fatal suicidal case of poisoning by German aconitine, which came
under his own notice. He would confer a boon upon the profession
by placing on record the details of this perhaps unique case.—
British Medical Jourmd.

Dr. A. H. McNair died in Tarborough of the 5th of *April. He
was born in Tarborough, on 22d December, 1819. He was the
Superintendent of Health of Edgecombe county since the organiza-
tion of the county board, and rendered efficient service in the per-
formance of unpleasant pioneer work.

A sketch of his life is in preparation by one of his Tarborough
confreres, whicli will probably appear in our next issue.

238

NOTES.

North Cauolixa Medical Journal — Old Series. — Any one
having a complete set of the old series of the Journal will oblige
the editor by communicating with him.

Any one having the Transactions for the 2J, 3d. 4th and 5th
meetings of the Medical Society of North Carolina 1851-54, will
do a favor by dropping me a line. The Editor.

Prof. CIross. — Professor Gross has resigned the chair of Surgery
in the Jefferson Medical College, of which he has been the incum-
Ijcnt for twenty-six years. His son, Dr. S. W. Gross, has been
elected to the char of Principles of Surgery and Clinical Surgery,
and Dr. John II. Brinton to the chair of Practice of Surgery and
Clinical Surgery.

Facial Significance as a Clew to Phthisis. — Mr. Francis
Gallon and Dr. Mahomed {Afed. Times and Gaz., March 18, 1882)
have been trying to determine the value of the significance of the
different types of faces as generally admitted to belong to consump-
tives. "Comparing phthisical with non-phthisical patients, they
found the same proportion of narrow, ovoid faces to exist in each.
Thus far, theh" conclusions are opposed to the belief that one single
type of face prevails among "consumptives" persons generally, or
that persons of any special type are moie predisposed to phthisis,
although the phthisical members of each class are generally of a
more delicate type, with finer features, lighter lower jaws, and nar-
rower faces. It is an exceedingly interesting study, and the meth-
ods employed seem to be well calculated to produce reliaole results.

Eemoval of the Entire Uterus for the Cure of Cancer
OF THE Cervix. — In the American Journal of the Medical Sciences
for April, 1882, Dr. Clinton Gushing reports two cases of removal
of the uterus for cure of cancer of the cervix, one of which was
successful aftd one was fatal, with the following deductions :

First. Do not undertake the operation of entire removal of the
uterus if the surrounding tissues are involved in the disease, or the
uterus is at all fixed, for the operation is then very difficult, and the
disease would certainly return at the scat of operation.

NuTKs. :t:v.i

St'cni'l. Operate by the v.ioinal method, it being .1 much safer one.

Third. Leave the opening made by the removal of the uterus
open, so as to allow perfect drainage, tliere being apparently no dis-
position to prolapse of the small intestin-',

Foiirtli. Keep a self-retaining catheter in the bladder, in order to
avoid its distension, and to prevent the too frequent disturbarcj of
the patient.

Dr. Gushing suggests that, wiierc it can bo dore, enough of tlie
diseased strncturo be removed for a micro«cojiical examination, b -
fore the decision is made final as to tiicadvisab lity of an opt'iatiou.

Is THE Suspension" Treatment Foit Spinal CL'iiVATL'iiE a
Re-discovery ? — I. Artificial suspension of the body is effected by
means of a certain instrument hanging from a girdle arranged in
such a manner, that the chest shall be encircled under tlie armjiits,
the head be embraced by another bandage pressing under the chin
and the hands be sustained by cords, two to each hand, so that the
vveiglit of tt e body is held up in pirt by the child, in part by tin'
head, and in part by the armpits, and the body can be swung to ami
fro by the bystanders like a pendulum in the air, not altogether
without a sense of comfort to the patient. This kind of exercising
is believed to be beneficial in many ways in tli's atlliction. For it
serves'to restore the curved bones, straigh'en the joints wiiich are
bent and to lengthen the shortest stature of the body. Indeed, that
which excites the vital heart, and at the same time promotes a
richer supply of nourishment to the parts primarily affected, and
in children accustomed to this kind of motion creates a pleasurable
rather than a painful sensation, surpassing all other exercises.
Some, to largely extend the parts, put leaden shoes on the feet, and
attach a weight to the contracted side of the body by which they
more easily bring the parts to an equal length. But this kind of
exercising is only applicable to the more robust children. — Trans-
lation from Glisson's on Richets, 1G82.

Circular of the Fourth International Congress of Hy-
giene.— The third Congress of Hygiene, which met at Turin in
1880, selected Geneva, by acclamation, as the seat of the fourth
Congress.

240 NOTES.

The Swiss Federal Council, the Genevese Oouncils an! People,
gratilied by so flattering a decision, are preparing to welcome the
hygeists, botii Swiss and foreign, who may attend this scientific
meeting.

The Congress shill meet on the fourth and sit until the ninth of
September, 1882.

The Geneva Committee, entrusted with its organization by the
the S'.ate Council, hope to make it worthy of its predecessors, the
Congresses of Brussels, Paris, and Turin.

Supported by the Swiss National Committee, they appeal to all
])crsons who, by their writings, their position or personal experience,
strive to elucidate the theory of hygiene and to practice it.

With the assent of the International Committee of the Paris
Congress of D rnography in 1878, they have resolved that a Demo-
graph'C Scct'on sliall supplement the Congress of Hygiene.

Let then the hygeists and demographers of all countries prepare
to bring to the Geneva Congress the contribution of their learning
and labors.

They are invited, together with the Boards of Health, the Scien-
tific and Sanitary Societies, to submit as soon as possible to the
Managing Committee, the questions they may tiiink worthy of
treatment by the International Congress.

Several essays have been announced, and as soon as a full list of
them shall have been obtained, the Committee shall apprise the
public r,f their drift, calling special attention to the main points of
invesiigition.

An exhibition of books, plans and instruments of all kinds con-
cerning Hygiene and Demography shall be opened in Geneva on
September ls\ and last until September 30ih.

Authors, inventors, manufacturers of every nationality are in-
vited to give notice at their earliest convenience, of their intention
or attending the Exhibition.

The Committee will endeavor to obtain a reduction of tariffs both
for members of Congress and for the objects sent to the Exhibition,

Trusting you will honor the Geneva Congress with your coopera-
tion, we beg to remain. Sir, Very trulv yours,

THE MANAGING COMMITTEE.

Picsidriif.— II -CI. Lombard, M.D., Vice-President of the In-

BOOKS AND PAMPHLETS RECEIVED. 241

tarnational Congress of Medical Sciences held in Geneva in 1877.

Vice-President.— :i. -L. Prevost, M.D., Professor of Thrrapeu-
tics, Dean of the Faculty of ^Medicine.

General Secretary.— v. -Dunant, M.D., Professor of Hygiene.

Assistant Secretaries.— WY.i\i'mQ, M.D., Professor of Internal
Pathology; G. HaltenhofF, M.D., University Lecturer on Ophthal-
mology.

Memhers.—V. Gautier, M.D., Head Physician of the Butini In-
firmary; M. Julliard, M.D., senior, sometime Medical Inspector (f
Puhlic Health ; M. Denis Monnier, Professor of Biological Chem-
istry; E. Eapin, M.D , sometime President of the Medical Society.

Important ^^o/'tce. — Manuscripts and prints that concern the
Congress should be directed to Profei-snr Dunant, M.D. , -General
Secretary, Geneva.

BOOKS AND PAMPHLETS RECEIVED.

Annual Reports. 1881. Department of Health of the City of
Charleston, S. C. The News & Courier Book Presses. 1882.

Lectures on Diseases of Children. A Hand-book for Physicians
and Students. By Dr. Edward Henoch. New York : William
Wood & Company. 1882. Pp. 358.

First Biennial Report of the State Board of Health of the State
of Iowa for the Fiscal Period Ending September 30, 18S1. Des
Moines : F. M. Mills, State Printer. 1882.

Annual Report of the Board of Health, of the State of Louisi-
ana, to the General Assembly, for the Year ISSl. New Orleans :
J. S. Rivers, Stationer and Printer, 74 Camp Street. ^ 1882.

The Incidental Effects of Drugs. A Pharmacological and Clini-
cal Hand Book. By Dr. L. Lewin. Translated by W. T. Alexan-
der, M.D. New York : William Wood & Company. 1882. Pp. 240.

Annual Report of the North Carolina Agricultural Experiment
Station for 1881. Printed by Order of the Board of Agriculture.
Raleigh : Ashe & Catling,' State Printers and Binders. 1882.
Pp. 172.

Intermittent Spinal Paralysis of Malarial Origin. By V. P. Gib-
nev, A.M., M.D. Reprinted from the American Journal of Neu-
rology and Psychiatry. Vol. 1, No. I, 1882. New York : B. West-
ermann & Company. 1882.

24:3 BOOKS AND PAMPHLETS RECEIVED.

Infant Feeding iiml Infant Foods. The Anniversary Address,
Delivered before the Xew York Medical Society, February 8th,
]S82. (Reprinted from the ^[edical News, February 18, J 883.)
Philadelphia. 1883. Pp. 34.

Transactions of the Medical Society of the State of Pennsylva-
nia, at its 33d Annual Ses-ion, held at"L»ncaster, May, 1881. Vol.
XIII. Part II. Published by the Society Philalelphia: Collins,
Printer, 705 Jayne Street. 1881.

The One Hundred and Eleventh Annual Report of the sta^e of
New York Hospital and Bloom ingdale Asylum,' for the Year 1881.
New York: L. H. Biglow & Company, Printers and Sta'ioners,
13 William Street. 1883. Pp. 50.

Materia Medica and Therapeutics. Inorganic Substances. By
Charles D. F. Phillip?, M.D. Edited and Adapted to the U. S.
Pharmacopoeia. By Laurence .Tohnson, A.M., M.D. Volume I.
New York. William Wood & Company. 1883. Pp. 398.

Anas^thesia and Non Anfesthcsia in the Extraction of Cataract.
With Some Practical Suggestions Regarding the Performance of
this Operation and Comparative Statistics of Two Hundred Cases.
By Hasket Derby, M.D. Cambridge: Printed at the Riverside
Press 1SS3. Pp. 33

Illustra'ions of Clinical Surgery, Consisting of Plates. Photo-
graphs, Woodcut-!, Diagrams, &c. Illustrating^Surgical Diseases,
Symptoms and Accidents, Also Operative and Other Methods of
Treatment, with Descriptive Letter-Press. Fasciculus xiv. By
Jonathan Hutchinson, F.R C.S. P. Blakiston, Son & Co., 1013
Walnut Street.

The Importance of Introducing the Study of Hygiene into the
Public and Other Schools. Address on the Forty-Eighth Com-
mencement Day, March 39th, 1883, of the Medical Department of
the University of Louisiana. By Stanford E. Chaille, M.D., Pro-
fessor of Physiology. New Orleans : L. Graham & Son, Printers,
137 Gravier Street. 18S3.

NORTH CAROLINA

MEDICAL JOURNAL.

THOMAS F. WOOD, M. D., Editor.

Number 5. Wilmington, May, 1882. Vol. 9.

A CRITICAL, HISTORICAL AND CLINICAL STUDY OF

' SMITH'S ANTERIOR SPLINT.*

By J. Edwin Michael, M.D., of Bultitnore, Md.
Professor of Anatomy and Clinical Surgery in the University of

Maryland.

No injury is more common than fracture, no service is more fre-
quently demanded of the surgeon than that of setting a broken
bone, no subject in the whole range of snrgery has been more ably
and vigorously discussed, and yet, perhaps, there is no subject upon
which there exists at this present time more radical difference of
opinion. It is quite true that surgical progress in the matter of the
treatment of fracture has been very decided. The tendency has
been toward simplicity of apparatus, and the comfort of the pa-
tient has of late years received more consideration than it did at the
hands of our fathers. The principles of treatment and the ana-
tomical ditHculties which stand in the way of their application are
so thoroughly understood that the discussion is practically limited
to the method. Every one admits that the proper wiiy to treat a
fracture is to place the bones in apposition and keep them there

*Read before the Clinical Society of Maryland, December 2, 1881.

244 smith's anterior splint.

until union has occurred ; but so great are tlic difficulties wliich lie in
the way of carrying out this dogma, that tiie ingenuity of surgeons
has so far been unequal to the task of devising a method so perfect
as to receive general support. The best talent of this, as well as of
preceding ages, has been devoted to the subject — especially with re-
gard to fractures of the lower extremity — and numerous claims to
perfect results in all cases of fracture of the femur have been made
and are still made; but the constant recurrence of the experience
that the boasted apparatus will not achieve the same brilliant re-
sults in the hands of surgeons other than the inventors, and that
even the measuring tape in unprejudiced or inimical hands will not
verify the claim to a perfect result, is acircumstance which he, who
wishes to study fracture apparatus, would do well to consider. One
instinctively shudders in looking over the various machine which
went under the name of fracture apparatus among the older sur-
geons John Bell denominates them instruments of torture more
terrible than those used by the Inquisition for that purpose, and
casts them all aside for the simple method of Pott. In speak-
ing of some of the elaborately cruel methods of his day, and more
especially of those of the French school headed by Dessault, he
says : " Extension was the fixing of lacs and bandages upon the
lower part of the fractured limb, to which were applied ropes and
pulleys by which the assistants pulled; counter-extension was the
resistance which other assistants made with table-cloths, quilts and
bandages put around the pelvis and upper part of the thigh ; coci}^-
tation was the thumbing and working the smaller fragments and the
broken end of the bone into nice contact with each other; but
delegation was a process which it would take hours to describe as it
took hours to perform ; of compresses applied round the broken
ends of the bone, pads and cushions to belaid along the sides of
the limbs, splints above the compresses and cushions, with distinct
rollers for each separate stage of the operation. Such practices are,
or soon will be, totally disused by all sensible men, nor will the
terais be allowed to remain as memorials of those absurd cruel-
tieSjOr as stumbling blocks to yonng students who read about these —
aye, and about more desperate operations which never will be per-
formed again." Bell's prophecy is fulfilled, at least, as far as Amer-
ica is concerned, and whether we nse straight-extension, plaster, or

smith's anterior splint. 245

one of the various forms of inclined plane, our setting of a broken
femur is no such ordeal for the patient as that process referred to
by him. And, although we still retain the terms extension, coun-
ter-extension and coaptation, they have no such terrible signifi-
cance as they possessed a hundred years ago.

In regard to fracture of the femur, probably the most important
of all the fractures, modern American surgeons will be found to ad-
vocate one of three great plans of treatment, viz. : straight exten-
sion variously modified, plaster-of-Paris or other immovable appa-
ratus, and the double inclined plane in one or other o^ its various
forms. It is true that the fracture box is still retained by some,
but Ihe part it plays in the treatment of fracture of the femur by
surgeons of the present day, scarcely entitles it to consideration in
a discussion of the subject. And" even if it were introduced it
would be relegated to the same class as the starch and plaster
methods, since the principle on whi(ih it acts is the same. The
■ great principle involved is that of extension, and the question which
arises is whether such extension as is necessary for bringing the
fractured ends together should be made at once when the apparatus
is applied, or whether the apparatus should be such as will exercise
constant traction on the lower fragment. Among the advocates of
this latter proposition are many of the ablest surgeons of the day,
whose names are too well known to require any mention from me ;
and, perhaps, the most generally accepted practical exposition of
the doctrine of continuous extension is seen in the method of Gnr-
don Buck. The advocates of the other proposition, that reduction
should be effected at once, and the apparatus so arranged as to re*
tain the parts in apposition, arc much divided as to the best method
for putting their doctrine in operation, and so advocate one orother
of the various forms of immovable apparatus or inclined plane. It
would be interesting to follow up the subject philosophically, to
develop it in its various directions, and to point out the various
attempts which have been made to combine the principles of treats
ment and achieve the best results, but the scope of this paper is too
narrow and my time too limited for such an undertaking.

What I propose to consider is one of the forms of inclined plane^
which has the additional feature of suspension. It is but natural
that I should be accused of local prejudice by those who are not

34G

SMITHS ANTERIOR SPLINT.

acquainted with Smitli's Anterior Splint, but I hope to show, be-
fore I conclude, that I have considered the subject impartially, and
that tlie conclusions arrived at will be justified by facts and
principles. I propose to show that what we know as Smith's An-
terior Splint is not the work of any one man, but the result of the
development of an idea which originated a hundred years ago, and
has been elaborated from time to time, until made complete by the
genius of Smith ; to demonstrate that the splint, as applied by the
inventor, cannot produce extension in its modern surgical sense?
as claimed by him, and to show that the instrument is the best
exposition of the principle of treatment, which I shall caW retentive;
that it performs this function in a manner equally efitloient and in-
finitely more comfortable to the patient than any other apparatus,
and that for general purposes it is the best instrument for the treat-
ment of fracture of the fen)ur, whether simple or compound.

The obvious advantages of suspending a broken leg do not seem
to have become apparent untiil the latter part of the last century,
and even then no one seems to have thought of applying it to the
treatment of fracture of the femur, and the earliest example of its
practical application, that I have been able to discover, is found in
" Benjamin Bell's Surger\," published in Edinbui-gh in the latter
])art of the eighteenth century. I present a cut of Rae's apparatus,

RAE S APPARATUS.

which will save words, and give a better idea of it than any de-
scription I could give. The cut is a tracing from the original

SMITH S AXTERIOR SPLINT.

247

representation in Be'l's work. Bell figures a sort of hammock made
of independent strips of cloth laid across two parallel bars, the
wli /le supported upon a frame work made to rest on the bed. This
appliance was invented by James Eac, and improved by his son
John Rae, both surgeons of Edinburgh, and was successfully used
by them in the treatment of the fracture of the leg. Bell, him-
self, modified the apparatus of Rae, substiiuting in jilace of the
hammock of straps, a wooden trough with an opening for the heel,
atid making several other changes which it will not be )iocessary to
discuss here. In fact I only introduce the apparatus of Rae, as a
liistoiical relic, since, although itsinven'ion marks an epoch in the
histoiy of the treatment of fractuie, it is itn])ortant rather on ac-
count of the principle involved than because of its utility.

Ti e apjiaratui of Ravaton, in use in France about the end of the
last century, and 'described by M. ^r. Boyer, Merchie and others,
brings us a good deal nearer the present time and the perfection of
suspensory splints than could have been dreamed of by those who
only knew of Rae's invention. Ravaton really deserves the credit
of first using suspension, pioperly so-called, for although Rue, by
his instiument, attained the desired elevation and flexion, it was

FiG. 2. rayaton's suspexsory splint.
supported from bel.;wand allowed none of thelateral motion which
is one of the chief points in favor of suspension. The plan of

248

SMITH S ANTERIOR SPLINT.

Ravaton was carried out by placing tha leg in a z'nc trough or
lottine with a footpiece, and supporting it by straps on the sides of
a wooden frame which, in turn, was suspended upon supports above.
This apparatus is evidently a modification, and m great improve-
ment on Bell's modification of Rae, which had been introduced into
France by Dupuytren.

In 1S12, Mr. Sauter, a surgeon of Cons!ance, having studied the
method of Ravaton, and modified it considerably, published a
pamphlet, entitled : Instniction for Treating Sureli/, Conveniently
and Without ^^plints, Fractures of tlie Extremities, JSspecialty Com-
jjJicated Ones and Those of the Nech of the Femur, According to a
JVeiv, Easy, iSimpIe and Cheap Method. Sauter ])ushed the applica-
tion of suspension with the aid of a double inclined plane
to the treatment of fractures of the femur. He used few reguhir
band;ige?, and relied on what we would call handkerchief bandag-
ing chiefly for retaining the ])roper relationship between limb and
splint, lie claimed great advantages for his apparatus, and among
them most prominent were lateral mobility and facility in dressing.

FIG. 3. SAUTER'S POSTERIOR SUSPENSORY SPLINT.

the wound in ca?es of compound fracture. Although Sauter used
much indu£t:T a;id ability in elaborating and disseminating his
views, the surgeo.-s do not seem generally to have adopted them,
and while his apparatus is often figured and his ingenuity com-
mended, his method seems to have been practiced chiefly by himself.
In 1838 another distinguished Swiss surgeon, M. Mayor, of
Lausanne, published in his " Muvcau Systcme de Delegation Chir-
vrgicale," the various modifications which he had made in Sauler's

SMITH S ANTERIOR SPLINT.

249

method, together with a stroDg plea for its adoplion by surgeons.
In speaking of what lie calls his '■^ mctliodc liyponnrilieciqnc" ho le-
marks with commendable modesty : *' The illustrious and ingenious
Sauter, as every one knows, had the first idea of the apparatus of
which I have given a description. But I have added so many mod-
ifications to every part of Sauter's npparatus, and have given such

FIG. 4. mayor's POSTERIOR SUSPENSORY SPLINT.

development to this particular mode of treating fractures that I can
claim a very lai'ge part of the good which the new method has pro-
duced. " Mayor's modification consisted in substituting a wire
frame work for the plancliettc of Sauter, suspending by converging
cords and changes in minor details which it will not profit us to
follow. That he made considerable impression on the surgical
opinion of the day is apparent from the consideration his apparatus
receives from his contemporaries. So great an authority as Vidal
de Cassis remarks in regard to it, that " when fractures are treated
according to this plan, the member remains uncovered ; if we have
to do with a compound fracture it is not necessary to change the
splint to attend to the dressings. Fractures treated in this way are
not followed by so much oedema, as those placed in the ordinary
apparatus in which Mie member is for a long time subjected to a

250 smith's anterior splint.

decided compression. If theajiparatns issuspoiided, the patient can
execute a variety of movements and change his place in bed.
M. Merchie, while he does not heartily approve of the plan, says :
" One cannot deny that the apparatus for suspension is founded on
an extremely ingenious idea, and shows a marked superiority over
other splints, especially in cases of compound fracture of the lower
ex'retnity." Mayor's posterior suspensory splint may be looked
upon as the imnaediate predecessor of the subject of this paper, and
a comparison of the two will show a great niny poimts of resem-
blance.

But the necessity of placing cushions betweeen the limb and the
splint, and the impossibility of so arranging them that the pressure
would be evenly distributed, presented objections which the genius of
Smith was t" surmount. We shall, however, commit a gravo error
if we conclude that Smith took up the mat'cr where Mayor left
it off, and that his splint is simply a modificatio'i of the litter's,
lie had also been working in the same direction, and, in 1832, in
the Baltimore Medicil Journal and Ileview, published a description
of a posterior suspension splint for which he claimed great merit.
It consisted of a doubled incline {)lane resembling in many points
that of Mr. Amesbury, with the exception that it was suspended.
But theie was with it the same difficulty of equably distributing the
pressure on the posterior surface of the limb. The thigh was enclosed
in a leather trough, while the leg was supported upon muslin strips
connected to the side bars of the splint. In his work on the "An-
terior Suspensory Apparatus" he does not give an account of the
development in his mind of the great idea of placing the whole

smith's anterior splint. » 251

splint on ttic anterior face of the limb ; but it is fair to presume
that it developed from the facility with which the pressure was dis-

FiG. 5. smith's posterior suspensory splint.

tributed in the leg portion of his posterior splint. Tiiat the idea
was original with him, I believe has not been questioned, and if it
bad been, ihc matier coul 1 easiiy ba set at rest by the positive
statement of Dr. E. Fischer in v. Piiha and Billroth's "General
and Special Surgery," that "suspension by means of an anterior
splint fust came into general use through Smith of Baltimore."
This, then, i' the only element in the apparatus for which the in-
ventor can c'aim superiority, and this, indeed, is the feature which
was the grci.t desideratum in suspenso-y apparatus. Everything
else which the anterior splint is capab'c of could have been achieved
by that of ]\rayor or even Sauter. Merchie, in his criticism of
these posterior splints, says : "Circular compre:sion, which, in our
rpinion, is as necessary in the treatment of solutions of continuity
of bone as perfect retention, does not exist; and its absence in the
case may produce inconveu'ences which are not compensated for by

252

smith's anterior splint.

any of those qualities so highly praised." The criticism perfectlv
just as it is, as applied to any splint which
causes the limb to rest on a flat surface, loses
its power in the presence of the anterior ap-
plication of the splint and the perfect adapta-
tion of bandage to conformation of limb which
this makes possible, and it is this feature which
has immortalized the name of Smith, and en-
abled his splint to hold its own among Balti-
more surgeons for the last twenty years.

The anterior splint can bo described in few
words as it c.\n b3 applied in a few minutes. |
It consists of a parallelogram of wire about •
the size of a No. 10 bougie, about three inches 1
wide, and six or eight longer than the limb ,
to be treated ; cross wires connect the two I
parallel wires at intervals of about six inches, ;
and these are twisted so as to make a rins; iu '
the middle to which the hooks used iu sus- t
pending are attached. Two hooks are used, c
one end of a stout cord about eighteen inches \
in length. This cord plays through a ring or '
hook in a longer cord which passes through
a pulley secured in the ceiling and is made l
fast by a tent block, thus allowing the eleva-
tion of the limb to be changed at will. The
splint can be bent over the back of a chair or
other convenient support, at the hip, knee,
and ankle, to suit the exigencies of the case in
hand, the injured limb serving as the guide
xor the flexures. The fractures is reduced
and retained by assistants while the surgeon
secures the limb to the splint by short pieces
of bandage. The apparatus is then sus-
pended, arrangements to that end having
been previously made, and after the surgeon has assured himself
that all is right, the roller is applied. In cases of compound frac-
ture the seat of the wound may be left free and afterwards supi^lied
with an independent bandage, which can be changed according to

smith's anterior splint.

253

the requirements of the dressin^^. If the surgeon expects trouble
and wishes to be especially watchful of the case, the bandage may

TEMPORARY BANDAGES.

be strongly stitched to the splint and the whole middle part cut out
with scissors, thus opening the whole anterior face of the member
to daily inspection. A few turns of bandage secures the apparatus
to tlie pelvis. Coaptation splints may be used at the seat of frac-
ture, but these are generally a useless encumbrance rather than an
aid, since the splint and bandage, properly applied, do all that is
necessary for the proper treatment of the case. The member rests
evenly on its ivUole posterior surface, the roller makes comfortable
and efficient lateral compression, and the whole swings easily from
the suspending cord. The range of movement allowed the patient
without disturbing the relation of the fragments or causing pain is
very considerable, and as the casp progresses he may even leave his
bed and sit in a chair, his limb remaining, meanwhile, comfortably
suspended.

It will be observed that so far in my description of the anterior
splint and its application I have said no word in regard to extension.
I have, in fact, reserved it for specitil discussion, because I find

254

smith's anterioe splint.

myself ccmpelled to differ vvilh the distinguished inventor of the ap-
paratus in feganl to that point. His view is, that extension may be

FIG. 8. SPLINT APPLIED.

produced by the obliquity of the suspending cord, and that this
acts continuously, the weight of the body, assisted by elevating the
foot of the bed, acting as the counter-extending force. I think I
am prepared to show, out of his own nioulh, and by reference to
certain well recognized mechanical facts, as well as by the authority
of some very distinguished surgeons, that with regard to this point
at least, Professor Smith entertained erroneous views. Extens'on,
as used in surgical discussion, means a force applied loan ex'remity
below the seat of fracture, and constantly acting in the axis of the
broken bone. And upon this understanding of the term depends
the great difference in the principles upon which fiactures of the
femur are treated. Now, it appears to me, that as the bandages
which secure the limb to the splint are applied in the same man-
ner above as below the seat of fracture, and that in addition to
this the splint is bandaged to the pelvis, whatever extending force
is required from t'le obliquity of the cord is exercised as well upon

SMITH S ANTERIOR SPLINT.

255

the parts iibove as n(ion ihose below the break, and hence no differ-
ence in the reLiiion of the broken fragments can be secured.
Smith, himself, says : '• The apparatus being secured to tlie pelvis,

SPLINT xVPPLIED FOR COMPOUND FR.VCTUUES.

the limb is obedient to all the movements of the tiunk, and always
preserves the same relation to it.'^ Now, it is quite apparent to me,
that this preservation of the relation between the limb and the pel-
vis, precludes the possibility of change in tiie relation between the
broken ends of bone. In fac% even if the splint was not made
fast to the pelvis, extension coulJ n )t be accomplishei unless we
should so apply the bindages that they would slip on the parls
above the fracture, hold fast on the parts below, a style of band-
aging with which probably no one would have shown less patience
than Professor Smith himself. Dr. G. E. Porter, of Lonaconing:,
Md., nn ardent admirer of Smith's anterior ?[)lint, has long ago
recognized this feature and has devised a modification of the instru-
ment with a view of overcoming it. Dr. F. II. Hamilton, in his
admirable treatise on "Fractures and Dislocations," says : " Wliat-
ever the alvocates of flexion in fractures of tlic femur may say to
the contrary, they are never able, in this position, to employ
effective extension and counter-extension, A careful examination
of all the doubled inclined planes v»'hic;i ha^e been devised, includ-
ing Nathan R. Smith's and Ilodgen's suspending apparatuc — I say

256 smith's anterior splint.

it with all respect for those distinguished surgeons— on^ht to con-
vince any experienced observer that such is the fact." Again, "In
Nathan II. Smith's anterior suspension splint, not even the weight
of the pelvis is employed as a means of counter-extension, the pel-
vis being secured to the splint by rollers equally with the thigh and
leg, and there is no possible chance for extension and counter-ex-
tension. 1 hope I have made my position clear upon this point, for
upon it depends the propriety of my having considered Smith's an-
terior splint among those instruments which retain a reduced
fracture in place until healing has occurred, rather than among
those which produce extension during the process. I believe that
the splint does something which, in a great majority of cases of
fracture of the femur, is much better than continuous extension,
and that is prevention of retraction, or, in other words, retention ;
and tliis is accomplished by means of the obliquity of the cord as
well as by other means, which I will proceed to point out.

Continuous extension is coercion of muscles, and like all oihcr
coercion excites a certain amount of irritability in the muscles so
treated, :nd a corresponding amount of discomfort in the patient.
Moreover, since it is clear that effective extension can only be em-
ployed in the straight position, the practice of it in the treatment
of fracture of the femur entails that position which is an exceed-
ingly disagreeable one. And, although I freely admit that there
are certain cases of this fracture where great obliquity is found, in
which this plan of continuous extension promises the best possible
results, I am far from believing that i!s application is necessary in
a o-rcat majority of the cases. If we know an instrument which
will be sufficient for the case, and will at the same time relieve the
patient from the discomforts of the straight position it is plainly
our duty to use it. It is just as true to-day as it was a hundred
years ag) when Benjamin Bell said it, that "if the muscles of the
limb are rehixc I by making the limb form an obtuse angle with the
body, while the j );nt of the knee is moderately bent, it is surpris-
ing with what ease we may, in most cases, place the bones in their
natural situation ?" and it follows naturally from this, that if by
nieans of an apparatus we can maintain this flexion until sufficient
time has elapsed, we can secure union without deformity. M.
Mayor, in commending his own splint, which acts on the same

smith's anterior splixt. 257

princ'ple with that of Smith, remarks : "All that is necessary,
therefore, is to offer to the tcmloncy to contract a rcs'stance propor-
tionate to the degree and mode of action." This he accomplished
also by flexion. Smith, himself, says: "It will be observed that,
iu the method of treatment here described, the necessity of severe
mechanical constraint is superseded by evading the causes of d's-
placement rather than ty contending with them." Moreover, with-
out bringing to our aid such eminent surgical authority, it is quite
evident from the anatomical considerations involved that we can,
by performing and maintaining double flexion where the fracture is
notextremly oblique, fulfil the great dogma of fracture treatment,
i. e., put the broken fragments in apposition, and keep them there
until union has cccurred. In whatever part of the shaft the frac-
ture may occur, it will be the psoas, iliacusand hip-muscles, assisted
somewhat by the adductors acting from above, and principally the
gastrocnemius acting from below, which produce displacement, and
the hamstring muscles, aided by the adductors a^.d rectus, which
produce shortening. Double flexion approximates the points of
origin and insertion all these muscles, that is, relaxes them and pro-
portionally removes the deformity produced by their contrac.ion.

I think it fairly deducible from what has preceded, tliat in Smith's
anterior splint we have an apparatus belonging to the division which
we may call retention instruments and the class of double inclined
planef, which possesses features of the greatest possible cliiiical in-
terest, and adds materially to the stock of our armamentarium. I
am not one of those who are disposed to ride hobb'es, and I wish it
to be distinctly understood that I do not look upon the apparatus
under discussion as the only proper means of treating a fracture of
the femur or leg, although that seems to have been the way of think-
'ing in our city from the time of its invention until a very few years
ago. Nay, I am even convinced that in the worst cases of this
dreadful accident where the fracture is simple, when the obliquity
is very great and the broken ends afford each other no supp rt, ore
of the continuous extension methods would in the long run give
better results. And in simple fractures of leg, unless there was a
great degree of laceration of soft parts (in which case I would use
it), I would greatly j)refer one of the dressings which allow the pa-
tient to go about on crutches, and among which none has given me

258 smith's anterior splint.

more satisfaction than the ingenious modification of Crofi's method,
lately devise! by Dr. 0. J. Coskery, of this city. But the a}>para-
tiis philosophically meets all the indications presentelin an ordinary
fracture of the femur, and gives to both patient and eurgeon, an
amount of comfort scarcely known in the use of any other plan.
It is in compound fractures, however, whether caused by gunshot
wound or otherwise, that the splint is peculiarly efficient. How-
ever extensive the laceration of soft parts or comminution of the
bo:-:e, we can keep the limb in good position, give the patient com-
fort, and by using an independent bandage at the seat of injury,
alwaj^s have access to the wound without disturbing the relation of
the fragment or giving the patient pain. I have kept the patient
comfortable and the limb in excellent position with the wounds ex-
posed, in a c se in which the tibia was ground to bits and the
fibula brv)ken in several places. After amputation (to which the
patient refused to submit on admission), twenty-five i)i;cc3 of libia
were counted.

j\Iayi)r, in spcakii g of his own apparatu.^, says : '' With it is re-
solved this problem — so difficult that it seems almost a paradox —
to treat a broken member even wiili the most untovvard complica-
tion, bysimple ))osition without a splint, and to perfnit (at the time)
the member, without inconvenience or pain, to ]iractice all the
movements parallel to the horizon." This and more may be truth-
fully said of Smitlj's splint since, in addition to tlie advantages of
Mayor's, it gives literal support and a better adap'ed posterior sur-
face for the repose of the member. The splint was exceedingly
popular among the surgeons of the Confederate army. Chisolm,
in his " Military Surgery," after discussing otliei- methods of
treatment, says : "Abetter method of treati-g fractures of the
tiiigh is the one in the nsc of Smith's antcii r splint is the p('rft'C->
tioncf a fracture apparatus. Fur, her on, speaking of com[onnd
frac'urcs of the ankle, he says : "It is in tliis class of cases iliat
Smith's anterior splint a d Mayor's postcrioi' splint will exhibit a
long list of si)lendid triumphs, cures without deformity ami the
smallest amount of shortening, a panic s tieatmci.t, allowing the
patient to move about at will, and even to leave l.is bed the first
week after the reception of the injury." War/en, in his "Surgery
for Field and Hospital," also commends it. " By means of Smith's

smith's anterior splint. 259

anterior splint the conjoined advantages of relaxation and extension
may be secured. * * * j]^q suspension of the limb precludes
such displacemen's as arc likely to occur in consequence of the
movement of the body, thus securing a much greater latitude in
that regard, and contributing materially to the comfort of the pa-
tient. Dr. Holloway in a d'scussion before the Medical and Chir-
urgical Society of Kentucky, published in the June number of the
Louisville Medical Herald for ISSO, says : "I htd the honor to be
the first surgeon of Eichmoiid, Virginia, tu ajiply Smith's anterior
splint to a gunshot fracture. Without going into the details of this
])lan I will s3y that I have seen compound fractures of the thigh by
gunshot, heal without suppuration, without any special treatment
except suspending of the limb during the process of repair. 1 am
satisfied that by its use I have saved a number of limbs which would
otherwise have required amputation. It was also considerably used
in the Federal army, as we gather from Hamilton's " Military Sur-
gery." He says : "This splint was employed very much during
the first two years of the war, and is still preferred by many sur-
geons ; but, in our opinion it ought, except in few cases, to give
place to Hodgen's suspension splint or some of the other forms of
apftaratus. Surgeons i-n civil practice have also from time to time
commended the anterior splint in terms which are unequivocal. In
1858, Dr. Ephraim Cutter described it to the Massachusetts Medi-
cal Society, and gave a glowing account of the success with which
he had seen it used by Smith himself in B.iltiimre. Probably the
most flat'eriiig eulogy ever passed on the splint is that published in
the Pars Medical Gazelle, by ]\IM. Schrimpton and Gantillon.
Those gentlemen having usei the apparatus in a very difficult case
with success, came to the following conclusions in regard to it :
" On the whole we aver that the apparatus of Professor Smith
realizes at least the followi.ig advantages over every other system
employed in the treatment of fractures of the lower extremity : (1)
The cxtremiies of the flagmen's a-e maintained in perfect apposi-
tion without the exercise of any constriction upon the limb. (2)
In cases of extensive displacement of the fragments, extension is
easily accomjlished by the weight itself of the member, and the
reduction accomplished by the 2^oinl d\tppui a'tachcd to the
apparatus, and this without any dragging. (3) The method of

2G0 smith's anterior splint.

suspension is exceedingly convenient for the employment of irriga-
tion and for the dressing of all the wounds of the member, upon
which we may practic3 all the operations necessary without disturb-
ing the apparatus. (4) The heel being uncovered is cxompt from
pressure and from the acute pain which, in the use of other means,
so of ten embarass the surgeon. (5) The patient can change his posi-
tion and raise himself in bed without inconvenienc-?. ((>) Finally,
what is not least important, the apparatus of Smith is the only one
which, even in the most severe and comjjlicated fractures, allows
the patient to bo conveyed to any distance without exposing him to
any danger and without causing him the least pain. Dr. Addinell
Hewsoa, of Philalelphia, has recently called attan'ioi to the ad-
vantages of Smith's splint in treating fractures of the leg, and Dr.
H. Black calls attention to it and to the success he has recently had
in treating with it a case of frac'ure of the neck of the femur in a
woman of 59. His case recoverel with only perceptible shortening
and a slight limp. It would be vain for me to give in detail the
experiences of Baltimore surgeons in the use of Smith's splint, since
it has been in high favor among all the teachers of surgery in this
city, as far as I am informed, ever since its invention.

The impression which the splint has produced upon those who
are acquainted with it is apparent from the number of surgeons who
have produced modifications of it. These I do not proposj to give
an account of since it would unnecessarily increase the length of
my communication. It may be well, however, to mention that the
most important of these are recommended by Dr. Hodgen, of St.
Louis ; Dr. G. E. Porter, of Lonaconing, Maryland ; Dr. 0. J.
Coikery, of Baltimore; Dr. Palmer, U. S. N. ; and Dr. T. \V .
Simmons, of Hagerstown, Maryland. Many other surgions have
produced modifications, but they do not concern u^ here. I have
so far not put any of the modified forms to the te,t, and therefore
should not speak too dogmatically in regard t) them ; but I cannot
gee in what respect they improve on the original, and am therefore
inclined to the opinion that they aro in no sense improvements.

In saying what I have in regard to the anterior splint, I have
been actuated by a desire to bring before the profession a subject,
which it seems to me is too much neglected, and to call the attention
of surgeons to an apparatus which may be a sourc3 of great satis-

smith's anterior splint. 261

faclion to themselves ar.d comfort to their patients. I have at-
tempted, and I liope I have succeeded in discussing the subject
from a judicial point of view, and while I heartily approve of the
anterior splint, I should dislike exceedingly to be considered a par-
tisan of it or of any other instrument. The conclusions at which
I arrived are based upon a philosophical consideration of the prin-
ciples involved and supported by a suflHcicnt amount of testimony
from thoic who have put the matter to the clinical test to give them
stability. My own cxpericnc3 has led me to adopt the anterior
splint, as a rule, in the treatment of fractures of the femur. I have
used the fixed splints of piaster, starc'i, etc , and while my cases
have generally done well, I have found the treatment more or less
unsatisfactory. I have also used Gurdon Buck's extension method,
and should use it again in a casj of extremely oblique fracture.
Bat the position is uncomfortable to th3 patient, and unless there
should exist cipccial indications for it, I would deem it unnecessary.
I have, therefore, found it to the advantage of myself and my pa-
tients to return to wha', with me, is Grst principles. The meagre
accounts which I find in Gross, Bryant, Erichsen, Holmes and
other systcma'ic text-bDoks on sargory which have como under my
observation, convince methitthe apparatus of Smith has not re-
C;?ived the attention it merits, and I have no doubt that if surgeons
would put it to the test in their practice they would find it possessed
of all the good qualities we claim for it. It acts on well recognized
surgical and anatomical principles, is cheap, sirap^.e, easy of appli-
cation, allows the patient considerablo frocdom of movement, gives
perfect access to wounds in compound fracture, without interfer-
ence with the splint, and is for the general run of casis the best
apparatus for the treatme.it of fracture of the femur whether it be
s'mple or compound, and of compound fracture of the leg. I wish,
in conclusion, to express my appreciation of the kindoess and
artistic skill of my prosector, Dr. J. L. Doerksen, who made the
drawings with which I h.ive illustrated my rerrarks.

BIBLIOGRAPIIY.

Biaek, H. PIdl. 3Ied. and Sarg Reporter. April, 1880.

Bryant. " Surgery." 18S0.

Bell, B. " .Surgery." Edinburgh, 178!>.

Bell, J. " Surgery." London, 1820.

2G2 A NEW TEST TOR MORPHIA.

Cutter, E. " Med. Communications to Mass. Med. Society." 1858.

Chisholm. " Military Surgery." ISOi.

Erichsen. " Surgery." 1873.

Fischer, E. v. Pitha and Billrotli's " Handbiicli der Algemeirien
und Speciellen Cliirurgie," vol i., ahlii. 2. 3 tes. Heft.

Gross. " Surgery," vol. i.

Goflfres. " IJandages, Panscments et Appariels." Paris, 1833.

Hamilton, F. H. " Treatise on Military Surgery." ISOo.
" P'ractures and Dislocations." 188:).

Hewson, A, IVnla. Med. Times, March 1, 1881.

Holloway. Louisville Med. Herald, June, 1880.

Merchie. " Nouveau Systeme do Deligation pour les Fractures des
Membres. Paris, 1858.

Malgaigne. " Traite des Fractures et des Luxations." Paris, 1847.

Mayor. " Bandages, Appariels et Pansements." Paris, 1838.

Nelaton. " Eleuiens de Pathologic Chirurgicale." Paris, 1844.

Porter, G. E. riiil. Med. and Surg. Reporter, March 18, 1876

Smith, N. R. Bait. Med. and Surgical Journal and Ecvictn, 1833.
" Fractures of the Lower Extremity." 1867.

Schrimpton et Gantillon. Gazelle Mediccde de Paris.

Simmons, F. W. " Trans, of the Med. and Cliir. Soc. of Md." 1881.

Vidal (de Cassis). " Traite de Pathologic Externe et de Medicine
Operatoire." Paris, 1857.

AVarren. " Surgery for Field and Hospital." 1863.

A Xew Test fur Morp]tia.—3o\y'\&o\\ [Zeilschr. fiir Analijf,
C/ieui., Band xx. p 4'^2) proposes a new and delicate test for nior
pliia A solution of lie alkaloid, fico from foi-eign tnatciials, is
evaporated to dryness, and the residue is liea'ed in the water-bath
with sul[)huric ac d. A mi:uito cryst d of ferrous sulphate is added,
and stirred with a glas.^ rod. The mixture is heated for a minute
longer, and poured into a whi n Ciipsule, containing about half a
fluid drachm df strong solution of anrnon'a. The morphia s du-
tion sinks to the bottom, and a rod color — 'iolet at the margin —
forms where the two liquids touch, whilst the ammoniacd liquid
becomes blue. Codeia does not give this reaction, which succeeds
with one-!enth of n. grain of morphia — London Med. Record,
March 15, 1882.

263

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artifcial limbs.

The solicitude of the surgeon is not always cndcil when he sees
l.is patient recover with a healthy we!l-c -vercd stump There c )tnes
up another matter qui'c as impor'anC in refeienco to supi)lyirg- a
limh that will overcome the deformity and enable his patient to get
about without the aid of a crutch.

One will consult the best text-books in vain for advice that will
lead hiu) to a correct solution of the dinieulties for Irs patient. In
the most recent edition < f II hnes, < r B .jant, or Gross, he wdl
get little satisfaction. He, there'ore, is compclleil to write to the
maliers of artificial limbs, and from them he gets a pamphlet of
testimonials from persons wh > h:iveb:en using t!ieir " very superior
limbs," (all of them are th js blosse 1 with certihcates) to wh'ch v^as
awarded sp' cal medals at nil the world's fairs and expo^^itions of
the l»st twenty years. S )me of the illus'rations are really enticing,
and ona in a recent pamphlet so much so that it makes a pjrson feel
that the loss of one or evt n of both legs is more a mat!er of esthetics

2G4 ARTIFICIAL LIMBS.

than of pra3lical moment. The parLicnlar cut referre 1 to shows
an exciting sk'iting race, in which many boys are participating, but
lo the wonder.s of mechanic il skill ! the boy who has lost both legs
is the successful com[)etitor in the race ! A cut explanatory on the
page opposite to this illustration shows the same biy en lUsliahiUe
with his artificial legs removed, and revealing an amputation at the
thigh of one side, and of the leg on the otlicr.

We are convinced too that tl:ese ai'e not sensational pictures, but
ai'C published in good faith by the maker of the limbs. If you visit
their shops, you will find tlicm all equally satitfied that the limb
they produce is the verv best. The opinion of one is founded on
his long experience, another on his perfect and peculiar mechanical
adjustments, another on the high finish and natural appearance of
his compL' c 1 w>.ik, another on the extensive patrona^^b awarded
him by L' e ai my and n ivy. Having encountered all the practical
dilliculLios growing out of the necessity of our maimed patients, wo
give some of our observations for what they arc worth.

The methods of the dilTerent artificial limb makers are somewhat
the same. The woik is under the personal eye of practical men,
some of the workmen, especially the adjusters, being legless. The
fitter has the mcst important part of the work to perform. After
the limb is examined, and it it is decided to be fit for an adjustment,
the leng'hs are taken, and a piece of willow- wood roughly shaped
a!id hrllowed out, to which is attac'^ed tlie jointings, the foot, and
the Ili';^h — leather with lac'ngs, is prepared for the customer
for it.i adjustment at his second visit. The amputated ex-
trcmi y of the limb, covered wiih a heavy knitted stocking,
chalked over lightly, is thrust into the hollow of the artificial limb.
Thcadjuster by this means is able to detect where there needs to be
a little taken out, by the markings on the inner surface, and with
this guide he pares out the limb, until by a great deal or patient
mani[iulatio:^, \,v lives the customer a comfortable fit.

The finishing w'.ich consists in shaping the leg, — painting, cn-
amnaeling and polishing it, — is attempted in a few days, and the
final trial is made at a subscquCLt visit. It is tare that oneisfittcd
t) such a comfortable degree that he can walk off without his
cru'ches on the first trial, and indeed, the limb-makers discourage
such at'ernpts.

ARTIFICIAL LIMBS. 265

The IJrst itiiprcssion the crippled man will get of his new limb is
that i: is very natural and the motion a success, and he builds castles
of the complete results that awaits him. But his obstacles are
many. As soon as he stands erectly, he finds that the adjustment
of the leather hip piece is not such a simple matter. If it is too
tight or too loo. 0, he flnds that there is rubbing of the end of the
stump. There is no pressure upon the amputated end of the limb,
in the sense that it used as a support upon which to walk, for all
good limbs distribute the pressure over the peiiphery of the log and
thigh, the leg and thigh being jointed together by means of a steel
joint, in which there is allowed no lateral motion at the knee. The
pressure generally complained of is the lateral pressure of the am-
putated end of the bono?, or the pressure which comes from tlic
traction of the skin.

With wonderful painstaking the lioib-m^ker adjusts and read-
justs— studying the accounts of his customers as to the sensations
of pain or pressure, adding a felt pad here or there, and conti'iving
nice adjustments day by day to meat the ever recurring pain and
soreness which the continued use of the limb causes. Finally, the
crutches are discarded, ar-d the patient is willing to try to walk
alone. Some of them succeed well, but nearly every one who wears
an artificial limb, has more cr less discomfort, and this too among
those having the very best stumps to begin with.

A satisfactory examination of the work of different makers, con-
vinces us that there is a great room for improvement upon all the
mechanical devices so far before the public. You will hear of the
advantages of the pure rubber foot because it is clastic and noise-
less, upon the adjustable cushion because it does not hurt the stump,
on the la oral foot motion because it gives it a very natural gait,
and the hard rubber leg because it is light, and so on through the
catalogue of advantage.-, and still, if these, and all the other im-
provements now known were combined in the artificial limb of ore
maker, the result as far a^ perfection is concerned would not com-
pare favorably with the won lerf al improvements which have been
made in other mechanical contrivances in daily use.

266

NOTES.

The Abortive Treatmext of Buboes with Carbolic Acid.
—Dr. Morse K. Taylor, U. 8. Army, in the April number of the
American Journal of Medical Sciences, publishes a paper on the
abortive treatment of Inbocs by injections of carbolic acid.

lie reports twenty cases in which he certainly ob'ained remarka-
bly successful results, am] ho states that within the last seven years
he hastrea'ed nearly one hundred ani fifty cases of various forms
of lymphadenitis, arising from specific and non-specific causes ; and
where he saw the cases before the formation of pus was well estab-
lished, he had not failed to arrest the process immediately, and allay
the pan in a few minutes. His method is to inject from ten to
forty minims of a solution, containing eight or ten grains to the
ounce, directly into the interior of the indnmed gl md.

Mrrcury axd other Remedies in tue Treatment of Sythi-
Lis. — In the New York Medical Journal and Obstetrical Review
for March, 188;2, Dr. George Henry Fox, Clinical Professor of Dis-
eases of the Skin in the College of Physicians and Surgeons, New
York, maintains that mercury, while undoubtedly our most Vdlui-
ble remedy in the medicinal treatment *of syphilis, is yet an over-
rated drug, and is not essential to the cure of the disease. It is
best administered internally rather by inuction, by vapor baths, or
hypodermic injection. The amount usually given is unnecessarily
large, and its local irritant effects should be avoideJ. The duration
of its use should vary according to the severity of the case ; no ab-
solute rule can be la'd down. loddo of potassium, the author
thinks, should not be reserved solely for the late period of the dis-
ease, for their is no st'ige in which cither iodiiic or mercury is inca-
pable of doing good. Instead of the so-called " mixed trca'ment,"
he prefers to give the two agents separately. Iodide of potassium
ought not to be administered continuously for any great length of
time. It does its work quick'y or not at all, and when necessarily
continued is sure to do harm. Very large doses should not bo used
without the very plainest indication, They are not without their
value in certain cases, but iodism has doutless often been mistaken
for the manifestations of syphilis. Iron deserves to be ranked with

NOTES. 267

mercury ;iud iodide of potassium, from its effect on the anaemia
that invariably accompanies the early stage of syphilis. Cod liver
oil is another remedy of great value, especially where there is a
strumous taint.

Syphilitic Rein'fectiox.— This question of the possibility of a
reinfection by syphilis is a very important and interesting one,touch-
ing as it does upon the poss bility of a cure of the disease, for it
is generally believed that, while the patient is under the influence
of the first infection, he is obnoxious to a second.

In the American Journalof the Medical Sciences for April, 1882,
Dr. F. E. Sturgis reports the history of a man, who, apparently free
from previous disease, entered the hospital with two initial lesions,
followed by a macular syphilide, osteocopic and muscular pains,
and a double iriti?. Under treatment, extending eight months, his
symptoms entirely disappeared and remained absent for fifteen
months from the last date of his taking medicine. He then entered
the hospi'al again with a couple of lesions of the genitals, which
appeared three days after coitus, no other connections having bee.n
indulged in for a period of five months. At time of his entrance
these ulcers were already a month old, and j)resented the appearance
of initial lesions. Auto-inoculation practiced with the matter from
one of these ulcers produced an apparently jiositive result, but the
resultant pustule was short lived, and did not have the characteris-
tics of the simple venereal ulcer. It was followed by a macular
syphilide, osteoc^p'O [la'ns, and other symptoms of an early syphilis.

Disinfection^ of Urixe. — In the Medical Annals, Dr. E. C.
Curtis sta'es, bydra'e of chloral has the property of disinfecting
urine. In August last he received a specimen of urine, four ounces,
containing five grains of chloral to the ounce. No special care was
taken to facilitate its preservation. It has been simply corked, and
has several times opened. It is nnv perfectly transparent, of a
c'ear amber odor. A slig'it £emi-flocculent deposit covers the bot-
tom of the vial The chemical analysis is identical wiih the notes
made when it was present ; sp. gr. 1.015, acid, a'bumen one and a
fourth.. The preservation of the albumen is a marked test. On
microscopic examination, the epithelial cells are as perfect as in

2G8 NOTES.

recent nrine. JVo casts were noted and ODne are no;v seen. The
specimen seems to be quite the same as wlien freshly voided, and is
manifestly instrnctive and of considerable interest. — Philadelphia
Medical and Surgical Reporter.

Insufficiency of the Internal Eegt'i Muscles. — In the
American Journal of the Mediccd /Sciences for April, 1883, Dr.
Theobald publishes a careful examination of the question a? to
what constitutes insufHcicncy of the internal recti muscles. IIo
believes that the ordinary tests are calculated to lead to erroneous
conclusions regarding the strength of the internal recti muscles;
and that to prevent this it is sure that the accommoJatiou is prop-
erly regulated, and to be careful that an incentive to binocular fixa-
tion does not arise through overlapping of portions of the vertically
separated images ; but, in addition, to recogniz3 the fact that rela-
tive divergence of the visual lines, even of considerable degrefj
occuiring in connection with vertical diplopia, and after these
several precautions have been taken, does not necessarily indicate
insufficiency of the internal recti muscles, or, at least, that it is not
incompatible with entire freedom from functional disorder.

Training Versus "Education." — It is hopeless to expect, re-
marks the Lancet, February 25th, that the mental and physical dis-
advantages accruing to our modern system of "education" will be
sensibly reduced until it begins to be recognized that education
should consist in the development of the faculties rather that the
mere acquisition of knowledge. It may appear a paradox, but it is
a simple and plain statement of fact, that a man may be well edu-
cated, and yet know little or nothing. The best intellectual organ-
ism is not that v^hich has been most heavily charged with informa-
tion, but that which possesses in the highest degree the faculty or
power of finding facts, and using them logically and with prompt
ability. A ready wit, in the true sense of the term, is incompara"
bly better than a loaded brain. Attention is frequently drawn to
this matter in our columns, and the lay press does us the honor to
quote and ampLfy our remarks on the subject, but little, if anything,
is gained by the ventilation of the idea, because it is opposed to th® '
spirit and feeling of the day. So much the worse for the prevailing

NOTES. 269

sentiment on the subject. Onr appeal must no.v lie to parents and
teachers. Miserable cases of meutal collapse are constantly falling
under notice in which the process of cramming has^ produced a
blighting effect on the brains of the young. Their physical health
has been sacrificed in the attempt to make them prodigies of learn-
ing. It would be more reasonable to remember that the brain is not
only as much part of the body as is the muscular system, but the
organ of the mind is so intimately connected with the centres of
vitality, that unless the whole body be full nourished the brain must
quickly lose its strength, and the mind power itself be exhausted in
the loss of general health. — Boston Medical and Surgical Journal.

Physiological Tests in" Criminal Cases.— In a recent arti-
cle we dealt with physiological tests, tracing their operation to
certain historical cases up to a recent date. "We now propose to
consider the present aspect of the question, and the application of
such tests in the recent cause celebre of Lamson.

In the analysis of the viscera, urine, and vomit of Percey John,
the scientific experts, Drs. Stephenson and Dupre, having discovered
the presence of aconitine in certain quinine powders and pills,
which might possibly have been connected with the death of the
unfortunate youth, had this task before them — to discover whether
any active vegetable substance, notably an alkaloid, and abo\e all
aconitine, was present in the viscera, etc., of the deceased ; and
whether that active substance, if present, was mixed with quinine
or other medicament. They did obtain an alkaloid — or, at all
event?, a substance reacting as an alkaloid — from all the articles
clearly connected with the body of the boy ; but the quantities of
the substances thus extracted appear to have been exceedingly small;
so minute, indeed, that a further chemical analysis was, perhaps,
barely possible. The presence of quinine and certain other sub-
stances having been negatived, the experts were, perhaps, hardly
justified in wasting much material in applying chemical tests for
aconitine, seeing that the chemical tests for that alkaloid are by no
means definite and certain, and that chemists of repute are not
agreed as to their value. They, therefore, relied upon the physio-
logical tests— the test of taste as applied to themselves and others,
and the test of lethal effects produced upon small animals, viz. :

270 KOTES.

m

ice. The taste — under which term is inchuled the whole
effects resulting from the application to the tongue — of acon-
itine is so marked and special, that some persor.s are irclncd
to rely upoi this test alone as conclusive as to the presence of
the alkaloid, and io regard the further (est of application to
animals so as to result in their deat'i as superfluous. We believe,
however, tiiat the experts werj right. In < ur opinijn, the
lives and suffering of a few m'ce were not for one moment
to be weighed a^a'nst the issue at task ; the life of a fellow-creature;
not to sjieak of oiher issues. Further, it is known to those having
fpejial knowledge of aconilinc that the commercial article, even
that sold as pure English aconitino, made by I\[ors n and other
makers of reputation, is not a pure article in the sense that it con-
tains one active substance oisly. It iji, doubtless, a mixture of al-
kaloids, repre:enting in the aggregate all the potent active substance
of monksliood. Of this, we have as.uied ourselves by actual ex-
periment. It is a well known fact to pluumac utists that the
crystallized specimens of the alkaloid, when tested in the ordinary
manner by making liicni in'o ointment, and applying this to the
skin, do not, as a rule, produce so much local linglingas amorphous
specimens ; and hence an amorphous alkaloid is most in demand in
this country for therapeutical purposes. The chrystallized speci-
mens of aconitine are, nevertheless, most deadly in their effects
upon animuls ; and hence lethal effect and benumbing effect do not
always go hand in htnd. Had, then, the experts in the Lamson
case rested satisfied with testing the effects of the alkaloid which
Ifhey obtained upon themselves, and not experimented upon animal;
also, their conclutions would have been less convincing than they
actually were.

The scientific evidence in the Lamson case exhibited a decirled
advance on that offered in previous cases where physiological tests
were employed. In neither the Palmer case, nor in th.e case of
Pritchard's mother-in law, was the vegetable alkaloid which caused
death de'ected in the deceased person ; whereas, in the Lamson
case, aconitine was detected in the viscera, in the vomit, and in the
urine. Its detection in this last fluid was all-important ; and Dr.
Stevenson, in giving his evidence, rightly laid stress upon its pres-
ence there, as proving not only that aconitine had been adminis^

NEW LICENTIATES OF TDE BOARD OF EXAMINERS. 2T1

tered, but that it had b?en absorbed ; an 3, further, that a portion
of it liad been again exc cted. In fu'.ure cases, we may expect the
anal\-ais of the urine to form an important factor. Its examination
after death in cases of snspzcted poisoning lias hitherto been too
often neglec'ed. We understand that both Dr. Stevenson and Dr.
Dupie^ have, in ihe'r hospital lectures on toxicology, been accus-
tomed to lay stress upon urinary analyses.

We apprehend that, in the future, i)hysiological experiments
upon animals will play an imp'rtant ]iart in toxicologic tl exami-
nations f r the detection of pjisons. Where such substances as"'
digitalis and aconitine are to be sought f'>r — bodies possessing no
clearly defined and unmistakable refic ions, and the riiictions of
which are destitute of the extreme del c.cy which characterizes
the color test for strychnine, are to be lo"ked for — physiological
experiments are indispensable ; and were the profession to be de-
prived, by the efforts of anti-viviscctors. of thij method of i;ive*-
t'ga ion, the public safety would undoubtedly be put in jeopardy,
and the detection of some of the most sub le and potent poisons
Wuuld be rendered impossible. This is a dang.r which ought to be
kept clearly in view in any changes which may be made in the law
relating to vivisection. — Briti^li Medical Journal.

NEW LICENTIATES OF THE BOARD OF EXAMINERS.

At the late meeting of the Bjard of Melical Examiners, in Con-
cord there were twenty-four ajipiicants f r the liccns3 of the Board.
Of this number five were roj.cted.

Upon the whole, the standing of the successful candidates as
compared with previous years Ehowed a decided improvement, al-
though there was a very marked difference in the standing of these
as compared with each other.

It is safe to say that the influence of the B aid of Examiners is
developing yearly, and if its reflexive influence on the Medical Cvl-
Icges is not good, it will not be for a lack of onscientions work on
the part of the Board.

MINUTES

— OF THE —

TWENTY-NINTH ANNUAL MEETING

— OF THE —

Medical Society of North Carolina.

first day — morning session.

Concord, N. C, May 9LIi, 1882.

The MoJical Soc'.ety of the Sttte of North Carolina assembled
at the Court House in Coucorc], N. C, at 10 A. M., Tuesday, May
9th, 1882. The President, Dr. Th:)mas F. Wood, called the meet-
ing to order.

Prayer was offered by the Eev. W. S. Creecy, of Concord.

The address of welcome was made by Mr. Richard C. Puryear, of
Concord, as follows :
Mr. Frcsidenf and Gentlemen of the Medical Society :

Representing its citizens, I, on this occasion, extend to you the
welcoaie and hospitalities of our town. Knowing, as we well do,
how, thr.-ugh centuries of patient, toilsome and ofttimes most self-
sacrificing labor, you have, tliroughout the world's civilization dC'
veloped and elevated one of the grandest, if not the grandest of all
sciences. I, in the name of m} townsmen, in the name of science,
in the name of moral culture, and in the name of humanity, extend
to you, not only a most cordial welcome into our midst, but also a
God'speod in the continued prosecution of those labors, the results
of which are the physical and nigral elevation of one common hu-
manity.

COMMITTEE ON CREDENTIALS.

The Committee on Credentials were appointed as follows : Dr.
Eugene Grissom, Dr. J. L. Henderson, Dr. J. II. Tuckcn

TRANSACTIONS MEDICAL SOCIETY OF NORTH CAROLINA. 273

The Secretary called the roll, ar.d the following gentlemen an-
swered to their names :

Dr. N. J. Pittman, Tarborongh ; Dr. 11. W. Faison, Faison ; Dr.
A. Holmes, Clinton ; Dr. F. M. Henderson, Concord ; Dr. P. E.
Hines, Ealeigh ; Dr. M. Whitehead, Salisbury; Dr. Eugene Gris-
som, Raleigh ; Dr. Charles J. O'Hagan, Greenville ; Dr. J. W.
Jones, Wake Forest ; Dr. W. W. Gaither, Charlotte; Dr. Thomas
F. Wood, Wilmington ; Dr. P. A. Barrier, Mt. Pleasant ; Dr. G. G.
Smith, Concord; Dr. J. R. McCorkle, Mooresville ; Dr. H. T.
Bahnson, Salem ; Dr. W. T. Ennet% Burgaw ; Dr. G. Gillett
Thomas, Wilmington ; Dr. A. G. Carr, Durham ; Dr. J. M. Had-
ley, La Grange ; Dr. Joseph Graham, Charlotte ; Dr. J. L. Hender-
son, Mt. Pleasant; Dr. John Fink, Concoid : Dr. W. H. Lilly,
Concord ; Dr. T. D. Haigh, Fayetteville ; Dr. W. C. Murphy,
South Washington ; Dr. Geo. W. Long, Graham ; Dr. R. H. Lewis,
Raleigh; Dr. Geo. W. Graham, Charlotte; Dr. J. D. Roberts,
Goldsborough ; Dr. W. R Wilson, Townesville ; Dr. H. M. Alford,
Grcensborough ; Dr. A. M. Lee, Clinton ; Dr. J. H. Tucker, Hen-
derson ; Dr. Paul B. Barringer, Charlotte ; Dr. L Wellington
Faison, Fulton ; Dr. A. W. Knox, Raleigh ; Dr. Charles M. Glenn,
Greensborcugh ; Dr. L. M. Powers, Plymouth ; Dr. J. L. Nichol-
son, Richlands ; Dr. M. Pool, Salisbury ; Dr. R. A. Hauser, Beth-
lehem ; Dr. J. W. Moose, Mt. Pleaiant ; Dr. J. A. Reagan, Wea-
verville ; Dr. J. Anderson, Callahan ; Dr. E. Crowell, Lincolnton ;
Dr. T. A. Crowell, ]\Ionroe ; Dr R. L. Payne, Jr., Lexington ; Dr.
Theo. F. Meisenheimer, Big Lxk ; Dr. T. F. Pharr, Concord ; Dr.
W. L. Reagan, Ivy ; Dr. H. B. Weaver, Weaver ville.

The Chairman of the Committee on Credentials announced that
any gentlemen present desiring to join the Society would report at
once to the Committee.

The President announced the following

COMMITTEE ON FINANCE.

Dr. G. G. Thomas, Wilmington ; Dr. J. D. Roberts, Goldsbo-
rough ; Dr. J. A. Reagan, Weaverville.

RESTORATION OF THE NAME OF AN HONORARY MEMBER.

Dr. Grissom called the attention of the Society to the fact that
the name of Dr. J. D. Bellamy, of Wilmington, an HoiioraTy,

274 TRANSACTIONS MEDICAL SOCIETY OF NORTH CAROLINA.

lias by some error been omitted from the published list. lie moved
that it be restored which was unanimously agreed to.

CORRESPONDENCE FROM THE NEW HANOVER COUNTY MEDICAL

ASSOCIATION.

Dr. G. G Thomas, of AVilmington, presented the following, cor-
respondence from the New Hanover County Medical Association :

Wilmington, N. C , April SGth, 18S2.
To the Medical Society of the State of North Carolina :

Ilavingbeen appointed a Committe for the purpose, at a meeting
of the Xew Hanover County Medical Association held on the 25'.h
inst., of directing your attention to an innovation in ethic.il law
recently enacted by the Med'cal Society of the State of New York;
and we i'.voke such action on your part as will lead to its rtpu lia-
tion by the American Med'cil Assf^ciation.

The article to which reference is made is as follows :

*' Members of the Medical Society of the State of Xew York and
of the med'cal soc'eties in aflRliat'on therewith may meet in con-
sultation legally qualified practitioners of medicine. Emergencies
may occur in which all restrictions should, io the judgment of the
practitioner, yield to the demands of humanity."

In the State of New York any person having a diploma, by ihe
mere act of registration, becomes a legally "qualified practitioner."
There is thus let loose upon its citizens a class of men whose tenets
are opposed to those of regular medicine, consultation with whom
is interdicted by the Code of Ethics of the American Medical Asso-
ciation.

In consequence of the coaiparatively few legally qualified medical
men and the'paucity of irregular pr ctitioners, the first clause is,
except in one or two localities, practically in ijiplicable to North
Carolina. It is the principle involved whch we would have yon
scrutinize and condemn.

The rule enunciated by the American Medical Association, Art.
IV, Sec. 1 appears to us to be founded up3n correct leasoning. It
is as inconceivable that a regular practitioner and one of an exciu-
6ive school should concur upon a plan of treatment for an invalid,
as a Christian and Voudoo priest should arrange conjo'ntly a course
of devotional exercises. Their belief is dissimilar. Should .they

TRANSACTIONS MEDICAL SOCIETY OF NORTH CAROLINA. 575

cigrcc, one necessarily becomes a convert to the opinions of the
other and being thus devotees at the same shrine they may and
ought to fraternize. If, however, while adhering to their respec-
tive doctrine, they should make a pretence of fraternization they
would be guilty of (term it which you please,) diss'mulation— -bad
morals — unethical conduct

The second clause appoars more objectionable, if possible, than
the lust, since consultatiTo is made mandatory rather than optional
in certain con'ingencics. The as.-umption upon which the precept
is founded is that an cmergjncy may demand a sacrifice of truth.
The premise being fahe the argument fails. If the premise were
true it would not, in our opinion, apply for the reason that we can-
not conceive an emergency where it would bo impracticable to as-
sume the position that we are willing to render professional assis-
tance when required, but that we cannot do violence to our moral
sense by assuming to consult with persDn?, to agree wi'.h whom, is
to imperil, or, rather, to sacrifice our principles.

Hoping that we have succeeded in impressing upon you the im-
portance of arresting this heresy in its incipiency and that your de-
liberation?, in their manifold capacity, maybe characterized by jus-
tice, moderation and a love ol truth, we beg leave to subscribe
ours.l es. Very respectfully,

Wm. J. Love, 1

Geo. Gillett Thomas, ^

F. AV. Putter, ' Komm.ttee.

^\. W. Lane, J

It was moved by Dr. J. A. Reagan that the report of the Xew

Hanover Medical Association be referred to |a committee of three.

Carried.

The following Committee was appointed : Dr. W. 11. Wilson,

Dr. J. L. Nicholson, Dr. T. D. ILvgh.

report of the committee on the correspondence of the
neav hanover couxty medicvl assocration on medical

ETHICS.

Your coriiiuittce to v\hom was referred tlij communication from
the New Hanover County Medical Association ia regard to the re-
ce..t action of the Xew York Medical Society respectfully offer the
following resclution :

276 TRANSACTIONS MEDICAL SOCIETY OF NOIITII CAROLINA.

Jlesolved, We hereby rciiffirm our strict aflherence to the Code of
Ethics of the National Medical Association and rtquest our dele-
gates to its next meeting to further all efforts that may b3 made i n
that Association to compel its members to a strict adherence to the
mandates of our Code of Ethics.

CORRESPONDENCE OF SECRETARY.

Letters were received from the following gentlemen regretting
their inability to be present :

Vice-President, Dr. D. J. Cain, Df. 8. S. Sitchwell, Dr. R. L.
Payne, Dr. Duncan M. Patterson, Dr. Frank Duffy, Dr. Charles
Duffy.

A complimentary invitation from the citizens of Concord to be
present at an entertainment on Thursday night was accepted.

PARTIAL REPORT OF THE COMMITTEE ON CREDENTIALS.

The Committee^on Credentials present this partial report, and
beg leave to^recommend for memb3rship in this Society the follow-
ing gentlemen :

Dr. R. 11. Morrison, Jr., Shelby.
" P. A. Barrier, Mt. Pleasant.
" C. W. Woollen, Randleman, Randolph County.
" W. A. Woollen, Randleman, Randolph County.
" Robert S.'Young, Matthews, Mecklenburg County.

Eugene Grissom,
J. L. Henderson, \ Committee.
J. H. Tucker,

Adjourned to meet at 2^ o'clock.

afternoon SESSION-^FIRST DAY.

The Society w'as called to order promptly at 2^ o'clock.

REPORT OF THE COMMITTEE ON FINANCE.

Your Committee on Finance beg leave to report that they have
carefully examined the books of the Treasurer and find his account
correct. They would suggest, however, that he s'lall file with his
annual statement of the financial condition of the Society all of his

TUANSACTIONS MEDICAL SOCIETY 03. NORTH CAROLINA. 277

vouchers and evidences of credit, to avoid, what their absences might
cause, troublesome delay.

To amount on hand June 2d $474 85

To amount mailed by members 145 00

Total 1619 85

By amounts paid for Transactious, postage and mailing,
Secretary's fees and Treasurer's fees Incidentals, and
Society stamps $474 85

Leaving balance in Treasury $145 00

Your Committee respectfully urge that all members whose
arrearages have exceeded three years dues shall be notified by the
Treasurer, and if they fail to respond in 30 days, that they shall
cease to be members of this Society, and their names be erased from
the Revised Roll.

We recommend that the fees of the Treasurer and Secretary be

raspectively $50 00 and 1100 00 as formerly, and that the per

capita lax be $3 00.

Geo. Gillett Thomas, )

J. A. Reagan, V Committee.

J. D. Roberts, )

REPORTS OF chairmen OF SECTIONS.

Report of the Chairman of Section on Pathology and Microscopy
— The Chairman of this Section, Dr. H. W. Lilly, of Fayetteville,
being absent, it was read by the Secretary, Dr. Picot.

On motion of Dr. Holmes the report was referred to the Com-
mittee on Publication. «

SECTION ON OBSTETRICS AND GYNECOLOGY.

Dr. A. W. Knox, of Raleigh, Chairman of the Section on Ob-
stetrics and Gynecology read his report. It was referred to the
Committee on Publication.

Dr. Grissom said he was very much instructed by Dr. Knox's ex-
haustive paper, but more particularly was he interested in the report
of the case of recovery from insanity, after ovariotomy. lie would
like to enquire of Dr. K*?ox if the operation was directed espe-
cially to (he cure of insanity. It was a matter of great moment to

278 TRANSACTIONS MEDICAL SOCIETY OF NORTH CAROLINA.

collect and compare and anal3Z3 all cases of ovariotomy, oophorec-
tomy, &c., fur the radical relief of diseases of the mind.

Dr. Knox replied from memory that he believed that the ovariot-
omy was not nndertaken for the relief of insanity; but that the
ovariotomy being necessary, was resorted to, and with the recovery
of the pa'ient from the operation, htr reason was restored.

REPORT OF THE CHAIRMAN OF THE SECTION ON THERAPEUTICS
AND MATERIA MEDICA.

Dr. George G. '\ homas, of Wilmir gton. Chairman of the Section
on Materia Medica made his report.

Dr. Iluigh icmaikcd upon the n.erils of this report, the amount
of discriminating re?earch exhibited in it, and moved that it be re-
ferred to the Committee on Publication. Carried.

The President announced that the annual addriss by Dr. A. W.
Knox would be delivered in the Court House lo-monow, Wedi.esdciy
night, at 8-j o'clock, and the citizens of Concord were cordially in-
vited to attend.

He also announced that the conjoint session of the North Caro-
lina Board of Health with the Society would take place on Wednes
day morning immediately after the disposal of the usual order of
the day, and that the annual essay by Dr. W. P. Beall, of Greens-
borough, being upon State Medicine, would be set apart for an early
hour of the session.

• SECOND DAY — MORNING SESSION.

May lOih, 1882.

The Society was called to oi'der by llie Piesidcnt, Dr. Wood, at
0| o'clock.

Dr. Knox moved that Dr. Charles W. Dubney, Jr., be invited to
a scat during the sessions of the Society. Dr. Dabney is the Chem-
ist of the State of Agricultural Department, and had not only
served our auxiliaiy, the North Cnrolijia Board of Health in his
official capacity, but had shown indiviijual interest in the work in
which we are engaged.

TRANSACTIONS 3IEDICAL SOCIETY OF NORTH CAROLINA. 279

The motion curried, i^.d Dr. Dabney was invited to a scat in the
Society

Dr Dabney remarked in substance :

Gentlemen : — I thaiik you for your kind and com|tlimcntaty in-
vitation to take part in your procccdinj^s. While I am uot a Doc-
tor of Medicine, and my duties are confintd entirely to Chemistry,
an aux I'ary branch of medical science, yet I feel an abiding inter-
est in the great work you arc doing in North Carolina.

Although chemistry and mcd;cino,are now unfortunately too much
separated for the praclical good of the ])rvfession of medicine, yet
there is really a strong bond of union whicli wo might make mu-
tually advantageous.

PAUTFAL KEPOliT OF COMMITTEE ON CKEDENTIALS.

Tlirough the Charrnan of Committee on Credmtials, the follow-
ing gentlemen are recommended for membership, having success-
ful'y passid their examination be'ore the Board of JMedical Exam-
iners :

Dr. J. R. Irwin, Alexandriana, Mecklenburg County.
" J. H. McBrayer.
'* Robert S. Young.
" M. C. Hunter.

*' A. R. "Wilson, Grcensborough, Guilford County.
" Kemp P. Battle Jr., Chapel Uill, Orange County.
" Geo. S. Lloyd, Tarborough, Edgecombe County.
" Jolm B. Gunler, Durham, Durham ConiUy.
" C. F. Anderson.

" J. T. Strickland, Bliss, Surry County.
Respectfully submitted,

Eugene Grissom, ]

John L. llEND&iisoN, [■ Committee.

J. H. Tucker, )

Dr. W. T. Ennett, of Burgaw, called the attention of the So-
ciety to the violation of the Code of Ethics by Dr. A. D, Lindsa}',
of Kernersville, in that the said Dr. Lindsay had put forth a hand
bill advertising a medicinal preparation. He believed that the let-
ter and spirit of the law had been violated by Dr. Lindsay, and
moved that the whole matter be referred to th3 Board of Censors.

Dr. G. G. Smith seconded the motion.

280 TRANSACTIONS MEDICAL SOCIETY OF NORTH CAROLINA.

Dr. Whitehead said that the propor course would have been for
this matter to have been brought to the attention of the Board of
Censors but not in open meeting, in order to avoid taking up the
time of the Society in the discussion which usually ensued.

Dr. O'llagan member of the Board of Censors faiJ : Tlie proper
course of action in such violations of the Code, was for the auxili-
ary Scciety of the County in which the person resides, to take cog-
n'zauce of it ar.d report to the Society their action. If they could
not agree upon a verdict, or if the accused saw fit to appeal, then
it would be in order for th.- case to come before the Board of Cen-
sors. He thought that there was alack of firmness, generally, upon
the part of county societies in dealing with offenders, but it was
very obvious that both the Society and the accused could act more
justly by fully investigating these cases in the vicinity where the
the accused lived. As no member of Forsyth County Association
was present, he moved that the whole matter be laid on the table,
and he would claim the privilege of calling it up at the afternoon
session, and in the meantime he would make further investigation.

Dr. J. P. Beall, regular Essayist, read an instructive and earnest
paper on the subject of rreventive Medicine.

The paper of Dr. Beall was ref;r;ed to the Committee on Publi-
cation.

CONJOINT SESSION OF THE SOCIETY AND THE NORTH CAROLINA
BOARD OF HEALTH.

Tlie hour (IH o'clock A. M.) having arrived, the President of
the Society called on Dr. M. Whitehead, of Salisbury, the Presi-
dent of the Board of Health, to preside over the meeting.

Dr. Whitehead explained that it was the custom of the Society
to hold these conjoint sessions, in order that the work of this aux-
iliary body m'ght be properly brought before the members present.
It was important that all should bo acquainted not only with the
w^rk already done, bu^ what was proposed to be done, tbat this
st^'uggling auxiliary of the Sjciely should receive a proper support.

The Essay of Dr. Beall was a very excellent introduction to this

session, and he would now ask the attention of the Society to the

yearly report of the Secretary of the Board, Dr. Thomas F. W^ood.

■ The annual report of the Secretary was read, and referred to the

Committee on Publication.

TRANSACTIONS MEDICAL SOCIETY OF NORTH CAROLINA. 281

The Secretary explained tliat by a resolution of Dr. W. W.
Gaither at the Asheville meeting, in 1881, the duty of appointing
a committee from every county in the State to canvass in the inter-
est of prospective legislation for the Board of Health, devolved on
him in his double capacity of President of the Society and Secre-
tary of Board of Health. He learned though, that the extra ses-
sion of the Legislature, in March, 1882, which was contemplated
by the Governor, was not concurred in by his council, and there-
fore the appointments were delayed until this meeting.

He furthermore desired to announce that if any gentleman re-
ceiving his appointment as Committeemen would not be able to
undertake the work in earnest, that he would signify this fact, and
that a successor could be appointed without delay.

The following is the list of

COMMITTEEMEN TO ACT AS CANVASSERS IN THE INTEREST OF FUTURE
LEGISLATION FOR THE NORTH CAROLINA BOARD OF HEALTH.

Alamance Dr. Geo. W. Long.

Alexander

Alleghany Dr. John L. Smitli.

Anson " Simpson Jones.

Ashe " James Wagg.

Beanfort " John McDonald.

Bertie

Bladen Dr. Jas. S. Eobinsou.

Brunswick " W. G. Curtis

Buncombe " W. L. Milliard.

Burke

Cabarrus Dr. W. H. Lilly.

Caldwell

Camden Dr. J. H. Pool.

Carteret.. " Manney.

Caswell

Catawba Dr. George H. West.

Chatham " L. A. Hanks.

Cherokee " Patten.

Chowan " R. H. Winborne.

Clay.... " Killyan.

Cleveland , " J. C. Gidney.

Columbus ..".!......;... " M. R. Morrison.

Craven .................■.■;.■.■.. " Frank Duflfy.

Cumberland " T. D. Haigh.

282 TRANSACTIONS MEDICAL SOCIETY OF NORTH CAROLINA.

Currituck

Dare

Davidson Dr. U. L. Payne.

Davie

Duplin Dr. L. Hussy.

Edgecombe '. " L. L. Staton.

Forsyth " H. T. Bahnson,

Franklin " E. S. Foster.

Gaston " E. B. Holland.

Gates

Graham

Granville Dr. W. R. Wilson.

Greene " W. C. Galloway,

Guilford " W. P. Beall.

Halifax " Isaac E. Greene.

Harnett

Haywood Dr. G. D. S. Allen.

Henderson " J. L. Edgerton.

Hertford " R. P. Thomas.

Hyde

Iredell Dr. Thos. E. Anderson.

Jackson " J. M. Cliandler.

Johnston " R. J. Noble.

Jones

Lenoir Dr. Henry Tull.

Lincoln " J. M. Lawing.

Macon " S. H. Lyle.

Madison " W. L. Reagan.

Martin " T. 8. Burbank.

McDowell

Mecklenburg Dr. J. Graham.

Mitchell

Montgomery Dr. W. A. Simmons.

Moore " A. V. Budd.

Nash " David N. Sills.

New Hanover " J. C. Walker.

Northampton :.. " V. S. McNider.

Onslow '' J- L- Nicholson.

Orange " T. B. Harriss.

Pamlico ..h

Pasquotank Dr. Wood.

Pender " W. T. Ennett.

Perquimans

Person Dr. li- B. Baynes.

TRANSACTIONS MEDICAL SOCIETY OF NORTH CAROLINA. 583

Pitt " C. J. O'Hagan.

Polk

Randolph ,

Richmond Dr. J. M. Covington.

Robeson " R. F. Lewis.

Rockingham

Rowan Dr. J. J. Summerell.

Rutherford .-.

Sampson Dr. A. Holmes.

Stanly " T. F. Meisenheimer.

Stokes " M. D. Phillips.

Surry

Transylvania Dr. ('. W. Hunt.

Tyrrell

Union Dr. Isaac H. Blair.

Wake " R. H. Lewis.

Warren " Geo. A. Foote.

Washington " L. M. Powers.

Watauga " W. B. Council.

Wayne " J. D. Roberts.

Wilkes

Wilson : Dr. John K. Ruffin.

Yadkin " L. G. Hunt.

Yancej^

No other business appearing before the Conjoint Session it was
adjourned sine die, and the regular session of the Society resumed.

Ecspondiug to the call by the President for voluntary papers.
Dr. E L. Payne, Jr., of Lexington, read one entitled " The
Cause of Organic Stricture, with Some Suggestions for Treatment."

Dr Pittman, of Tarborough, made remarks on the value of slip-
pery elm bougies for the dilatation of stricture. These were easily
made, and should be nicely finished. After soaking them a shore
time in water, they were ready for use.

Dr. A (I Carr, of Durham, in referring to the statement by Dr.
Payne ih it he was not prepared to write about the electrolytic treat-
ment of s'ricture, said that he had become quite interested'on this
point, and that he enquired of Dr. E. L Keycs, of New York citv,
as to his experience. He was informed, thatjhe (Dr. K.) had em-
l)loyed i*-, an 1 he at (irst thought it was successful, but he afterwards
abandoned it, as on'y alfording temporary relief, the striclurc
always returning.

284 TRAISFSICTIOXS MEDICAL SOCIETY OF NORTH CAROLINA.

By the President : It is not proper that sucli a contribution to
the surgery of stricture shoiiM be received without a word of com-
mendation from the Society. There were few more importatit sub-
jects which engage us practically thun the Surgery of Stricture, and
Dr. Payne's view are charac'.erized by an intelligent conservatism.

The mass of information which had nccumulated ujion the sub-
ject of stricture in the last ten years, was niore important khan of
several decades preceding. But in this country the current of sur-
gical opinion seemed (o be dominated by one and the other teaclicr
successively, an indication that the whole practice of urethral sur-
gery was in a stage of transformation.

Prof. Otis, of New York, had made valuable C)ntr.bu 'ions to the
literature, as well as to the science and art of tlie surgery of stric-
ture, and has succeeded in impressing the American profe.-sion with
h's views to a very considerable extent ; but after all it is question-
able whether he has done more for the surgery of stricture, by his
teachings, than for lithotrjty. It was" his demonstrations of the
diUtability of the urethra that paved the way for Bgelow'd rapid
lithotrity, and if no other good result is effected, this alone would
entitle him to a conspicu us place in this department of surg ry.

But the medical profession yet remained to bo convinced upon
the relative merits of urethrotomy and forcible and gradual dihita-
tion, as these methods are still undergoing trial. As poin'ed out
in Dr. Payne's paper, all of these methods have in certain cases,
their proper place, but do what we wlU, most strictures of small
cilibre will i-equire dilatation during a very long period, if not for
a life time. x\ll treatment has its dc'cctj, as is evidenced by the
nunierous relapses. It is evident, though that adiscriminating and
judicious selection of some one of the methods now in vogue is
capable of producing more satisfactory results, than by the old plan
of gradual dilatation by means of gum bougies.

Tne recurrence of the gleety discharge in paticts who have been
operated upon, and which causes so much anxiety to the patient
and disappointment to the doctor, is many times the losult of the
very operative procedures we adopt. For instance, we divulse or
cut throug'i a stricture and dilate u|) to the maximum
calibre of the urethra as indicated by the measurement estab
lisbcd by Otis. Ti:c patient is instructed to use a sound at stated

TKANSACTIOXS MEDICAL SOCIETY: 01 NORTH CAROLINA. 285

intervals. Now most persons suffering with stilctir.e 1 ave a morbid
anxiety as to the possibility of maintaining the proper calibre, and
also Hs to every discharge which may show itself. Ilis attention
is constantly drawn to the urethra, and in h's anxiety he resorts to
the sounJ as the source of relief. For, adopting the current doc-
trine that a glce'y discharge is the index of a stricture, he resorts to
the sound to overcome it. He repeatedly passes the largest sound
he has been instructed to use, and so irritating the prostate by thosj
frequent stretchings, he brings on a prostatic discharge, which is
set down as the discharge of gleet. Tiiis is t:ot an exaggerated state-
ment and has occurred many times under my observation.

Dr. Payne has dwelt instructively on one of the methods of dila-
tation which has met with great success in my hands. He asso-
ciates the name of Dr. Brinton with the method of gradually
dilating tight and tortuous strictures, by means of filiform bougies.
However, priority is an ever recurring question and has no practical
bearing. The method is lucidly described by Mr. Reginald Harri-
son, of Liverpool, Eng , [Lectures on Surgical Disorders of the
Urinary Organs, p. 70, 2d Ed.) from whose book I first learned it.
It consists in passing filiform bougies (usually made of whale-bone)
into the urethra. If it is remembered that strictures are some-
times eccentric with the opening, not in the axis of the urethra, the
advantage of a fine and flexible instrument as an explorer and a
guide, is at once appreciated. If the first bougie does not pass
readily, it should b3 slightly bent to meet the emergency. The in-
strument makers pi'epare for us whalebone bougies twisted in various
ways,— jpiral, and at various angles, on one end, and straight on
the reverse end. Theso are to be introduced in a rotary motion, or,
as iMr. Harrison says, by " twizzling" them between the finger and
thumb. Should the first one not pass, but stick in a lacuna or make
a false passage, let it alone, and continue attempts at introduction,
until finally all the false passage being closed there isbut one direc-
tion for the bougie to take, and that directly through the only re-
maining opening. Now, after the bDugie is cleverly engaged in the
urethra all the others may be withdrawn, and this used as a guide
whereby to enter the stricture with a dilator, or urethrotome. This
whole subject though, has been so fairly treated by Dr. Payne that
I must a^k your pard:)!i for saying so much about it. After sur^

286 TRANSACTIONS MEDICAL SOCIETY OF NORTH CAROLINA.

veying the whole scope of urethral surgery, it seems to me that we
owe more to the conservative practitioners who are open to convic-
tion as to the gooJ in all metkod?, rather than to the original man,
whose horizon is shut in by the exclusion of all methods but his own.

It may be remarked, in conclusion, though, that the physician,
who, in general practice, attains to a degree of success in the use of
one particular set of instruments, whether it be by divulsion or ure-
throtomy, would be safer in cultivating the particular instrument in
the field of his successes, rather than doing only half-way, the
several methods about which he has no serious conviction.

Assuggested by Dr. F. E. Daniel in the Mississippi Transactions,
the busy country practitioner will fir.d the employment of fiddle-
strings an admirable substitute for whalebone sounds, in an emer-
gency. It is only necessary to round off the ends of the cat gut in
the flame of a lamj), and rub off the charred end.

Another admirable assistance to the physician in the dilatation of
stricture is the cmi)loyment of a full head of urine, A stricture
patient of mine recently, complained for some days after the weekly
use of a No. 14 sound, found that he had an uncomfortable dis-
charge. Oce night while taking his weekly hot bath, preparatory
to dilatation he found that his sound was not at hand. His blad-
der was very full, and the hot water relaxed the parts so that he
could with difficulty retain his water. He resisted though, and
finally when he could no longer resist, he found that the force of
the urine dilated his urethra as satisfactorily and more pleasantly
than by the sound, as it was not followed by discharge. He has
since used only this method. It' is a rational way, at least, and if
as declared by Sir Henry Thompson that the urethra is a valve hav-
ing its open end at the ves!co-ureihral end, then dilatation from the
natural direction would be fr.m behind forwards, as in the hydrost-
ii'ic method. There is nothing new in all this, nor is it devoid of
danger in some cases, but it is well to consider all the means at our
command in those emergencies which must occur to phys'cians
practicing in the country.

Dr. Pittman moved the reference of Dr. Payno'd paper to the
Committee on Publication. Carried^

TRANSACTIONS MEDICAL SOCIETY OF NORTH CAROLINA. 287
CONGENITAL ABSEN'CE OF THE EXTERNAL AUDITORY CANAL.

Dr. I\. F. Lewis presented a nrgro boy for the examination of
the Society, pointirg out the congenital absence of the external
auditory canal, and of the lobes of thecal".

Adjourned to meet at 2^ o'clock.

SECOND DAY — AFTERNOON SESSION.

Society called to order at 2| o'clocP. D . Thomas F. Wood, the
PrCfi lent, in the chair.

The call for voUintaiy papers was responded to by Dr. Pitot, the
Secretary, who read a report by Dr. E. II. Lewis, of Lumberton,
of a "Case of Forcible Separati n of the Right Arm from the
Body."

Dr. Giitlur could not agree with the reporter, that there was no
siiock. lie d d not think it possible to escape it after such a;i irjurv.

Refei'rcd to the Committee on Publication.

Dr. W. W. Gaither read a report of some miscellaneous cases
occurring in his practice, which was referred as above.

RESIGNATION.

Dr. McL. Graham oS'eral his resignation wh'ch was accepted.
The President announced the following committees :

COMMITTEE ON NOMINATIONS.

Drs. J. W. Jones, Wake Forest ; AV. II. Lilly, Concord ; P. F.
llines, Raleigh ; II. W. Faison, Faison ; Geo. Gillett Thomas, Wil-
mington.

COMMITTEE ON ESSAYIST.

Drs. W. p. Beall, Greensbor> ugh ; I. Wellington Faison, Fulton;
J. M. Iladley, Li Grange.

TYPHOID FEVER.

Dr. Charles J. O'llagan introduced for discussion the subject of
"Typho'd P'ever, as Regards its E iology and Treatment."

288 TRANSACnOXS MEDICAL SOCIETY OF XORTII CAROLINA.

He said in substance. In P. it and the adjoining counties in
1879 there \va% absolute f.eedom from malarial fever. In the en-
tire valley of the Tar Ivi\cr there was less malarial fever .han in the
Valley of the Connecticut, if ho couU judge by the report of the
Secretary of the Board of Health of that State. The following
Spring we bad an epidtmic of Injluenza, and from July to the
'*^)resent time, typhoid or typho-malarial fever has existed up to the
present time. He would like very niucli to hear f i-orn the members
of the Sjciety, their views on the etiology a-.d treatment of ty[)hoid
fever. It seems to bo the current opinion of the profession that it
is probably due to the decomposition of animal matter. He c.^uld
not believe that this theory was entirely true for he hal known
cases to occur in localities where there was no visible agent of this
sort at woik, ai;d where there was good water and no sewage eflflu-
va. The theoi-y was not entirely satisfactory.

It is the belief of some that malarial influences are antagonistic
to tjphoid fe\er, but this is not so, for the disease frequently coexist
in the same Iccalitics side by side, and also seem to be mixed as in
the so-called typho-malarial fover. This latter teim he did not
like. It was making a new disease of a really well-known or.e,
common in all tide water malaiial regions.

The question of the communicability of typhoid fever was also
a very important one. Is it contagious in any degree, he would ask ?
There are various opinions en this subject ; and if we can deter-
mine i's communicability by infection orcontag'on, means of isola-
t'on should be adopted. He had seen tv})hoid g) through house-
holds and even entire setilements, but what the med a of the dis-
ease were he had not settled in his mind. He thought that it was
wise to prevent free communication of the well with the sick. To
attend carefully to the hygienic surrounding-:, as much for the sick
as for the well.

The diagno is nf typhoid is somewhat diflicuh in the early stages.
All the continued fevers have a certain resemblance in the begin-
ning. There v.as noth'ng new in the diagnosis, for the princ'ples
for lur guidai-iCe are well laid down. Nevertheles?, there arc a
large number of cases in which we see no lenticular abdomiiial
patch.e?, and still these cases present every other resemblance to
typhoid. In his observation the disease never roiches its crisis un-
til the tweLty-eighlh day.

TRAKSACTIOXS MEDICAL SOCIETY OF NOIITII CAROLINA. 280

As for the treatment, quinine fails to cut short the fever. Noth-
ing is so serviceable in the reduction of temperature as the use of
cold water. He employs water about the lenipcrature of wa'cr
freshly drawn from the well. It could be used by simple affusion,
but he preferred the use of Ihe wet pack. Tympany and diarrhoea
arc frequently trcublcsome. Opium was the thing to rel eve the
d'arrloGi. As to the diet the patient should be confined r'gidly to
a course of nourishing fluids.

He had intended to pr<:sent a paper on thissul jec', but had failed
to do so, his remuks now were rather to draw forth information
from the Society on the subject, than to offeranything new himself.
When we consider that dia!hs from typhoid ftver stand second or
third in importance in our nation;tl death-rate, it seemed to him
that the subject needed renewed study, in order to establish the
etiology, and also to determine, if possible the means of prevention.

Dr. A. G. Carr said in substance. The diagnosis of fevers in
general has always perplexed him, 0,ic teacher wdl eay that the
lenticubr rose-colorel spols are the only pathognomonic signs of
typhoid, while others thought that a failure to fin J these spots would
not necessarily exclude it from such a diagnosis, many caees goitg
through their course without any such signs. lie called those cases
typhoid only, that exhibited the vose-colorcd spots, and consequent-
ly he had seen very few genuine ones. Some authoi's teach that
the diurnil variation of the thermometer is a sufficient guide, but
he thought that if thermometry was to be a guide, it was to be de-
termined by our future knowledge on the subject, rather by what
wo at present know.

Dr. II. W. Faison believed that typhoid fever must Lave local
peculiarities. He was tempted to believe that typhoid fever in
North Carolina differed from the same disease in New York. So in
pneumonitis. In his sec ion of the State the malarial impression
is so strong that it failel to show that clear, classical outline given
in the text-books. He believed thit the thermometer was an accu-
rate means of diagnosis as well as of prognosis.

The treatment of the disease could not be la'd down in inflexible
rules. It was neces-ary day by day to meet the exigency of the day.
There was but one rule that was undeviating, and that was to see
that the patient is properly nourished. For this [uirp so nothing
excelled animal broths and milk.

290 TRAXSACTIOXS MliDICAL SOCIETY OF NORni CAROLINA.

Dr. J. D. Roberts, of Goldsboroiigh, thought ihut sufficient stress
had not been laid upon the cause of typhoid by the use of polluted
drinking water. He eitod a clear instance in which he had trca'cd
ty|)hoid fever in a household from using foul water froai a well.

Dr. O'llagan did not deny that the pollution of drinking wa'cr
was iio'ent to engender the disease, but he was of the opinion that
the detection of the particulate element has not yet be r, and may
be, ncvir would be accomplished. But he could speak more confi-
dently about the communicubility of the disease; he did not sco
how this point could be doubled.

Dr. J. W. Jones, of Tarb trough, said we can not be very posi-
tive how the disea33 origlna'e^ with our present knowledge. When
we sec much typhoid fever prevailing we see vei'y little malarial
fever. S )me light is thrown on the subjec' by our ability to euro
malarial fever with quinine, and our failure to accomplish anything
by it in typhoid. In the fever we call typho-malarial we have gas-
tric inflammation. The gastric symptoms are very prominent, but
ihero is no disrase of the intestinal glamls. One thing he had no-
ticed which he would mennon inc'dentally, that jiatients affected
with rheumatism are exempt from typhoid fever. How account for
the typhoi 1 fever ;n the mountains where the air and water arc
pure, and where there can possibly.be no sewage influences. We
are willing to accept the theory of sewage c ntamination for cities
but that drives us to the invention of some other cause operating
in the isjlated mountain farm house.

Dr. M. Whitehead, of Salisbury', hal seen the typhoid fever
ravage two or three counties, in an instancj in which he was able
to trace its very beginning. In eight months he bad seen 700 cases
of typhoid in a very severe form in the countici spoken of. Iledid
not believe the disease was contagious, but it was infectious.

lie objected to the term typlio-malarial fever. During the war,
Assistant-Surg.on Woodward gave this name to the fever that was
prevailing so extensively in the Chick diominy bottom. But it was
a misnomer, and a misleading one. lie believed that the fever di^
scribed by Dr. Woodward under this name, was the bilious adynamic
fever of Culleu, and the older writers. Typhoid fever was a spe-
cific disease characterized by rose-colored spots on the abdomen and
thorax, and by ulceration of the glands of Peyerand Brunner, and
nothincr else should <ret the name.

TRANSACTIONS MEDICAL SOCIETY OF NORTH CAROLINA. 391

Dr. F. M. Henderson, of Concord, had under his charge in the
First North Carolina Confederate Hospital, patients sick with camp
fever, or iypho-malarial fever. Post-mortem examinations revealed
disease of the glands of Peyerand Brunner.

Dr. Reagan, of Weaverville, had no theory to advance as to the
causation of typhoid fever. Of one thing he was certain the dis-
ease was contagious.

By the President: In closing this discussion he would remark
upon one or two points. The nomenclature of the fevers had at-
tracted the attention of writers for many years. No real refinement
of diagnosis commenced until Louis pointed out the patliological
differences between typhoid and typhus, and so established an ad-
vanced point in tiie whole system of nosology, in fact transferring
nosology from the domain of speculation. Now typhoid is almost
universally regarded as a specific fever, having a constant patho-
logical entity in the disease of the intestinal glands. Thus Dr.
George B. Wood calls it enteric fever, and Trousseau, dothinente-
ria, each term constructed to impress the predominant pathological
lesion. Still some other authors had not been so willing to accept
whole and entire this naming, because they found it more conve-
nient to comprehend all fevers whose characteristic feature is stupor
by a term signifing it. Thus, Dr. Thomas K. Chambers in his
Reneivalof Life, includes them all under the general designation of
" Typhoid Fever." But as long as there is so little precision in our
pathological studies, our nomenclature must be provisional. Now
it is not often that one sees a case of typhoid corresponding in all
of its features to the classical account of the text-books, and this
may be said of all diseases ; but there is a group of coarse but dis-
tinctive phenomena which serve to keep clearly in our minds the
general features. The term typho-malarial fever may not be any
better than tlie old term bilious-adynamic fever, but it expresses a
generally received idea and was intended to show that the continued
malarial fevers have a constant lesion of the intestinal glands. He
was inclined to think the line of demarcation ought to be made at
a different place. He believed that true enteric fever furnished im-
munity to the person attacked, against a subsequent attack, almost
as surely as small-pox protected against a second attack. On the
other hand the continued form of malarial fever afforded no such

922 TKANSACTIOXS MEDICAL SOCIETY OK NORTH CAROLINA.

immunity. It was convenient to use the prefix iypho to indicate the
stupor attendant upon the disease, even if the intestinal lesion was
constant. If typho-malarial was to be applied to all the fevers
commencing as sharp remittent?, and subsiding in a continued form,
tlien the term was inacurate. But tliere is without doubt a typhoid
fever, having distinct marked malaiial features and there is an ady-
namic bilious fever, which has no specific protective power, and for
this we can reserve the name adynatnic-malarial fever.

Of the cause of tvphoid fever there was no uniformity of opinion.
Teachers in the large cities think they see a causa'ive element in
sewage and the faecal dejeciions of tvphoid patients, while physi-
cians in the country find it hard to rccept this idea. In our East-
ern counties we have a typhoid fever rarely agreeing with the class-
ical description, and not recognizrd as contagious. This fever is
the acclimating fever of the German population in Wilmington.
It is not considered conttigious, and there is no dilTiculty in getting
nurses for patients attacked with it as easily as for other diseases.
In the mountains, though, the disease is very serious, and so de-
cidedly contagious that it often creates a panic in families, and
makes it difficult to get a nurse except from among those who have
once had the disease. It would seem, therefore, that there is a ma-
terial difference in the two fevers, and it would be difficult to admit
that there is constant causative element in the Eas'ern and West-
ern types of the fever. But m to a causation in disease, we know
extremely little, and ve are not much farther away from it in
typhoid than other fevers. Filth, though, is a factor in all zymot'c
diseases. It either causes disease, or it intensifies it when it is es-
tablished. Filthy surroundings in a solitary case of fever or
diphtheria may only iccrease the rociptivity of the persons who are
in the nearest contact with the sick, but whether this is all the
harm resulting, or whether disease germs spring de novo from it, it
is ecjually important to enjoin the strictest attention to hygienic
surroundings.

Now, lastly, as to the diet of a typhoid patient. It is a common
error to tax the stomach and intestinal digestion of the typhoid pa-
tient with too much nourishment. It stands to reason that the
idiosyncrasy of a given pitient's stomach is not overcome by the
typhoid state, and that if any given article of food does not agree

TRANSACTIONS MEDICAL SOCIETY OF NORTH CAROLINA. 293

with him when he is well, it is not to be expected to answer for him
when he is sick. Feeding with milk requires much judgment. It
cannot be denied that milk is the nearest approach we have to a per-
fect nourishment, but it would be folly to give even milk to a
typhoid patient wilh whom it did not agree when he was well. Sir
Wm. Jenner pointed out some time ago that milk was not the best
diet for typhoid patients. One pint of rick milk was equal to a
mutton chop and as hard to digest. This does not signify that
milk is to bo condemned as c* diet but to be given with discretion.
Water and lime water could often be added with advantage, as our
typhoid patients generally get far too little water, and lime-water
tends to prevent the formation of solid curds in the stomach.

Peptonized food is attracting much attention. It is a rational
way of giving nourishment. The design is to introduce a food so
nearly resembling natural peptone as to tax the stomach and duo-
denum the very least. Expensive preparations arc on the market,
but the physician could easily extemporize it, by the artificial diges-
tion of meat and meat juice with pepsin and pancreatin, the minute
directions for which are given in Dr. Robert's (of Manchester,
E ig,,) famous lectures.

Another article of diet, beef tea, an old one by a new method, is
thus prepared. Mince lean, juicy beef and place it in a water bath,
the temperature of which is not raised above the point that the finger
could bear a moment. Digest it for an hour carefully not exceed-
ing 108° F. Then put the meat thus prepared in a small fruit or
curd press, and squeeze out all the juice. In this way all the
muscle juices and albumin are separated, giving a product resem-
bling blood more than the beef-tea made by the old process of
digesting at the boiling point, and probably much more nutritions.

Adjourned to meet at 8^ o'clock.

NIGHT SESSION — SECOND DAY.
ANNUAL ADDRESS.

The Society assembled in the Court House at 8^ o'clock to listen
to the Annual Address by Dr. A, AV. Knox, of Raleigh. The citizens
of Concord responded to the invitation to be present, by a full house.
The subject of the Address was Vaccination.

294 TRANSACTION'S MEDICAL SOCIETY OF NORTH CAROLINA.

Tlie history of the practice was traced from the time anterior to
Jenner'iS discovery. He mentioned the historical fact of Farmer
Benjamin Jestey, of Dovvnshay, England, following the tradition
of his neighborhood, inoculated his family with cow pox for the
prevention of small-pox. But he did not succeed in impressing the
people of his time sufficiently to establish the practice. It was due
to the genius of Jenner to interpret the meaning of the exemption
of milk-maids from small-pox who had taken the cow-pox from the
cattle. He it was, who in 179G actually demonstrated the practice
by taking the lymph from the hand of a milk-maid, inoculating his
own son, and then afterwards proving by the crucial test of small-
pox inoculation, the absolute protection ob!ained by the vaccination.
A group of his early cases was brought together in his first great
work entitled "An Enquiry into Variolas Vaccinas," and by this
touch of a master-hand the benificent system was given to the world.

The speaker dwelt upon the protective power of vaccination,
proving by statistics what immense good had been done by means
of it.

He also showed how foolish and wrong the anti-vaccination move-
ment was. He referred to Bergh's insane tirade in the North Amer-
ican Eevieio, and the incisive and conclusive reply of Dr. H. A.
Martin. He discussed the propriety of compulsory vaccination,
and the difficulty of accomplishing it, in communities where there
are large numbers of negroes.

The address was well conceived, and delivered in a clear im-
pressive manner, eliciting from time to time the applause of the
audience.

At the conclusion of the address, it was moved by Dr. A. Holmes
that the thanks of the Society are due and are hereby tendered to
Dr. Knox for his address and that it be referred to the Committee
on Publication. Carried.

Adjourned to meet Thursday morning at 9^ o'clock.

THIRD DAY — MORNING SESSION.

The Society was called to order promptly at 9^^ o'clock.

Dr. Henderson from the Committee on Credentials reported the
name of Dr. Gaston Bradshaw, of Lexington, for membership
Adopted.

TRANSACTIONS MEDICAL SOCIETY OF NORTH CAROLINA. 295

The Chair made the following announcement :

CHAIRMEN OF SECTIONS.

Dr. K. L. Payne, Jr., of Lexington, Surgery.
" H. B. FurgcrsoD, of L'ttleton, Therapeutics and Materia
Medica.

Dr. Geo. W. Long, of Graham, Fractice of Medicine.
" F. A. Crowell, of Monroe, MicroscojTy and Pathology.
" J. M. Hadley, of La Grange, Obstetrics and Gynecology.
" A. G. C-irr, of Durham, Diseases of Children.

REPORT OF THE DELEGATE TO THE BRITISH MEDICAL ASSOCIATION
AND THE INTERNATIONAL MEDICAL CONGRESS.

Dr. N. J. Pittman, of Tarborough, entertained tbe Society with
an account of his visit to the International Medical Congress, held
in London, and also the British Medical Association held in Ryde,
in 1881.

On motion of Dr. Bahnson the report was referred to the Com-
mittee on Publication, with the thanks of the Society.

Dr. H. W. Lilly, of Concord, exhibited a case of Bncejjhalocele
in the person of a little girl. He spoke of the nature of the case,
of the strong temptation to interfere surgically for its relief, and
also the great dangers attending such interference. He also read
letters from Drs. Gross, A. A. Post and Van Buren, advising that
in some cases the elastic bandage might be successfully used to ac-
complish gradual constriction, but the propriety of any interference
in this case was very doubtful.

The Committee on Nominations made the following report :

For President :
Dr. J. K. Hall, of Greensborough.
Vice-Presidents :
Dr. A. W. Knox, Raleigh.
" J. M. Hadley, La Grange.
" E. S. Foster, Louisburg.
" John Whitehead, Salisbury.

Treasurer :
Dr. A. G. Carr, Durham.

396 TUANSACTIONS MEDICAL SOCIETY OF NORTH CAROLINA.

Secretary :
Dr. L. Julian Picot, Littleton.

Orator :
Dr. W. R Wilson, Townesville.

DELEGATES TO AMERICAN MEDICAL ASSOCIATION.

Dr. B. L. Payne, Lexington.
Eugene Grissom, Raleigh.
N. J. Pittman, Tarborongh.
H. T.Bahnson, Salem.
J. ^Y. Jones, Tarborougli.
Thomas F. Wood, Wilmington.
R. n. Lewis, Raleigh.
G. G.Smith, Concord.
Paul B. Barringer, Charlotte.
L. Julien Picot, Littleton.

DELEGATES TO VIRGINIA MEDICAL ASSOCIATION.

Dr. A. M. Lee, Clinton.
*' R. Lee Payne, Jr , Lexington.
" W. C. Murphy, South Washington.
'* Willis Alston, Littleton.
•' John Wilson, Milton.

DELEGATES TO THE SOUTH CAROLINA MEDICAL ASSOCIATION,

Dr. W. J. H. Bellamy, Wilmington.
*' S. B. Jones, Wadesborough.
'* D. J. Cain, Asheville.

COMMITTEE ON PUBLICATION.

Dr. Thomas F. Wood, Wilmington.
•■' G. Gillett Thomas, Wilmington.
" L. Julien Piciit, Littleton.
*' H. W. Lilly, Fayctteville.

OBITUARY COMMITTEE.

Dr. Allman Holmes, Clinton.
" J. M. Henderson, Concord.
" J. M. Baker, Tarborough.

TRANSACTIONS MEDICAL SOCIETY OF NORTH CAROLINA. 297
BOARD OF CENSORS.

Dr. Charlts J. O'Hagan, Greenville.
" N. J. Pittman, Tarbo:ough.
" J. J. Summerell, Salisbury.
Respectfully submitted,

J. AV. Jones, ]

W. H. Ltlly, I

P. E. IIiNES, J^Corrmiittce.

IT. ^\. Faison, I

G. G. Thomas, J
The report was approved and adop'ed.

PROPOSED AMENDMENT OF BY-LAWS.

Dr. Walter 0. Murphy introduced the following amendments to
the By-Laws which lie over under the rules, until 1883:

RULES OF ORDER FOR N. C. MEDICAL SOCIETY.

First Dai/— Morning Session.— W. The President, or in his ab-
sence, one of the Vice-President-, shall call ihe Society to order,
and Eequest a Resident Clergyman to Open the Proceedings with
Prayer.

2d. Address of Welcome.

3d. Calling Roll of Membtrs.

4tn. Appointment of Committee to Examine Credentials of Del*
f gates.

5th. Appointment of Committee on Finance.

6th. Resolutions, or Motions Introducing New Business.

7th. Presidential Address.*

First Day— Afternoon Session. — 1st. Report of Chairman of Sec-
tion on Surgery. Discussion.

2d. Report of Chairman of Section on Obstetrics a- d Gyne-
cology. Discussion.

3J. Report of Chairman of Section on Pathology and M.cro-
scopy. Discussion.

Second Dai/— Morning Session— Ut. Reading of Essay by An-
nual Essayist.

*The suggestion that the President's Address was so often of the nature of a mes-
sage on the policy of the Society, and an outline of new work, tliat it would properly
be put at the beginning instead of the close as heretofore.

298 TRANSACTIONS MEDICAL SOCIETY OF NORTH CAROLINA.

3d. Conjoint Session of North Carolina State Medical Society
with State Board of Health.

3(1. Brief Volunteer Papers may be Road and Discussed.

becond Day — Afternoon Session — 1st. Report of Cluiirman of
Section on Practice of Medicine. Discussion.

2d. Report of Chairman of Section on Materia Medica and
Therapeutics. Discussion.

3d. Announcement of Committee on Nominations.

4th. Announcement Committee to Appoint Essayist.

5th. Announcement by the President of Time and Place for the
Delivery of the Annual Oration.

ndrd Day — Morning Session — 1st. Uniinished and Miscellane-
ous Busines?.

2d. Reading of Volunteer Papers.
' 3d. Oral Communications may be Made Discussed.

Third Djy — Afternoon Session — 1st. Report of Committee on
Nominations.

2d. Report of Committee on Annual Essayist.

3d. Installation of Officers.

4th. Selection of place for next Annual Meeting.

5th. Unfinished and Miscellaneous Business.

Gth. Adjournment.

The Secretary read a letter of resignation from Dr. W. W.
Gaither which was accepted.

Dr. Knox moved that the case of Dr. A. D. Lindsay, brought to
the attention of the Society by Dr. Ennett, be taken up by the
Board of Censors at this meeting, rather than to refer back to the
Forsyth County Medical Association.

Discussion ensued upon this motion, but it was tlnally postponed
until after the Presidential address, the hour (IH) having arrived
for its delivery.

president's address.

The Society was congratulated upon the advanced ground it had
reached in its race of progress. The history of medical societies
in North Carolina was reviewed, beginning with the society founded
in 1709 or 1800. It was shown that even then there was great care
taken in the selection of members, all applicants for membership
being examined in open meeting by the Board of Censors. This

TKANSACTIONS MEDICAL SOCIETY OF NORTH CAROLINA. 299

Board of Censors was the germ from which the present Board of
^Medical Examiners sprunor. The work of the Board of Examiners
was commented upon, showing the reflexive influence of their ex-
aminations upon the medical colleges, and upon the tone of the
profession in the State. He stated that the Board has attempted
to make the standard progressively higher but had not thought it
wise to go in advance of the standard set by the best medical col-
leges in the country, although he intimated that there was great
improvement needed before the standard would be what was de-
sired. He urged the separation of the teaching and the diploma-
granting bodies, as the great desideratum in medical education.

The present Board had examined 142 candidates from 33 different
colleges. Of this number 27 had been rejected, or about one in
seven. He thouglit the Society had improved the trust given them
by the State, and now the time had come when the law should be
changed requiring the successful candidate to receive five or six
votes in seven, instead of four in seven as now provided by the
law ; and that it ehould be a misdemeanor to practice without this
license.

He believed the time had not arrived in this State for the estab-
lishment of a medical college, and he hoped it would not be under-
taken until an endowment eufficient to support professors inde-
pendently of the fees of students, bad been secured.

The other topics dwelt on by Dr. Wood were the present status of
med'cal education, the necessity for the endowment and encourage-
ment of original rese rch ; the cultivation of preventive medicine ;
the dangers of specialism ; the proposed amendment of medical
ethics as undertaken by the New York Medical Society. Lastly,
he said that it was as late as 1820 when quinine was first discovered,
it made an era in chemistry and therapeutics; and only sixty-two
years later we get the startling announcement that quinine has been
made by a French Maumene, by synthesis.

Upon Dr. Knox's motion, the address was referred to the Cora^
mittee on Publication.

TIME AND PLACE OF MEETING OF THIRTIETH SESSION.

The Academy of Medicine, of Raleigh, sent a formal invitation
for the Society to hold its next session in Raleigh.

300 TUANSACTIOKS MEDICAL SOCIETY OF KORTII CAROLINA.

Dr. Pittman invitetl the Society to meet in Tarbon). "
Dr. Iliiics was in fdvor of accepting the invitation of Dr. Pitt-
man, ont of ic'gpcct to ore of the original members of the Socic ty,
who had so long faithfully iJentiiied himself with licr interests.

Tarborongh was unanimously selected as the place of meeting,
and the tliird Tnesd ly in Mayas the time.

THIRD DAY — MORXIXO SKS.SIOX.
PRO POSED AMENDMENT TO COXSTITUTIO N".

Dr. Geo. G. 'I honiMS introduced an ametiduieiit to the Cvjns'itii-
lion making tlic tertn of office of the Board of C'erjsors six years.
. Lies over undei' the miles until 18S'5.

liEPORT OF COMMITTEE ON" ESSAYIST.

We, the Committee to s lect an Essayist for our next a' nnal

meeting, beg leave ti) nominate Dr. Paul B. Barringor, (.f C'mr-

lotte, N. C.

W. P. Beall, )

I. "VV. Faison", y Committee.

J. M. Hadley, }

IXSTALLATION OF THE PRESIDENT.

At VH o'clock the newly elected President. Di'. J. K. IIAI, of
Greensborough, was conducted to the chair by Drs. P. E. Ilines
and Joseph Graham.

The retiring President said : I congratulate vui, Sii-, Miid the
Medical Society of North Carolina, upon y ur promotion to ihis,
the highest oflice in her gift.

Dr. Hall thanked tiie Society for ihe honor they had conferred
upon him, and said that he would d schaig-; the duties devolving
upon him, to the best of his ability.

A'^journed until 2'\ o'clock.

TRAXSACTIONS MEDICAL SOCIETY OF NORTH CAROLINA. 501
THIRD DAY — AFTERXOOX SESSION.

Socio'y met at 2^ o'clock, Dr. J. K. Hall, ProsiJent, in the chair.

The discussion upon the case of Dr. A. D. L'ndsay was resumed.

The following resolution, introduced by Dr. O'Hagan, was
carried :

Whereas, one A. D. Lindsav, M. D., whose post office is Ker-
nersville, Forsythe county, N. C, and who claims to be a member
of the North Cirolina Medical Society, has issued to the public a
card setting forth the virtues of a certain Nostrum, called by him
Analeptine, the formula of which ho professes to publish ; and
whereas, the wording of the card exhibits gross ignorance of the
first principles of medicil knowledge and savors strongly of the
tricks of the average medical charlatan,

This is to warn ihe public in the first place that the Medical So-
ciety of North Carolina, because of the above violation of Arts. 3
and 4, chap. 2, of the Code of Ethics of the American iledical
Association, hereby expels from membership in this Society, said
A. D Lindsay, and inform the public that he is no longer in fel-
lowship with it.

And this Society hereby warns the public that any confidence
which might be given to said Lindsay because of his supposed mem-
bership in this body, is entirely unworthy, and the North Carolina
Medical Society hereby utterly repudiates both him and Analeptine.

N. J. PiTTMAN, I jy Ten

C. J. O'IIagan, i ^°^^^ °^ ^^"^°''^-
Dr. Geo. G. Thomas introduced the following resolution, which
was unanimously carried :

Resolved, That so much of the rule relating to the tariff of Insu-
rance fees, requiring the payment; of $5 for certificate of one phy-
sician as to the professional standing of another, be repealed.

Dr. Wood stated that during his term of office heiiad pledged
§30 for the sup])ort of the Index Medicus. lie did this because
he believe! the Society would approve his action. At any rate it
was hel|»ing forward an undertaking that was of the greatest mo-
ment to ttic interests of medical literature.

On motion of Dr. Haigh, the Society endorsed this action of the
cx-Presiiient, and directed the amount of 830 to be paid.

Tlie fuHowing resolution, offered by Dr. J. A. Reagan, was
adopted :

Resolved, Tnat the thanks of this Society are due and are hereby
tendered to the citiz3ns of Concord for the kindness and hospital-
ity extended its members during our s'ay among them, and that
we will evLM- cherish a kind remembrance of them.

Societv ad j )iirned to meet in Tarborough on the third Tuesday
.in Mav, "1883.

" ■ Thomas F. Wood, M. D , Piesidcnt.

L JuLiEN Picot, M. D., Secretary.

303 TRANSACTION'S MEDICAL SOCIETY OF NORTH CAROLINA.

MINUTES OF THE BOARD OF EXAMINERS.

At the regular meeting of the Board of Medical Examiners of
the State of North Carolina, held in Concord, N. C, beginning
May 8th, 1883, the following gentlemen received license to practice
Medicine and Surgery, to wit :
Dr. J. H. McBrayer, Boiling Spring.

" Robert S. Young, Matthews.

" Robert H. Morrison, Jr., Shelby.

" Marcus C. Hunter, Huntersville.

*' A. R. "Wilson, Grecnsborough,«Guilford County.

" Chas. A. Meisenheimer, Mt. Pleasant.

" Kemp P. Battle Jr., Chapel Hill, Orange County.

" Geo. S. Lloyd, Tarborough, Edgecombe County.

*' John B. Gunter, Durham, Durham County.

'' Willard P. Whittington, Biirnsville.

" 0. F. Anderson, Mocksvillo.

" Henry B. Ferguson, Littleton.

" William G. Bradshaw, Lexington.

*' James T. Strickland, Bliss, Surry Count}'.

" John R. Irwin, Alexandriana, Mecklenburg Count}'.

" James McP. Templeton, Dallas.

*' John J. Clingman, Huutsville.

*' L. E. Kirkman, Smithfield.

'* Roger A. Smith, Princeton.

" Thomas S. Royster, Henderson.
The next meeting of the Board will Be held in Tarboro, on Mon-
day before the third Tuesday in May 1883. The following is the
order of examinations :

Materia Medica — Dr. P. E. Ilines.

Anatomy — Dr. T. D. Haigh.

Physiology — Geo. L. Kirby.

Surgery — Dr. Thos. F. Wood.

Practice of Medicine — Dr. J. Graham.

Chemistry — Dr. R. H. Lewis.

Obstetrics — Dr. II. T. Bah n son.

In accordance with the provisions of Sec. 16 of an act for the es-
tablishment of a Medical Board of Examiners, the license granted
B. G. Ilarri?, formerly of Higti Point, N. C, is hereby rescinded.

Henry T. Bahnson, M. D.,
Secretary Board of Medical Examiners of N. C

DONATION OF A VALUABLE L'bRARYJ 303

THE GIFT OF DR. TONER'S LIBRARY TO THE NATION.

The American public, and especially the citizens of Washington,
will learn with interest and satisfaction the fact, recorded in the
proceedings of Congres-', ttiata valuable collection of books, form-
ing the treasures and the life-gatherings of a private citizen, have
been presented to the nation. Dr. Joseph Meredith Toner, of this
city, has given to the United States, for permanent preservation in
the library of Congress, his entire collection of books, pamphlets,
manuscripts and periodicals, amounting to between 20,000 and
25,000 volumes. The learned and laborious donor has been known
for a quarter of a century past as a most intelligent and indefati-
gable collector, and his library is rich in American history, biogra-
phy, topography, medical science, and scientific and miscellaneous
literature.

The conditions of the donation are such as reflect honor upon
the giver, who reserves to himself the right to add to the collec-
tion during his life, and to create a fund to still further increase it
after his decease. The unanimous acceptance of the donation by
both branches of Congress assures the proper care and preservation
in this District of this important and unique collection, which
there has teen reason to fear would go elsewhere. It is the first
instance, we are informed, in the history of the government of the
gift of any large and valuable collection of books to the National
Library, and the example may be productive of the greatest bene-
fit in leading to similar literary and scientific benefactions in the
future.

Dr. Toner thus adds hi^ name to the honorable roll of public
benefactors to which Mr. W. W. Corcoran, Mr. George Peabody,
and others belong, whose gifts are wisely bestowed during the life-
time of the donor.

The above item is from the Washington Star of the 17th instant.
AVe are glad to know that this valuable collection is soon to have a
safe resting place, as it has no equal in America for medical.
Americana. How the venerable scholar and bibliographer could
part wi'h his children on any terms, we cannot comprehend.

Apology. — Absence from home at the time the earlier proof
sheets of this issue were read, is our apology for failure to give the
proper credit to the Annals of Anatomy and Surgery, for the ex-
cellent article on Smith's Anterior Splint wc present this month.

TVA.R:NrER & OO.'S

SOLUBLE SUGAR-COATED

sphorus Pills.

The method or ])reparinft- Phosphorus in pilular form has been
Discorere*! au<l Brought l<> Pcrlcctioii I>y us, Mith-
out the necessity of combining it with resin, which forms an insol-

uble compound. The element is in a perfect state of subdivision

"^~r and incorpoiated with the excipient while in solution. The uor.-

porous coating of sugar protects it thoroughly from oxidation, so that the pill is not
impaired by age. It is the most pleasant a:id acceptable form for the administra-
tion of Phosphorus.

Specify WARNF.R & CO. when prescribing-, and order in bottles of

one liundred each when practicable, to avoid the substitution of cheaper

and interior brands.

&sm&

1.

PILLS SENT BY MAIL OX RECEIPT OF PRICE LIST.
-Pil. Pliosphori 1-100 gr., 1-50 g-r., or 1-25 gv. [Warner & Co,]

Dose. — One pill, two or three times a day, at meals.

Therapeutics — When deemed expedient to prescribe phosphorus alone these pills
will constitute a convenient and sale method of administerins: it.

2.— Pll. Pliosphori Co. [Warnor & Co.]

R. Phosphori, l-lOO gr.; Ext. Nucis YomiciC, J-^gr.
Dose. — One or two pills, to be taken three times a day, after meals.

Thehapeutics. — As a nerve tonic and stimulant this form of pill is well adapted
for such nervous disorders as are associated with impaired nutrition and renal de-
bility, increasing the appetite and stimulating digestion.

[Warner & Co.]

3.— Pil. Pliospliori C'niu Niic. Vom.

R. Phosphori, 1.50 gr.; Ext. Nucis Vom., y^ gr.

Dose. — One or two, three times a day, at meals.

Therapeutics. — This pill is especially applicable to atonic dyspepsia, depression,
and in exhaustion from overwork, or fatigue of the mind. Phosphorus and Nux
Vomica are .sexual stimulants, but their use requires circumspection as to the dose
which should be given. As a general rule, they should not be continued for more
than two or three weeks at a time^ one or two pills being taken three times a day.

[Warner & Co.]

4r>— Pil. Phosphori Cum Ferro.

R. Phosphori, 1.50 gr.; Ferri Redacti, 1 gr.

Dose. — For Adults. — Two, twice or three times a day, at meals : for children be-
tween 8 and 12 years of age — one, twice or three times daily, with food.

Therapeutics. — This combination is particularly indicated in consumption,
scrofula and the scrofulous diseases and debilitated and ansemic condition of chil-
dren ; and in ana-raia, chlorosis, sciatica, and other forms of neuralgia ; also in car-
buncles, boils, etc. It may be administered also to a patient under cod-liver oil
treatment.

WM. R. WARNER & CO.,

PHILADELPHIA,

KEU YORK,

12'J8 Market Street, 19 Cedar Street.

|^"C'o:.;PLETn: Lists FoRVVARDrjD upox Application. 10

NORTH CAROLINA

MEDICAL JOURNAL.

THOMAS F. WOOD, M. D., Editor.

Number 6. Wilmington, June, 1882. Vol. 9.

ORIGINAL COMMUNICATIONS.

BONY OCCLUSION OF BOTH POSTERIOR N ARES— PER-
FORATION OF THE SEPTUM WITH THE REVOLVING
CURVED TROCAR— SUCCESSFUL.

By T. B. WiLKERSON", M. D., Young's ^ Roads, Granville

County, N. C.

The parents of W. C, a^t. 6 years, consulted me in September,
1881, in regard to some congenital malformation of the nasal cav-
ities There had been no respiration through the nostrils since
birth, til s deformity rendering hand-feeding a necessity, the child
being unable to nurse from the mother's breast. The general men-
tal and physical condition good, but a glance at the face, the open
mouth, red bordered eyelids, and irritated appearance of the ante-
rior nasal fos?a^ were characteristic of chronic nasal trouble. The
occasional (.verdow and trickling of the tears down the cheeks
showed thctL t c irritation had involved the lachrymo-nasal duct,
also the anterior outlets were very small, scarcely admitting the
ordinary female silver catheter. There was no deafness noted, but

30G 130NY OCCLUSION" OF BOTH POSTERIOR NARES.

the .special senses of smell and taste were very deficient. Having
the head of the patient secured batwcen the knees of an assistant, a
small probo was passed along the anterior inferior nasal floor, the
instrument meeting with no obstruction until it rcjched a point
about two and a half inches from the frontal opening, here the
cavity ajipeared to be firmly closed by a solid material, both chan-
nels closed at the same point. Flexible probes were tried with no
better result, a silver ftmale catheter well oiled was passed down to
the occluded point ; percussion with this gave a clear solid sound,
owing to the constricted condition and deep seated obstruction of
the canals, the nasal speculum and mirror illumination added but
little to the diagnosis. The mouth well opened, tcngue depressed
and the throat well illuminated, after some trouble a rectangular
probe was passed into both posterior nares a half inch This exam-
ination clearly demonstrated the fact, that both anterior and poste-
rior nares and the intervening c.mals were patulous up to the stated
point of occlusion, and that a perforation of this obstructing of
septum wou'd likely give great relief to the patient. Never having
met with a similar case, I consulted my distinguished friend, Prof.
Henry II. Smith, of Philadelphia, Pa., as to the practicability of
the operation, lie stated that the attempt might be prudent. Fear-
ing that the force employed with a trocar properly curved to
perforate the bony lamina, might cause the point of the instrument
to vary from the natural line, thereby endangering important
structures, and if moving along the natural channel there would be
considerable fracture of the bony septum, and these comminuted
spicule remaining might give rise to an after dangerous septic con-
tamination of the system. To lessen the danger, and inflict the
least injury on the parts, I had made by Messrs. George Tiomann
& Co., of Xew York city, a new and ingenious instrument a re-
volving trocar and curved cannla, the drill attached to cable-screw
wire, the latter being elastic allows the handle of the trocar to be
circularly rotated, whilst the curved canula remains stationary, the
slit in posterior under surface of the tub3 and pliability of the wire
render the retraction and withdrawal of the trocar easy. The drill
point protrudes beyond the end of the canula half inch, length of
trocar and canula about four inches, length of handle two
and a half inches, without this instrument the operation would have

BONY OCCLUSION OF BOTH POSTERIOR NARES. 307

been impracticable. My thanks are clue Messrs. Geo. Tieniaiin &
Co. for the skill ami beautiful finish displayed in the manufacture.
The cut below gives a correct representation of the instrument.

Doc. 8th, 188 J, the following operation was perforraed. Fearing
that a fatal asphyxia might ensue from chloroform should the
mouth become closed during anaesthesia, patient was secured by
tying the hands behind the back, the body put in a narrow bag, the
mouth of the latter drawn tolerably tight around the neck, and the
back of the bead placed in a clamp attached to the table Passing
a female silver catheter down to the obstruction in the nasal fossa,
a mark was made on the catheter at the anterior nasal outlet, with-
drawing the instrument a similar pointof measurement was marked
on the canula of the revolving trocar. After retracting tiie enl of
the drill withiu the tube, the latter dipped in carbolized oil, was
passed down to the obstruction, slowly pushing forward the trocar
point, and holding the rim of the canula in the leff, and the handle
of the instrument in th.e right hand, the drill was given a rapid
circularly rotary movement quickly and smoothly boring through
the bony septum. The other nostril \fas treated in a like manner.
Pretty free hemorrliage followed the perforation, but the little pa-
tient was enabled to disqjiarge the blood from the mouth as it
flowed back into the throat ; the bony plate appeared to be about
one-fourth inch in thickness. Afcer arresting the bleeding, a gum
bougie was passed through both nostrils into the pharynx; as soon as
the drill was withdrawn the patient forced air and blood from both
nostrils, sending it some distance. A piece of gum-tubing having
small holes on the sides of both ends and a good sized hole in the
middle, the drainage tubing a little over six inches in length. One
end of this tubing having been passed into one nostril from the
front and through the perforation, and while held in position, the
other end of the tube was carried to a similar point in the other
nostril, the protruding part of the tube was fastened to the upper
lip with adhesive plaster. Through the central eyelet each nasal
cavity could be readily washed out by means of a small syringe. But
little irritation followed the operation. On the sixth day the tubing

308 CnAKGES IN THE APPEARANCE OF THE OPTIC KERTE.

was removed and a gum bougie passed through the nasal cavities
every day. The result was highly satisfactory, the channel kept
pervious and nasal resi)iration established, adding greatly to the
comfort of the [)atieat. The passage of air, together with the oc-
casional passage of au instrument for some time, will doubtless
bring about a gradual dilatation of ihe constricted nasal tracks, this
widening of the nostrils will greatlv increase the after benefits of
the operation. Congenital deformities completely closing th3 nasal
cavities are rare, and the treatment for their nlief is unsettled.
Owing to the varied difference in the anatomical arrangement of
the parts in different subjects, oj)erations for the relief of tlic c
obstructions are frequently rendered both difiicult and dangei'ous.
Whether the occlusion in this ca e was due to a separation of the
lamina of the vomer, or to a bony exostosis, conld not be definitely
determined, but doubtless due to the latter cause; for had tlie cause
been a separation of the vo%er — there would likely have been a
gradual narrowing of the canal down to the final seat of obstruction.
The revolving curved trocar and canula depicted in this article
» will, I hope, prove a valuable aid to the surgeon and specialist in hard
nasal obstructions, rendering perforation comparatively safe and
certain. The sharp point of the drill retracted within the canula,
the soft parts arc well protected, by the tube during the introduc-
tion of the instrument to the elected point, the tube also steadies
the drill preventing wabbling or str.iying from the i)ro[)er course.

CHANGES IN THE APPEARANCE OF THE OPTIC NERVE
AS AN AID IN THE DIAGNOSIS OF CEREBRAL AF-
FECTIONS.

By Charles W. Hickman, M. D,, Augusta, Ga.
Lecturer on Eye, Ear and Throat Diseases in the Medical Depart-
ment of the University of Georgia.

The thoughts suggested in this article have arisen from a long
and close study of the advantages tj be gained from the use of the
ophthalmoscopy in brain and nervous disease?. As the subject is
ore so great that a few words here, could scarcely do justice to it, I

CHANGES IN THE APPEARANCE OF THE OPIIC NERVE. 309

will first bring forward a few marked and special cases and then
confine my remarks to the thought which would naturally arise
from a careful contemplation of them.

Some time back, I was called in consultation to see two children
suffering from basilar meningitis. In the first, the little sufferer
was found lying in a state of complete stupor, pulse feeble, and a
cold clammy skin. The pupils were not so much dilated as is
frequently found in this class of cases, but the optic nerves p:e-
sented a reddish obscured look, the retinal veins and arteries com-
monly seen over their surface being entirely concealed from view.
The child had been for some time ailing, restless and peevish, cr}'-
ing out in the night, and this state of alfairs gradually going from
bad to worse finally brought the affection to the stage of stupor
with its unhappy termination. The other, was a case so similar in
every particular to the one just described that I shall not attempt
to go into detail.

The next is the case of a gentleman aged thirty-three who had
leJ a fast and dissipated life. AVhen first seen it was on account of
failure of vision, dark spots before the eyes and so on. Examina-
tion showed the optic nerves highly congested, as well as congestion
of the retina. Specific virus at work in the brain as well as an
excess of alcohol being suspected as the cause of his troubles, every-
thing possible was done to prevent the cal unity which we a]\ know
likely to be the result of a specific action once started somewhere in
the brain (most likely here the base) and aggravated by excesses in
drinking. In spite of every care, however, the patient rapidly
growing worse, a trip to the Hot Springs of Arkansas was advised
and undertaken. Here, too, notwithstanding every attention of
his attending physician coupled with every advantage which this
well knowji resort could afford, his condition steadily grew from bad
to worse and after a severe illness from some obscure brain trouble
he was brought home in a truly helpless and pitiable condition.
Soon after his return I again saw him and found him lying in an
unconscious stupid state, with the power of speech almost entirely
lost, and at the same time his whole left side paralyzed. His pupils
were dilated to some extent, and the ophthalmoscope showed
atrophy of both optic nerves far advanced. It was not until quite
recently, a period of seven months having elapsed, that through

310 CHAiq^GES IN THE APPEARANCE OF THE OPTIC NERVE.

the courtesy of his last aLtcnding physician, Dr. Eugene Foster, I
was enabled to see the patient again, as well as make another exam-
ination of his eyes. Too much praise could scarcely be bestowed
upon the dvill and perseverance of his attending physician, for
through iiis untiring energy and persevering en leavors the change
produced in his patient seemed scarcely short of miraculous The
use of speech had been almost entirely restored, the mental facul-
ties greatly improved, and the piralyzed side though still somewhat
loggy and heavy in its action, was nevertheless restored sufficiently
to give the patient considerable use of it, enabling him to walk
with quite an amount of comfort and ease. Ilis sight at the same
time, was greatly improved, and examination showed the optic
nerves though still atrophied by no means so colorless, showing evi-
dently some amount of improvement.. The treatment of Dr. Fos-
tei' cuiiJa'cd of a hundred grains of iodide of potassium, with occa-
sioniil use of mercury, coupled with electricity to the paralyzed
side. Any other indications being met according to circumstances.
His opinion is that the pitient will slowly but ultimately recover.

In the next case I would bring forward, tlie patient had received
a severe blow just at the base of the skull, which knocked her
senseless, and in which condition she remained, more or less, for
several days. The physician in attendance stated that her pup'ls
were dilated, but that he could give no information in regard to
the condition of the optic nerves. The patient slowly recovered
from the effects of the injury with the exception of its leaving her
in an irritable nervous condition accompanied by grcatLonsitiveness
to light as well as considerable pain in both eyes. It was for this
latter state, six months afterwards, that I was requested to sec her
in order that a complete examination of her eyes might be made.
The ophthalmoscope showed the optic nerve swollen, presenting
almost a mottled purplish appearance, the retinal arteries smaller
than natural while the veins were proportionately distended. Tlie
pupils, however, lesponded readily to light and shade and vision was
very little reduced. The eyes were exquisitely sensitive to light so
much so that the patient could scaicely bear the necessary examina-
tion, the nervous and mental irritability being at the same time
very great. As the patient soon afterwards passed out of notice
what the ultimate result of her case was I am not able to say.

CHAJS^GES IN THE APrEAEANCE OF THE OPTIC NERVE. 311

What then do these few cases fell ns, and what may we gain from
a close stud}^ of the s'gns thrown out by the optic nerve in regard
to what is going on in the deeper structures of the brain beyond.
Although upon the continent of Europe many observers were early
engaged upon the subject, yet among the English speaking portion
of the profession we are mainly indebted for our first thorough
researches to Drs. Clifford Allburt, Hugblings Jackson and
Buzzard, and I could not do better than refer those interested to
the valuable papers which these eminent physicians have from time
to time given to us.

Tubercular meningitis is an affection which when once seen is not
easily forgotten. The peculiar look of the little sufferer, the sharp
cry, the unea?y sleep interrupted at intervals with sudden scream-
ings out. the convulsive attacks and final coma presents to our mind
a picture not easily effaced. If in addition we find that for some
time the child has been feverish and out of sorts, with frequent
attacks of vomiting, obstinate constipation, headache, startings in
the sleep, and may bo one or both parents to have suffered from con-
sumption, we have everything before ns to constitute a case of well
marked basilar meningitis, and one which almost invariably ends
fatally.

Have we then any means of detecting the affection in its earlier
stages, and, if possible, thus saving the life of the child, and what
connection has the congested and inflamed optic disc with the men-
ingeal trouble. It is interesting first to trace the course of the
optic nerves from their origin to their entrance into the eyes. They
arise on either side as two flattened tracts from the optic thalami,
corpora quadrigemina and corpora geniculator, pass obliquely across
the under surface of the cms cerebri becoming cylindrical as they
pass along, and finally join together in front of the pituitary body
to form the optic commissure. At the commissure the fibres inter-
cross in a complicated manner and pass forward on eith.er side as
the optic nerves to each optic foramen. The o})tic nerve takes from
the pia mater an inner sheath, the neurilemma which sending (>ut
fine septa into the trunk divide it into bundles of nerve fibres, and
as these septa carry with them blood vessels it will be seen that the
capillary circulation of the nerve is directly continuous with the pia
mater. On reaching the orbit the nerve obtains a' second sheath

312 CHANGES IN THE APPEARANCE OF THE OPTIC NERVE,

from the dura mater and between the two is an interval known as
the intervaginal space, and which interval is directly continuous
with the arachnoid cavity. On reaching the optic foramen the
nerve fibres pass through the little sieve-like openings of the lamina
cribrosa, the inner slieath here terminating while the outer becomes
blended with the sclera. The artcria centralis retina pierces the
nerve about half an incli posterior to the eye, emerges at the disc
where it immediately bifurcates and afterwards continues subdi-
viding over the retina until it becomes capillary. The venules
collect themselves together in the rcftina and finally form the veins
which dive into the disc, soon to be united in one which empties
into the ophthalmic vein or at times into the cavernous sinus
direct. It can then be easily seen that the optic nerves run along
the very part most likely to suffer as from effusions of lymph from
affections of the base of the brain, and very naturally to show the
effects of such at their entrance into the eyes in the way of a
hypeiasmic or inflamed condition. Inflammation of the meninges
may travel down the optic nerves, or, again, the inflammatory pro-
ducts of such may press upon or interfere with the circulition of
the nerves or tracts and bring about an engorgement of the papilla.

Von Gra'fe first brought forward the idea that pressure upon the
cavernous sinus from any cause whatever, must necessarily produce
a stagnation of the veins emptying into it, and as the unyielding
sclerotic ring so closely fits the nerve trunk, the venous stagnation
upon the surface of the disc must be necessarily sufficient to pro-
duce the well-known engorged papilla or choked disc. This theory
was afterwards set aside on account of the discovery that even if
the central vein of the retina should empty directly into the cav-
ernous sinus, that the connection between the superior and inferior
ophthalmic veins as well as fac'al would b3 .sufficient to prevent
stasis of any consequence.

Mention has already been made of space between the inner and
outer sheaths (f the optic nerves continuous directly with the
arachnoid sac Any increase in the intracranial tension or any
affection producing an increase of the contents of the skull can
easily drive the sub-arachnoid fluid int> this space even with suffi-
cient force to distend the extern.il sheath into a bulbous enlarge-
ment and thus produce a high degree of stasis.

CHANGES IN THE APPEARANCE OF THE OPTIC NERVE. 313

Scliraidt holds from liis experiments that not only can fluid be
injected from the arachnoid cavity into this intervaginal space but
also into the net work of the lamina cribrosa, and that consequently
even a canal system here exists continuous with the arachnoid cavity.

Schweiggcr, although offering no other explanation apparently so
good, is not much inclined to this almost acknoweledged view of
choked disc. Jle thinks that the pressure must be so great that
the external sheath can no longer yield to it, and that the external
sheath'can no longer yield to it, and that the intracranial pressure
must be equally great, otherwise the fluid would be forced back
from between the sheaths into the arachnoid space. He frankly
admits at the same time that pathological effusions into the arach-
noid space are almost always associated with an accumulation of
fluid between the nerve sheaths, and that this condition, if kept up,
may cause oedema of the inner nerve sheath and of the processes
which it sends between the nerve fibres, and that this oedema may
cause swelling of the optic disc of varying degree. Whether this
be the true explanation of the nerve inflammation or not, the prac-
tical fact for us to know is that it is so frequent an accompaniment of
affections of the ba^e of the brain, among which may be most
prominently named basilar meningitis. Dr. Clifford Allbutt states
that in thirty-eight cases of marked tubercular meningitis which
were followed up to death, he found ophthalmoscopic changes in
twenty-nine. M. Bouchert goes still further and states that in
fifty-nine cases he found changes in all but two.

If, then, tubercular meningitis, as seen by us in its marked forms
is almost always fatal, and as the symptoms in its early stages are
so very misleading of themselves, can we not hope to obtain valu-
able aid from the changes which the optic disc undergoes, in detect-
ing the disease in its very commencement. Dr. Allbutt speaks
with great Luiphasis on this point, and states that he has had many
cases under his care where a child, say, may have suffered occasional
vomiting of a purposeless kind, subject to an evening fever, com-
plained of pain in the head from time to time sufficient to drive
l)im from bis companions and g^mes, may have been restless at
night anil suffered from spasmodic movements during sleep or even
full convulsions, whose temper may have c'langed from good to a
state of irritability, and that such a cbild may have returned to

314 CHANGES IN THE APPEAllANCE OF THE OI'TIC NERVE.

good health of body, with more or loss injured mental faculties. In
many such cases he found the same ophthalmoscopic changes
which exist in meningitis of an undoubted character, and in illus-
tration cites two of considerable interest. Two boys came under
notice about the same time, complaining of symptoms such as just
described. In the eyes of both, the ophthalmoscope showed choked
papillfB. Both boys recovered, one permanently, but with the excep-
tion of some irritability of temper and mental incapacity. About
six months afterwards the other was seen for a renewal of his old
trouble, the ophthalmoscope again showing the choked discs in both
eyes. In this attack he died, and an autopsy being obtained re-
vealed meningitis of two distinct dates. One in which he died,
and the other corresponding to his previous attack months ago.

If then future researches will enable us to tell with certairjty
whether a meningitis is the cause of the mischief under which a
child may be suffering, we can see at orce how priceless is the gift
of the little mirror placed in our hands by Helmholtz. A remark-
able fact in connection with the engorged papilla? is that it may
exist in a most marked degree without the slightest injury to vision,
and consequently as Dr. Hughlings Jackson well remarks, the
reason it is not often seen in brain diseases is because it is not looked
for. The explanation of this peculiarity is given in the fact that
the bacillary layer of the retina derives its nutrition from the ves-
sels of the choroid, and that the conducting nerve fibres are not
affected by a degree of pressure sufficient to block up the veins.
Equally important is it, however, to be borne in mind that choked
discs whether the sight be impaired or nof, often terminate in
atrophy, and in this way is to be accounted the blindness following
cerebral diseases and affections in which head symptoms have been
prominent.

From what has been stated we find that in what we might term
the milder forms of meningitis, ending in recovery, impaired mental
powers are often the result. The child's memory is poor, he is more
or less stupid, and can only with great difficulty learn, where pre-
viously he may have been remarkable for his brightness. Unfortu-
nately wo may go still further and state that where marked engorge-
ment of the discs have been present, idiocy with comple'e nerve
atrophy is but too often a result.

315

REPORT OF SECTION ON PATHOLOGY AND MICRO-
SCOPY.
Read before the North Carolina Medical Society, at the SOth Annual
Meeting, held at Concord. May 9th, 18S2.

By H. AY. Lilly, M. D., Fayetteville, N. C.

Mr. President and Gentlemen :

Having been honored at the last meeting of the State Medical
Society with the chairmanship of the Section on Pathology and
Microscopy, I shall proceed, without preface or apology, to give the
results of my studies in these branches eince our last annual gath-
ering.

Those morbid conditions whose pathological nature is most ob-
scure will especially claim my attention ; and I shall lefer only to
the most recent advances in the art of microsco]iy, withoutessaying
a lengthy review of a subject which is now so generally studied by
the professional men of our time.

In the London Lancet (Annus Medicus for 1881), a good idea is
obtained of the general advance of Pathological Research. Assum-
ing this to bo a standard of authority, we are led to believe that
while pathologists, during the past year, have evinced no lack of
energy and zeal, their labors have not been distinguished by any
specially brilliant results. Their efforts, for the most pirt, hare
been directed to the old, familiar, knotty pathological problems,
which have for time immemorial been stumbling blocks to the pro-
gress of our science ; and, though success may be far in the future,
by the unremitting zeal and perseverance of sanguine pathologists,
we are brought nearer each year to the solution of the difliiculty.
The fields of these labors are situated mainly in Germany and
France where the opportunities for pathological investigation in
their well organized laboratories are unusually superior ; and where
there is no legislation, as there is some parts of Europe, that places
any restriction on extended experiments. Still English and Amer-
ican pathologists have not been idle and have added useful matter
to this branch of our science.

We are indebted to the London Lancet for the following gener:il
resume of recent investigations in pathology :

316 REPORT OF SECTION ON PATHOLOGY AND MICROSCOPY.

The researches of the year which liave most attracted attention
are those of Pasteur in France which have reference to bacterial
pathology. He has made extended investigations and experiments
in this direction, and together with the contributions of Touissaint,
Klebs, Arloing and Thoma^, he now includes quite a large number
of diseases in that class which is thought to depend upon the exis-
tence of special organisms and to which the practice of prophy-
lactic inoculation is applicable. Typhoid fever has for some years
been thought to be related in some way to a special organism, and
the researches of Piisteurand Kiebs have tended to contiim this to
a great extent. A great many of the pathological changes which
mark this disease arc thought by them to bsar to this organism a
very intimate relation ; and the idea is well borne out by the exper-
iments of Branlccht, whicli were made during an epidemic of
typhoid fever, and which resulted in the discovery of an organism
in the drinking water very similar in its nature to that noticed by
Pasteur and Klebs

Diphtheria has Lorn produced by Talamon by means of inocula-
tion, the inoculating matter being obtained from the throat, lungs
and kidneys of a diphtheritic patient. This shows the existence of
a special organism.

Investigations have been made by Cornil and Neisser which show
conclusively that leprosy depends upon the presence of a special
bacterial organism ; and by a close study of the manner and growth
of these organisms, the peculiar devebpment of the bacteriae is
thought to account for the strange lesions by which the disease
manifests itself.

In syphilis, there has been discovered by Aufrecht a specific
micrococcus which is thought to be the pathogenic agent. Thid
view, however, has not been supported. It; seems, therefore, that
bacterial organisms are not confined exclusively to acute diseases ;
and their recent detection as morbid agents in the production of a
few chronic disorders has given birth to the hope that a great many
chronic diseases, enveloped now in mystery, may ba traced to a sim-
ilar origin, and be amenable, therefore, to a more rational and
decided plan of treatment.

So great has been the interest and enthusiasm manifested by in-
vestigations in bacterial pathology during the past year, that it
has tended to divert their attention from other important subjects.

KEPORT OF SECTION ON PATHOLOGY AXU MICROSCOPY. 317

Bat in the Anuus Medicus we find a eoudensed account of the
labors of pathologists in other directions. It is little more, how-
ever, than a mere index to their work.

Among chronic diseases, tuberculosis his been afresh stuJied
in its aspect as an infectious disaase by Rindfleisch and
Creighton, but with no \ery important additions to the literature
of the subject. Some interesting and rare forms of local tubercu-
losis of the mouth and throat have been described by Rassner and
Eciihofif, and of the urinary organs by Finue, while the histology of
tubercular disease of the testes has been carefully studied by Wald-
stein. The relation of tuberculosis and scrofula has been the sub-
ject of animated discussion in Paris, but, while it directed atten-
tion to the subject and stimulated furtherstudy of the two kindred
diseases, it was productive of no new developments. The study of
structural blood-diseases has been mainly confined to their connec-
tion with blood formation in bone-marrow.

Jivon ha? examined the changes in tlie blood in traum it:c anae-
mia, and the result has estabished the fact that it constitutes a dis-
tinct variety of anaemia, but i^s exact nature was not satisfactorily
determined. Compared with the progress of previous years, very
little of importance has been discovered in regard to the localiza-
tion of nerve centres in the brain. What new facts have been
noticed have increased rather than lessened the difficulties which
before existed in the correct interpretation of experimental facts.

In diseases of the spinal cord, it has been established by Dresch-
field that locomotor ataxia may be due to sclerosis (primary) of the*
lateral, as well as of the posterior columns. It has heretofore been
the accepted idea that the posterior columns alone were involved in
this affection. When the lateral columns aie the primary seat of
disease, the ataxia is accordingly modified in its manifestations.

The discussion regarding the relation existing between syphilis
and locomotor ataxia has been continued during the present year
by Erb, Gowers and others ; and it has been conceded that a syph-
ilitic individual is especially predisposed to ataxic disease.

Brown-Sequard has continued his investigations in regard to tlie
production of paralysis and contractures through the agency of the
peripheral nerves, and has clearly demonstrated that mechanical
irritation of the medulla oblongata may give rise to pulmonary
emphysema through the agency of the pneumogastric nerves.

318 KEPORT OF SECTION OJ^ PATHOLOGY AND MICROSCOPY.

Conheim has studied the effect of occlusion of the coronary arte-
ries, and Martin has made able researches in atheroma, demon-
strating the important part played by the vasa vasornm in produc-
ing the change in the larger arteries.

These then, according to my authority, are the main tnattcrs of
interest to which the attention of foreign pathologists has been
directed during the past year. In some cases, the investigations
have not been completed ; in others, no new fact of importance
have been discovered. It is, at anv rate, pleasing to know that
these matters are revived every year or two ; that they give rise to
extended experimentation ; and that in the mind of a pathologist,
the obscurity and complexity of a subject do not detract from its
interest.

The pathology of chronic lead-poisoning is one of the questions
that engages now the attention of investigators ; and the opportu-
nities for i^o.s'/ luorlein examinations of patients afflicted with the
disease are so rare that it may not be amiss to give the result of an
autopsy recently made by Dr. Birdsall, of New York, in a case of
plumbism complicated by a fatal pneumonia.

The spinal cord was the seat of the changes. The principal
lesions were disc- vered at a point midway between the decussation
of the anterior pyramids and the cervical enlargement of the cord,
Ihere being very little abnormal below this point. The changes in
this section were greatest in the gray matter about 4 ctm. below
J:hc crossing of the pyram'ds. xYt tiiis point for a distance of
2 ctm. hardening did not take place well, and there was noticed a
marked increase of vascularity. The cells of the anterior horn
were unusually large, and there were scattered throughout the sub-
stance of the gray matter numerous lymphoid cells. The only
change in the cellular element of the cord that approximated a
patholog'cal lenon vvas discovered in the cells of the anterior horn
of the upper cervical region. Wnile in health they are large, well
developed and [ilainly discernible, the} were in this instance very
small and indistinc\ No special change was noted in the fibres of
the anterior roots, except the increased vascularity of the parts and
tiie i)resence of a few lymphoid cells lying between the fibres. In
regard to other parts of the cord, there were discovered sclerotic
spots in the antero-lateral columns, and there was some thicken-

REPORT OF SPXTION ON PATHOLOGY AXD MlCttOSCOPV'. 319

ing of the septa near the gray matter. There was noticed also
slight evidence of sclerosis in the Cjliimns of Goll. These patho-
logical appearance?, taken as a whole, were thought to indicate the
existence of a mild grade of myelitis.

PATHOLOGY OF SHOCK.

At a recent meeting of the State Medical Society of Pennsylvania,
a very interesting and elaborate paper on the '• Pathology of Shock"
was read by Dr. C. C. Seabrook. He reached his conclnsions from
experimentation on frogs and rabbits, asserting th:it violent injury
to these animals produced a condition analogous to that observed in
man.

The experiments are described as follows :

The animal was fastened on the stage of a microscope and the
tongue or a web fixed under a power not over 250 diameters. A
limb was crushed with a pair of forceps without disturbing that
under the microscope. He wished now to discover the effect on the
circulation. Upon the receipt of the injury, there was an iustanta-
neous contraction of the capillary blood-vessels, which was quickly
succeeded by dilatation and increased rapidity of the blood-current;
as the dilatation became excessive, there was slowing — indeed,
almost a stoppage of the circulation. He next divided the spinal
cord just below the origin of the brachial plexus, and crushed a
limb connected with the cord below the section, and another above
the section. The crushing of the lower limb produced merely a
capillary dilatation without slowing; while the crushing of the
upper limb was followed by instant contraction, quickly succeeded
by excessive dilatation, with at lirsf", increased rapidity of the blood
current and then stasis.

His conclusions are these :

That an impression made by an injury to a limb is conveyed to
the cord and along the cord to the nervous centre which co ••ols
the tonicity of the blood-vessels, that is, to the vaso-motor con ore ;
that the situation of this co'ifre is at some point above the brachial
plexus; and that there are numerous ganglia disseminated through-
out of the cord which exercise a similar function though in a mod-
ified form, as is evident from the dilatation which follows an injury
to a limb situated below the true vaso-motor centre. After this.

339 REPORT OF SECTION" ON^ PATHOLOGY ANTD M[CR03C0PY.

I'opeated stctions wore made up and down the cord to determine the
exact location of this vas)-motor centre. The upper^of the lower
^ of the mednlLi was decided to be the point in question. The
point to be determined next was : are these effects attributed to the
cardiac nerves proper, to the centre of the inhibitory nerves of the
heart or to the vaso-motor nerves? To decide this question, sec-
tions v/ere made of the pneumo<^astric-% the cord, and of thesympa-
thetic, and from careful cxperimentatio'', the following conclusions
were reach e.l :

I. The impression produced by an injury is conveyed by different
nerves to the medulla, and then apparently paralyzes the vaso-
motor centre in preference to all other centres, and destroys either
the susceptibility to impressions or the power of generating im-
pulses ; and the blood-vessels under its control dilate because of the
lack of stimulus necessary to the maintenance of the equilibrium
of their calibre

II. The heart is slightly influenced, if at all, through the
inhibitory nerves or centre ; and then always secondarily to the
vaso-motor (except when some branches of the pneumogastrics are
injured).

Addison's disease.

At a la'.e meeting of the Pathological Society of London, imst
vwrfem specimens of Addison's disease were presented, and gave
rise to a lengthy and important discussion of its pathology. It was
scarcely possible to detect in the specimens the existence of any
supra-renal capsules ; they were much atrophied, and were repre-
sented by only a very thin band of fibrous tissue. One of the
sympathetic semilunar ganglia, on sections, was found to contain
an increase of fibrous tissue and nuclei, with a marked lessening of
the number of cells. The cells, however, were healthy which pre-
cluded the thought of any serious disease. The question discussed
was : Is Addison's disease, with the accompanying pigmentation
of the skin, produced by tubercle or other disease of the supra-
renal capsules? It was decided that disease of the capsules was not
essential to the development of the condition in question ; for, in
many cases, the capsules are destroyed long before death and there
is no bronzing of the skin. All were ajrreed that it was a disease

KEPORT OF SECTION ON PATHOLOGY AND MICROSCOPV. 321

produced by a pathological condition of the abdominal sympathetic,
manifesting itself in the form of chronic neuritis. The specimens
exhibited, taken from a well marked case of Addison's disease,
showed the presence of this chronic neuritis, and the absence of any
tubercular disea-e of the capsules. The capsules were atrophied,
but it was claimed that this was no evidence of structural disease.
It was admitted that tubercle of the capsules might itself give rise
to chronic neuritis, and, in this indirect way, be a cause of Addison's
disease ; but other changes, such as spinal disease and injuries, can
produce the eame condition without being necessarily connected
with the pathology of the disease.

In the Yomitiog and skin-bronzing of early pregnancy, the abdom-
inal Eympathetic ganglia are especially affected, and this condition,
in its symptoms, is closely allied to Addison's disease. In a word,
we must rid our minds of the one idea that Addison's disease is but
a manifestation of some morbid condition of the supra-renal cap-
sules, and remember that it is a nervous disease in that it bears a
very close relation to disease of the sympathetic system.

Dr. Geo. M. Sternberg, in a report to the National Board of
Health, has given the results of an interesting research with refer-
ence to the etiology and pathology of malarial fevers. lie cjuotes
extensively from Klebs and Tommasi-Crudeli, who claim in a
memoir concerning the hacilhis milarice, that this organism is the
pathogenic agent in fevers of this type. Dr. Sternberg, after close
study of the subject, has not been able to identify the organisms
described by them ; and maintains that they have included more
than one species of plant under the name haciUns malari(B. He
attaches no importance to the pigmentary matter found in the
blood and spleen by these authors, since in rabbits, that have died
of septica?mia, the same features may be observed. Ilis experi-
ments were conducted at New Orleans in a manner very similar to
that adopted by Klebs and Tommasi-Crudeli ; but the results were
not favorable to the bacillus theory.

He says : "Among the organ'sms fonnl on the surface of the
swamp-mud, near New Orleans, and in the gutters within the city
limits, are some which closely resemble, and, perhaps, are identical
wi h the bacillus malarice of Klebs ; but there is no satisfactory
evidence that these or anv other of the bacterial organisms found

32'i KEPORT OF SECTIO>J O'S PATHOLOGY ANTD MICROSCOPY.

in such situations, when injected bcncatli the skin of a nibbit, give
rise to a malarial fever corresponding with the ordinary paludal
fevers to which man is subject."

It was my original intention t) refer at length to the valuable
researches of Pasteur and Toussaint in regard to the pathological
conncc'ion between anthrax and the bacterial organisms. But I
have already detained you too long. An account of their experi-
ment may be found in the Proceedings of the Paris Academy of
Medicine, 1881, and will amply repay any one disposed to read it.
They have established an intimate relation between charbon and
hacilhis aaf/iracis, whicli, they maintain, is the pathogenic ngent.

MICROSCOPY.

■ Tiie f Mowing observations on '"Mounting in Fluid," extracted
from the New York MicroscopicalJouvnal, are worthy of Attention:
Fluid mounting is applicable to all objects that are suflicienlly
transparent. The Huids employed are usually one of the following:
Distilled water; carbolized water. 10 per cent. ; camphor water;
mixture of water and glycerine ; pure glycerine. The process is
about the same fi)r all of these, for any fluid that d()es not dissolve
the cement which is used. The cell must first be made, and for this
jnir|)ose shellac is the best cement ; it should be used rather thick.
The o*'jects should be thoroughly permeatei.1 by the fluid before
they are placed in the cell. The niounting is conducted as follows:
1st. Choose a shellac, all of suitable thickness ; put it on the turn-
table and run out a layer of benzoate balsim. Set aside for one
minute or until a thin skin has formed upon the balsam, ^d. In-
vert the cover of a pill-box and lay the slide upon it ; then place a
larj^c drop of the (In d within the cell. Transfer the object to the
slide and arrange it prop'-rly with need es, 3d. Take a mounted
needle in the left hand and in the right the cover with a pair of
fiucejis Phice the needle point on tiie cell on the left hand side,
and place the edge of the cover against it on the cell ; then let the
cover down si )wly, breathing upon the lower surface so that the
fluid may readily come in contact'wi'h it. When the cover is dovvn,
press it in the still soft balsatif! but api)ly the pressure only on the
outside. Let the slide stand for a few minutes, and then wash
it gMitly with a stealy current of cold water and set it aside to dry.

REPORT OF SECTION ON" PATHOLOGY AXD MICROSCOPY. 353

4th. ^Y[\e•A diT, lun a circle of lenzjle b.ilsam around it, after
whicli the slide may be set as'de for months before the finishing
process is carrdl out. Tiie slides are most geneially laid asiJe im-
mediately ciftcr the last layer of balsam is a])plied, until a number
of them his accuniuKited to undergo the finishing process together.
5. F.nish^the slides by applying several coats of the mixture of
asphalt and g Id-s'zo, followed by a final coat of asphalt to give a
glossy black.

The above process is especially adap'cd to these cases in which
strong give. rin is the fluid used.

The following is the result of some microscop'cal investigations
by Dr. F. 8. killings, embraced in a report to the Massacliusetts
State Board of Iltalth ; and constitutes a useful discrimination
between trichina' spiralis and obj -cts for whic'i they are some-
times mistaken.

He first describes, after Cubbol 1, the micr sc )[)'cj1 a| pcaranco
of Ihe trichina sjnralts, \]z. :

Trichina spiralis is an extremely minutie nematoid helminth, the
male in its fullly developed and sexually mature! condition meas-
uring only l-]8th of an inch, while the perfectly developed female
re dies a length of about one-eighth of an inch ; body rounded
and filifoini, usual'y slightly bent upon itself, rather tiiicker be-
hind than in front, especially in the m I'es ; head narrow, finely
pointed and unarmed, with a central minute oval aperture: poste-
rior extremity of the male furnished with a bilobcd caudal appen-
dage * * * female stouter than the male, bluntly
rounded posteriorly • * * * oggs measuring l-12?0th
of an inch from pale to pale, &c.

lie says, with reference to the objects that simulate /r/c/a/^rr., that
there are sources of error in examining for these parasites which
can be avoided with proi)er care. That the capsules of the para-
site.-', formed by the sarcolemma of the muscular fibre, are frequent-
ly much thickened, the trichina} being deal within them.
The cajisules, ui.der these ciicumstances, present an abnormal ap-
pearance. And, in other case?, their true nature is disguised by
calcification of the capsules and their contents. In some cases,
ci/sticcri perish and bccoaie calc'fied ; but these formations arc
very, much larger than those of trich'na3 and present more of a

334 REPOllT OF SECTION ON PATHOLOGY AND MICllOSCOPY.

caseous appearance " Psorospermia ov the sacs of Raitieyc nsti-
tute another source of error. These have nearly the same physical
appearaccc as the trichina, being filiform and elongated, and their
situation within tie sarcolemma which is included in the capsule of
the trichina; by the psorosperms, however, it is retained, and only
displace] by the object itself, limiting it on each side, and continuing
directly from its poles." Bruch, Virchow and Lcuckart have de-
scribed an object, which is sometimes noticed in the muscular tissue
of bams and which resembles trichina? to a certain extent. It ap-
pears as " peculiar roundish or oval masses of a whitish color," and
has been demonstrated microscopically to consist of " agglomerates
of needle-like crystals." They arc distinguishable from trichina? in
that " they fill the muscular fibre to a variable degree, without
otherwise disturbing its struclure, and disappear upon treatment
with muriatic acid, the normal transverse striation again becoming
apparent." These deposits are what are known as tyrosin crystals.

Some recent microscopical investigitions by Dr. J. G. R chard-
son, of Philadclph'a, publiihed in Gaillard's MedicalJournal, hn\c
a most important bearing upon the medico-legal question of the
diagnosis of blood-stains. An intelligible synopsis even of his in-
teresting paper would be too lengthy for a report of this kind. I
shall, therefore, give only a few of the cocci usions- an ived at.

1st. That in unaltered blood-stains, upon clothing, leather, wood
or metal, we can, by tinting with aniline or iodine, distinguish
human blood corpu cles from those of ox, pig, horse siieep, and goat,
whenever the question is narrowed down, by the circumstances of
the case, to these limits.

2d. By the method I have devised, we can measure the size of
the corpuscles and apply the two corroborative tests of tincture of
guaiacum with ozonized ether and of spectrum analysis, to a single
particle of blood clot, weighing less than 1-15,000 pait of a grain
and barely visible to the naked eye.

3d. J[ence when an ignorant criminal attempts to txplaiu sus-
picious blood-clots upon his person, weapon, etc., by attributing
them to the ox, pig, sheep or goat, or to any of the birds used for
food, wo can, under favorable circumstances, absolutely disprove his
false statement, and materially aid the cause of justice by breaking
down his lying defense, even if twenty years have elapsed.

REPORT OF SECTION ON PATHOLOGY AND MICROSCOPY. 335

4ih. But if tlie accused person ascribes tLc blood to a dog. an
flephaiit, a capibara, or to any atiimal other than those mentioned
abov •, it is impossible, on microscopical evidence of the size of the
bloi)d-c<)rpuscle?, to say absolutely whet' cr the statement is true or
f Ise.

5th. In cases of innocent persons, sta'i ed wiih the blood of a
pig. ox or sheep, ttstimony of experts, founded upon measurement
of ih c r, usclcs, would be valuiibh', but not conclusive, because,
und»r(crtain circnms'auces, human blood-cjrpuscles may s'irink
to the size of those of the ox, whilst, under no known condition,
do ox or pig corpuscles extend to the magnilude of those in human
blnod.

'J'hese conclusions were all based upon tl.e fuicroscopical measure-
nn nr of the corpuscles.

Since tl e pathologist-^ of this day arc so activ.ly engaged in the
study of bacteria" and the relation iluy bear to various morbid con-
diions, the following method of sta iii'g these crgan'sms for |iho-
tographii g should be read by every One interested in the progr. ss
of pathology.

The method ist)riginal with Dr. Geo. M. Sternberg (U. S. Arm\)
and is described as follows :

The bacteri;\3 are dried upon a slide or upon a thin glass cjver,
and are then trca'ed with a drop of commercial sulphuric acid.
After two or three minutes the acid is gintly washed off, and the
bacteria are then covered with the following solution : Iodine,
grs. iij ; Potass. lodid. grs. v ; water m 500. After a few minute?,
they will be found to present a deep origin or brown color, which
gives the desired contrast in a photograph negative. This method
ij useful for extemporaneous prepara'ions only, which are to bo
photographed immediately. The color fades after a time and the
bacteria? undergo changes in form (swelling) m a result of this
treatment, which renders the method unsatisfactory when the object
is to make a permanent preparation. For this purjiose, there is
nothing better than the aniline violet, which, indeed, leaves noth-
ing to be desired when a collection is being made without reference
to photography. The specimens may be mounted in s<dution
ace'ate potash, or, better, in carbolic acid water.

Anilin violet ink, which may be obtained from any stationer, is a

32G REPORT OF SECTION ON PATHOLOGY AND MICROSCOPY.

cheap and satisfactory staining fluid. After a minute's immersion
in this, the bacterid assume a deep violet color. Those who have
not resorted to this method will be astonished at the facility with
which it is practised, and at the variety of forms which may be de-
monstrated at a mom3nt's notice, without a resort to culture exper-
ijients or to a search in ditches and sewer^"'. The mouth, the rec-
tum, the extremity of the urethra in the m^ile, and the vagina in
the female, are constantly supplied wi.h an incredible number of
these minute, vegetable organisms, and a great variety of forms may
bo observed, especially in the discharges from the bowels. The
smallest particle of saliva from the surface of the tongue, of vaginal
mucus, or of fecal matter dried upon a slide, stained with violet
ink and washed with a gentle stream of water, will furnish ample
material for s'.u ly, and will serve as a practical demonstration of
the extensive distribution of bacferia. To obtain a eatisfactory
view, a good l-5tli inch objective will be required, and, for the
smaller species, a l-13th inch is desirable.

This method of staining haderice is considered now the most val-
uable and least complex of any heretofore employed ; and, if for
no other reason, its simplicity, and the ease and readiness with
which it may le used, should commend it to every one.

If, in this paper, I have failed to interest you, or to bring to your
notice any new developments in microscopy or pathology, I at least
feel that I have endeavored faithfully to perform the duty assigned
me as chairman of the section.

English and Yankee Ingenuity in Improvising Catiie-
XERS. — We noticed some months ago that a southwestern doctor
(a Yankee therefore only from an English standpoint) in an emer-
gency used a quill tooth-pick for a catheter. A Britisher now, from
Durslc}', (somewhere rear Jencei-'s home) found himself withont a
ca heter when he was called on to draw the urine from an elderly
paraly7,ed lady, selected a dandelion stalk, and found it (o answer.
Next'l

32^

SELECTED PAPERS.

ASHEVJLLE, TUE CLIMATIC HEALTH RESOIiT OF
WESTERN NORTH CAROLINA.

Asheville has of late acliieved such a rcpntatiau as a health re-
sort, and its uame has been mentioned in so many circles, that it
has seemed advisable to publish some data concerning the charac-
ter of its clima'e, its effects on invalids, the accommodations
offered, &c., in order to meet the increasing demands for informa-
tion, which is daily called for by numerous inquirers.

If we free our minds as far as it is possible from any practical
results which we daily observe in invalids making their residence
here, it is easy to show, on mere theoretical grounds, why this re-
gion, and especially Asheville, has gained its well-deserved fame as
a health resort, particularly for consumptives. Almost all modern
writers and therapeutists concur in their opinion about the deside-
rata for a climate for invalids, viz. : a certain amount of elevation
above the sea level a temperature equally free from great extremes
of heat and cold, a small amount of moisture of the atmosphere,
without excessive degrees to cause vibration of the throa*-, and
respiratory organs, a moderate amount of rainfall, a great number
of sunny, cloudless days ; besides these also qualities of a more
social charac'er, as easy access, good accommodations, a varied
scenery to relieve the monotony of invalid life ; and last but not
least, a friendly, sympathizing, hospitable population, ready to
welcome and assist the weary and worried stranger who left his
home, surrounded by friends and comfort, to seek health and frcth
life in a distant land. Having now pointed out the demands we
ought to make from a climate which can be conscientiously recom-
mended to the large army yearly traveling for the bencGt of their
health, it is not a difficult task to show that Asrheville combines all
these characteristics in a happy degree.

In taking up the several points separately, and turning our atten-
tion to the question of altitude first, we nof'ce even amongst its
advocates a great divergence of opinion as to how the salutary
effect is obtained. But we feel confident in being able to show evi-
dence towards a satisfactory explanation as to why elevated regions

338 CLIMATIC HEALTH RESORT OF WESTERN^ NORTH CAROLINA.

lire jircft ruble to low-lands for invalids. There are four iheor'es all
emanated from and advocated by eminent investigators in this special
branch of so'enc^, who wish to prove how mountain air afft'Cts the
respiratory organ. Some assert, that the respirations bicomo more
frequent and le.s deep; o'hers only speak of more frequent
respirations; a third party describes them as more frequent and
deeper; whilst the last on) believes in deeper ones with their natu-
ral respirations. Though in our opinion none of these theories
will hold good for every individual c;i-e without exception, we think
not to encounter much opposition when we give our reasons for ad-
hering to the explanation.

It is a mathematical thesis, that in ascending heights, the mercu-
rial column sinks in proportion to the rise in elevation. This shows
that the weight of the air grows less, that the density of the atmos-
phere decreases, in other words the a'r becomes rarified. Therefore
air in ekvated regions will contain a lesser amount of oxygen in a
given space, say a cubic foot, than at sea level. Generally we ob-
serve in invalids coming toahigher altitude an increase in the num-
ber of respirations in the beginning, which is very natural, as the
system tries to fupply the lung with the same amount of oxygen as
at sea level, and less oxygen being contained in the air, the compen-
sation is arrived at by an increased frequency of breathing. If the
elevation is not too high, and the lungs of the ])atient not too ma-
terially affected as not to allow acclimatization, the system becomes
accustomed to the changed condition of the atmosphere, atid the
respirations assume their normal frequency, i. e., as they were at
the low lands. But naturally and spontaneously they become deeper
at the same time, as the lung lakes up a certain unvarying amount
of oxygen to supply the blood, and has to do that in a vicarial man-
ner by deeper inhalations when the air is rarifie 1. One of the re.i-
sons why there is £0 much controvt r,-y and disbelief amongst ec'en-
tific men in regard to this point is due to the fact that the exact
amou'.it of air consumed by an individual with one or more inhala-
tions in mountain districts has to our knowledge never been ascer-
tained. In the large physiological laboratories of our scientific
centres we find all the necessary appliances and instruments to
measure the quantity of air take i up by the lung^ with a certain
number of respirations in ordinary breathing. Such apparatuses

CLIMATIC HEALTH KESOET OF WESTERN NORTH CAROLINA. 329

are costly, voluminous and not obtainable by private individuals,
who do not carry ou scientific pursuits on a large scale. We feel
confident that if such experiments were made, the same patient
would require a larger volume of air to make the same number of
respirations, or what is the same, to exhale the same amount of car-
bonic acid at a high altitude than at s?a level. This would plainly
show that the respiratory organ has to take in a larger volume of
air to satisfy its demands for oxygen, that it has to make deeper
respirations to obtain the same end than at sea level. The very
effect of these deeper respirations is a larger expansion of the
chest, and this can always be achieved in healthy people living at
high elevations. It is a known fact that the configuration of the
thorax of the inhabitants of the Cordilleras, of the mountain In-
dians in Mexico, of the tribes in Tibet, deviates very much from
what we are accustomed to see in our homes. The chests of natives
inhabiting these countries grow to such an extent, are so deep and
broad, that this alone signifies the larger evolutions the lung has to
make in order to supply the system with the necessary oxygen. Con-
ceded then that deeper respirations are required to enable the lung
to perform its normal functions in mountain districts, their bene-
ficial effects can easily be shown. Deeper inhalations expand the
lung and counteract its natural tendency to contract and collapse.
When we make a deep inhalation we conduct air to parts of the
lung into which the air with a common respiration does not fully
enter. We make air pass into the finest bronchioles and the alve-
oles, they gain in capacity, and if collapsed by disease, they will be
reopened and ventilated again. By a continuance of these respira-
tions, parts already consolidated and filled with the products of
chronic inflammation will finally be reached and be made accessible
to the air. Under these conditions obturated masses, even tough
secretions, the products of chronic catarrh, will be loosened and
removed. The great advantage of loosening the adherence of these
morbid masses, and finally freeing the lungs from them, is obvious,
H8 this is the first step towards a successful fight of the disease. The
circulation of the blood is also materially aided by the increased
expansion of the lung, the carbonic acid gas escapes more readily,
the blood in the affected lung can better divest itself of it, and
tissue change is indirectly promoted. If we can achieve by elevated

330 CLIMATIC HEALTH RESORT OF AVESTERN NORTH CAROLINA.

regions gradually to relieve the affected lung from morbid deposits,
and improve the circulation and tissue-change — points which we
endeavored to ]irove in the foregoing — we claim the right to state
that altitude is one of the important features of a climate which an
invalid should select for his abode.

It is with a certain kind of dread that wo ajiproach the subject of
temperature. All sorts of temperature have been advocated as
benefitting the consumptive., and to ennmera'e in detail all the dif-
ferent opinions and places claiming advantageous thermomctrical
conditions for invalids would swell this little essay to double and
trip'e its size. Stating briefly the well-known resorts that have been
recommended, as examples we will mention the dry and warm,
(Egypt;) dry and cold ones, (Minnesota ;) moist and warm ones,
(Maderia, Florida;) further equable climates with very small diur-
nal or annual change of the thermometer, (California,) and as justly
claimed, also climates with great range as not injurious on that
account, (Colorado and the AVestern Territories.) As said before,
only a limited number of instances are given, but it covers climates
of almost all descriptions; only one climate has to our knowledge
not been recommended, and that is a cold moist one. It is generally
asserted and rightly believed that cold moisture is dangerous to pa-
tients with pulmonary affections. We draw attention to this point,
that a population living in such a climate has for a long time been
represented as a type of immunity from consumpti n, and later and
more thorough investigation have found cold to the ijresent time
only a sporadic occurrence of the disease. These are the Icelanders,
near the Arctic circle. Of course, assuming that each advocate of
a climate is writing bona fide, it is obvious that the question is
rather a confusing one, which is only somewhat sifted by an exam-
ination of the results with patients. It is a laudable endeavor now
prevailing to publish reports of such results at different resorts
more or le s every season, and it can be seen that altogether any
climate with moderate temperature, without excessive degrees of
heat and cold, yield the best and longest lasting results. If a re-
gion has a few degrees more or less of heat or cold, a few degrees
more of diurnal range, it is in our opinion a very indifferent factor,
as we see invalids imjirove in climates showing vastly larger ther-
momctrical differences.

CLIMATIC HEALTH RESORT OF WESTERN NORTH CAROLINA. 331

To give the reader as near as possible an idea of the monthly
means and range of the thermometer at Asheville, we insert a copy
of a part of a meteoreological table, for which we are indebted to
Mr. E. J. Ashton, of this place, and which is made np from the
means of eight years.

'Table giving means and extremes of temperature and means of rain-
fall for every month from an average of eight years :

MONTHS.

MEAN.

HIGHEST.

LOWEST.

RAINFALL.

January

February

March

April

May

June

Julv

37.3
38.9
44.8
54.1
61. .5
69.3
71.9
70.9

m.v

5:?. I
43.9
37.3
53.8

67
69
75

m

86
87
90
88
86
81
72
72
90

3
4
i

30

as

5t
53
51
34

24
7
I

1

2.4

4.4

3.8

2.3

4.

4.1

4.6

August

September

October

4.8
2.3
2.

November

December

Kight years

2.8

2.7

40.2

If we take into consideration the well-known excessiveness of
climate of the Eastern portion of the United States, the above table
shows greater uniformity than any other mountain sections of this
country, also greater uniformity than places with the same annual
mean East of the Rocky Mountans. Eurther, places with the same
summer temperature (37.8 deg. mean of December, January and
February,) show lower extremes of cold, and such with the same
summer temperature (70.7 deg. mean of June, July and August,)
greater heat than Asheville. AVe must refer the more scrutinizing
investigator for substantiation of these data to the reports of the
Chief Signal Office at Washington, D. C, and to a pamphlet
'* Western North Carolina as a Health Resort," by Dr. W. Gleits-
man, a former resident here and a zealous writer on the climatology
of our section.

The chapter of humidity of the atmosphere is easier dispensed
with, as there is a general demand for dry air amongst the medical
profession as well as the public. Atmospheric moisture is usually
determined by the use of the wet and dry-bulb thermometers, and
from their difference the calculation is made. The usual waj to
speak of moisture is by naming the degree of relative humidity,
which is the amount of aqueous vapor contained in the atmosphere

332 CLIMATIC HEALTH RESOKT OF AVESTERN NORTH CAROLIN'A.

expressed in percentage, 100 degrees being full saturation. Rela-
tive humidity therefore only gives a relative idea of the moisture of
the air. The same degree of relative humidity will be felt naore
unpleasantly, by well and sick, when the temperature is high than
when it is low, as with the change of temperature the dew-point
and the actual absolute amount of moisture also changes. Air at
higher temperature holds more water suspended in a given vol-
ume of air than air at lower temperature, both having the same
degree of relative humidity. The only data of atmospheric mois-
ture for Asheville we could obtain were for the year ending June
30th, 1867, and the relative humidity for the period was 09. 1 per
cent. If we take 54 degree temperature as Asheville's annual mean,
and CO per cent, its relative humidity, we find about 3.9 grains
of aqueous vapor contained in a cubic foot of air, whilst with 09
per cent, relative humidity and 80 deg. temperature we have 9.9
grains vapor in a cubic foot. The amount of vapor the lungs exhale
with each respiration has been shown by physiological experiments
to be nearly the same whatever air we breathe. It is obvious that
more moistnre will be drawn from the lung, when we inhale an air
3.9 grains vapor, than one containing 9.9 grains vapor in a cubic
foot. If dryness of the air is therefore claimed for a place, we"
ought not to be satisfied with data of relative humidity alone, and
ought to extend our investigations to the absolute humidity before
we form a definite opinion. The almost general neglect of not con-
sidering the absolute humidity is in our opinion the only reason that
the climate of Florida could of late be called a not moist one, its
average relative humidity being about 70 per cent., with a few de-
grees varying more or less. This figure is not high, especially when
compared with European resorts, but its mean temperature being
high, the absolute amount of "\apor in the air is large. Where the
gray hanging moss, Tilhindsia,grows to any extent,a large amount of
moisture beyond doubt is contained in the atmosphere. The rela-
tive humidity, as well as the rainfall at Asheville, are less in the
colder months than in the warmer ones. The humidity for the
third quarter of the year 1870 was 82.4 per cent. ; for the fourth
1870, 05.1 per cent. ; first 1877, 61.7 per cent. ; second 1877, 07.1
per cent. The rainfall for the third quarter 1870 was 12 33 inches;
fourth quarter 3870, 5.91 inches j first 1877, 9.22 inches; and

CLIMATIC HEALTH KESORT OF AVESTERX NORTH CAROLINA. 333

second 1877, 23.93 inches; giving a total of 41 41 inches for the
year ending June 1877, which corresponds very nearly with E. J.
Ashton's table, 40.2 inches being the mean of eight years. From
these figures the greater dryness of the winter months is apparent,
and a natural consequence of this state of the atmosphere is a great
number of clear, cloudless days in winter. The effect of bright,
genial sunshine on invalids cannot be too highly valued. The natu-
ral beautiful scenery of this appears then in its full glory, and the
eye never gets tired looking at the variety of mountains towering in
a high continuous range from the South to the North, with a lower
range to the cast of Asheville. Our pen is not skilled enougji to do
just ce to the grand and romantic character of country ; many able
wriers have pictured and praised its winders. But the n)anifold
changes caused by different light and atmospheric conditions, espe-
cially the beautiful sunsets, only equalled in Italy, imbibe new
pleasure, new enjoyment even to the oldest. The variety of land-
scape is most apt to counteract the monotony of invalid life, which
otherwise grows more and more on patients the longer they remain
in any one place, liides in buggies or on horseback can be made in
great number in all directions, opening new outlooks. Several min-
eral springs are in immediate vicinity of the town, of which we
only mention a chalybeate spring not quite two miles from Ashe-
ville, and a sulphur spring five miles distant.

The important question of proper accommodations for invalids
can happily be answered in the affirmative. There arc five hotels
here, two of them capable of accommodating from 150 to 200
guests each. One of them has of la*o been thoroughly relntted and
supplied with modern conveniencea, electric bells, speaking tubes,
bath rooms, &c. The telegraph office is also located there. If pri-
vate boarding should be preferred, selection can be made amongst a
great number, as the inhabitants are anxious to make the invalid
comfortable and feel at home in their midst. The population is
extremely kind and hospitable, and ever ready to assist and help the
sick stranger, even with personal sacrifice. It is quite common to
have them send flowers and little delicacies to invalids, and it has
become almost a usage amongst the young men in town to attend
and nurse a patient who is unfortunate enough to be taken ill with-
out having a friend or relative with him.

334 MEDICATION BY SALICYL COMPOUNDS.

Access to Ashevillc has of late become very easy and quick. The
Western Nortli Carolina KailroaJ connect.^ at S.ilisbury, N. C, with
the large net of the Piedmont Air Line, and has its terminus now
at Asheville. The section of the railroad approaching the Blue
Ridge from the East presents certainly the most picturesque and
romantic scenery, besides the grandest railroad engineering on this
continent, being even not surpassed by European railroads, crossing
the Alpine Mountains. The train generally leaves Salisbury in
direct connection with the Piedmont Air Line. The same railroad
is being built and extended now down the French Broad river, and
has now reached the Warm Springs in Madison county and the
Tennessee line, facilitating the approach from the West. At
present peoi)le coming from the West have to leave the Tennessee
route at Monistown, Tenn., take the railroad to Wolf Creek, and
travel then through the beautiful valley of the French Broad by
stages to Asheville, 45 miles. Another railroad is in progress
towards Asheville from the South, leaving the Piedmont Air Tjine
at Spartanburg, S. C, and running at present as far as llenderson-
ville, 21 miles distant. Weddin & Bailey's stages convey passen-
gers with ease and comfort to Asheville.

If we have shown to the reader in this little essay that Asheville
deserves the reputation it has already gained as a health resort, and
that it can justly claim to offer unusual advantages to the invalid,
our labor will not be in vain.

MEDICATION BY SALICYL COMPOUNDS.

[From S(juibb's Ephemeris for May.]
The recent discussion by the IMedical Society of London on the
use of salicyl compounds in rheumatism, summarized in these
pages, brings forward anew two or three important points, which it
leaves unfinished. "More than a thousand cases of rheumatic
fever" were treated with salicyl compounds, embracing salicin ;
salicylic acid made by Kolbe's process, from carbolic acid ; salicylic
acid made from oil of wintergreen, and salicylate of sodium made
from Kolbe's salicylic acid. Toxic symptoms occurred in a

MEDICATION BY SALICYL COMPOUNDS. 335

considerable proportion of the cases treated with the Kolbe acid,
and with salicylate of sodium made from that acid ; but in the
large number of cases reported by Dr. Fowler, of Cambridge, where
the acid made from the oil of wintergreen was used, these toxic
symptoms were practically absent. This led to, or strengthened,
the inference that there were impurities in the Kolbe acid, which
produced these disagreeable symptoms. In The Pharmaceiiiical
Journal and Transactions of April Gth, JSTS, p. 785, Mr. John
Williams, F. C. S., shows conclusively that there is, or was at that
time, another acid occasionally or commonly present in the Kolbe
acid to the extent of 15 to 25 per cent,, and that this acid formed a
contaminating sodium salt. In the subsequent discussion of the
subject this acid and its sodium salt were very generally believed to
be the sources of the toxic symptoms.

The experience in this country has, in a desultory inexact way,
confirmed this, although within this writer's observation it has been
sometimes difficult to decide whether the toxic symptoms were due
to over-dosing, or to the contaminating acid. As a rule salicyl com-
pounds are rapidly eliminated, and, therefore, the effects are of
comparatively short duration. This p int has been too much over-
looked in the use of these compounds, especially in Great Britain.
It leads directly to the necessity for moderate doses frequently re-
peated. The English practice as deduced from the la'e discussion
seems to have been to give from GO to 180 grains in the twenty-four
hours, divided into three or four doses, occasionally in six doses,
and still more rarely in eight doses. In this country the best
practice seems to have been in better conformity to the rate of elimi-
nation, for it is common to hear of its use every twenty-four hours.
The doses of either the acid or the sodium salt are perhaps usually
twenty grains at first. Then fifteen grains until the i)ain begins to
abate, and then ten grains or less, but always with frequent repeti-
tion. Such practice would indicate that somewhat less of the med-
icine is used in a given case, but in larger doses at first, and always
more frequently repeated. The acid, however pure, is more apt to
disturb the stomach primarily than the sodium salt, but in equiva-
lent doses they seem equally liable to produce perversion of the
special senses and delirium. Ringing in-' the ears seems to be for
salicyl compounds, as for quinia, the indication of saturation, or of

336 MEDICATIO]!^ JiY SA.LICYL COMPOUNDS.

full physiological effect. Next comes disturbed or perverted vision,
and finally delirium. If, as with quiuia, the dose be reduced on
the first appearance of ringing in the ears the other symptoms will
not occur, and the medicine need not be suspended. The parallel-
ism with quinia, strychnia, atropia, etc, is also noticeable in the
circumstance that when the full physiological effect is reached,
larger or more frequent doses are hurtful or toxic, aiid of still more
importance the circumstance that the full physiological effect is
reached in different persons by widely different quantitie?. This
latter consideration is so often neglected in therapeutics that the
stated doses of medicines are not regarded simply as quantities to
begin with, but are carried from patient to patient, and throughout
case after case without regard to differences in individual suscepti-
bility, and individual rates of elimination. If in two persons
equally susceptible to a medicine — say salicyl compounds — the rate
of elimination be different, either naturally or temporarily, the
same full physiological dose will in one case be therapeutic only,
while with slower elimination it will be cumulative until a toxic
explosion occurs.

Hence io any consideration of the toxic effects of salicyl com-
pounds, it is manifestly unsafe to charge them all to impurities in
the medicine, when idiosyncrasy brings into operation two other im-
portant causes of similar effects, namely different susceptibility and
different rate of elimination, under which condition the moderate
or small doses of one case become excessive in another.

While then it may be fairly assumed, that in a proportion of the
cases when the medicine had to be suspended on account of toxic
effects, these were due to over-dosing, yet still a very large propor-
tion may be as fairly attributed to the contaminating acid.

In some rather roughly made observations on the subject, soon
after Mr. Williams' paper was published, the writer came to the
conclusion that the contaminating acid was most largely present in
the extent of more than six to eight per cent., and farther that sub-
limation freed the salicylic acid from this contaminating acid.
Within the last two years, however, the markets have been supplied
for those who chose to pay for it, with a well chryetalizsd acid,
which does not contain more than three or four per cent, of all im-
purities. Such an acid is all that can be needed for medical uses,

MEDICATION BY SALICYL COMPOUNDS. 337

and is quite as pure as any made from oil of wiotergrecn and any
toxic effects from such an acid, or from the sodium salt made from
it, must be due either to idiosyncrasy or mismanagement. A well
made sodium salt from such an acid is always white, butafter being
shut up long in a battle, is liable to have a faint odor of carbolic
acid. This, however, should be so faint as only to be perceptible
on close examination, and should not be perceptible after exposure
to the air for a time, nor in the solutions.

The salicylate of sodium having now pretty generally, and very
properly superseded both salicin and salicylic acid for medicinal
uses, it becomes quite important to know when it is of good quality.
This is the more difficult because its appearanc3 and sensible prop-
erties are no indication, and because any chemical examination
or testing in order to be conclusive must be elaborate and trouble-
some. It is made by the careful saturation of a solution of a pure
cu'brnate of sodium with good salicylic acid, and the evaporation
of the solution to dryness by a carefully regulated heat, with con-
stant stirring. The process, though not difficult, is tedious and
troublesome, and, therefore, with the proper skill is rather expen-
sive. The salt is never used in substance but always in solution,
and, therefore, when redissolved all the trouble and expense of the
drying process is lost.

Therefore, as salicylic acid is much more easily judged both by
appearance and by tests than salicylate of sodium, and is much
ejsier to get of assured quality, it is far belter to save all risks of
impurities and expense by making the solution for use as wanted.
That is, each pharmacist or physician should make it for himself
extemporaneously as \vinted.*Several formulas have been published
by which to do this, but all have needed the detail necessary to
those who might not be accustomed to such work.

Each 100 parts or grains of medicinal salicylate of sodium con-
sists of about 89 of the acid and 11 of the sDdium, both elements
taken as hydrates and the average dose of the salt to begin with,
or to test the susceptibility of a patient with, is say 20 grains every
two hours. The average case of acute rheumatism will, perhaps,
require the U33 of tiie salicylate for say fifteen days, at an average
of say 80 grains a day, or 1,200 grains in all, consisting of 1,070
grains of the acid and 130 grains of base. This is best made up by

338 MEDICATIOJf 15 Y S.VLICYL COMPOUNDS.

using an ounce bottle of salicyl'c acid at a time, about 3j ounces
being needed to the average case. The ounce bottle of acid will
contain about 437 grains, and this will require about 270 grains of
bicarbonate of sodium and will yield about 490 grains of the salicyl-
ate of sodium. A very convenient solution is one which contains
10 grains in each fluid drachm, and of such a solution one avoirdu-
pois ounce of acid would make six fluid ounces and one fluid drachm
— say six fluid ounces. This is easily and quickly made by the fol-
lowing formula :

Take of salicylic acid, well crystalized, 437grains=28.32 grammes.

Bicarbonate of sodium, 270 grains^l7.5 grammes.
Water, fi-ee from iron, a sufficient quantity.

Put the acid into a vessel of the capaci'y of a pint, add four
fluid ounccs=120 c.c. of water, stir well together and then add the
bicarbonate of sodium in portions with stirring until ihe whole is
added and the effervescence is finished. Filter the solution and
wash the filtei through with water until the filtered solution meas-
ures six fluid ounces or one hundred and eighty cubic centimetres.

This solution contains 18 grains=0.G5 grammes of the medicinal
salicylate of sodium in each fluid drachm=3.75c.c.

If made from good materials, the solution before filtration is of a
pale amber color, but as most ordinary filtering paper contains
traces of iron, the filtered solution is often of a deeper tint. Owing
to the varying proportions of hygrometric moisture in the materials,
the'solution may not always be perfectly neutral, but it must be
very nearly so, and quite near enough for all practical j)urposes,
as both ell ments are medicinal in the same direction. When the
alkaline base is in excess, however, the solution soon becomes of a
much deeper color. The carbonic acid (carbon dioxide) present in
the solution is not only of no disadvantage, but is a positive advan-
tage, since it improves the taste and renders the solution more
acceptable to the stomach. It however interferes with the testing
by litmus paper for the neutrality of the solution, unless the moist-
enod paper, both blue and red, be expose 1 to tlie air a shoit time
before judging of the coloration.

In this way an ounce of crystalized salicylic acid costing say- 25
to 30 cents, and the bicarbonate of sodium costing less than one
cent, will make about 480 grain3=31.1 grammes, or l.l avoirdupois

PARASITIC CAUSES OF AN.T.MIA. 339

ounces of the salicylate, and any physician or pharmacist can make
the solution.

In common with other bitter and nauseous salines it is best taken
simply diluted with ice-water. A moutliful or two of ice-water
before and after the dose to blunt the sense of taste, and the dose
between them in the proportion of about two fluid drachms of the
solution in a wine-glass full of ice water, renders it easily taken by
most persons. In acute cases it should be taken every two hours at
first, or in urgent cases every hour, until very moderate saturation
occurs. Then the dose should be diminished before the intervals
aie lengthened, and finally the intervals should be lengthened first
to three hours, and then to four hours, but it should not be omitted
until the usual time and risks of relapse are past. In chronic cases
one fluid drachm of the solution every two or three hours during
two or three days will probably do all that the medicine is capable
of, if the patient have the ordinary susceptibility, but it cannot
fairly be said to have failed until the full physiological effects have
been obtained without abatement of the symptoms.

Parasitic Cause of An.emia. — The anaemia of the workmen
in St. Crothard's tunnel is due, in a great degree, to the presence of
intestinal parasites — anchylostoma duodenale — and that the parasite
is identical with the one (Bilhargia) which causes such intense forms
of pernicious anemia in Egypt. Griesinger found that oil of tur-
pentine and calomel were necessary to cause the expulsion of the
parasite, before a course of iron was available to overcome anaemia.

Anchylostoma duodenale is a round worm, having the power to
pierce the intestinal wall. It infects chiefly the lower part of the
duodenum and jejunum.

It would be well to be on the lookout for this parasite in the
Southern States as many cases of anremia caused by it arc mistaken
for malarial anaemia, it is possible it may be so in the South.
ZiemsscQ gives a full account of the parasite in ('yd. Prac. Med,,
Vol. 7, p. 777.

340

REVIEWS AND BOOK NOTICES.

The Puysician Himself and What he Should add to the
Strictly Scientific. By D. W. Cathell, M. D. Baltimore:
Cushings & Bailey, 1882. Pp.194. Price 11.50.

This is a veritable medical Talauul ! There is a great deal of
worldy wisdom in this volume, and much of it accords so readily
with the experience of the elder practitioner, that it seems like the
utterance of truisms; but to the junior practitioner it will reveal
valuable knowledge. The doctor who starts on his career knowing
and practicing the ethical and business maxims here recorded, would
be saved many a false step, and the doctor who attempts to go on
with less, will eventually have to pay dearly for his experience. The
trouble is, however, that the young practitioner for whom such a
book would be a wise counsellor, is generally too elated with his own
knowledge to condescend to read it, and the old practitioner whose
ways are too fixed to be altered, would only read it to compare it
with his own experiences.

We must take issue with the author in one matter: He says that thi
law recognizes all kinds of doctors — Thompsonians, Eclectics, real
Homoeopaths and bogus Ilomcoopaths, the Any-way-you-choose and
the Ilydropaths, Indian doctors and mid wives precisely as it does
the regular profession, and if you ever hold a public position you
will have to recognize them all ofiicially, therefore " This necessity
renders State Medical Laws and State I^oardi of Examiners, organ-
ized to break up quackery (?) and prevent malpractice ? of vcrj/
doubtful utility."

Our deductions would be exactly the reverse of this. State
Boards of Examiners are necessary to compel the State if need bo
to recognize that educational qualifications alone enable a man call-
ing himself a physician, to make a reliable certificate. State Boards
of Examiners are very useful in suppressing quackery, and mal-
practicing by demanding of the medical man just on the tiiresh-
hold of his profession what preparation he has for undertaking
such a responsible calling. State Boards ef Examiners are neces-
sary because the professional faculty hold just such dangerous views
as are held by Dr. Cathell, and it has become a great necessity for
States to defend themselves against the results of such teachings.

REVIEWS AND BOOK NOTICES. 341

The rejections by the North Carolina Board of Examiners of cer-
tain graduates would indicate very clearly that his view was enter-
tained to a considerable extent in his own city, and elsewhere.

AYe are sure that the author when he comes to a revis'on of the
second edition will rectify the numerous errors.

LEf;oN DE Clinique TiiERAPEUTiQUE. Professees a I'llupital
Siint Antoine. Par le Docteur Dujardin-Beaumetz. Octave
Doin, Editeur. Paris: 1880. VIII. Pp. 900.

Clinical Lessons in Therapeutics. Djlivered at the Ilos^.ital
S.iint Aitoine by Dr. DuJARniN-BEAUiiETZ. Published by
Octave Doin. Paris: 1880.

Among the leaders of therapeutics of ihis generation, must be
reckoned the distinguished author of this work — Physician in Chief
of the Hospital St. Antoine, Editor in Chief of the Bulletin de
TJii'vapcutique (the oldest and most influential journal of thera-
peutics in the world), Dujardin-Beaumetz has been successively
Interne of the Hospitals, (1858) Laureate of the Hospitals, (1801)
Laureate of the Faculty of Medicine, (18G1) Clinical Chief of the
Faculty, (18GG-GT) Laureate of the Institute (1880) and Member of
the Academy of Medicine, (1880). lie has written several prize
theses which possess rare merit ; his tliese (Vagregalion on acute
myelitis, contains much that is original, and has become a medical
classic. As an original experimenter, Dr. Dujardin-Beaumetz has
accomplished much, and no one can read the stout octavo volume
'•' On the Toxic Power of the Ale jhols" which he has lately pub-
lished, and in which he details many hur.dred experiments on ani-
mals which he has made, in conjunction with Dr. Audege, without
feeling that we are already fast obtaining the data for au exact
science of medicine. Towards this devoutly wished consummation,
other of Professor Beaumctz's labors have contributed. We in-
stance the following memoires : "Researches Respec iiig the Me-
dicinal Use of Phosphorus," 18G8 ; "Researches Concerning Sub-
cutaneous Injection?," 1870 ; " Studies Res])ecting the Physiologi-
cal and Therapeutical Effects of the Compounds of Ammonia,"
1873 ; " On the External Application of Chloral and Meta-Chloral,"
1873 ; "On Intravenous Injections of Water in the Treatment of
Cholera," 1873 ; "Study Concerning Boldo,"J874; "Researches

343 REVIEWS AND BOOK NOTICES.

♦

OQ the Action of Ailanthus GUindulosa," 1874; "Oa Apoinorphine,"
IS74 ; "■ On the Action of Phosphiitcs of Lime," 1875 ; " On Ferru-
ginous Medication," 1870; "Action of the Salts of Cicutice," 187G;
etc., etc. We slioulJ, perhaps, have mentioned valuable data which
this earnest investigator has furnished, respecting the action of
ergot and ergotininc, drosera xotundifolia, pelletierine, gelseminm,
&c., but we have said enough to indicate the fitness of Dujirdin-
Beaunietz to produce a work in therapeutics which shall be worthy
of wide welcome, and whicli thall be fruitful in practicil sugges-
tions to the hoary headed medical professor as well as to the inex-
perienced junior practitioner.

The work before us consists of tlireo parts. The first comprises
the " Treatment of Diseases of the Heart and Aorta," the second,
"Treatment of Diseases of the Stomach," tlie third, "Treatment
of Diseases of the Intestines."

ui propos of the title " Cliniquc Tlierapeutique" which the
author has affixed to these lessons, he makes this explanation :
" When we study Therapeutics properly so called, we pass in review
the different articles of the Materia Medica and learn their natural
history, their physiological properties, their dosage, and the differ-
ent applications recommended in the treatment of diseases; all
this is purely theoretical ; it is like commencing the study of
Practice of Medicine and Surgery by learning all about diseases,
their progress, symptoms, &c., from text-books. Now in order that
Therapeutics, like Pathology may become a practical science, useful
and productive, the theoretical notions acquired must be applied to
the sick person, and just as Clinical Medicine is the study of the
modifications which different organisms impose on the march of
morbid affection?, so also Cl'nical Therapeutics enables us to note
the deviations from the precise laws formulated by Materia Medica
which living beings exhibit." P. 2.

A great amount of scientific research isenibodied in these lessons.
The profusion of foot notes is sometimes appalling. The labors of
English and American co-workers in science are generally, perhaps
not sufficiently recognized.

I. Diseases of the Heart. Seven lessons are devoted to the study
of treatment of these diseases. The author shows the importance,
from a therapeutical standpoint, of dividing the hcart-aflfectiona
into diseases of the mitral and diseases of the aortic valves.

REVIEWS AND BOOK NOTICES. 343

As for mitral diseases, the treatment is summiirizod in the eo-
doavor to fulfil the following imlications : first, to make the heart
equal to its task, second, seems to combat the fatty granular degen-
eration of this organ.

In the chapter devote! to "Tonicdof the Heart," much space is
devoted to digitalis and the methods of its administration ; in the
estimation ol the author, digitalis is the heart tonic par cxccUencc.

A projjos cf dropsies, a classification of diuretics is given, and
passive congestions of the dilTerent viscera are studied.

As for the aortic diseases, he advises the use of the preparations of
opium, and devotes several pages to the study of nitrate of amyl,
which he thinks may render important service in aortic insufficiency
by favoring de'erminations of blood, and thus Tghtening the task
of the heart.

II. Trecitment of Aneurisms of the Aorta.— ThxcQ lessons are de-
voted to the treatment of these aneurisms. After a brief review of
the usual remedies, he discusses the application of electrolysis to
these aneurisms. Dr. Dujardin-Beaumetz, by the way, was the
first in France to treat aneurisms by electro-punciure. He has
given in this volume the details of twelve cases, operated on by him
since 1877, and from his experience thus far is able to speak confi-
dently of the advantages of electrolysis in aneurisms of the aorta.

III. Treatment of Diseases of the Stomnri. — We have fifteen
lessons on this subject, in which the therapeutics of the dyspepsias
are treated at length. The author emphas'zes the importance of
alimentary hygiene, (five lessons) gives the most recent data of ex-
perimental physiology, and endeavors to bring these data into
agreement with the dietetic rules formulate!.

The dyspepsias are divide 1 into several groups, the ba^^is of his
classification being the function of the par:; principally affected.
Thus, the muscular and mucous coats and the innervation of the
organ may be modified in their functions in three different ways :
by exa^Tgeration, by diminution, by perversion of their function. On
these data he founds his classification of putrid dyspepsia, acid and
pituitous dyspepsia, (mucous coat) ; atonic and flatulent dyspepsia,
and vomiting, (muscular coat) ; and lastly the neuroses of the
stomach.

In another chapter intestinal dyspeps'a and secondary dyspepsia

344 REVIEWS AND BOOK NOTICES.

arc treated. A wliolo chapter is given to the study of dyspepsia of
the lew born.

A propos of these dyspepsias, the author advises a medicament
which has hardly yet been applied to tiiese all'eclions, viz : dextrine,
the peptogcnous qualities of Ijiis substance rendering it especially
useful in dyspepsia from 'deficiency of gastric juice.

Ulcer and cancer of the stomach arc treated in Lesson XV. lie
recommends chloral in these ctses for its topical efTect, in consid-
eration of the antiseptic, a^ also the anjBJthetic and anodyne prop-
erties of this drug. Here he avails himself of the results of an
interesting series of experiments of his own.

IV. Treatment of Disecises of the Intestines. — Here wo find six
lessons : constipation, intussusception, (and other causes of obstruc-
tion) diarrhoea, dyicntery arc successively treated of, and a chapter
is devoted to purgatives and their ther;ipeutic action.

All these lessons, taking their point of departure, not fram the
ri-medy but from the patient, are completed by very extensive noces,
which furnish, a 2)ropos of e ich medicine, the most recent data of
science respecting them. E. P. IL

TiiE Names of IIerbes in Greke, Latin, Entglisii, Ducii and
Frenciie wytii the Commune Names that IIekbaries and
Apoticaries vse. Gathered by William Turner, A. D., 1548.
Edited by James Britten, F. L. S. London : N. Triibner &
Co. 1881. Pp. 134.

The English Dialectic Society has given us a reprint of a rare old
book tha^- will serve a good purpose for students of botanical syno-
nyms and also to show the condition of medicil botany in the IGth
century. It has rarely been accessible until now. An original
copy is to be found in the L'brary of the .Surgeon-General.

Tlie author's commentary in liis own work shows how closely
botany was related in the olden time to the healing art as then
practiced. lie says :

'' Thys litlc boke coteineth the names of the moste parte of
herbes, that all auncient authors write of both in Greke, Lattin,
Englishe, Duche and Erenche, I have set to also the names whiche
be comonly vsed of the poticaries and comon herbaries. I have told
also the degres of so many herbes as Galeno the Chiefe Doctour of

REVIEWS AND BOOK NOTICES. 345

al pbisicians hath written of, and because men should not thynke
that I write of it that I never saw, and that poticaries shoulde
be excuselesse when as the ryghte herbes are required of tlie, I
have showed in what places of Englande, Germany and Italy the
herbes growe, and maybe be had for laboure and money, whereof I
declare and teache the names in thys present«.treates. AVhich howe
profitable it shall be vnto al the sicke folke of thys Realme, I re-
ferre the matter vnto all them whiche are of a ryght iudgemet in
phisicke."

The account given of plants would hardly be satisfactory to the
medical student hungry to learn materia medica. For example :

" Ricinus. — Ricinus is called in Greeke, Cici or Crotoon, in Eng-
lish, Palma Christi, or ticke sede because it is lyke a tycke, it is
called in Duch, wunden baume, kreutz bautne and Zekken corner,
in French, Palma Christi. It groweth only in gardines that I have
setn."

Such is an example of the humble beginning of materia medica
in England.

The Incidental Effects of Drugs : A Pharmacological and
Clinical Hand-Book. By Dr. L. Lewin. Translated by
W. T. Alexander, M. D. New York : William Wood & Co.

1883.

We are pleased to be able to notice two foreign books on thera-
peutics from the two great schools of medical teaching, France and
Germany. There is no real parallel, however, between the two
books discussed, as the German now under our notice only essays
'* the incidental or accidental, or unexpected effects of drugs." We
delayed this notice purposely, because of the announcement by Mr.
Geo. S. Davis, of Detroit, that he would issue in a few months the
same work, with the latest revision of the author.

At flrst sight the field undertaken by the author is not sufficiently
extensive to warrant the production of a book of 235 pages. He
begins with the assumption that it is of far greater importance for
the physician to know the incidental effects of drug?, than the non-
occurrence of a normal drug effect. For instance, the administra-
tion of quinine is not uncommonly followed by the appearance of a
polymorphous exanthema, or, in very rare cases, intense effects upon

346 REVIEWS AND BOOK NOTICES.

the organs of vision, manifested by permanent amaurosis. For
these different anomalous symptoms produced by drugs, the Ger-
mans employ the term " Nebenwirkungen," &c , &c.

The author has not confined himself to the consideration of tiio
accidental or unusual efifects of drugs, but has introduced here and
there a new remedy. .But there are some unusual effects noticed
by him that will be considered rare by most practitioners. For in-
stance he sounds a warning against Colombo root* a drug long ago
settled in its position as a simple astringent bitter tonic, of feeble
power. He says that Colombo contains berberine, and a little
crystalline substance called Colombine. He quotes Kohlcr as ex
periencing from it in his own person, nausea, repeated vomiting,
pain in the epigastrium, and finally unconsciousness, after the sub-
sidence of which, a condition resembling a debauch remained.

We need not be incredulous ab )Ut these statements, in face of
the fact that greater care in the preparation of old remedies, and a
renewed study of their therapeutical properties, has of late years
rjvcaled to us a species of knowledge of scarcely less value than the
sum of all our therapeutical knowledge at the time when the clini-
cal method was alone employed in therapeutics.

We must take issue with the author in his declaration, that Vir-
chow first enunciated the axiom that "Certain substances have affin-
ties for certain parts of the body," for this idea, as inaccurate and
unproven as it seems to us, has possessed the minds of therapeutists
from the earliest times.

Flores Arnicce. — In endeavoring to explain the vesicating proper-
ties which sometimes follow the external application of arnica
flowers, we do not think Dr. Lewiu's reasons for it are so rational
as those given by Dr. Piffard. The latter gentleman says that the
vesicating property some time observed is due to the presence of
minute insects which infest the flowers. For this reason he pro-
poses the employment of arnica root.

It is also a little singular to note that Leube "saw an urticaria
appear after the administration of 3 i of salicylate of sodium,"
and very recently we applied the same remedy for the cure of urti-
caria, successfully, upon the theoretical ground that the drug pro-
duced alkaline sweating.

The tumerous references given in the foot notes must be of value
to the students pursuing similar line of enquiry.

REVIEWS AND BOOK NOTICES. 347

Dr. Lewin's book in short is a review of recent therapeutics, with
especial reference to the out-of-the-way effects of drugs, and sug-
gests many valuable thoughts, and points out many rare phenomena,
v/hich will be of practical use to the busy practitioner.

As we may have occasion to return to this author when the vol.
ume in press by Mr. Davis is issued, we refrain from saying more.

A Study of the Tumors of the I^ladder with Original

Contributions and Drawings. By Alex. W. Stein, M. D.

New York : William Wood & Co., 27 Great Jones Street. 1881.

Pp. 04.

This is a well prepared treatise on the subject of tumors of the
bladder, containing some valuable original research, and a com-
plete bibliograph}', we judge, covering as it does five pages of refer-
ences from 1740 to 1881. The illustrations are good, and instruc-
tive, and upon the whole we do not know where one could go to get
so much desirable knowledge, of these somewhat rare affections, as
to this book.

Materia Medica and Therapeutics. Inorganic Substances.

By Charles D. F. Phillips, M. D. Edited and Adapted to the

IT. S, Pharmacopoeia by Laurence Johnson, A. M., M. D.

Volume 1 and 3. Xew York : Wm. Wood & Co. Pp. 298, 300.

We had occasion to notice (Vol. 4, p. 208, 1879,) the volume on
organic materia medica. This is a continuation of the same work.
In arranging these volumes, the author has thought it best not to
separate pharmacology and therapeutics, but to study them simul-
taneously, and in order more clearly to elucidate his subject, he has
given unusual attention to pharmaceutical chemistry.

A good idea of the method of subjects may be learned by reading
the article on phosphorous. This substance has been prominently
in the hands of manfacturing pharmacists for the past ten years,
and these enterprising firms have made the most of the subject.
Pamphlet after pamphlet has been issued by these gentlemen, to in-
doctrinate the profession into the mysterious effects of pure phos-
phorous upon the brain and nervous system. We have here twenty-
three pages devoted to its preparation, physiological and therapeu-
tical action, and it betokens a degree of sober reasoning, endorsed

348 REVIEWS AND BOOK NOTICES.

by practical experience, calculated to strike any reader with the
general reliability of the author. It appears to us that his faults
chiefly consist in placing too much confidence in authors that other
therapeutists have not been able to admit as reliable. His strong
point is in his own way of expressing the action and value of a
medicinal substance.

Dr. Phillips' work has been favorably received in his own country,
(England) and notwithstanding the fact that we have numerous
recent works on the same subject, this one will be none the less
esteemed. Although all systems of classification have serious
points of objection, we think the general reader would have been
better pleased, if our author had .-.dopted some system of classifi-
cation, or at least have arranged his subjects alphabetically.

Sanitary and Statistical Report of the Surgeon General
OF THE Navy, for the Year 1S80. Washington : Govern-
ment Printing Office. 1883. Pp. 468.

The interest for the general reader, in this volume, will centre
upon the sanitary investigations undertaken at the Washington
Laboratory. The analyses and examinations of a scientific charac-
ter give promise of valuable additions to our knowledge ul methods
of investigation.

The microscopic examination of the air is handsomely illustrated
by photypes by Gutekunst, and consist of ten plates potraying salts
of fat-acids from in-door, and bed-room air, fat-crystal from epi-
thelium, crystal of calcium butyrate, fungus spores, bacteria, leaf
hairs and pine pollen, (the latter the poorest of them all), and spore
of a pollen common in the uir dust of late summer and found in
large quantity in the secretions of hay fever.

The aggregate reports of the medical officers from the numerous
stations all over the world, are valuable contributions to medical
geography. The practice of liygienics is a study to which the med-
ical corps of the navy especially direct their attention. The prob-
lem of living in narrow and confined apartments and at the same
time preserving the air fresh and sweet, is the ever recurring prob-
lem if we are to judge by the reports of the surgeons. We also
githcr that very few vessels in the navy have adequate ventilation,
notwithstanding the scientific light the surgeons shed upon the

REVIEWS AND BOOK NOTICES. 349

sanitary construction of ships. We presume it is in the navy as it
is in towns, the doctors woik out the scientific problems, and
attempt to indoctrinate with them those supposed to be the most
inteiested, and the financial managers put a quietus to the whole
matter by pronouncing the plans impracticable or too expensive.

The sanitary student will get much valuable instruction from this
volume, and we recommend it to all such.

A Practical Treatise on Diseases of the Skin. By Louis

A. DuHRiNG, M. D. Third Edition. Revised and Enlarged.

Philadelphia: J. B. Lippincott & Co. ]8S3. Pp. 085.

Only a few years ago and American dermatology had no existence.
Every book we consulted for skin diseases was either of English, or
(rarely) German or French origin. Now the former old favorite: —
Wilhin and Willan and Bateman and Wilson, and even llebra, —
are fairly eclipsed by American work:?. The high esteem in which
the volume before us is held, may hi estimated by the fact that a
new edition has been called for in the short space of sixteen months,

AVe have nothing but praise to bestow upon Dr. Duhring's work,
and taken together with the handsome atlas to compltte the picto-
rial diagnosis, nothing more could be dcoired.*

The author has embraced the opportunity of a new edition to
re-write the chapter on the anatomy of the skin, and to introduce
valuable therapeutical matter, drawn from bis large experience.
The publishers have executed their part of the work handsomely.

Dr. Squibbs' Ephemeris of Materia Medica and Pharmacy,
Therapeutics and Collateral Information.
We take this method of thanking Dr. Squibb and his sons, for the
E2)liemeris sent us. Xo apology is duo for printing and distributing
without price, a pamphlet that contains in one issue more sound
and valuable information than most medical journals are able to
sive.

*VVe might make this exception, that sonic insight into tlie skin diseases of ne-
groes would be necessary to complete tliis or any Work. The Southern practitioner
has to take very much for granted in diagnosticating skin diseases among this race,
but aside from the difficulty of mastering these diseases, the negroes are not yet
sufficiently profitable patients to enlist the Investigation of students of derma^
tology. It is an unexplored field In which dermatologists might achieve great
distinction.

350 KEVIEWS AND BOOK NOTICES.

In this issue the discussion of the " New Code of Medical Ethics"
is logical, frank, honorable, and incisive. It includes the history
of the motive of the movement, and points out the element of
suicide which the new code contains.

The article on the Salicyl Compoiuuls we print entire for the in-
formation of our readers.

Although Dr. Squibb stands at the head of the manufacturing
pharmacists in America, and makes for sale a large number of
preparations of tiie most reliable character, not one word is said
about them either by way of advertisement or in a quasi-scientific
way. Our readers can therefore appreciate our expression of admi-
ration for the work Dr. Squibb is doing for the pharmacal and med-
ical profession. AVe trust that long years of vigor of body and mind
are in store fur him, and that his Ephemeris may keep the pace it
has begun. Tiiere is but one Dr. Squibb in America !

Clinical Lectures on Diseases of the Urinary Organs.
Delivered at University College Hospital. By Sir Henry
Thompson. Sixth Edition. Philadelphia : P. Blakiston, Son
& Co., 1012 Walnut Street. 1882. Pp. 175. Price To cents.
The American publishers have imitated the English, in bringing
out a cheap edition of this excellent work, and thereby placing it
within reach of the st ngiest or most impecunious of the medical
profession. Who is able to forecast the outcome of the experiment
of putting the very best works in science, romance and poetry in
the handj of the people ? Kobinson Crusoe, Vanity Fair, Gulliver's
Travels, for ten cents ! and an illustrated medical work by a famous
surgeon for 75 cents ! Not long ago we were luxuriating in 20
sumptuous volumes of Ziemssen's Practice at five dollars a volume!
now for |!7.20 a doctor can get 3525 pages of sterling reading mat-
ter, substantially bound in cloth. These great literary advantaged
ought to be equal to a post-graduate course for those who are will-
ing to read and think for themselves.

As for this volume on Urethral Surgery it is enough to announce
its authorship, without any other approval, for Sir Henry Thompson
has been an acknowledged master in this branch of surgery for many
years. The five chapters on the early history of calculus, and its
medical and surgical treatment, are exceedingly entertaining and in-
structive, and are alone worth ten timea the price of the volume.

351

CURRENT LITERATURE.

REPORT OF CASES OF EXTENSIVE FRACTURE OF NA-
SAL BONES TREATED BY A NEW METHOD.
By Lewis D. Masox, M.D., Surgeon to the Long Island

Hospital.

Case /.—John Grady, aet. 14, U. S. school boy, on April 5, 1880,
fell from a wagon, striking upon his forehead and face, sustaining
in addition to contused and lacerated wounds of forehe:»d and up-
per lip, a compound and comminuted fracture of nasal bone, with
fracture of nasal processes of sup. maxillae. He entered the Long
Island College Hospital for treatment the following day, April Gih,
and was seen by Prof. Wight, then on duty, who requested Dr.
Mason to take charge of the case and perform his special operation
for fractures of this class.

The patient was etherized, in the presence of the medical class
and the resident sfaff of the hospital. A careful inspection of the
fractured bones was made. The nasjl processes of both superior
maxillje were involved. The line of fracture of left was near the
base of the processes, on the right side near its middle. The bridge
was very much depressed and flattened. The right nasal bone was
lateralized to the right, and made a small puncture through the
tkin on that side. There was considerable oedema of eyelids, and
the face was somewhat puffy. Viewed from either side the deformity
was very greaf, the end of the nose seeming to be at right angles to
the depressed bridge.

After elevating the depressed fragments, and overcoming the de-
formity as much as possible, in the usual manner, Dr. Mason passed
an ordinary surg'cal needle (ground to a drill point) through the
line of fracture on either side, thus supporting the nasal arch.

To complete the dressing and give it further stability, a piece of
thin rubber about half an inch wide was slipped over the head and
point of the needle, and rendered moderately tense, so as to exert a
gentle compression. Small pieces of cork were placed on the head
and point of needle to protect the face.

The patient was placed in bed, bead slightly e'evated, and

353 FRACTURE OF NASAL BONES.

evaporating lotions of an agreeable temperature applied to face and
nose over the dressing.

With the exception of some suppuration from the wound upon
the forehead, cedema of face, and a smart secondary hemorrhage
from coronary artery of upper lip, the case progressed favorably
unt 1 the eleventh day, on which date the needle was easily removed
without an ana?athetic, and without pain to the patient. At this
date there is a slight ulceration at the seat of needle punctures, but
of so tlight a character that the cicatrix, if any, will be scarcely no-
ticeable.

The contour of the nose is excellent over sight of needle, a slight
periosteal thickening renders the bridge of noFC a line or so too
prominent, but this is observed on close inspection, and will un-
doubtedly in due time be absorbed.

At no time subsequent to the operation was there any pain or un-
comfortable sensation at the seat of the needle. Nor did its remo-
val cause any suffering. The result may be said to be perfect.

The boy remains in the ward for future observation, and has re-
covered entirely from his severe fall.

Case II. — C. B , U. S., set. 27, truckman, was brought to the
Long Island College Hospital, Nov. 29th, 18S0, for treatment. He
had fallen from the seat of his truck some eleven feet upon the
pavement. He was intoxicated at the time. The force of the fall
was received upon his face, producing a comminuted fracture of the
nasal bones, and also fracturing the nasal processes of the superior
maxillae, There was also a lacerated wound of the right inner can-
thus, and a contused and lacerated wound of the forehead. The
usual complication of serous intiltration of the tissues was present
in a marked degree, but not enough to completely mask the de-
formity, flattening of the bridge being quite apparent. A probe
introduced into the superior meatus demonstrated that the space
was encroached upon by the broken fragments. Marked crepitus
with free lateral motion of the nasal processes was present. The
depressed bridge was elevated in the usual manner, care being taken
to restore the full calibre of the superior meatus by later'al, as well
as forward pressure of the probe. The restoration was easily
effected, the contour of the bridge being readily traced with the
finger. As no especial line of fracture could be determined, owing

FRACTURE OF NASAL 150NES. 353

to tlie extensive comminution and swellinc^, the needle was passed
as nearly as possible through the base of the nasal processes between
the comminuted fragments, not meeting with any resistance. A
ribbon of thin rubber was passed over the nose, made moderately
tense, and the ends fastened to the point and head of the needle by
puncture. Over all a cloth wet with evaporating lotion was applied.
An ana?3thetic was not necessary during the passing of the needle,
the patient being in a state of partial alcoholic coma. The needle
was withdrawn about the tenth day following the operation. Con-
siderable suppuration resulted from the wounds on the forehead and
inner canthus. With this exception, the case progressed favorably,
and a few days subsequently he left the hospital.

As the tissues were somewhat congested, the outline of the nose
could not then be accurately determined. The patient returned for
inspection December 28th. The nose was quite straight, the swell-
ing had entirely subsided, and the nasal respiration was perfect. lie
was well pleased with the result, and stated that he had always had
a marked deviation of the nasal cartilage to the right. His nasal
respiration had also been somewhat impaired ; but since the opera-
tion the nasal septum was much straighter and his respiration im-
proved, the air now passing readily through the formerly partially
obstructed nasal passage.

Case III. — The following case was reported by Dr. C. B. Nan-
crede, Surgeon to the Protestant Episcopal Hospital, Philadelphia :

" , German, ast. 45, was brought to the hospital in the

early part of September, 1880, suffering from an extensive com-
pound comminuted fracture of the nasal bones, and the nasal pro-
cesses of the superior maxillas, involving also the nasal spine and
eminence of os frontis, and possibly a displacement of the vertical
plate of the ethmoid. The injury resulted from the kick of a
horse. The bones were extensively comminuted. Not having a
proper pin at hand, I passrd a long insect pin between the hinder-
most fragments and what remained of the nasal processes of the
superior maxilla^. A strip of ordinary adhesive plaster, having a
slit for the head of the pin, was then passed over the bridge of the
nose, and the pin's point forced through the other end. A wet
dressing was applied, and rest in bed enforced. At the end of the
fifth or sixth day the i)in wa^ removed. Before tlie rem ,val of

354 FRACTUEE OF NASAL BONES.

the pin the nose was occasionally moulded by my fingers or those of
my assistant. When the patient was discharged his nose had cer-
tainly as good an appearance as if no injury had been sustained. I
have since been informed that considerable necrosis ensued. This,
of course, would have resulted under any plan of treatment, being
due to the extensive comminution of the bones, which were fairly
' powdered.' I can bear testimony to the excellence of the method,
being much less painful and annoying in the end than those usually
employed.

" I am convinced that by no other method could the natural

contour of the injured feature have been restored and maintained."

Case IV. — Dr. Fifield, of Boston, reported the following ca e at

a meeting of the Boston Society for Medical Improvement, held

March 28th, 1881.

'' A boy, aH. 9, had been amusing himself in company with other
boys by running to and fro over the roofs of some freight cars stand-
ing in a station, jumping from one car to another. In the dusk of
the approaching night he missed his leap and fell, striking the right
side of the nose near the inner angle of the eye, breaking the bone
into minute fragments. One of the fragments, apparently a por-
tion of the right nasal bone, was picked out by the physician who
first saw him, as it seemed entirely separated from any connection
with remaining parts. From this comiiound comminuted fracture
a gaping wound extended outward along the lower border of the
orbit whose bony rim seemed also to have sustained some fracture.
Another gaping wound passed downwards in line of the nasal
fracture to the cheek.

" A female silver catheter passed up the right nostril showed its
rounded end at the neighborhood of the internal angle of the eye.
quite free from covering of bone or other tissue. It raised in its
passage the mass of bone fragments, which immediately dropped
back into the nostril when the catheter was removed. The prob-
lem seemed to be not only how to elevate the comminuted bones,
but to make them remain so.

" A long hare-lip pin, with a glass head, was taken, passed be-
neath the lowest adherent fragment into the nostril, then the head
being slowly depressed the point was guided forward and upward,
passing over the point where the right nasal bone was missing, and

AMERICAN MEDICAL ASSOCIATION. 355

made to emerge well beneath the left eye-brow. It was a test of the
goodness of Weiss' steel, for the pin bent like a bow. A bit of rub-
ber was now slipped over the head and point of the pin.

The remaining wounds were sewed up in the ordinary way. The
pin was left in place for six days, and then withdrawn ; and,
although the wound healed by granulation, the deformity is said to
be remarkably slight. The open hole is firmly closed, no air pass-
ins : the bones remain in sfood line."

AMElilCAN MEDICAL ASSOCIATION.

We are compelled to omit the proceedings, at length, of this As-
sociation. The meeting was an eventful one, and we were pleased
to see the harmonious action of the Association when the question
of the alteration of the Code by the New York State Society was
discussed.

The report of the Judicial Council given below was adopted and
received with prolonged and enthusiastic applause.

REPOllT FROM THE JUDICIAL COUNCIL.

In reference to the Nebraska State Medical Society, the Judicial
Council reported that careful examination of the documents and
matters involved in the protest of certain members of the Nebraska
State Medical Society against the admission of said Society to rep-
resentation in the American Medical Association shows no proper
cause for such protest at the present time, and consequently the
Society is entitled to its full representation by delegates in this As-
sociation.

In regard to the resolution concerning the use of remedies con-
trolled ly a patenty copyrifjld, or trade-marh, etc., which was re-
ported from the Section on Practical Medicine and Materia Medica,
and by the Association referred to the Judicial Council last year,
the Council has decided, after careful examination, that, inasmuch
as said resolution includes matters not referred to in the Code of

356 AMERICAISr MEDICAL ASSOCIATION.

Ethics, and said Code contains all that is necessary for the proper
guidance of members of the medical profession, therefore the reso-
lution should not bo adopted by the Association.

Third, in regard to the protests against the action and reception
of the delegates from the New York State Medical Society, which
was referred to them, the Judicial Council reports as follows : Hav-
ing carefully examined tlie Code of Ethics adopted by the New
York State Medic 1 Society, at its annual meeting in February,
18S2, as furnished by the Secretary of said Society, the Judicial
Council find in said devised Code provisions essentially different from
and in confl'ct with the Code of Ethics of this Association, and,
therefore, in accordance with the provision of the ninth by-law of
this Association, decide unanimouslij that the said New York State
Medical Society is not entitled to representation by delegates in the
American Medical Association.

JOURNALIZING THE TRANSACTIONS.

The next important action taken by the Association was in con-
chiding to Journalize the Transactions. A special committee of
seven was appointed by the President to nominate the Board of
Trustees (nine in number) for the managemet of the Journal, as
follows :

Drs. L. A. Sayre, J. M. Toner, Foster Pi'att, K. J. Dunglison, E.
Battey, W. F. Peck, H, 0. Marcy.

A weekly journal is proposed, at six dollars a year to non-sub-
scribers. The editor to be selected by the Board of Trustees and to
be paid $0,000 a year, he to pay his assistants. The Journal to be
called the "Medical Journal of the American Medical Association,"
its advertising and all other pages to be under the control of the
Board of Trustees. The Transactions for 1882 to be published in
a separate volume as before.

Two delegates from North Carolina were present at the meeting,
Dr. Eugene Grissom and Dr. C. AV. AYoollen.

Dr. Grissom was appointed a member of the Nominating Com-
mittee and Dr. Woollen on the Committee on State Medicine.

The Committee on Nominations presented the following report :

The next place of meeting, Cleveland, Ohio.

President. — John L. Atlee, M.D., of Lancaster, Pcnn.

Pasteur's " microbes." 357

Yice-Presidents. — Drs. Eugene Grissora, of North Caroliim ; A.
J. Stone, of St. Paul, Minn. ; J. A. Octerlony, of Lonisvillo, Ky. ;
and II. S. Orme, of California.

Treasurer. — It. J, Dunglison, M.D., of Philadelphia.

Libra! ian. — \Vm. L:e, M.D., of District of Columbia.

Judicial Council. — N". S. Davis, of Illinois ; J. M. Brown,
U. S. N. ; X. C. Scott, of Ohio ; .\I. Sexton, of Indiana ; N. C.
Husted, of New Y"ork ; Wm. Lee, of District of Columbia ; and
J. E. Reeves of West Virginia.

The leport was referred back to the Committee, as it conta'ned
nominations which were rendered ineligible by absence of tlie nom-
inees

PASTEUR'S " MICROBES."

To maintain, while leaning on induction, that all contagious dis-
eases aro due to microbes, is one of those ideas which, by reason of
its apparent simplicity, gives an easy satisfaction to those who do
not look beyond the words. The re3ult is that many physic ans ac-
quire a tendency to adopt this manner of s.-eing things which ])urely
and simply carries us back to the middle ages. For, in fact, this
explanation is a very old one, and reappears at certain epochs, and
after having reigned for some time,always finislies by being repulsed.

* * :|: * -i: * H^ *

M. Pasteur in building up his theories has forgotten to take count
of a factor which is yet absolutely essential to the economy. It is
not the microbe, supposing there is one, that is the essential part of
the virulent disease, but the patient himself.

" To take as a base of operation a truth which is presented as
demonstrated, and which is in no wise so, is to sin against the most
elementary rules of a good method. M. Pasteur may affirm as he
likes that microscopic beings are never to be found in waters of
springs or in the tissues of animals or plant ; but such affirmations

358 ' CIREHOSIS OF THE LIVER,

will convince no one, because every one knows that they are far too
absolute. It would be much nearer the truth to say that they are
to be met with everywhere. It is not to be denied that epithelium
of certain cavities, and especially that of the mouth, contains well-
ni,c;h the entire collection of these microbes, which are represented
to us as so redoubtable. Will any one venture to maintain that solu-
tions of continuity never take place in tliese mucous membranes,
that in this way the door may not often be opened to the invasion
of microbes, and that they may not thus have the opportunity of
passing from the saliva into the blood ? How is it, then, that wo
are not every instant poisoning ourselves with our own microbes ?
* * * * * * # *

The truth is, that in these questions we arc actually walking in
the most absolute manner amidst the unknown, and if there is some
progress to be rcal'zed, this can only be attained from the side of
medicine. Let physicians, therefore, not figure to themselves that
the problem of contagious diseases is resolved, and that nothing
more has to be done than to search for the microbe. We have not
reached that jioint. M, Pasteur's explanations are only hasty hy-
potheses. It is in no wise demonstrated that diphtheria, variola,
cholera, and typhoid fever are caused by the invasion of microscopical
beings into the human organisms. It is just as probable that they
may be due to variations as yet unknown in the composition of the
liquids of the economy, or in the evolution of certain cellular
elements. — Medical Times and Gazette.

Case of Eecovery from Cirrhosis of the Liver in which
Paracentesis Abuojminis was Performed Twelve Times. —
This case, reported in the Lancet, May, 18S3, p. 730, by Dr. R. A.
D. Lithgow, occurred in an intemperate man, who was induced to
leave off his stimulants, and who eventually returned to his duties
almost quite well. After three years and a half he relapsed into his
intemperate habits, and the disease became again developed. —
Richard Neale, M.D.^ in London Medical Record,

359
NOTES.

Sir Erasmus Wilson is in bad health.

To antidote one grain of morphia it requires one-twentieth of a
grain of atropia. — BartJioloiv.

Dr. John Browjst, of Edinburgh, the well-known author of
" Puib and Ilis Friends," died recently aged 72 years.

Prevention of purulent ophthalmia of infants is claimed to be
effected by Dr. von Crede {Arclu'v. f. Cti/ii.) by washing the eyes
with cold water, and drojiping one drop of a two per cent, solution
of nitrate of silver in each eye.

The London Pathological Society was so encumbered by accumu-
lated material at its last meeting, that the necessity of calling an
extra session is being considered. When may we look for such a
state of things in our societies ?

Fluoric Acid for Enlarged SpleexN". — Dr. Coatcs {Indian
Med. Gaz., Med. Times and Gazette) has had some apparently suc-
cessful cases of splenitis, treated with solution of annnoniuni
fluoride. He gives, 15 minims to 3 ij doses, a solution of one-half
per cent, strength.

Salicylate of Soda in Urticaria. — It may have occurred
theoretically, to many practitioners, that salicylate of soda would
overcome attacks of urticaria by reason of the alkaline ssveating it
causes, and recent experiences prove the theory correct. The dose
should be large — say 20 grains every two hours.

White Ash Wine for Dysmenorrikea. — Dr. Charles P. Tur-
ner, of Philadelphia, has found good results from the use of this
preparation in dysmenorrhcna. Take of the inner bark of Fraxi-
nns Americana (White Ash) powd.. No. 40, 3 viij, sherry wine
sufficient for Oij., macerate three days, pack in cylindrical percola-
tor, and displace slowly two pints. The dose is a teaspoonful three
times a day.

3 GO NOTES.

The AssocIxVtiOxN for tub Advancement of Medicine uy
Eesearch is the name of a new society organized in London, the
objects of which are sufficiently explained by the name adopted. It
numbers many of the leaders of medical thought among its mem-
bers, and at its first meeting more than £1,000 were subscribed.
Eecently the surplus remaining in the hands of the International
Congress was transferred to the treasury of this society.

Score Another Remedy for Diphtheria. — A Russian doc 'or
has discovered that compound decoction of senna in sufficient
quantity to produce liquid stools, followed by a cooling draught
with some hydrochloric acid in it, and a gargle of hot milk and
and lime water to be used every two hours, "generally leads to a
rapid recovery of diphtheria patients." We mention this for the
benefit of those of our readers who may be keeping a record of all
the methods.

Gelsemium in Pruritus. — Dr. Lewis S. Pilchcr in Annals of
Anatomy and Surgerv, (Vol. Ill, p. 143) calls attention to the use-
fulncs,-! of gelsemium in overcoming pruritus, especially that form
it in which the itching and distress are out of proportion to thesu-
pei'ficial lesion of the skin, lie gives ten drops of the tincture and
repeats it every half hour until a teaspoonful is given, or until the
trouble is overcome. It does not always succeed, as Dr. Bulkley has
shown, but it may prove to be one of our remedies in time of need,
others failing.

OXALIS ACETOSELLA (WoOD SoRRELL) AS A CaUSTIC. — The

expressed inspissated juice of v/ood sorrel is snggested by Edgar
Ettinge, M. D., as a caustic, after a personal trial in epithelioma of
the lip. It has been one of the ingredients of the caustic plasters
of empirics for years, but has not leceived much recognition from
the regular profession.

Dr. Ettinge made three successive applications of the inspissated
juice of oxalis, at intervals of 13 hours each, to an inflamed, burn-
ing, and offensively ulcerating epithelinl tumor; the resulting
eschar separated on the eighth day, leaving a healthy granulating
surface which rapidly healed. The pain resulting from the appli-
cation was intense.

NOTES. 301

Agaricus for N"[GHT Sweits. — Wo nolico extracts in the
Louisville Medical Xews from the Glasgow Medical Journal and
Medical Times and Gazette in the substitution of Agaricus for
atropia in night sweats, because the litter is so dangerous in one-
seventieth grain doses. It would be much more dangerous to take
agaricus at random, without a full knowledge of the species. There
are many Agaracini, especially Agaricus muscarius, which yield an
active principle muscariu as deadly as atropia. If the reference
made by the above journals is to Agaricus albus the statement is
entirely too loo^c.

Disintegration of Renal Calculus uy Administration of
Large Draughts of Cistern (Filtered Rain) Water. — Dr.
Ralfe exhibited (May IGth, 1882) at the London Pathological So-
ciety, a renal calculus that had passed in a state of disintegration,
after it had been lodged in the right kidney for upwards of three
years, which had latterly given so much pain that nephrotomy was
entertained. The calculus which showed signs of erosion on its
surface, was reduced to a mere shell. The patient was at Gr=t put
on alkaline treatment for solutiou of the stone, subsequently re-
course was had to the administration of five to six pints daily of
filtered rain water. Occasional doses of turpentine and opium were
given for relief of pain. After some months, pieces of grit and
scales began to pass with the urine ; and finally, at the end of two
years the shell of the calculus was expelled.

Pasteur's Prophylactic Inoculation.— In Hungary official
experiments with Pasteur's inoculating fluid, have been performed
by Roszahegyi. Two series of experiments were made, with solu-
tions of different strength upon sheep and bullocks. The fluid re-
ferred to is a meat solution, in whicli baccilli from the blood of
animals affected with splenic fever, have been cultivated, at a tcm-
peratare from 77° to 104° F.

It seems clearly shown that inoculations with this fluid, at inter-
vals of twelve days on the same animals, render them less suscepti-
ble to splenic fever at each inoculation. Three inocu'ations are em.
ployed, first the ''primary," then the '•'secondary," and finally
the "control inoculation." The Hungarian result was one death.

3i'i2 NOTES.

iu a lot of 30 sheep and five bullocks, after tlie pi-itnary. The
second inocuhition also resulted in but one diath. Tlie hist called
the '"'control inoculation," resulted in two deaths. Upon the
whole, though, the mortality has been 14 5 per cent, and other dis-
eases have been developed in the course of the inrcu'ated disease.
The Hungarian coinmiss'on concludes that the general adoption of
Pasteur's method would be premature, and that it should not be
undertaken at all by private individuals.

As the investigation of Pasteur's brilliant [irophylaxis progresses,
the verdict not proven, will b3 surely written against it,

CiiL'DE AND Blundering Microscopy. — S)me time ag) Dr.
Cutter published an article in the American Jji-Wcrkl/j on the char-
acter of certain infant foods, charging several of them with being
deficient in gluten. This lie demonstra'ed, apparently, byillustra-
t'ons of the microscopic appearances, damaging these valuable ai'ti-
clcs of food in the estimation of the profession and their patients.

In the Medical News of June 24, Dr. J. (1. Richardson, of Phil-
adelphia, shows how great a blunder Dr. Cutter ma3e, and the
statement is so evident, that it is a little singular the wronged dcrd-
crs in these foods had not published a counter statement based upon
their common-sense every-day knowledge.

Dr Richardson says: " Let Dr. Cut'er separate the gluten [by
mixing flour into a dough with water and letting it stand, and
th reby washing away all the starch, by adding more water] from
whole wheat flour, and then by examining under his microscope one
of the bran particles which arc deposited with the stai'ch from the
wa'rr used in washing the glutinous mass, he can enjoy looking with
one eye at his hypothetical gluten cells, and with his other eye at
the real f/lafcii, prepared from the san-.e identical sample, by the
method long known to sanitary scientists, and (;f which the masti-
cating process, used as a test for wheat by millers, and even by farm
boys all over the country, is but a homely modilicatic n."

Is this the same Dr. Cutter who had to be corrected by Professor
Leidy in a statement made respecting a new microscopic organism
he designated '' AstJunatos c'Unris ?" If so woull he not do well to
put some of jiis crude science in quarantire for the present ?

NOTES. 363

A Medical Course for Doctors. — A medical school has been
organized in St. Louis to complete the education of graduates. It
is huniilialinty to confess ft to be a necessity. It would not bo a
nccessiiy if examinations for degrees weie conducled by Boards in-
dependent of the colleges. A fair training of the mind in simple
methods of thought wliile at college, a good library of reference, a
'• clinic" at evci'y bed side, ought to supphmt medical colleges for
doctors.

Sounding the Female Ureters. — Dr. Pawlick, Priva'-Docens
of Vienna, formerly an assistant of Professor C. von Braun, read a
jiaper recently in Salzburg upon this fubjtc't. lie iinds that when
;i woman is placed in the knee-elbow position, and the posterior
vaginal wall is drawn upwards ar.d compressing the rec'.um by means
of a Sims' speculum the trigonum vesica} and the entrance-places
of the ureters are plainly visible. It is then not difficult, with a
specially designed catheter, to sound the ureters. lie demonstrated
h's proposition upon two women whom he brought with him ; and
was able, in both cases, in a short time to sound the ureters with
perfect safety. — Philadelphia Medical Xcws, April 8.

The Working Bulletix.— Under this title the enterprising
house of Parke, Davis & Co , of Detroit, Mich., are sending out,
gratuitously, journals containing clinical reports of new remedies.
These reports are made out by the active practitioners all over the
country, and furnish us with fresh a'd reliable material from
month to montli.

We have three numbers of the Bulletin before us, containing
numerous reports upon Jamaica dogwood, quebracho, and cascara
sagrada.

Pegarding the object of this enterprise, Parke, Davis & Company
say this :

"The working bulletin, accompanied by the drug to be investi-
gated, or a preparation cf the same or both, as the circumstances
rerpiiro, is distributed gratuitously to the Cjlleges, Universities and
other institutions engaged in scientific work, and to the govern-
ment hosi)itals, and public liospi'als and dispensaries, and to the
medical profession at large, to obta'n the results of the drug in
treatinir tlie &ick.

3Gt OBITUAUY.

"The object is to promote original investigation in the science of
drugs. This we propose to do by furnishing gratuitously to those
engaged in oiiginal research, material for investigation, and by pub-
lishing the lesults of the same as a donation to scientific literature.
It is apparent that the only return which we can receive for this
work is the increased demand for the valuable drugs which we are
introducing to science, for we guarantee to publish full reports,
favorable or otherwise."

They should be earnestly encouraged in these objects, for the ir-
sults cannot b3 otherwise than invaluable.

OBITUARY.

ClIARLKS T,. WHITE, M.D.

Dr. Charles B. White, of New Orleans, died on Sunday, ihe
IGth of April, lie was the last President of the Association, one
of its original members, and a member of the Executive Commit-
tee from the beginning. In the death of Dr. White the Associa-
tion suffers an irreparable loss, sanitary science loses oec of its
ablest exponents, and evtry one who knew him, in any capacity, a
rare friend and counsellor. His life was an example : his memoiy
will ever bean incerti\c to whatever is noble, faithful and just.

Dr. White's remains found burial at Crawford ville, Ind., the seat
of his alma mater, Wabash College,

AUGUSTUS UARVEY 5IACNA1K, M.D,

Dr, Augustus Harvey MacNair, died in Tarborough, N. C , on
the mornnig of the 2'Jth of March, 1882, of acute endocarditis,
succeeding to an attack of articular rheumatism.

The subject of this notice was born on the 22d of December,
1819; was detcended from some of the best families in EJgecombe
and Beaufort Counties ; was liberally educated, and graduated from
the Medical Department of the University of Pennsylvania, in the
Spring of 1843. On reaching home he commenced the practiceuof
his profession, in this, his native town, and pursued with assiduity
and great industry, the duties of this self sacrificing and laborious
vocation for forty years. Highly respected by his professional
brethren, beloved by his patrons, lie enjoyed the confidence in a
large degree of the community in which he lived, — a gentleman of
sterling integrity, a good man, and a consistent Christian.

BOOKS AND PAMPHLETS RECEIVED. 3G5

III 180T, Dr. MacNair b( came a metnbor of the MeJicul Society of
North Carolina. In 1S7'J, upon the organization of the Board of
Health of Edgecombe County lie was elected Superintendent. lie
di. charged the duties of this office in a highly satisfactory manner
for the term, and was ree'ected in a highly spirited, though friendly
contest; during his second incumbeiicy, this useful citizen went
down, ami in the beautiful cemetery of the Episcopal Church of
this litilt' city, his remains were interred, with Masonic rites, assisted
by the American Legion of Honor, of which Orders he was an
horioitd member. Almost all casts and conditions in life, Jew and
Gentile alike, were gathered in silent sympathy around his grave to
witness the last sad ceremonies in honor of their lamented fellow-
townsman ; a fitting tribute to the memory of the dead ; giatif)iiig
manifestation to the feelings of the living, "honoring likewise to
all who pait cipated, as they but honored themselves in honoring
th(ir frie d and good physician." In (he beautiful langu.Mge <f u
devoted friend let: me say, ''Those long, weary, wearying 3 ears of
ceaseless and laborious toil are at length ended ; that busy, task'ng,
useful life — "hat life devoted mainly to theservicoof his fellows has
bi en forever extinguished in death, and after 1 fe's fitful dn am. he
slei'p-i well." l».

BOOKS AND PAMPHLETS RECEIVED.

Catalogue of the University of North C irolina. Eighly-sevenlh
}ear. lS81-8-->. Pp. it.

An Act Amending and Keenacting Cnapter 150 of the Code of
West Virginia, Concerning Public Health. Pp. 8.

Restriction and Prevention of Scarlet Fever. Document Issued
by the Michigan State Board of Health. (Revised Edition, 1881—
30,000 printed. Pp. 8.

Sanitary and Statistical Report of the Siirgeon-Ceneral of the
Navy, For the Year 1880. Washingon : Governnunt Printing
Oniee. 1882. Pp. 4G8.

The Worcester Sewage and the Blackstonc River. Boston : Rand,
Avery & Co., Printers to the Commonwealth, 117 Franklin Street,
1882. With Map. Pp. 30.

The Physician Himself and What he Should add to the Strictly
Scientific. I'jv D. W. Cathell, M.D. Baltimore: Cushings & Bailc,
1882 Pp. ID-t. Price $1.50.

Hygiene in Relation to the Eye. By C. J. Lundy. M D. l^c-
^°ssor of Diseases of the Eye, Ear and'Tliroat in the Michigan Col-
lege of Medicine. Detroit. Pp.8.

366 r>ooKS and pamphlets received.

The Special Therapeutic Value of Ilyosciamine in P.-ychiatry by
0. II Hughes, M.I)., St. Louis. (Keprint from the Alienist and
Neurologist, April, 1882 ) Pp. 11.

Parallel Drift-Hills of Western New York, by Liurence Johnson,
A.M., M.D. (From the Annals of the New York Academy of
Science, Vol. II, No. 9, 18S2). Pp. IS.

A Practical Tieati'-~e on Diseases cf the Skin, liy Louis A.
Duhring, M.D. Third Edition Revised and Enlarged. Phila-
delphiu : J. 13 L'ppincott & Co. 38S3. Pp.085.

A Study of the Tumors of the r)hidder vviih 0 iginal Contribu-
tions and Drawings. By Alex. W. Stein, M D. New York : AVm.
Wood & Co., 27 Great Jones Street. 1882. Pp. 94.

Inebriety : A Study upon Alcohol in its Pelations to Mind and
Conduct By T. L Wright, M.D. Bellefontaine, Ohio. (Reprint
from Alienist and Neurologist, April, 1882.) Pp. 2.3.

The Incidental Effects of Drugs : A Pharinacological and Clini-
cal Hand-Botik. Bv Dr. L. Lewin Translated by W. T. Alexan-
der, M.D, New Yoik : William Wood & Co. 1882.

Acute Dementia Occurring in an Old Man — Recovery After Two
and One-half Montlis of Treatment. By C. II. Hughe's, M.D., St.
Louis. (Reprint from Alienistand Neurologist, April, 1882). Pp G.

Prevention, and Restriction of the Small-Pox. (54) Document
Issued by the Michigan State Board of Health. (Edition of 1882—
oO,000 Copies Reprinted from tlie Annual Report of the Board for
1881.) Pp. 10.

Two Cases of Malignant Tumor of the S|)henoidal Cavities Im-
plicating Vision. By Julian J. Chisolm, id.D. Baltimore: (Re-
]irir.t from the Archives of Ophthalmology. Vol. XI, No. 1.
March, 1882.)

Rupture of the Eye-ball in its Posterior Hemisphere from a Blow
in the Face. By Julian J. Chisolm, M.D., of Baltimore. (Re-
prin'ed fiom the Archives of Ophthalmologv. Vol. XI, No. 1,
March, 1882 ) Pp. 5.

Gonorrheal Ophthalmia, its (Complications and Results : Iridec-
tomy for Artificial Pupil. A Clinical liCcfuro at Michigan College
Hospital, by C. J. Lundv, M.D. (Reprint from Michigan Medical
News, February 2)lh, 18S2.) Pp. 8.

Civilization in its Relation to the Decay of Teeth : An Essay Read
Before the Internationfil Medical Congress, August, 1881. By Nor-
man W. Kingsley, M.D.S., D.D.S. New Y'ork : D. Apple'ton &
Company, 1, 3, and 5 Bond Street.

]\Iateria Medica and Therapeutics. Inorganic Substances. By
Charles D. F. Phillips, M.D. Edited and Adapted to the U. S.
Pharmacopwia by Laurence Johnson, A.M., M.D. Volume 1 and 2.
New l^ork : Wm. Wood & Co. Pp. 298, 300.

BOOKS AND PAMPHLETS RECEIVED. 3G7

Clinical Lectures on Diseases of the Urinary Organs. Delivered
at University College Hospital. By 8ir Henry Thompson. Sixth
Edition. Philadelphia : P. Blakiston, Son & Co., 1013 Walnut S\
188;.\ Pp 175. Price 75 cen's.

Color-Names, Color-Blindness, and the Education of the Color-
Sense in our Schools. By Joy Jeffries, A.M., M.D, (Harvard).
Reprinted from "Education," iMarch, 1SS2. Boston: L. Prang
& Co. 1883.

The Vest-Pocket Anatomist (Founded upon "Gray.") Bv C.
Henri Leonard, A.M,, M.D. Eleventh lievised Edition. Price
75 cents. Detroit: The Illustrated Medical J.-urnal Couipany,
1883. Pp. S3.

The Names of Ilerbes in Greko, Latin, English, Dach and
Frenche wyth the Commune Names that Herbariesand Apoticaries
vsc. Gathered bv William Turner, A. D.,1548. Edited by James
Biitten, F.L.S. "London: N. Triibner & Co. 1881. Pp. 134.

Lidiana State Board of Health, liules and Regulations Issued
by the S'ate Board. To this is Added a Nosological Table, Pre-
pared and Published bv the State Board of Ilealih. Indianapolis :
Wm. B. Burford, Printer, Lithographer and Binder. 1883. Pp. 53.

Thirty-Se-oud Annual Annourcement of the Woman's Medical
College of Pennsylvania, North College Avenue and Twenty-first
Street, Philadelphia. Session of 1881-82. Philadelphia: Grant,
Faries & Rodgers, Printers, 53 and 51 North S.xth Street. 1881.
Pp. 30.

Observations on Surgery in Children. By Edward Borck, M.D.
St. Louis, Mo. Read before the St. Louis Medical Society, April
1st, 1882. (Reprinted from the St. Louis Medical and Surgical
Journal, June, 1883.) St. Louis Medical Journal Publishing Com-
pany. 1883.

Observations on Hemiplegia, Based on Eighty-one Recorded
Cases with Special Reference to Cerebral Localization. By A. D.
Rockwell, A.M., M.D. (Reprinted from the Medical Record,
April 39th, 1882.) New York : Trow's Printing and Book-bind-
ing Co., 301-313 East 13th Street. 1883. Pp. 14.

The Separate System of Sewerage : A Reply to the Paper Pub-
lished in tlie Report of the State Board of Health, Lunacy and
Charity of the State of IMassachusetts, 1880, by Eliot C. Clarke,
Esq. By Geo. E. Waring, Jr. (Reprinted from the American
Architect, March and April.) 1883. 'Newport, R. I. Pp. 10.

Ninth and Tenth Annual Reports Relating to the Rpgistry and
Return of Births, Marriages and Deaths, in Michigan for the Years
1875 and 1876. By the Superintendent of Vital Statistics, under
the General Direction. of the Secretary of Sta'e of Michigan. By
Authority. Lansing: W.S.George & Co., State Printers and
Binders. 1881. Pp. 330 and 333.

368 BOOKS AND PAMPHLETS KKCEIVED

Current Fallacies about Vaccination. A letter to Dr. W. B. Car-
penter, C.B., &c., by P. A. Taylor, M.D. Second Edition of
100,000; with Additional Eemarks on Dr. Carpenter's Article on
Disease-Germs, in the XIX Century Magazine for October. Lon-
don : E. W. Allen, 4 Ave., Maria Lane, E.C. 1881. Price, one
penny, or five shillings per hundred. ]^p.37.

Lecture No. 2. The Historical and Scientific Society of Wil-
mington, N. C. An Essay — The Nebular Hypothesis. liead
April 5th. 1882, by E S. Martin, Esq. Published by order of the
Society. Copies can be procured at the Book Stores and of the
Curator of the Society. Price 25 cents. Wilmington, N. C. :
S. G. Hall, Book and Job Printer. 1882. Pp. 11.

Fourth Biennial Report of the State B lard cf Health of Mary,
land, January, 18S2. Frederick, Md. : Baughman Brothers-
Steam Printers. 1882. Pp. 149. Also, Report to the State Board
of Health, on the Epidemic of Diphtheria in Frederick City,
Maryland, and the Smali-Pox in Charles County, Md. By C. W.
Chancellor, M.D., Secretary of the Board. Pp. 03.

Atlas of Cvurecology and Obstetrics, Edited by Dr. A Martin,
l*rofessnr of Gyna?cology at the University of Berlin. Parts VI,
Vn, Vnr, IX, X, Xr, Xn, XIU, XIV, XV. Containing 475
Black and 37 Colored Hlnstrations, from the Original Designs
of 02 Authors. Supplemented by Numerous Illustrations from
J. P. Maygrier's Nouvelles Demonstrations D'Acconchements. A.
E. \7ilde & Co., Publishers, Cincinnati, Ohio.

Opium Habit ; Its Successful Treatment by Avena Sativa. A Pa-
per Read Before the New York State Medical Society, February
7th, 1882, by E. IL M. Sell, A.M., M.D. Fellow of the American
Academy of Medicine, of the New York Academy of Medicine,
Member of the American Medical Association, etc. Reprint from
the Medical Gazette, April 22d, 1882. Published for the Author
by Birmingham & Co., 1260 and 1262 Broadway, N. Y. Pp. 8.

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