(navigation image)
Home American Libraries | Canadian Libraries | Universal Library | Community Texts | Project Gutenberg | Children's Library | Biodiversity Heritage Library | Additional Collections
Search: Advanced Search
Anonymous User (login or join us)
Upload
See other formats

Full text of "Peoria Medical Monthly (1880-1891)"

.^ 



A 



u V 



:/ 



,^ 



.^r 










BRADLEY UNIVERSITY LIBRARY 



3 1272 00528 9036 



Digitized by tine Internet Arcliive 

in 2010 witli funding from 

CARLI: Consortium of Academic and Researcli Libraries in Illinois 



http://www.archive.org/details/peoriamedicalmon06peor 



VOLUME vr. 



1885-1886. 



THE PEORIA 



H 



jj_y 1 



A PRACTITIONER'S JOURNAL, 



•^ 

i""- 



THGS, M, McIL¥AlNE, A, M,, M, □ 



Editor and FunlishEi, 



TWO DOLLARS PER ANNUM IN ADVANCE, 



FEGRIil, ILL,, 
Nn, SC4 EDUth JeffErsnn StrEEt, 

IBEB. 



LIST OF CONTRIBUTORS TO VOL, VI. 



C. C. ALLEN, M. D. 

A. B. ANDHRSDN, M P. 

C. BAKr<()\V, M. I). 

ROBKKTS BAKTrini.OW, M. 1). 

F. B. BATCHia.DKK, SI. U. 

IL S. BKLL, ^L I). 

ROBT. BOAL, M. I) 

K. BRKNDHL, M. I). 

S. J. BLMSTKAD, M. D. 

\VM. A. BYRD, ^^ D. 

F.. N. CAMPBia.L, M. D. 

W.J CHKXt)\Vl-;TH, M. n. 

A. A. COXKLLXG, M. D. 
ROMAIXK J. CURTIS, A. M , M. I) 

s. w. DODc.i;, ^^ d. 

J. M. DA COSTA, A. M., SI. I). 

C. l)V HADWAY, M. I). 

J. I). EBHRT, SI. D. 

J. S. Gt;iGLF;Y, M. V. 

\V. E. GILLILANI), M. D. 

N'. R. GORDON, :\L D. 

J. L. HAMILTON, M. D. 

B. F. HEKNDOX. 

V. L. HIXSDAI.i;, M. I) 
H. C. IIOLTON, SI. D. 
SILAS II r KHAR D, I\t. D. 



\VM. A JAMF:S, M. D. 

f; l. larkixs, :\i. d. 
w. SI. LLC as, m. d. 
C. B. m.aclay, a. m., m. d. 
J. E. marsh, m. d. 

S. F. MEACIIAM, M. D 

1' \v. mf:xi)Exhall, m d. 

!•'. W. :\IOFFITT, M. D 
\V:\I. M. MOORE, M. D. 
R. L. MOORE, M. D. 
J. OETTIKER, M. D. 
O. C. REYXOLDS, M. D 
O. K. REYXOLDS, .M. D 
O. J. ROSKOTEX. M. D. 
A. SCIIMID, M. D. 
T. H, STETLEK, :M D. 
J. T. STEWART, .M. D. 
W. T. STRODE, :M D. 
A. B. STRONG, M D. 

W. H. TATE, M. D. 

F. C. VAXDERVORT, M. D. 

J. P. walki;k, M. D. 

MARCrS WllITIXG. :\I. I). 

J. s. wiiitmirf:, m. d. 

O. B. WILL. M. D. 



Table of Contents.— Vol VI. 



ORIGIXAL ARTICLES. 

About Hydrophobia A. Schmidt 660 

Acetiim, or Vinegar O. C. Reynolds 620 

Ameuorrhoea W. H. Tate 505 

Angina Pectoris E. Brkxdel 509 

Biliarj' Calculi F.B. Batchelder 321 

Blood— Is the. Life S. F. Meacham 614 

Blood, and the Vital Endowment of Tissue O. K. Revxolds 547 

Brain— Tumor of A. B. Axdersox 623 

Bronchitis in Children O. J. Roskotex 605 

Capillar},- Bronchitis with Lobar Pneumonia J. K. Marsh 506 

Clinical Lecture — Incipient Locomotor Ataxia. Spastic 

Muscles. Ptosis Prof. Roberts Bartholow. M. D. 647 

Conjunctivitis with Copious Purulent Discharge P. \V. Mexdexh.all 72 

Cough R. L. Moore 324 

Diabetes R. L. Moore 324 

Eclarap-sia — Caused by Phymosis. Operation, with Recovery ... Fr.^xk L. Hixsdale 199 

Ftclamp.sia in Infants O.J. Roskotex 7 

F;piphysitis— Acute, with Osteomyletis; Amputation of the Leg. Recovery . J, T. Stew.-vrt 28 

F'emur— Compound. Comminuted Fracture of the J. P. W.^lker 568 

Financial Problem W. T. Strode 372 

P'istula- Treatment of M. D. 626 

Forceps— The Obstetric Proe. Theophilus Parvix 599 

Gastralgia Prof. J. M. DaCosta 499 

Heart and Pulse in Organic Functional Derangement and Disease .... J. S. Whitmire 429 

Human Bite — Septictemia from, Recovery M. Whitixg 4 

Hydrocephalus— Intra-Uterine C. B.^rlow 14S 

Hysteria Prof. J. M. DaCosta 495 

Ichthyosis— Case of F. C. Vaxdervort 197 

Immunity from Disease— Cause ol R.J. Curtis 261 

Immunity from Disease — Natural Selection in R. J. Cirtis 127 

Immunity from Disease C. B. Maclay 194 

Inverted Uterus— Reduction of R. J. Curtis 133 

Locomotor Ataxia— Incipient Proi'. J. M. DaCosta 498 

Man: An Essay W. J. CHEXO^VET^ 135 

Menstruation— Infantile E.X.Campbell 75 

Xaso-Pharj-ngeal Catarrh and Chronic Suppuration of Middle Ear— Results 

of Systematic Treatment in X. R. Gordox 361 

Oesophagus— Silver Dollar in, F^xtraction H. C. Holtox 85 

Us rteri— Some of the Causes of Rupture of W. E. Gillilaxd 554 

Ovariotomj-- Death O. B. Will 311 

Ovary— Fibrous Tumor of Operation, Recovery J. L Hamiltox i 

Oxaluria Prof. J. M. DaCosta 496 

Pa'tlla-Upward Dislocation of S W. Dodge 132 

Penis— Fracture of A. A. Coxklixg 619 

Placenta-Prtevia and its Sequelke— A Case of \Vm. A. J.\mes 315 

Pneumonia J- D. Ebekt 36S 

PoUtjus— Gelatinoid, To Remove from the Xose Prof. J. M. DaCosta 324 

Pregnancy — Cough in Prof. Theophilus P.arvix .603 

Pregnancj-- Palpation in . . . Pruf. Theophilus Parvix 604 

Pustule— Malignant F. W. Moffitt 511 

yuinia for Children W. M Lucas 572 

Quinia by Inunction Wm. W. Moore 320 

Retention of Secundines of Abortion B. F. Hfkxdox, M. D. 658 

Rhus Toxicodendron Silas Hubbard 323 



iv The Peoria Medicae Monthly. 

Kh us Toxicodendron — roisoning with W. H. Tate 198 

Scarletiiia— Treatment of Some of tlie More Important Complications of: 

and the Seqnelhe J. S. Whitmire 16 

Sciatica— Flexion of Thigh with Leg in Straight Position for A. B. Stroxg 427 

Septic Poisoning from Watery Discharge from Bowels of a Dead Subject . . W. H. Tate 29 

Sexes— Production of the; Theories of the Silas Hubbard 500-562 

Spina Bifida J. P- Walker 82 

Surger>-— Address on \V. A Byrd 65 

Tape Worm J- Oettikek 436 

Tinea Capitis— Oleate of Copper in R. Boal 24 

Tonsils— Enlarged J- S. Geigley 364 

Trichina Spiralis C. DrHADWAY, M. D. 661 

Typho— Malarial Fever E. L. Larkixs 189 

Typhoid Pneumonia — FHaterium in C. C. Allex 25 

rlcerofthe Foot— A Case S. F. Meacham 572 

Uterus— Ante-Partum Honr-Glass Contraction of, Complicating Labor . T. H. Stetler 570 

Woman in Travail— Pleading for the H. S. Bell 76 

SOCIETY TRANSACTIONS. 

CHICAGO mf:dical socif:ty. 

Acute Coryza— Treatment of 203 

Aspergillus Glacus from the Kar 201 

Cervix I'teri— Laceration of 213 

Colpo— Myotomy 5 '4 

Laparotomy in Gunshot Wounds of the lutestiae 37^ 

Larynx — Intubation of 33° 

Lithotrity 5i6 

Medicine— Study in, Special vs. General 324 

Mutual Protection Against Blackmail 573 

Mycellia from a Tonsil 202 

Oleate of Manganese 210 

Osteoma from a Tooth 202 

Pneumonia Abscess 512 

Posterior Xares — Membranous Occlusion of 207 

Syphilis— Treatment of 326 

Tobacco— Does Use of Injure Sight 213 

Tonsilitis — Report of 200 cases of 44' 

Uterus — Sponge in the 33° 

PEORIA ACADEMY OF MEDICINE. 

Blenorrhoea Xeonatonnn H. Kruse, M. D. 666 

CORRESPONDENCE. 

Cases from Practice 43^ 

Citcal Obstructions 439 

Colleges and Things in General— X. Y. Letter 150 

Corrected— Mistake 437 

F^xcessive Sweating ' 438-439-44° 

Lichen Agrius 3^ 

Mercury— Was it Indicated 37 

Mistake Corrected 437 

New York Letter— Studies of Medical Men 30-86-150 

Peculiar Skin Affection 44° 

Ouinia for Children— Sweating 43^ 

Rheumatic Aflfections of the Eye • • 670 

Spinal Chord at the Region of the Fourth and Fifth Dorsal Vertebrae 35 

Was Mercury Indicated? 37 

PERISCOPE AND ABSTRACT. 

Abscess of the Liver 221-457 

Acne Rosacea 49 

Action of Chlorate of Potash 635 

Acute Articular Rheumatism 4^1 



Tabi.e of Contexts. v 

Acute reritouitis — Treatment by Abdoiuinal Section loo 

Administration of Aniesthetics 579 

Adulteration of Iodoform 591 

Albuminuria — Causes and \'arieties 2S4 

Albuminuria of Pregnancy — Milk Diet in 155 

Amenorrhcca — Manganese in 163 

Ammonia Poisoning 52S 

Animals — Epidemic-Zymotic Diseases in, and How They are Communicated to Man . . . 449 

Anaemic and Atrophic Conditions — Arsenic in 106 

Ansemic Murmurs and Congenital Malformations 3S2 

Aucesthetics — Administration of 579 

Ancesthesia by Ether — Rapid 94 

Anaesthesia — Corning or Local 683 

Anaesthetic — Creosote Water as a Local 39S 

Anatomy — How to Learn and Remember 463 

Angina Pectoris — Iodide of Sodium in 164 

Angioma — Carbolic Acid in 588 

Another Incompatible 453 

Another Use of Coffee 637 

Antiquaries 386 

Antiseptics — Bilroth's View of 448 

Application for Syphillitic P'ruptions 116 

Arsenic in Anaemia and Atrophic Conditions 106 

Asthma — Causes of and Treatment 292 

Asthma — Nervous 637 

Asthma — Prophylaxis of 632 

Atropia Poisoning— Treatment of, by Jaborandi 411 

Bad Teeth — Prevention of 466 

Bees and Apollo — A Fable . '. 336 

Beta — Napthol in the Trefitment of Scabies : 481 

Biliary Calculi 468 



Bills— Doctors' 



453 



Bladder— Perforating Ulcer of the 235 

Blood— To Render More Coagulable 114 

Bowels — Ulceration of in Young Children 172-290 

Brain Disease — Precursors of 400 

Brain — Gunshot Wound of the, Recovery 245 

Bromide of Ethyl in Obstetrics 167 

Bromides in Infantile Therapy •^95 



Bromidrosis of the P'eet — Treatment of. 



93 



Bronchitis of Children — Counter Irritation in 338 

Burns — Creosote Water in i6q 

Buttermilk in Sick Stomach 92 

Calculi — Biliarj' ^68 



Calculus — Vaginal 



53 



Cancer — Epithelial — New Treatment of 114 

Cancer — Influence of Diet on *624 



Cancer of the Uterus 



401 



Capsicum in Haemorrhoids - 477 

Carbuncle — Oleate of Morphia in 170 

Carbuncle — Treatment of Without Incision 3S 

Carbolic Acid — Angioma Treated by 58s 

Cardiac Disease in Adolescence 382 

Cardiac Dyspnoea 116 

Cardiac Weakness 165 

Case Books 679 

Causes of Albuminuria 284 

Cervical Follicles — Therapeutic Significance of 155 

Chloral— Paraldehyde in Place of 167 

Chlorate of Potash— Action of 635 

Chloroform in Treatment of Tape Worm 244 

Chloroform as an Anesthetic 685 



vi The Peoria Medical Monthly. 

cholera loS 

Cholera — Influence on Marriage 462 

Chorea Laryngis — Clinical Notes on 52s 

Chromium in the Treatment of Syphilis 1. . . 116 

Cimicifuga Racemosa — Influence of, on Parturition 51 

Climatic Treatment of Consumption ^23 

Clinical Notes on Chorea Laryngis 52s 

Clinic— Prof DaCosta's •. 399 

Citric Acid in the Kxtirpation of Malignant Tumors 34)5 

Cocaine — Dangers of *623 

Cocaine in the Treatment of Inflamed Nipples 160 

Cocaine — Nitric Acid 434 

Coffee — Another I'se for 6-?- 

Colles Fracture 231 

Colles' Fracture— Treatment of 676 

Constipation — Formulas for 249 

Consumption— Climatic Treatment for *623 

Consumption— Curability of 339 

Cornea — Ulceration of 6S4 

Corrosive Sublimate as a Surgical Dressing 46s 

Corrosive Sublimate— Peculiar Eff'ect of 317 

Coryza and Conjuctivitis 671 

Cough 266 

Cough — Whooping, Treatment of 45 

Counter Irritation in the Bronchitis of Children 33S 

Creosote Water in Burns 169 

Creosote Water as a Local Aiuesthetic 39s 

Cure for Hj-drophobia 339 

Curious Mistake 535 

Cystitis— Kava-Kava in 50 

DaCosta's Clinic 399 

Dangers of Cocaine 623 

Decisions — Iniquitous ? 472 

Diarrhoeas 226-294 

Diuhtheria— Treatment of 237-452-5.S5 

Diphtheria-Croup, O'Dwyer's Method 681 

Disinfectants— Action of, on Microzooids 448 

Doctors' Bills 45- 

Drugs— Influence of on Milk 395 

Dysentery — Acute 249 

DyspncEa — A IMixturc for Cardiac 116 

"Kclectic" Journals 338 

Kczema — Treatment of 52 

Klectricity in (iynrecology 460 

FHectricity in Intestinal Obstruction 115 

Kmmet's Operation— When to and When Not to Perform 162 

Knteric Fever 1 See Typhoid). 

P'.nteritis — Membranous 173 

Enuresis — Nocturna .^55-,S.vS 

Knuresis— Scutilaria Lateriflora for 246 

Kpidemic at Plymouth, Pa 15S 

Kpidemic-Zymotic Diseases and How They are Communicated to :Man 449 

Kpithelial Cancer — New Treatment of 114 

Kpithelioma— Results of Operative Treatment for 223 

]\ther — Rapid Antesthesia by 94 

Kthyl — Bromide of, in Obstetrics 167 

l-'eeding Infants — Dietetic Krrors in 39S 

I'eet — Bromidrosis of the 93 

l-'eniur — I-'racture of Neck of 272 

Fever — Enteric (See Typhoid 1. 

Fever — Mountain 351 

Fibrous Tumor— Peculiar l-"orni of Which Tends to Indefinite Growth and Multiplicity . . 95 

Fistuhc— Injections of Oil of Turpentine for Radical Cure of 674 



Table of Contents. vii 

Follicles Cervical — Therapeutical Significance of i.ss 

Forearm — Unusual Case of Fracture of , 3>^7 

Fracture — Colles 231 

Fracture of Neck of Femur 272 

Freckle Lotion 454 

Gastric Affections with a Malarial Basis 230 

Gastralgia 11'^ 

Glycerine Preparations 40*^ 

Gonorrhoeal Rheumatism 403 

fiuiishot Wound of the Brain, with Recoverj- ' 245 

Gunshot Wound of the Lumbar Vertebrfe 523 

G ynjecolog^- — Electricity in 460 

HKmatnria 221 

Hare-Lip— Treatment of '. 345 

Hay-Fever 456 

Headache — Remedy for 234 

Heart — Congenital Malformations of the 3S2 

Hemorrhage — Post-Partum 407 

Hemorrhoids — Capsicum in 477 

Hou.se-Maid's Knee — Recovery without Removal of Sac 237 

Hypertrophy of Tonsils 4S 

Incompatible — Another 453 

Infants — Surgical Treatment of 280 

Infantile Paralysis 6S0 

Infection of Scarlet Fever 414 

Inflamed Nipples — Cocaine in 160 

Inflammation — New Aspect of 6S2 

Influence of Diet on Cancer 624 

iTiflnence of ilarriage on Cholera 462 

Iniquitous Decisions 472 

Injuries of Head and Face 239 

Insomnia — Surgical 6S5 

Internal Administration of Chloroform — Poisoning by 411 

Intestinal Obstruction — F'lectricitj' in 115 

Intestinal Obstruction — Operative Treatment for 390 

Inversion of the Uterus '. 6S4 

Inversion of Uterus — Complete, Following Parturition 446 

Iodides — Action and Elimination of 627 

Iodide of Sodium in Angina Pectoris 164 

Iodoform — Adulteration of 591 

Iodoform — Inodorous 5S7 

Itching of Skin 173-217 

Kava-Kava in Cystitis 50 

Klepto-Coccus 47S 

Lactic Acid as a Destroyer of Pathogenic Tissues 625 

Lawson Tait — Personal Observations of the Work of 243 

Lemon — Decoction of, in Urethretis 115 

Leucocythemia — Leuktemia 51S 

Lithiasis ■ . . . . 467 

Little Learning is a Dangerous Thing 477 

Liver — Abscess of 221-457 

Lumbar Vertebrse — Gunshot Wound of 533 

Lupus Vulgaris — Relation of, to Tuberculosis 524 

Malarial Basis of Gastric Affections 230 

Malformation of Heart — Congenital 382 

Malignant Tumor — Citric Acid in Fl.xtirpation of 34S 

^langanese in Amenorrhcea 163 

Marriage on Cholera — Inflvience of 462 

Medical Society and How to Build it Up 455 

:\Iedical Students — Female, in France 4''2 

Membranous Enteritis I73 

^Menstrual Suffering — Abuse of Morphia in 159 

Microzooids — Influence of Disinfectants on 44^ 



viii The Peoria Medical Monthly. 

Milk Diet in Albimiimiria of Pregnancy 155 

Milk — Influence of Drugs on 395 

Mistake — A Curious 535 

Morphia — Abuse of in Menstrual Suffering 159 

Morphia — Oleate of, in Treatment of Carbuncle 170 

Moth and Tan 591 

Mountain Fever 351 

Murmurs— Ana'uiic , 382 

Nasal Asthma — Its Cause and Treatment 292 

Xapthaline— For Old Ulcers . . . . " 377 

Nerve Stretching 113 

Neuralgia — Pelvic 636 

Neuralgia — Superficial 173 

Neurasthenia 473 

New Remedies — Notes on 9S 

Night Cough in Young Children 154-414 

Night Cough — Treatment of 53 

Night Sweats — Treatment of 472-478 

Obstetrics— Bromide of F;thyl in 167 

Obstinate \'omiting — Ice to the Spine in 294 

offensive Urine 636 

Oleate of Morphia in Treatment of Carbuncle 170 

Otitis Media— Chronic 27S 

Out of Place 637 

f)varies— Vagina and Uterus Lacking 53 

Palmar Ganglion 353 

Pastes in the Treatment of Skin Diseases 217 

Paraldehyde in Place of Chloral 167 

Paralysis— Different Forms of, Met with in Young Children 529 

Parturition — Cimicifuga in 51 

I'athogenic Tissues — Lactic Acid as a Destroyer of 625 

Pelvic Neuralgia 636 

Penis— Retraction of the 68.s 

Perforating Ulcer of the Bladder 235 

Peritonitisof Lower Abdomen— Perityphlitis 2S6 

Phthisis— Tonic in 685 

Physician and Patient— Relations Between 396 

Poisoning — Ammonia 528 

Poisoning by Internal Administration of Chloroform 411 

Post-Partum Hemorrhage 407 

Practitioner Sued 47S 

Precursors of Brain Disease 400 

Pregnancy — Diagnosis of 479 

Pregnancy— Milk Diet in Albuminuria of 155 

Pregnancy — Extraordinary Case of 3S5 

Pregnancy — Vomiting of 355 

Prevention of Bad Teeth 466 

Primary Union in Large Incised Wounds 630 

Professional 535 

Prolapse of the Rectum 343 

Prophylaxis of Asthma 632 

Pruritis Pudendi Due to Vascular Tumor of the Urethra . 346 

I'soriasis— Salicylic Acid and Castor Oil in 401 

I'tomanies — Origin, Character and Reaction 474 

Quinia Mixture— A Pleasant, for Children 413-444 

Quinia — Subcutaneous Injection of 470 

Quinsy— Causes and Treatment 4S0 

Ranula — Location and Treatn\ent of 516 

Rectocele 634 

Rectum — Prolapse of 1 343 

Relations Between Physician and Patient 396 

Renal Inadequacy 637 

Rest as a Therapeutic Agent 591 



Table of Contents. ix 

Rheumatism— Acute Articular— An fuique Case 461 

Rheumatism — Gonorrhoea! 403 

Rheumatism— Salicylic Acid in 334 

Rheumatism— Salicylate of Soda in 4* 

Round Ligament — Shortening the ^29 

Salicj'lic Acid in Rheumatism 334 

Salicylic Acid and Castor Oil in Psoriasis 401 

Scabies ^-^z 

Scabies— Beta-Xapthol in 4S1 

Scarlet Fever — Infection of ; . . . . 414 

Scarlatina — Diagnostic Value of White Streak in 47^ 

Sciatica — Treatment of 355 

Scrofulous Glands — Surgery of the 46 

ScutilariaLatiflora in the Treatment of Enuresis 246 

Shock and its Treatment 337 

Sick Stomach — Buttermilk in 92 

Skin Diseases — Pastes in Treatment of 217 

Skin— Itching of the 173-217 

Society Reports and Medical Journals 677 

Spinal Chord — Surgery of 215 

Stretching of Nerves 113 

Subcutaneous Injection of Ouinia 47° 

Superficial Neuralgia i73 

Surgery — Emergencies of, in Injuries to Head and Face 239 

Surgical Dressing — Corrosive Subl 465 

Surgical Treatment of Infants 2S0 

Sweats, Night — Treatment of 472-47S 

Synovitis — Treatment of 156 

Sj'philis — Chromium in 116 

Syphilis — Applications for Eruptions of 116 

Tape Worm — Chloroform in Treatment of 244 

Teething of Infants 51 

Tetanus 276- 

Tonsils — Hypertrophy of 4S 

Tuberculosis — Relation of to Lupus Vulgaris 524 

Tuberculosis — Vesical 675 

Tumor — Fibrous, Tending to ^Multiplicity and Indefinite Growth 95 

Typhoid Fever — Treatment of 3S7 

T3'phoid Fever — Bi-cliloride of Mercury in 412 

Typhoid Fever — Eucalyptus in 161-469 

Typhoid Fever — Ox-Gall in 413 

Typhoid Fever — Veratrum Veride in 521 

I'lceration of the Bowels in Infants . . 172-290 

I'lceration of the Cornea 6S4 

I'terus — Inversion of the 6S4 

I'lcer— Perforating, of the Bladder 235 

I'lcers — Napthaline for 377 

X'rethretis— Decoction of Lemon in 115 

Trine— Offensive 636 

Uterus — Cancer of 401 

I'terus — Complete Inversion of, Following Parturition 446 

Uterus — Vagina and Ovaries Lacking 53 

Vaginitis 634 

Venereal Warts 355 

Vescical Explorations no 

Vesical Tuberculosis 675 

Vomiting of Pregnancy 355 

Warts— Venereal 355 

Weakness— Cardiac 165 

When and When Not to Perform Emmet's Operation 162 

White Streak — Diagnostic Value of, in Scarletina 47 



X The Peoria Medical Monthly. 

Whoopinar Cough— Treatment of 45 

Wounds — Union by Adhesion in Large Incised 630 

Young Children — Paralysis in 529 

THERAPEUTIC NOTES. 

Absorbents 119 

Antiseptic Gauze 117 

Catgut Sutures 119 

Cerebral AnKtnia— Headache from 41C 

Chilblains 489 

Chronic Gastritis 295 

Chronic Diarrhoea 417 

Condylomata on Tongue in Syphilis 117 

Corrosive Sublimate— To Make Solutions of ii2 

Delay in Hardening of Plaster Paris 117 

Diabetes Insipidus 299 

Diabetes Mellitus 299 

Dilatation of the Stomach 298 

Dyspepsia 298-483 

Drainage Tubes 117 

Erysipelas n? 

fevers— To Produce Diaphoresis in 415 

P'lush Powder 483 

Gastralgia 299 

Gastritis— Chronic 775 

Gauze— Antiseptic 117 

Gauze — Iodoform H7 

Gonorrhoea ii7 

Headache— due to Cerebral Anfemia 415 

Headache— due to Malarial Poisoning 4>5 

Headache— due to Renal Poisoning 415 

Haematuria ^99 

Haemophilia 4^3 

Iodoform Gauze ii7 

Malarial Poisoning— Headache from . . 415 

Neuralgia 4^3 

Neurasthenia— Treatment of 415 

Pleurisy— Acute 4^3 

Renal Poisoning— Headache due to 415 

Rheumatism 4i5 

Scarlet Fever- for Malignant 4i5 

Sciatica 4'^3 

Stone in the Bladder ^'7 

Suppurative Otitis 483 

To Prepare Sponges "7 

Varicose Veins "7 



EDITORL\L. 



A Circulatory Riot 



181 



A Horse of Another Color 35^ 

A Literary Gem 54i 

A Lively and Newsy Medical Journal I75 

American Medical Association ^89 

An Attack on Dr. N. S. Davis 4i8 

A New Star - '"^ 

Announcement ' ^ 

A Pleasant Parting ^^ 

Articular Rheumatism St^^ ^^^ 

.\ Wail from Chicago "■ ^- "^'^ 

.\ Wonderful Man • ■ •'"'* 

.\ Word about our Monthly S 55 

Case of Pure Gall 5'' 

Chief of Marine Hospital Service Ik ^04 



^ 



Table of Contents. xi 

Cure for Hydrophobia i. 

Deaths in the Profession . .,, 

421 

Tl^ft-nlt A.T*»Hi^q1 r^i^11*inr^ 

125 



Diseases of Trotting Horse Trainers 

Doctor and Drug-gist jj. 

Doctor Austin Flint g.^ 

Epidemics -g 

Famous London Doctors j_g 

Grave Charge Cleared up 257 

420 



Great Offer 
Hard Times 



592 

How to Cure a Felon -g 

Hydrophobia — Cure for • • • c,q 

Illinois State Medical Society 

Is Ferran a Charlatan ? 



677 

176 

Jokes on the Doctors 126 

Lay Editors' Ethics 2^2 

Married — 

Dr. C. F. Ross 



Dr. W. H. Conibear 



420 



421 

Medical Advertising 2'S2 

Medical Congress — the International 130-174-592 

Medical Congress — the International — Rules for ,00 

Medical Experts 251 

Medical Opinions n6 

Methods of Practice ^^y 

Mind Cure • 416 

Newspaper Rules egg 

Night Sweats 540 

Nitro-Glycerine vs. Alcohol 540-641 

Notes and Comments., 5S-126-182-305-422-4S7-542-594-689 

Office Thief 420 

Our Business 305 

Our Last Explanation 250 

Placebo Question 54 

Progress of the War 250 

Questions 421-593 

Rapid Blstering 540 

Reading Notice 598 

Receipts 64-126-188-260-310-360-425-546-646 

Retrospect of 1S85 4S4 

Rules for the International Medical Congress 300 

Small-Pox in Peoria 419 

Society Work 536 

State Board of Health Statistics 303 

State Society Work 593 . 

Substitute for Iodoform 542 

The Ball that Wounded Hancock 687 

The Placebo Question 54 

The Registry Law 638 

To make up for Infant Mortality 688 

Ultra Scientific Medicine ./ 639 

Unwarranted Suspicion 58 

Weakening our National Energy 541 

Who is to Blame 123 

BOOK NOTICES. 

A Formula Book 425 

Asiatic Cholera — A Treatise on 187 

Atlas of Clinical Microscopy 490 

Bacteria Investigation — Technology of 257 

■Calculous Disorders and Urinary Derangements 62 



xii The Peoria Medical Monthly, 

Climatology and Mineral Waters of the United States 49° 

Clinical Notes on Uterine Surgery 493 

Cutaneous Memoranda 493 

Detection and Effects of Poisons 188-256 

Diagnosis and Treatment of Diseases of the Ear 644 

Diagnosis of Disease of the Brain and Spinal Chord 492 

Disease — Pedigree of 493 

Diseases of Children 30^ 

Diseases of the I^ung 49i 

Elements of Modern Medicine 256 

Epidemic Cholera 257 

Etpitome of Diseases of the Skin 493 

Essentials of Vaccinnation 494 

Formula Book 425 

Hand Book of Medical Science 4^5 

Indexed Catalogue 3°^ 

Lectures on Syphilis 645 

Local Antesthesia in General Medicine and Surgery 645 

:Methods of Bactereological investigation 645 

Microscope — Use of the 31° 

Milk Analysis and Infant Feeding ■ " ■ . . . 494 

Miscellaneous Affections of the Kidneys and l"rine ' 256 

Nervous Diseases 309 

Official Formula of American Hospitals 493 

Oleates — Their Nature and Action 63 

Pecflgree of Disease 493 

Practical Suggestions on Electricity 492 

Practical Therapeutics ' ' 309 

Poisons — Their F;ffects and Detection 1S8-256 

Reference Hand-Book of Medical Science 425 

Report of State Board of Tennessee 25S 

Reprints and Pamphlets 63 

Syphilis — Lectures on 645 

Technology of Bacteria Investigation 257 

Transactions of the Louisiana State Medical Association 25S 

Transactions of the New York State Medical Association (18S4) 62 

Transactions of the Tennessee State Medical Association 18S 

Use of the Microscope 31c 

"Venereal Memoranda 49? 



The Peoria 
MEDICAL MONTHLY. 



Vol. VI. : : JULY : 1885 : : Xo. III. 



ORIGINAL COMMUNICATIONS. 



NATURAL SELECTION IX IMMUNITY FROM DIS- 
EASE. 

BY ROMAINE J. CURTISS, M.D., JOLIET, ILL. 

It may be said that the germ theory of the origin of disease 
is accepted bv the medical profession, to the extent that there is 
an attempt to settle all medical problems from this standpoint. 

Experimenters and generalizers are now working at the 
question of what causes immunity from disease, after one attack? 
The theories, queries, or hypotheses advanced are numerous and 
ingemous: but, of course, not all of them can be correct. Gen- 
eralization means that a single antecedent, or cause, must be 
found for a class or group of phenomena, and the method of 
finding it is to select a cause that is a true cause in nature, and 
then test the different or many phenomena, and learn if the true 
cause is a sufficient cause for all of them. The next step is to 
show that all other h^'potheses are vain guesses, and the next is 
to verify, if possible, the generalization itself. The hypotheses 
■of ""ravitation, and the etherial medium of lifjht have been 
this method of solution. 

There are two or more important factors of the immunit}' 
from disease which must now be noticed. In the first place, 
with relation to communities, it is noticed that not all people, who 



128 The Peoria Medical Monthly. 

are exposed to disease, are made sick. Disease infection, or con- 
tagion is widely disseminated, or is diffused by epidemic forces, 
yet a large proportion of people, differing with different diseases, 
.are exempt. The condition of the exposure is such that this 
cannot explain the exemption — there is something else. Look- 
ing, now, at the person, w^e find that different tissues, organs, or 
cells bear this same relation of immunity, relating to different 
diseases. In each disease (or nearly) certain tissues or organs 
are exempt, which confines the contagiuin viviiin to certain other 
tissues or organs, as small-pox is limited principally to the skin. 

In this case as in the community case, this exemption has 
been acquired by some means. We sa}^ the germs have an 
"affinity" for certain tissues, but in organic or social life, affin- 
ity^, in a particular direction, only means greater resistance in 
other direction. •' Aflinit}- '' is the inverted expression for the 
direction of least resistance. 

It is now necessary to find an explanation for the fact of ex- 
emption from disease in certain' proportions of people in conimu- 
ties, and certain organs and tissues in people; but before naming 
the h3'pothesis I will mention another factor of immunity, which 
is observed by everybody, and which is that persons, tissues, and 
organs loose their protection, vaccination runs out, and so does 
^every other immunity run out. It is a corrollory of this law 
that immunitv is not iruaranteed for anv definite leno-th of time. 
It varies in duration, in different diseases, from a verv short time 

to a lifetime. I think as sfood a i>ceneral law as can be formu- 

. . . . ♦ 

lated is that the duration of immunity varies directly to the 

severity of the disease. This is whv small-pox gives greater 

immunit}' than varioloid and kine-pox. 

There must be found a single law, a true cause in nature, 
which can explain these diverse phenomena of immunity, as well 
as all, or any other phenomena, that mav be discovered. There 
can be no science on this subject until this law is found. As a 
hypotheses I porpose the law of natural selection, in relation to va- 
riation and atavism, and think this will explain everything that 
any man knows on the subject of immunitv from disease. 

I need not explain variation and atavism, further than to say 
that they are established causes in biology-, and account for even 
the origin of species. The law governing variation is that the 



Originai. Communications. 129 

strup'o-le for life, or individual antagonism, causes a differentia- 
tion of structure and function. When two organisms tight, or 
when each struo-ales with adversity in its environment, the result 
is that a variation is caused in its structure and abilities. This 
variation is what allows the " survival of the fittest."' But con- 
ditions change, and if the cause of antagonism and variation be 
resumed, the organism reverts again to its former type, which 
change along the retrograde line, is called atavism. Organic 
phenomena, relating to life and change, are made up of inter- 
changes between variation and atavism. If an animal acquires 
speed by being chased by other animals, the acqusition is due to- 
to a variation. If the beasts of prey which do the chasing are 
destroyed, the speed in the other animal, is gradually lost. When 
a fatigued doctor goes a lishing, by rowing about he acquires 
b}^ variation in the cells of the integument of the palm, which 
appears as callous. When he resumes his place in the profes- 
sion as a duly registered physician, he forsakes the oar, and the 
cells of the integument, by atavism, revert to their former type, 
and the callous is removed. These are two special instances of 
variation and atavism; but, now, what is meant by natural selec- 
tion in this relation.^ When the prairie wolf chases the antelope 
it is because the flesh of the antelope is adapted as food to the 
wolf. This general law is the wretchedest thing on the mun- 
dane sphere, and underlies all evil in the world. If the wolf 
can't destroy a bear or buffalo, and can't catch the birds, and 
can't find the rabbits, it is because these animals have acquired 
by immunity and heredity, by a successful resistance, so the wolf 
chases the antelope, if happily he may catch him. This is called 
natural selection. Some people like to call it ^- Affinity," but 
the wolf selects the antelope for the reason that he can't select 
anything else. Now, when the wolf makes this natural selec- 
tion, he persues the antelope, which, if he has acquired speed by 
such contests and heredity, escapes, and the wolf dies of starva- 
tion; following which the antelope stands around nibbling grass 
and loses its speed by atavism. 

This gives the whole story of natural selection, variation, 
atavism, and transmission by hereditary descent, and the sequent 
survival, immunity and atavism. 

The point I want to make clear is that a variation is brought 



130 The Peoria Medical Monthly. 

about b}' actual combat with a personal enemy, or by other 
environing- antagonisms to which the organism must adapt itself 
by a variation in order to live. 

With these general principles we are readv to investigate 
disease. The first question to ask and answer is, whv is there 
such a thing as disease? The reason is because living things 
live on each other, because their diet is the same as the material 
of their structure. The disease microbe is not in the body by 
accident. It is there because natural selection has determined it 
and the battle is now between the tissue cell and the microbe. 
Living things do not consume each other alive. Animals and 
other living things, kill each other, either mechanically or by 
poisons, before consumption. The microbe can not consume a 
living cell with its feeble osmosis, so it poisons the cell bv its 
own ph\-siological product for this purpose. It is then a struggle 
between virulence of the microbe and physical resistance of the 
cell, with the results of variation on the part of both, and sur- 
vival of the fittest. As the struggle and variation continue be- 
tween cells and their descendants and microbes and their de- 
scendants, with variation and its heredit}' on the part of both, 
the result depends upon the resources of the combatants in the 
hne of variation. 

That cells acquire a " tolerance"" to poisons, is known to all, 
in the use and abuse of alcohol, opium, arsenic, etc. This is 
proof enough that the cells acquire a resistence to poisons 
through individual combat with virulent microbes. 

Now let us apply the law to the phenomena of disease, and 
first, what gives rise to pathological products? The new for- 
mation in anatomy — the new cells, are the resultants of nature's 
efforts at repair, and the forces of disease. The force of dis- 
ease is poison and death of cells: the force of repair comes 
through the physiological creation of cells bv other cells. The 
pathological cell is a cell that has an extreme variation from the 
tissue cell. That these things are true, is confirmed by the fact 
that the definiteness and character of pathological cells corres- 
ponds directl}- with the character of contagion and the tissue 
that is diseased. Perhaps it is difiicult to verify that the varia- 
tion can be so great in the reproductive power of cells, but the 
pathological growth is the result of nature to repair injuries, sub- 



Original Communications. 131 

ject to poisons, and the new growth mav be a product of nutri- 
tive material, subject to poisons, rather than of tissue cells. 

But the variation of cells caused by combat with poisons 
which enables them to resist poisons, is not, in this sense, a new 
growth. It is the same as the variation which enables them to 
resist opium and alcohol. The variation is transmitted h\ 
heredity, and there is no escape from the conclusion that it is this 
acquired variation and its transmission which gives the immunity 
from disease and also brings about what is known as the law of 
limitation of disease, both in persons and communities. The dis- 
ease in a person terminates, not so much from " cure," but be- 
cause the susceptible cells have acquired bv conflict and ^^aria- 
tion and inheritance, a successful resistance to the poison. In 
communities a disease terminates because susceptible people 
have acquired an immunit}' and transmitted it. Of course there 
are other factors which relate to the environment of microbes 
that are not included in this calculation — for instance "sanitation." 

The person, by this means, acquires an exemption, for a 
variable time, to attacks from the same disease, and, as has been 
proven from attacks of certain other diseases. Experiments of 
Sternberg and others seem to show that ordinarv septic bacteria 
acting upon a person or animal give increased resistance to dis- 
ease microbes of many kinds, other than the septic organisms. 
Taking up the phenomena of disease, the question comes up 
why do diseases affect certain tissues or organs? The explana- 
tion is in the fact that all other tissues and organs have acquired 
an immunity. The microbe has an affinit}' for certain tissues be- 
cause such is the direction of least resistance. It " selects" the 
tissue and cells which are least able to resist it. The same law 
holds good in relation to communities. Certain proportions of 
the people are not susceptible to a disease infection, and a given 
disease works only among those who are susceptible. Every 
feature of these phenomena that I can think of are readily ex- 
plainable b}- these laws, or by the law that natural selection or 
variation gives immunity from disease, and that this variation is 
transmitted bv hereditv. 

The cessation of the great epidemics of the middle ages — • 
plague, typhus, and sweating sickness may be explained by 
this law. The public acquired and transmitted a variation, the 



132 The Peoria Medical Monthly. 

character of which enabled a successful resistance to be made to 
the epidemics. 

But there is an obverse side to the problem. On this side 
we find the fact that immunity does not last. It <n'aduallv dies 
out. W e account for all such phenomena bv the law of atavism. 
The cells, no longer being subject to combats with the poison, 
revert to their primitive type, just as the antelope looses its speed 
when no longer chased by wohes. This type of atavism is 
transmitted by heredity, and in time the person or community is 
again susceptible to disease. 

I am confident that this law will explain all phenomena in 
question relating to disease. It being an established law of bio- 
logy, its claims cannot be ignored or its influence escaped in the 
solution of the problem of immunity. But to establish it we 
must show why other hypotheses are not explanations, which I 
will defer until a future time, as these h-\'potheses are rapidly ac- 
cumulatino-. 



UPWARD DISLOCATION OF PATELLA. 

BY S, W. DODGE, M. D., REYNOLDS. XEB. 

March 4, 1885, John W., Irish, single, age 30, almost a giant 
in physical make-up, was brought to my office about one hour 
after the following accident: He was chopping a large limb 
from a fallen tree that was lying over an embankment. He was 
aware that when the Hmb was severed that it would shoot up- 
wards, and he expected to move in time to avoid a collision, but 
his expectations were not realized, and ere he was au*ire of it 
the end of the limb struck him with great force under the knee- 
cap of the left leg and he was precipitated down the embank- 
ment. Friends brought him to me and on examination I found the 
patella driven upwards nearly four inches with the ligamentum 
patella completel}- ruptured from the patella. 

No discolorization of the skin, nor was there any at all after- 
wards. Now as to treatment. I confess 1 was in a quandary. 
My works on surgery simply stated that it w^as an uncommon 
occurrence and to treat same as for fracture of patella. I finally 
hit upon this mode of treatment: Elevated the foot to relax the 



Original Communications 133 

extensors, manipulated the misplaced bone till I had returned it 
as nearly as possible to its original position: an assistant held it 
firmly while I put on a strip of surgeon's rubber plaster about 
one inch \yide and a foot long, the center coming oyer and aboye 
the patella, the ends being carried do\yn\yard and back\yard and 
made fast. I then put on figure of 8 bandage, and a temporary 
splint till I could get one made for better seryices. 

Patient ^yent home \yith instructions to keep foot eleyated 
and remain quiet. What \yas my chagrin the next morning to 
be summoned in haste to learn that he had attempted to walk 
across the room to breakfast and had fallen, tearing eyerything 
loose and the patella apparently higher than at first. I now had 
a tin trough made to reach from middle of leg to middle of thigh, 
which, after again. putting on the rubber plaster and figure of 8 
bandage, I bandaged firmly to the limb. I reapplied the dressing 
eyery two or three days, each time gaining on the patella till now 
there is only about one-half inch interyening and that is filled 
with hard callous effusion. In six weeks the spHnt was remoyed? 
patient walking with aid of cane. Now (July 10) scarcely a 
noticeable limp. No stiffness of joint, and very litde weakness. 
There neyer was yery much swelling nor much pain. He is a 
farmer and was following the plow within two months after the 
accident . 



REDUCTION OF AX INVERTED UTERUS. 

BY ROMAINE J. CURTISS, M.D., JOLIET, ILL. 

Mrs. A., of Irish extraction, was attended in her fifth con- 
finement, when about 30 years old, by a midwife (unfortunately 
not a " licensed " midwife). The results of the labor, and efforts 
of the midwife were the birth of a boy and complete inyersion of 
the uterus. After two or three weeks Dr. Casey, of this city, 
was called to the case, who made a diagnosis. The patient, 
during this time, was subjected to hemorrhages, and had the 
usual sequeloe of such a condition of things. 

Dr. Casey, after palliating the symptoms of his patient for a 
few weeks, brought about a better condition of things in gen- 
eral, and reported his case to Dr. Hosmer and m3'self, by way of 



134 The Peoria Medical Monthly. 

consultation. A council of war was held, and the conclusion 
was to attempt the restoration of the natural position of the 
uterus. The accident occurred about two years ago, and the 
operation for the reduction of the in\ersion was performed two 
months after accident. The method adopted was that of the late 
Dr. James P. W^hite of Buffalo — the writer having been present 
at several of these operations b\- Dr. White was acquainted with 
his method, and its phenomenal success. Dr. White was cer- 
tainly the professional hero of the operation for replacement of 
the inverted uterus. 

The method consists in compression of the uterus bv the 
hand, for the purpose, at tirst, of depleting the tissues of blood 
and other fluids. This effect of depression naturally makes the 
uterus much less in bulk. After this effect is accomplished, the 
effort is to invert. The inversion may begin either at the mouth 
or fundus — depending on which of them has the least resistance 
to the remedial forces. The force brought to bear for the pur- 
pose of inversion is bv the use of an instrument devised by Dr. 
White, which he named his " egg beater,"" because it looks like 
one. It is made of (i) a wooded stem, probablv i6 inches long, 
and should be curved. On one extremitv is fashioned a cup, not 
quite so pronounced as the cup at the end of Mcintosh's univer- 
sal uterine supporter, while at the other end is ( 2 ) a spiral spring, 
made of steel wire. When in use the cup is applied to the 
uterus, the spring rests against the chest of the operator, who 
can thus exert all needed force. While using compression, and 
the force through the egg beater, counter pressure is used to the 
uterus through the abdominal walls. 

Provided with these tools and methods, we etherized the 
patient and went to work. One hour was occupied b}' Dr. 
Hosmer and mvself, alternatelv relieving each other, in the work 
of compression. This labor, to a non-laboring man, is para- 
lyzing. 

The uterus was larger, nearlv rilling the pelvis, but in an 
hour we had it so small that the hand could surround it. The 
blood escaped in every direction — through the vessels into the 
circulation, and out of the vessels into the vagina. In about an 
hour and a half it became apparent, through the medium of 
tactile sense, that the uterus was turnin<; bv wa\' of the mouth 



Original Communications. 135 

and cervix. We could feel that it was growing smaller and 
shorter. Our fatigue was great, but we were braced up by the 
expectation of success. After two and a half hours, as Dr. Hos- 
mer and I relieved each other, the contest appeared to be not 
only with the uterine condition, but I am constrained to say 
that the two operators were subject to an unconscious struggle 
with each other. Each, no doubt, wanted the operation done — - 
wanted it over — but no doubt each, unconsciously to himself^ 
wanted to complete the operation. i\t the end of nearly three 
hours, my turn for work came on, after witnessing unusual effort 
on the part of Dr. Hosmer for nearly half an hour. On insert- 
ing my hand I found the uterus rather high in the abdomen, and 
nearly turned. My tirst thought was that I would tinish that job 
in live minutes, but feeling around I discovered that an " acci- 
dent " had occurred — there was a rent in the vaginal wall on the 
right side large enough to admit three fingers. Further effort 
was of course out of the question. I drew the uterus down and 
adjusted the fractures in as good a position as possible. 

The woman was placed in bed to recover from the ansesthesia.. 
The treatment for the next two weeks ^vas principally antiseptic 
vaginal washes, frequently repeated. There were no untoward 
symptoms except some phlebitis of right thigh. The next morn- 
ing after the operation, the patient described the sensation of a 
peculiar movement of the uterus. Being informed of her condi- 
tion fullv, she declared that her sensation indicated the restora- 
tion of the uterus to its natural condition — or the completion of 
the inversion. Subsequent events proved that she must have 
correct. In a few months her menses returned, and within a 
year Dr. Hosmer attended her in a premature confinement. 



MAN: AN ESSAY 



BY W. J. CHENOWETH, M. D., DECATUR, ILL. 
Read before the District Medical Society of Central Illinois 

I shall trust to the importance of my subject, and not to the 
introduction of new arguments or of recently discovered facts, to 
compensate you for the time spent in listening. 

Without controversv, man stands at the head of all organ- 
isms on earth. Whether this has been brought about by a slow 



136 The Peoria Medical Monthly. 

development from lower organisms, or is the result of an imme- 
diate creation, is in dispute. A literal interpretation of tlie history 
of man's orioin given in the Book of Genesis, has induced the 
belief that it was immediate. And that is, probablv, the pre- 
vailing belief at this time, although it is now agreed that a ver}' 
long time passed from the hour when God said " Let there be 
light '' to the time when He crested man. The statement that 
man was made tirst, and woman was made from man, is so op- 
posed to the method of frofao-ating the species, that it seems 
irreconcilable with any other theorv than that of immediate cre- 
ation. But the ditiiculty vanishes if )iiaiikind is substituted for 
man. While the doctrine of development had a theoretical ex- 
istence in the earlier centuries of the Christian era, and the view 
was extended after the conquest of Alexandria bv the Arabians, 
and many writers declared that immediate creation was an im- 
possibility. Draper says, " In the rehgious revolt against philos- 
ophy that took place toward the twelfth centurv, these ideas were 
exterminated and ne^■er again appeared in Islam. He further 
says, '• If the doctrine of the government of the world by law 
thus held in detestation bv Islam, it was still more bitterly op- 
posed by Christendom." There was no possibilitv of establish- 
ing the theoiw of evolution without the aid of the phvsical sci- 
ences. The starting point of Christendom, in this theorv, was 
the publication by Copernicus of the book - Dc Rcz'ohttionibns 
Orhiiijii CckstiiDu" in which the Pythagorean view of the em- 
placement of the solar svstem is revived." These ideas were 
matured by Kepler, Gallileo and others, and with the stead\- ad- 
vance made in the physical sciences the doctrine of evolution has 
grown apace. 

Lamark, in his " P/iilosophic Zoologic^' issued in 1809, ad- 
vances the doctrine that organic forms originated by spontaneous 
generation, the simplest coming tirst, and the more complex be- 
ing evolved from them. In 1S44 '^" anonvmous publication 
( ]'^€^t?'o-es of the JVatitral History of Creation^, set forth the 
view of Lamark, " and being cleverly and attractively written 
passed through a great many editions." In the discussion of 
this book the author made use of a most important anatomical 
discovery: "That even in the case of the highest species, man 
himself, the embrvo does not simplv grow, or increase in size, 



Origin Ai. Communications. 137 

but passes in succession through a series of forms \vhich. exam- 
ined from epoch to epoch, are total!}- dissimilar." It had hereto- 
fore been held that all parts of the animal existing at birth were 
present at conceptfon, and that the embrvo reached birth as the 
infant reaches maturity. 

While opinions were forming and men were confused 
fused in reference to the development of organisms, they were 
assisted in their studies bv the gradually accum.ulating knowl- 
edge of geology. x\s early as 1680 Leibnitz had proposed that 
the earth had once been in a molten state, from heat, and that 
the primary rocks were formed by the cooling of its surface: 
and in 1756 Lehman had grouped the earth's strata in chronolo- 
gical order. But to Lyell is due the credit of haying taught, in 
1830, in his '• Principles of Geology," the gradual deyelopment 
of the earth. And from that time it be^an to be belieyed that 
the six days spoken of in Genesis, in which the earth was cre- 
ated, were six periods of time, each of yvhich was many thou- 
sands of years duration; and it is not now a matter of opinion, 
but of demonstration, that the loxNcst forms of life, yegetable and 
animal, commenced in the hrst period, and that they were more 
complicated and more highly organized from period to period. 

In 1S59 Darwin published his work on the origin of species, 
in which he seeks to prove that organisms have a tendency to 
develop in the likeness of tht^ir progenitors. But variations are 
continally produced. '• No chick and no child is in all respects 
and particulars the counterpart of its brother or sister," and that 
variety which is best adapted to its surroundings will multiply 
more rapidly and be more vigorous thaij others; that a struggle 
for existence has been going on through all of the ages, the few 
and the weak "-ivino- way before the more numerous and the 
strong, or to those organisms which have been more perfectly 
adapted to their environment; if a surFicientlv long time be given 
a slight change may result in a vast moditication. 

Controversy succeeding the publication of this book became 
very bitter. Advocating; the views announced was res'arded as 
an advocacy of infidelity, and ostracism from Christian fellow- 
ship was not an infrequent result. But investigation is now per- 
mitted and what of truth is in it will stand. 

In 1871 Mr. Darwin published a work on "The Descent of 



138 The Peoria Medical Monthly. 

Man," in which he adduces proof tending to show that man's 
ancestors were a line of inferior aaimals, or to quote his words. 
" Man is descended from some less highly-organized form/' and 
"still bears in his bodily frame the indellible stamp of his lowly- 
origin ; or, as paraphrased by Balfour, " Each organism repro- 
duces the variations inherited from all of its ancestors at succes- 
sive stages .of its individual ontogeny which correspond with 
those at which the variations occurred in its ancestors.'' So 
that man's embr}-onic existence " is a recapitulation of his gen- 
ealogy during the enormous duration of terrestial life." If this 
is not so, " these progressive stages are not onlv inexplicable, but 
are so deceptive as to suggest the explanation once current as to 
fossils — they are 'delusions of the devil.'" — (S. E. Chaille. ) 

Embryo life ceases as soon as the embryo is capable of liv- 
ing in the element for which it is destined. So soon as the hsh 
acquires gills, and an alimentary canal, so that life can be main- 
tained, the vitelline circulation, which had supplied air, water, 
and food ceases. If the environment in which it is to live require 
an additional supply that embryo life may be prolonged, a new 
and most perfect means is instituted. With birds, the vitelline 
circulation having ceased, the organism is continued in its em- 
bryo state by the allantois, which maintains the supply of food, 
air, and water until the bird is able to live outside of the shell. 

In like manner mammals are dependent, first, on the vitellus, 
or yolk, then on the allantois, but these ceasing, and the embrvo 
being destined for a higher organization, the placental circulation 
is established, the embryo passing through all of the stages inci- 
dent to fishes, reptiles and birds before it reaches the placental 
stage. 

Tracing the develooment of a mammal, for instance, of the 
dog, sheep, horse, or man, all of, them originate from the coal- 
esence of two cells, the ovum and the spermatozoon, this pro- 
duct undergoes a process known as segmentation, in the course 
of which it becomes divided, in typical cases, in a number of cells 
which constitute the material from which the body of the young 
animal is developed. A variety may occur at some stage of 
growth whicii is inherited by the issue of the organism, and there 
is, afterwards, a divergance which increases until what com- 
mence life as one specie becomes many. A hog does not change 



Original Communications. 139 

into a cow, nor does a horse change to a dog, nor a monkey into 
a man, but at some remote period the ancestors of all of them 
were the same. Darwin has been grossly misrepresented, in al- 
luding to his views on this subject, that I call attention to the fol- 
lowing, copied from the descent of man: 

" The quadrumanna and all the higher mammals, are 
probably derived from an ancient marsupial animal, and 
this through a long line of diversified forms, either from 
some reptile-like or some amphibian-like creature, and this 
again from some fish-like animal. In the dim obscurity of the 
past we can see that the .early progenitor of all the vertebrata 
must have been an aquatic animal, provided with branchiae, with 
the two sexes united in the same individual, and with the most 
important organs of the body (such as the brain and heart) im- 
perfectly developed. This animal seems to have been more like 
the larvaj of our existing marine ascidians than any other known 
form." 

If it is true that man passes from an egg to birth through 
the same slow and gradually progressive modifications, de- 
pends on the same contrivances for protection and nutrition, and 
finally enters the world by the help of the same mechanism, 
wherein does he differ from other mammals ? 

It is a law that embryos, at any stage of their existence^ 
until prepared to live in the element for which they are being 
fitted, may grow without being developed, or develop without 
growing. A giant develops with an abnormal growth. A 
dwarf does not grow naturallv, but development may be perfect. 
It is also true that any part of an organism may fail to be devel- 
oped and continue to grow, or cease to grow and continue to de- 
velop, affording proof of the lowly origin of man. If, in the hu- 
man embryo, development does not ensue at conception, there 
may be growth and multiplication of cells, as occurs in hydatids, 
of the uterus. x\t the third week the embryo is, in appearance,, 
a jelly-like worm, which, growing without development, may be 
thrown off as a falsa conception. At six weeks it has tlje gill 
apparatus of the fish, the gill fringes not being required, are 
atrophied. But the branchial arteries which form the perma- 
nent arteries of the fish are transformed into the arterial system 



140 The Peoria Medical Monthly. 

of man. Branchial lissures are sometimes found in the neck of 
adult human beings. 

In fishes there are two little sacks which open into the upper 
part of the alimentary canal and which constitute their lungs. 
This condition is found in the human embryo. The heart of the 
embryo of man is tirst a small pulsating sack with a single cham- 
ber, such as is found in the lancelot, one of the lowest organiza- 
tions, a link between worms and yertebrates. Afterwards it is 
diyided into two parts, as in tishes. After this into three cham- 
bers, as in reptiles. And it does not become four chambered 
until about one week after birth. 

Paget cites a case of a heart, preseryed in the Pathological 
Museum, which had but a single cayity, but which was of more 
than the ayerage size of children of the same age. He also re- 
fers to another where the septum of the yentricles was incom- 
pletely formed: this patient liyed for eleyen years. C^'anosis, or 
blue disease, is caused by want of closure of the septum between 
the auricles, a condition which leayes the heart three chambered. 
The kidneys of man are at first wolfian bodies, the same as the 
permanent kidneys of the fish and the frog. The human embryo 
has, until twelye weeks, a common faecal and genito-ural outlet 
as fishes, reptiles, and birds haye permanently. 

At eight weeks the embryo man has a tail which projects 
beyond his legs as far as does a dog's tail at the same age. The 
muscles which formerh' moyed the tail are still present in adult 
man, but are atrophied for want of use. It is possible for the 
tail to grow. 

April 28, 1878, Mr. Owen related to the Haryeian Society 
of London the case of a fcetus which he saw, which had a tail 
which was curled up on one buttock and distinctiyely moyed. 
It was remoyed successfully, by ligature, and is now in the mu- 
seum of Guy's Hospital. The child Hyed to be sixteen years of 
age. 

We might call attention to the bones, the skin, the uterus, 
the yermiform appendix, and other parts of the body, as show- 
ing evidence of eyolution in man, and to rudimentary organs 
found in other organisms — as teeth in whales, snakes with feet 
which by disuse are atrophied and hidden: insects with wings 



Original Communications 141 

which are immovable, showing the common origin and mode of 
development of man and the lower animals. 

But we pass these bv to call attention to the nervous system 
of man. The brain of the human embryo at about the sixth- 
week consists of two lobes or vesicles. And subsequentl}- the 
posterior of these again becomes divided into two, so that three 
lobes are formed. Of these the hindmost is usually the longest,. 
The brain is now like that of the fish, " in the small cerebrum,, 
in the absence of convolutions, and deficiency of commissures." 
At the twelfth week it resembles the brain of a bird, the cerebral 
hemispheres being rudiments of the anterior lobes. During the 
fourth and early part of the fifth month, the middle lobes develop 
backwards, covering the corpora quadrigemina, extending sub- 
sequentlv so as to cover the cerebeltum. If development is 
arrested at this stage, the child will be born with a brain corres- 
ponding to the time of arrest; if before the sixth week it will be. 
without a brain, if later it will be idiotic. 

The hemispheres of the brain enlarge as we ascend in the 
animal kingdom, and the gray surface is further increased by 
being thrown into folds, and in any two animals of equal size and 
like structure, the one whose convolutions are more numerous 
and comphcated, and the sulci deeper, will be the more intelli- 
gent, the superficies of the grav matter determining the mental ca- 
pacity. Nervous matter manifests its presence in the lower organ- 
isms by what is known as reflex action. In the higher birds and 
mammals, similar, but a greater amount, manifests mental func- 
tions. Reflex action causes the heart to pulsate, the lungs to in- 
hale air, the liver to secrete bile, the stomach to digest, and en- 
ables the animal to procure food and avoid danger. The sim- 
plest form of reflex action mav be represented by the passage of 
a nerve fiber to a cell, conveving an impression, and the passage 
of a second nerve fiber from the cell communicating the receipt 
of the intelligence. As organizations become more complete, 
reflex action becomes more complicated, and it becomes impossi- 
ble to tell where reflex action ends and mental function begins. 

A case frequentlv cited will illustrate this. Pfluger decapi- 
tated a frog, and then placed some acetic acid on the animals 
thigh. This headless creature immediately wiped off the acid 
Avith the bottom of the foot of the same side. Pfluc^er then re- 



142 The Peoria Medical Monthly. 

moved this foot and again placed the acid on the same thigh. 
The animal at first, as though deceived, endeavored to rub away 
the acid in the same way as before. This being impossible, the 
frog soon ceased trving that method, and seemed to be seeking 
some other plan. Finallv, he made use of the foot which was. 
left and actually succeeded in removing the acid. The muscles 
in this case seem to have been used intelligentlv, in obedience ta 
will, although the frog did not have a brain. We therefore con- 
clude that the act was reflex, or that the spinal cord thinks and. 
wills. 

Another case will still further show the difficult v surround- 
ing this subject : Dr. William Darling, Professor of x\natomy in: 
the University Medical College of New York, nine hours before 
his death, when in a condition of delirium, delivered a complete, 
lecture on anatomy, which was perfectlv coherent. Ordinarily 
we look upon a feat of this- kind as a mental act of high order,, 
but as Professor Darlincj had neither consciousness nor will, sve, 
mav class this as a reflex action. In the case of the froff there 
was reflex action evincing mental function : in the case of the 
teacher there was recognized mental action of an exalted char- 
acter, simulating reflex action. 

We have but limited knowledge of nerve function and if^ 
after careful studv and patient research, we forever fail to imder- 
stand its mvsteries, we may console ourselves bv the reflection 
that we will also probablv remain in perpetual ignorance of the 
cause of heat, electricity, and chemical action, which result from 
certain molecular movements. 

A habit, however slowh' and painfullv acquired, becomes,, 
bv frequent repetition, automatic, the higher nervous centres not 
recognizing the act. It is with dilficultv and slowly that w^e 
learn the letters of the alphabet, then words, svllables, and sen- 
tences. But once having learned to read, we do not, conscious- 
ly, separate words into syllables or letters. The skilled musician 
may engage in conversation while performing a piece of often 
practiced music. The duck will swim as soon as it is out of the 
shell, and the quail will hide at the first sight of man. These 
acts are inherited, having been repeated by their ancestors from 
generation to generation, with little or no variation, from birth to 



Original Communications. 143 

death ; the tendency to perform them is complete!}' organized in 
the nervous system before birth. 

The frequent repetition of music by the musician has quali- 
fied his nervous system to act automatically. Just as frequent 
repetition in the ancestors of the quail, or duck, have qualified 
their nervous svstem. This will be more convincing if we will 
recall the fact that children born of parents whose lives have been 
passed in the performance of any special acts, requiring either 
physical or mental training, can not only learn to perform these 
acts more readily than other children, but in some instances will 
repeat them without instruction. In inherited acts there is per- 
formance without consciousness. In acquired acts there is a con- 
scious attempt before performance : and yet acquired acts by 
frequent repetition become as clearly automatic as are those 
which are inherited. 

While we may never be able to tell how nervous matter 
generates consciousness, thought, memory, or will, it is reason- 
able to infer that if stimulation of an afferent nerve will produce 
reflex action when connected with one of the lower nervous cen- 
tres, it will excite mental action when connected with the cere- 
iDrum— the recognized seat of the mind . If an impression is 
made on the sense of touch of one of the lowest organisms of the 
animal kingdom, reflex action immediately follows, resulting in 
an attempt to avoid further contact with the offending object. 
And if an impression is made on the eye, the ear, or on some 
other organ of sense in man, it is conve^'ed to the gray matter of 
the cerebrum and excites it, producing an idea. There is a sen- 
sation resulting in agitation of the mind which we call emotion. 
This is in some way registered or retained, and thus produces 
memory. And will, the most characteristic mental act, is the 
response given to the impression. Just as motion was the re- 
sponse given by the lowly organized creature to touch. 

What are the legitimate results of possessing a larger brain 
and greater mental capacity t This may be determined by a 
very rapid review of the past. The first " Lords of creation, 
huge flying reptiles," were followed by successive dynasties of 
mammals, all of them long ago entombed in the strata of earth 
which records the period of their existence. Sight, hearing, 
smell, fleetness, agility, or muscular power, enabled them to save 



144 The Peoria Medical Monthly. 

their own lives or to take the lives of their competitors. During 
the countless ages when life was lost or was preserved by these 
means, a time came when some mental superiority gave our 
brute ancestors an advantage over the physical power of their 
'enemies. And that part of the brain on which this mental su- 
periorit}' depended grew as the demand for its use increased, 
until finally the struggle for supremacy depended almost exclu- 
sively on mental superiority. And the result is now manifest, 
man is, and by this token, he ever will remain at the head of the 
.'animal kingdom. 

He has subjected to his will and made subservient to his 
purpose, many of the inferior animals ; has taught them to car- 
ry burdens, draw vehicles, and to guard property. He has do- 
mesticated some of them to give him food, others to afford cloth- 
ing. He has selected from the vegetable kingdom herbs and 
■fruits for his table, and flowers for odor and beauty. Minerals 
serve him for mechanical and for commercial purposes. Having 
made visible things subservient to his wishes, he is now laying 
his hands on the molecular and chemical forces, and as time ad- 
vances his power increases, and, judging from the past, it must 
continue to grow. Other animals may increase in intellect, and 
■even learn to talk; but at the vast distance at which man has left 
them, it will take them an incrediblv long time to reach the 
height which he now occupies, even if taught by him. But man 
"' has the promise and the potenc}- " of still greater knowledge 
and excellence. Every age marks the grave of some supersti- 
tion or error, and the presence of some truth which has sprung- 
up in its place. Each succeeding generation is more liberal and 
better informed than the preceding. We mav therefore reason- 
ably infer that man will retain his supremacy until some cataclvsm 
buries him, with all other creatures, beneath its indiscriminate 
waves. 

But if a man die will he live again? 

That man may be resurrected, it has been deemed a neces- 
."sity that he shall be possessed of an "immaterial supernatural 
'element. " The argument, if such it can be called, which is used 
to substantiate the claim, is like the claim itself, very beautiful 
^Tjut very flimsy. Dr. Parvin, in his inaugural address before the 
-American Medical Association in 1879, says: "Let this body be 



Original Communications. 145 

blown about by the winds, or sealed within the iron hills, it does 
not follow that the love and the hope, the aspiration and the de- 
sire, the knowledge, the will, the reason and the conscience — 
those spiritual elements which defy weights and measures, chem- 
ical analysis, and the most powerful objectives — should perish." 
This is very pretty, but it does not give reasonable hope for a 
future existence. God, or the knowledge, or by whatever title 
we may designate the great architect of the universe, has always 
worked out His plans in accordance with tixed and unalterable 
laws, and although we have the power, the more we study into 
his wonderful desi_gns, the less we are inclined io believe that any- 
thing has, or ever will occur, without strict compliance with es- 
tablished law. If there is, therefore, a renewal of life after death 
it will be in accordance with law. We cannot, therefore, reason- 
ablv suppose that we can exist in the future in a manner totally 
different from the present life. 

Now ' we have a tangible, material, substantial body. To 
exchange this for a shadowy apparition, is unnatural and contra- 
dictory. We need not put our faith on the stretch by resorting 
to the untenable and visionarv theory that life, as the cause of the 
organism, existed before it, and mav therefore exist after it. 
"Perception, intellect, motion and will"' are recognized attributes 
of mind. They are also supposed to designate the character- 
istics of the soul; but if we accept this definition it is not possible 
;o believe that all persons have souls, for all do not have minds. 
There are manv human beings who have less capacity to reason 
than dumb brutes, who are not supposed to have souls. If the 
soul is the mind, it is feeble at some periods of life, and st.iong at 
others. In infancy it is feeble as the semi-fluid brain it is cred- 
ited wdth producing. In adult life it is as strong as the brain and 
body will permit. But when life begins to wane, il is no longer 
buoyant and elastic, and in the decrepitude of old age it becomes 
as feeble as in infancv. And further, if a man as wise as Solo- 
mon, or Bacon, should have his skull crushed or the bloodvessels 
of his brain torn, his soul mio;ht be reduced to that of an idiot; 
and if the depressed bone should be elevated, or the extrava- 
sated blood should be removed, the soul would then be in a con- 
dition to regain its lost powers, unless the structure had been 
changed, necessitating the change of function. The soul, if it is 



146 The Peoria Medical Monthly. 

mind, depends on the quality of blood furnished to the brain. A 
bloodless brain has no soul. A brain supplied with poisoned 
blood is itself poisoned, and to add to the difficulty of believing 
that the soul and mind are the same, a child depends on its pa- 
rents for the quality of its mind, while the advocates of the soul 
claims that it depend directly on God and existed before the germ 
which prefigured the body was created and itself gave it life and 
form. 

Drunken parents beget idiotic, epileptic, or insane children, 
and wicked parents beget wicked children. In 1877 Dr. Dug- 
dale made a report to the New York Prison Association, in 
which lie traced the progeny of a thief and harlot to the sixth 
generation, and histories of 109 out of 1,200 descendants were 
obtained. More than one-third of them had been recipients of 
public charity, more than ten per cent, had been punished for 
crime, a large proportion had been diseased, and nearly all had 
offended against virtue. These " jukes '' had coarse and brutal 
minds, their delinquencies having resulted from inheritance and 
not from the instigation of the devil. 

The soul must, therefore, of necessit}- depend on the body 
for its qualities and its very existence, and separation here or 
hereafter means annihilation. 

As we have already seen, mental function is the direct result 
of impressions conveyed to the supreme ner^'ous centers from one 
or more of the senses, and if a resurrection occurs, that part of 
man which lifts him above other animals must be renewed. Balfour 
states the law in this way: "Reproduction essentially consists in 
the separation of a portion of an organism which has the capac- 
it}' of developing into a form similar to that which gave it origin." 
Independent of revelation, there is absolutely no hope of a life 
hereafter unless the bod}' be resurrected in accordance with the 
law of reproduction. The scientific idea of a resurrection is for- 
mulated in the adage '■^onine vivitw c rc/hilis.'''' Every living 
thing has sprung from a cell. The Great Teacher has expressed 
the idea in this language: "Whatsoever we plant that shall we 
also reap:"' " Do men gather grapes from thorns, or figs from 
thistles?" 

To me it is a pleasure to reconcile the teaching of science 
with the declarations of the Scriptures. Wherever in the New 



Original Communications. 147 

Testament mention is made of a futm-e life it is as a place. It is 
called a house, a mansion, a city, a country, and the resurrected 
are said to have bodies. St. Paul dwells on this as a funda- 
mental doctrine. He savs : " Christ was raised from the dead, 
the first fruits of them that slept." " For if Christ be not raised 
from the dead we are of all men the most miserable.'' " If the 
dead be not raised neither hath Christ been raised." But more 
emphatically still: '-With what manner do they come.'" He 
rephes to his own question, ': If you plant a seed of wheat or 
other grain it is not quickened except it die." 

We are thus assured that if this body dies another will spring 
from the remains. It will be changed to meet the surroundings, 
but will be a body. The cell from which it will spring has not 
been seen, or if seen has not been identified. Nor is this sur- 
prising, as in all probability it is a mere microscopic speck, sur- 
rounded by myriads of other cells more or less like it. From 
analogy we may infer that it is indestructible. It has been dem- 
onstrated by Mr. Dallinger and Dr. Drysdale that the spores of 
one variety of septic monads, which are so minute that the}' can- 
not be seen except in mass by the highest powers of the micro- 
scope, are capable of germinating after being subjected to a heat 
of 300 deg. F. for ten minutes. If, therefore, the received opin- 
that the earth will finally be destroyed by fire is correct, there is 
no reason why cells may not be found in the human body which 
are indestructible by heat. Doubtless cells existed when the 
world was a molten mass, and they may survive a burning world. 
The length of time which must elapse before a resurrection can 
be effected is not a bar to its occurrence. A germ may lie dor- 
mant for an indefinite period, and if placed in suitable soil will 
fructify. A grain of wheat has lain with the body of a mummy 
for three thousand years, and has grown when placed in the 
ground. The germ now hidden in our bodies may lie dormant 
for countless ages, in the grave, or in the ocean, or while driven 
about by the winds, and finally be evolved from the womb of 
time in a manner different from, but not more wonderful, than 
than that by which the present race of mankind have descended 
from a simple piece of protoplasm, or from the dust of the earth. 
" Throughout the whole series of living beings, we find Agomo- 
genesis,.not sexual generation." And Christ himself says, " In 



148 The Peoria Medical Monthly. 

the resurrection thev neither marrv nor are given in marriage." 
So we are warranted in advocating a resurrection of the body 
by the teachings of science and the declarations of Holy Writ. 



IXTRA-UTERIXE HYDROCEPHALUS. 

BY C. BARLOW, EATON, ILL. 

Last Friday evening (July 10) I was called to see ]Mrs. 
A. B. Primipara, who had been in labor for a short time. She 
stated that the membrane had ruptured at the beginning of labor, 
and that her pains had not been severe. On examination the 
child was found to be ver}- high up, and the os dilated so that 
I could readily introduce the index finger. This examination 
was not satisfactory. I was unable to make out the exact posi- 
tion of the child, but thought it to be a head presentation, left 
occiput to anterior position. During the night her pains were 
truly severe at times. The os was now dilated so that two 
fingers could be introduced readily enough, but the presenting 
part was high up as before. I could discover what I supposed 
to be the anterior fontanelle, but it was too lart^e. in fact I could 
feel nothing but fontanelle as far as I could reach. I administered 
a dose of hydrate of chloral and morphine, returned to my office 
until afternoon, when an examination revealed much the same 
condition, except the os was dilated so that three fingers could 
be introduced, but the exact condition of things could not be 
ascertained. 

The differential diagnosis was now to be made between a 
hydrocephalic head and a shoulder presentation. It was barely 
possible that the presenting part was the posterior border of the 
right scapula instead of the head. This was favored by two 
conditions. First, there was a great lateral obliquity of the 
womb to the left side, and a hard tumor in the ri<j[ht iliac fossa 
which would answer for a head, and was entirely too high up for 
the head to extend, provided the occiput was the presenting part. 

The fundus was too high up for a shoulder presentation, 
and the soft portion of the presenting part was very yielding and 
fluctuation could be perceived through it. The integument cov- 
ering the parts felt more like that of the scalp than the body. If 



Original Communications. 149 

it was a shoulder presentation the back of child occupied the left 
.dorso-posterior position, while the head was in the right iliac 
fossa. But if this was the position it would seem that the spi- 
nous process of the vertebral column and the ribs could be felt; 
but nothing of this kind could be discovered, but this might be 
prevented by tumefaction and the high position of the child. 

Thus undecided I called Dr. A. G. Meserve, and we com- 
pleted the diagnosis under chloroform. We found the head pre- 
senting in the left occipito anterior position. We also discov- 
ered that the head was full of water, that the edges of the par- 
ietal bones were separated about three inches, and that the fore- 
head and face occupied the right iliac fossa. Dr. Meserve per- 
formed craniotomy, after which we gave quinine for its oxy- 
toxic effect, and waited for nature to complete the delivery. But 
the OS was very rigid and dilated slowly. We resorted to arti- 
ficial di'aation vith the fingers. We also applied ext. belladonna 
to the OS and gave h3-drate of chloral in fifteen grain doses. 

After about four hours the os dilated sufficiently to pass over 
the head. There was some resistance at the perineum which I 
readily overcame by using the craniotomy forceps. It may seem 
a little strange that a head presentation could be confounded with 
a shoulder, but when we consider the extent of the hydroceph- 
alus, the very high position of the child, the great lateral obliquity 
of the uterus, with only the edge of one of the cranial bones pre- 
senting, and the extremely high position of the child in the iliac 
fossa, we can readily understand the difficulties in the way of 
making a satisfactory diagnosis. 

Playfair says that " nothing short of a careful examination 
under anaesthesia, the whole hand being passed into the vagina 
so as to explore the presenting part thoroughly, will enable us to 
be quite sure of this complication." He also states that '• under 
these circumstances such an examination is not only justified but 
imperative." 

After delivery we gave quinine every six hours, bathed the 
breasts frequently with belladonna and camphor liniment, and 
cleaned the vagina every eight hours with carbolized water. Pa- 
tient is recovering rapidly. 



150 The Peoria Medical Monthly. 

CORRESPONDENCE. 

NEW YORK LETTER— COLLEGES AND THINGS IN 

GENERAL. 

New York, April 15, 1885. 
Dear Doctor: Almost every medical college commence- 
ment which one picks up bears on the title-page the representa- 
tion of an elegant, commodious and massive structure, supposed 
to be the theatre of of operation for the great men whose cogno- 
mens and accompanying titles are grouped together on the in- 
side pages of the aforementioned pamphlet. The pictures, of 
course, are very attractive and suggestive. Quite as much so as 
the long array of names above referred to. Their designers 
meant them to be so. A magnificent building, standing out in 
bold relief, towering in a majesty of loftiness above all other ob- 
jects is the rule. To look at it is to be impressed with its great- 
ness and the eternal justice of its claims upon the patronage of a 
long suffering profession. Its appearance of silent grandeur calls 
a halt even from the most superficial observer, and to the thought- 
ful one, unacquainted with the facts, speaks volumes for the 
actual worth of the original and the devotion of its controlling 
spirits. 

Such an one, in his imagination sees an interior pregnant 
with inspiration. Grand old halls are filled with the habiliments 
of the science and art of physic. An air of mysterious and awful 
wisdom seems to pervade the very atmosphere — the result of the 
accumulated experience of ages — and bv some inexplicable and 
irresistible process of endosmosis find its wav into the verv fibre 
of the being of every student who has the devotion to place him- 
self within its classic walls. A hushed stillness, amidst the com- 
forts and conveniences of modern life, woo to thoughtfulness. 
Dignified professors, imbued with the spirit and wisdom of ^s- 
culapius, shed their benign influence upon the assembled devotees 
at the shrine of medicine, and true medical art, in all her purity 
of thought and action, finds herself and her children beneath this 
selfsame roof. 

Yes, those pictures are verv suggestive. Thev are meant 
to be. But to one person thev suggest one thing, and to another 



Correspondence. 151 

person another thing. Thev are a sham and a deceit. In nine 
cases out of ten, as everv man who has had an opportunity knows,, 
the architectural design is a gross exaggeration of the original,. 
and as to the interior, Oh mv! The same conditions which ex- 
isted twenty years ago, exist to-day. Almost every medical man 
can remember how disappointed he was when he hrst set foot 
inside the doors of his ahna mater. Her appearance did not 
compare in beauty with what his youthful fancy had pictured,. 
and instead of that air of philosophical profundity which he had 
anticipated, he encountered the shouts and hilarious demeanor of 
his assembled comrades. Bare floors, bare seats, bare walls 
alone greeted his eyes. Nothing, absolutely nothing, to break 
the eternal monotony of barenness and and make him feel suffi- 
ciently at home to remain throughout the term. He found that 
he could do yery much as he pleased, in so far as either study or 
deportment was concerned, if he onh' paid the necessary fee and 
secured his tickets. He selcom saw any of his instructors except 
during their lecture hour, and never had an opportunity to ask 
them any question. They said what they had to say, apparently 
under protest, and went their way to be seen no more until the 
necessities of the curriculum called them again into the arena. 

So it was in the West fifteen to twenty years ago, and so it 
is in the great city of New York to-day. 

The medical college buildings are of average appearance; 
certainly nothing more. And as for the internal arrangements :: 
why, there is the same old stereotyped appearance which has 
greeted the eve of every medical student from the time whert 
the memory of living man runneth not to the contrary. There 
is the same bare, uninspiring and uninviting aspect. The more 
to be deplored in view of the evident tendency of the medical 
student of to-day to discard and discountenance the rudeness and 
boisterousness which characterized the youthful seeker of med- 
ical wisdom years ago. 

With the exception of the post graduate school, the same 
apparently insurmountable obstacle to communication between 
pupil and instructor exists now as existed years ago. There is 
almost no means of gaining information on any subject, from a 
professor, except what is included in the text of his regular dis- 
course. He seems just as anxious to get away now as he ever 



152 The Peoria Medical Monthly. 

did, and only too gladly avails himself of the seemingly under- 
ground retreat provided for. the rapid escape of the professors of 
ever}' well-regulated medical college. The aim seems to be to 
give as little instruction for the monev as possible, or as is con- 
sistent with a due regard for the professor's reputation. 

\v'hen I iiave been from time to time impressed with the 
truth of what I have thus briefly referred to, I have felt impelled 
to exclaim in the language of the Apostle, " Brethren, these 
things ought not to be." 

No wonder that dissatisfaction exists with the present svs- 
tem of medical education. Why can it not be rendered possible 
for an individual to secure a medical education amid the sur- 
roundings of personal comfort, and decorations and appliances 
suggestive of frofessional thought and feelings? Give us a school 
in which scientific refinement is made an essential to admission. 
A school in which is cultivated a habit of interchange of thought 
as between teacher and pupil: where " phvsician "' and "boor" 
are not considered synonvmous terms; where some attention is 
paid to the cultivation of the amenities and humanities, or at 
least to the fostering of them, and we will behold an institution 
worthy of the name and of the age, and one worthv of the pat- 
ronage and encouragement of an enlightened profession. x\nd 
not until then. 

It was undoubtedlv in a feelinjx akin to the one which now 
inspires my pen, that the idea of the present post graduate schools 
originated. Men who had had some experience in actual prac- 
tice, and knew what they wanted to have an opportunity of 
studying, felt that attendance on the regular college courses was 
time and money thrown awav. Thev had no opportunitv for 
investigation. Thev found themselves in much the same pre- 
dicament as a prisoner at the bar — possessing the privilege of 
listening, but not of talking back. There wants were realized 
by some of their brethren in a position to help them, and the 
result has been the establishment of several schools of the kind, 
the most prominent being tn this citv. Much of the patronage 
formerlv given the regular schools has thus been withdrawn, and 
the latter have been practicallv relegated to the position of pri- 
mar}' schools, as it were, in view of the fact that all those who 
can, finish up in the post graduate schools, where opportunity is 



Correspondence. i53 

given for personal clinical investigation, and conversation with 
those who occup}- the position of instructor. 

But I have alread}- exhausted my time and must close for 
the nonce. Sutfice it to say that this subject of medical educa- 
tion is not 3'et settled, bv any manner of means, and if I am not 
greatlv mistsken a great change therein will be inaugurated ere 
long. Verv truly, 

O. B. Will, M.D. 



THE MORPHOLOGY OF THE COMMA BACILLUS. 

Editor Peoria jMedical Montlilv : 

In the June number of your journal you quote William Al- 
exander, M.D., F. R. C. S., as saying " An obscure practitioner 
who believes he has made a discovery, must keep w^-iting and 
speaking about it until he gets a hearing, else the discovery will 
sink into oblivion to be revived again by some one with the apos- 
tolic powers that the originator lacked." 

Last January I wrote you on the above subject stating that 
it was the progeny of the comma bacillus that was the immediate 
source of the infection of Asiatic cholera. I expect you consid- 
ered the theory so imaginative that you did not publish it; but I 
acted according to Dr. Alexander's advice and wrote in March 
to the Western Medical Reporter, and the JVezv York Medical 
Journal the same theory and they did not publish it. Since 
writing on the subject Dr. Jayne Ferran Cluna, of Tolosa, Spain, 
is seemingly on the verge of demonstrating what I first sug- 
gested, viz : that the progeny of the comma bacillus is the source 
of the infection of Asiatic cholera. The Western Medical Re- 
porter has become a convert to my theory as far as I have 
above reported it, for in an editorial in the July number he says: 
"The fact that the finest spirilla? are those directly derived from 
the muriform bodies or its subsequent generation, which similarly 
occurs with the seed from the dejecta, leads us to beheve that the 
primitive agent of infection of cholera in man is not the little 
muriform ovuh proceeding from the periplasm which are envel- 
oped in a coat sutliciently thick and resistant to protect them 
from the above named editorial, that Dr. Farran and many of 
his followers believed that it was from the annoyance of the 
stomach and bowels that caused the phenomena of the disease. 



154 The Peoria Medical Monthly. 

I will admit that in part the}' may; but now as my original 
theory is getting foothold among great authorities and their fol- 
lowers, I will again send it to v>ju tiiat all the great authorities 
on cholera may direct their microscopes in the direction I sug- 
gest, as follows : The comma bacillus is the mature cholera germ 
and they giye rise to a progeny which if inspired in the lungs of 
the susceptible are taken into the circulation and fasten upon the 
blood, and thus by their annoyance through the medium of the 
neryous system they cause yomititing and purging as a provision 
of nature to eliminate them: aud in this way many of them do 
reach the inside of the stomach and bowels and dejecta, and per- 
haps yomit, and also the drawn blood of the patient when in the 
algid stage, thep become rapidly developed into the comma ba- 
cilli to again resume their reproduction and cycle of metamor- 
phoses, through how many stages I know not. 

I will not make this article further tedious by giving my 
treatment, founded on the foregoing theories. 

Silas Hubbard, M.D., Hudson^ III. 



PERISCOPE AND ABSTRACT. 

OBSERVATIONS ON NIGHT-COUGH, ESPECIALLY 
IN YOUNG CHILDREN. 

Most children who are troubled with this affection show no 
illness during the day. The following propositions are submit- 
ted with respect to affections of this character: i. Many coughs 
are not dependent upon any inflammatory or catarrhal process in 
the larynx or bronchi. 2. They are not generally dependent 
upon prior enlargement of the tonsil or pharyngitis. 3. They 
are dependent solely upon a nasal catarrhal inflammation with its 
accompanying secretion. Mackenzie has shown that certain 
areas of the nasal chambers quickly respond to irritants or stim- 
ulants, and that an explosive act, like a cough, will quickly fol- 
low mechanical irritation to the posterior portions of the tubina- 
ted bones and the septum. The author has found that the 
anterior portion of the nose and septum are also extremely sen- 
sitive to irritation. The cough at night is caused by the accu- 
mulation of secretions in the nasal passages, some of which 
passes down the phar^-nx and touches the epiglottis, or escaping 
the epiglottis, lodges upon the arytenoid portion of the larynx. 
Cleansing the nasal chambers and removing the mucus will at 
once arrest the cough. — Med. JVcws. 



Periscope and Abstract. i55 

THERAPEUTIC SIGXIFICA^XE OF THE CERVICAL 

FOLLICLES. 

Dr. Simon Boruch in an interesting article {JVezv York 
Medical JournaT) on the Therapeutic Significance of the Cervi- 
cal Follicles, summarizes as follows : 

1. A thorough knowledge of the anatomy, physiology, and 
pathology of the cervical follicles will simplify the treatment of 
manv uterine affections. 

2. The cervix uteri represents a large gland of active and 
important function in the various sexual relations of woman. 

3. In the majorit}- of the more common diseases of the uterus 
the mucous membrane and its folHcles play the most important 
role. A recognition of this fact will make treatment more suc- 
cessful. 

4. Metritis, subinvolution, hyperplasia with catarrh, erosions, 
etc., must be studied in connection with the glands of the cervix. 

5. In obstmate cases medicinal applications fail because the 
secretincT surfaces of the follicles are not reached. Scarilication 
and the curette are valuable adjuncts in nulliparous women or m 
parous women without cervix laceration. 

6. In parous women with lacerations, trachelorrhaphy is the 
most valuable procedure. As a simple plastic operation it will 
fail. Success depends on extirpation of the follicles, which is 
more important than " removal of the cicatricial plug." 

7. The microscope demonstrates the dependence of catarrh, 
ulceration, erosion, and h^-pertrophy of the cervix, and often also 
of the body of the uterus, upon the glandular structure of the 
cervix uteri. 

8. The cervical follicles are signiiicant as elements in the 
pathology of cervix cancer, because the miscroscope demon- 
strates the dependence of the latter upon erosions, which are 
based upon the gland structure. 

9. Laceration and erosion must be regarded with suspicion, 
as possible sources of future mahgnant disease. In operating for 
their removal, extirpation of the cervical follicles must be un- 
sparing. — Louisville Jled. jVezvs. 



MILK DIET IN THE ALBUMINURIA OF PREG- 
NANCY. 

Tarnier's treatment of the albuminuria of pregnancy by an 
exclusive milk diet has counted in his hands, as well as in those 
of others, many successef, and it has received a very strong en- 
dorsement from Carpentier, among recent obstetric writers. 



156 The Peoria Medical Monthly. 

Under this treatment it is usual to see tlie albumen lessen, in 
some cases disappear, and the symptoms which threaten eclam- 
psia, such as headache, dimness of vision, indisposition to exer- 
tion, and drowsiness, cease, or become much mitigated. In some 
cases, however, it is important to conjoin »with milk diet a hot 
bath once in three or four davs. The temperature of the bath 
should be from 98 to 100, and while in the bath or immediately 
after it, the patient should drink a tumbler of hot milk. A pro- 
fuse perspiration usualh' follows, and the relief is prompt and 
positive. In one case, however, now under observation, a primi- 
gfravida now in the ei<rhth month, who has had albuminuria for 
at least four months, and who derives marked benefit from the 
hot bath, has also a very serious discomfort following it. There 
is unusual and violent activity of the foetus always occurring after 
the bath, so that she is for some hours unable to sleep — a very 
serious inconvenience, as the usual and most favorable time for 
the bath is just before retiring. 

\"aluable as most practitioners regard the milk treatment of 
the albuminuria of pregnancy, some entirely reject it. Pajot, for 
example, in a recent discussion held at the Paris Obstetrical and 
Gvnecological Society, and reported in the journal cV Acconchc- 
oneuts^ May 5th, refers to it as a bitter pleasantry. One of his 
arguments against the milk treatment is that infants from six 
months to the end of the first year, are peculiarly liable to eclam- 
psia, and yet they are then on milk diet. Gueniot very well 
answered this argument by saying that these infants that have 
eclampsia are not albuminuric, and the milk diet in albuminuric 
pregnant women does not act upon the eclampsia, but upon the 
albuminuria : it is onlv indirectly by curing the albuminuria that 
it renders eclampsia much rarer. It is impossible to attribute in- 
fantile and puerperal eclampsia to the same cause. — j\Ied. JVezus. 



TREATMENT OF SYNOVITIS. 

Dr. F. C. Martin, son of the late Dr. Henry A. Martin, who 
introduced the use of the pure rubber elastic bandage to the pro- 
fession, gives the results of his father's experience in the JVcu.' 
York Medical Record as follows: 

I. In the last twelve years over two hundred cases of syno- 
vitis of the knee, and its sequela?, have been treated by aspira- 
tion with a single strapping of the joint, and subsequent use of 
the bandafre. 



Periscope and Abstract. 157 

2. In these cases the knee joint has been punctured over 
four hundred times. 

3. In all these cases, with the exception of a ver}- few, and 
these only in the earh' stages of treatment, the patient was not 
■only permitted, but obhged, to take a daily and considerable 
amount of walking exercise. 

4. In no single instance has there been failure of absolute 
and entire cure, requiring, in one case, seventeen weeks, but in 
no other more than eleven weeks. 

5. Although no antiseptic measure, beyond perfect clean- 
liness of the aspirating needle, was emplo3'ed, in not one instance 
has any ill symptoms followed the operation. When the needle 
is withdrawn, the puncture is at once covered securely with ad- 
hesive plaster. 

Sir Benjamin Brodie long ago declared most emphatically, 
that when the synovial sac is distended with fluid, it can be 
punctured, and the effusion drawn off with perfect safety. He 
does not bv an}- means regard this as a help in any treatment, 
however, as he says the fluid will accumulate again, and in a few 
hours the joint will be as much distended as before. The orig- 
inality and value of my father's method of treatment lies in suc- 
cessfully demonstrating the fact that thorough aspiration of the 
knee joint, followed bv proper use of the rubber bandage, gives 
us a complete and satisfactory method of cure in even the worst 
cases of synovitis. Bv the Arm and equable pressure of the rub- 
ber bandage, the re-accumulation of diminished quantity, and a 
second, or perhaps in severe cases a third aspiration of the joint 
is all that is required. One great advantage cJf it is to explode 
the idea that perfect rest of the joint is the onh- way to hope for 
a cure. The patient is emphatically not to be confined to bed, 
or, worse still, to a flxed splint. When the joint is strengthened 
by a properly applied rubber bandage, evercise is a great and 
important adjunct in the treatment. This very day I have vis- 
ited a lady who passed last summer in Switzerland. While there, 
she was attacked with acute synovitis of the left knee, with large 
amount of effusion into the sac. She was kept in bed, with the 
limb placed on a fixed splint and continuously poulticed. After 
sweltering through the hot weather with the limb swathed in 
many thicknesses of cotton wadding, at the expiration of two 
months the splint was removed, and — she has come home with 
a joint almost immovable! I am sure that had this case been 
treated by prompt aspiration of the sac, and the proper use of 
the rubber bandage, a perfect and rapid cure would have resulted 
without a week's confinement of the patient to her bed. 



158 The Peoria Medical Monthly. 

THE EPIDEMIC AT PLYMOUTH, PA. 

The town of Plymouth is at present unenviably famous^ 
The occurrence of over a thousand cases of undoubted typhoid 
feyer in a population of eight thousand has drawn the eyes of all 
medical men to its sanitary condition, and to the relationship be- 
tween this and the outbreak of the disease. Never has a wide- 
spread epidemic been more clearly traced to its true source, and 
never has neglect of sanitarv precautions been more promptly 
and severely punished. Before hygiene had reached a state of 
accuracy and taken its position among the modern medical 
sciences, such afiiictions were counted among the visitations of 
an inscrutable Providence; but to-day we know that such visita- 
tions are not due to the unsearchable workings of a distant, mys- 
terious power, but are the legitimate effect of flagrant violations 
of sanitary laws. 

The investigations of the resident and visiting physicians all 
point to the conclusion, that the water-supply of Plymouth has 
been the agent in the propagation of the virus of the disease. 
Plymouth receives its water chief!}' from a pure mountain stream ; 
the water is stored up in four successive reservoirs, from the last 
of which pipes lead to all the streets of the town. When the 
water in this stream is very low, the pipes are supplied with 
water pumped directly into the mains from the Susquehanna 
River. This was done from March 20th to March 26th: but the 
river water was then reasonably pure, and no suspicion is at- 
tached to it. It was suggested that the mountain stream suppl}'-- 
ing the town might be at the bottom of the trouble; and a com- 
mittee of three resident physicians was requested by the Water- 
works Company to investigate the condition of the reservoirs 
and streams. 

The committee found that the stream was supplied with an 
abundance of pure water. Between the third and fourth reser- 
voirs, however, in the only house situated upon the stream, there 
was a patient convalescing from typhoid fever. This patient 
visited Philadelphia on December 25, 1884, and returned home 
on January 2, 1885. It is presumed that he contracted the dis- 
ease in Philadelphia, though the condition of the town itself, ac- 
cording to competent report, was bad enough to generate ty- 
phoid fever or any other disease; it does not matter where he 
took the disease, the fact remains that he had it. He partially 
recovered and suffered from a relapse, and on March i8th and 
19th he had severe hemorrhages from the bowels that imperiled 
his life. During his illness the dejecta passed at night were 
thrown out on the snow within a few feet of the stream and with- 
out any attempt at disinfection; while the da\'-stools were 



Periscope and Abstract. 159 

emptied into a privy, the contents of which lay upon the surface 
of the ground. The dejecta accumulated and remained innocu- 
ous upon the snow. From March 25th to March 31st the 
weather was sutlicientlv warm to melt large quantities of snow, 
and early in April there were frequent showers of rain ^^'ith mild, 
warm weather. The thaws and rains washed the dejecta into 
the stream, whence the poison was sent to all parts of the town. 

" Supposing that this occurred between March 25th and 
April 5th, and allowing from ten to fourteen days as the proper 
period of incubation, we would expect, from this cause, an out- 
break of typhoid fever to occur from the 5th to the 15th of April. 
The time of the proven contamination of the water supply, allow- 
ing the proper time as the period of incubation, corresponds so 
thoroughly with the onset of the epidemic, that the committee 
could but conclude that in this explanation sufficient cause was 
found for the epidemic of typhoid fever in Plymouth.'" (Dr. 
Lewis H. Taylor). Six hundred feet below the contaminated- 
reservoirs there lives a family in which two persons had typhoid 
fever; the family dipped their water directly from the stream, 
below the point where the dejecta were washed into it. A little 
further down is a house in which hydrant water (/. c, from the 
reservoirs) was used; the disease was prevailing in that house 
when the committee was investio-atino-. 

Only sixty feet away from the last one, stands a house sup- 
plied with well water; the family escaped. A short distance to 
the north there were eleven families using well water; none of 
these families were visited by the disease. On one side of a 
certain street, almost every family using hydrant water was 
stricken, while the families living on the other side of the same 
street, using well water, escaped. This was observed to be the. 
case on several streets. Many other cases and phenomena indi- 
cate that the epidemic arose from the contamination of the. 
drinking water of the town with the dejecta of one typhoid fever 
patient. 

It is a very eas}' and cheap matter to destroy the infective 
properties of typhoid fever excretions: and when we reflect that 
a little instruction to the family might have averted the terrible 
calamity that has befallen a thriving town we are inore than ever 
convinced that health authorities should institute a prompt sur- 
veillance over all cases of infectious disease, ane should take the 
necessary steps for stamping out a plague. 



THE ABUSE OF MORPHIA IN MENSTRUAL SUF- 
FERING. 
Many ladies afflicted with uterine disease suffer but little 
inconvenience from the local chano-es throufrhout the inter-men- 



i6o The Peoria Medical Monthly. 

strual period: hence attention is not directed to these conditions; 
medical advice is not sought and it is only in the intense suffering 
which precedes or accompanies the flow that the physician is 
called. All the usual hot applications, external and internal, have 
probably been tried; he must do something, and b}' an hypoder- 
mic injection, or a dose of morphine, quiets his patient and leaves 
her satistied that he has succeeded. She is satisfied because her 
sufferings are relieved, and the physician is equally satisfied that 
he has effectually accomplished \vhat he was summoned to do; 
he has relieved the pain: but this recurs month after month; the 
local disease, uterine or ovarian, is not improved: on the con- 
trary, most probably grows slowly worse, so that the nervous 
S3'stem of the patient, or the stomach, suffers from the constantly 
increased dose of morphine. 

Unfortunately the same treatment is but too often resorted 
to by the specialist, when, after months of treatment, the same 
menstrual suffering recurs. At first he uses it merely to afford 
temporary relief; but should the desired improvement not follow,, 
^fter all possible means have been tried, he again and again ad- 
ministers the same dose, and the same unfortunate result to the 
patient follows. Digestion is impaired, the nervous system shat- 
tered, and the mind finally suffers. Those who object to the use 
of morphine or opium under the circumstances, give whisky, 
and the unfortunate patients take glass after glass, until their 
sensibiHties are dulled and the pain at least becomes bearable. 
The stomach often suffers so that the patient barely has time to 
rally when she must again pass through the same ordeal. 

We would not for a moment deny the propriet}^ of relieving 
excessive suffering for the time being, or of administering the 
drug in those cases when it may have a curative effect, but it 
must be given only if the physician is for the first time confronted 
with a patient in the agony of the menstrual suffering, when he 
is acquainted with the case, when he must act at once and other 
treatment is out of the question; or if the menstrual period 
should appear, in consequence of a cold or over-exertion, with 
unusual severity; but when it has passed, treatment must be in- 
augurated so as to prevent the recurrence of such suffering. — 
American Medical Discest. 



COCAINE IN THE TREATMENT OF INFLAMED 

NIPPLES. 

The limits of usefulness of cocaine do not seem to have been 
reached. The sphere of its therapeutic activity, is on the con- 
trary, constantly increasing. One of the peculiar features of the 



Periscope and Abstract. i6i 

remedy is the promptness and constancy of its action. Its latest 
employment is that advanced by Unna in the treatment of^ in- 
flamed nipples, in which affection he holds it has no rival in mar- 
vellously removing both pain and soreness. Every plwsician 
knows how troublesome and difficult it is to cure a fissured nip- 
ple if a baby is nursing it. To afford prompt relief, even while 
the child nurses, has not been hitherto accomplished. Cocaine 
is said to have succeeded in all cases tried b}^ Unna and others. 
The nipple is to be brushed every ten minutes, in the intervals 
of nursing, by a weak solution (one-half to one per cent.) of the 
hydrochlorate of cocaine. Within one or two days the fissure 
will have healed completely, and all pain consequently will have 
completely disappeared. The bitter taste of the drug does not 
prevent the child from nursing, nor is there any danger of its 
absorption and consequent untoward effects in the child. It 
would even possibly benefit the child when irritable and restless. 
— T/ierapciitic Gazette. 



EUCALYPTUS IN THE TREATMENT OF TYPHOID 

FEVER. 

Leighton Kesteven, of Brisbane, Queensland ( The Prac- 
titioner, May, 1885), having made an extended trial of eucalyp- 
tus in the treatment of typhoid fever, both in hospital and in pri- 
vate practice, was so pleased with the favorable results obtained 
that he now warml}- commends the drug to the profession for 
further trial. Of two hundred and twenty cases of the disease 
which he attended in about eighteen months, there were only 
four deaths. He gives ten minims of drug every four hours. 
" Without being absolutely nauseous, this medicine does not 
agree well with all stomachs, but this difficulty can be entirely 
overcome by careful emulsification, and the addition of half a 
drachm each of aromatic spirits of ammonia, spirits of chloro- 
form, and glycerine, the latter entirely removing the rough semi- 
resinous taste of the oil. The effects of this medicine are, in 
brief, the following: First, it steadily and permanently reduces 
the force and frequenc}' of the pulse. Indeed in one or two cases 
I notice this result obtained with almost marvelous rapidit}- ; in 
one case in particular, the pulse, from being a sledge-hammer 
pulse of 120, went to 90 within an hour of the first dose of the 
medicine, and never went above 90 again. Secondly, lowering 
of the temperature. This occurs less rapidly, and (it has oc- 
curred to me) might be entirely secondary to, and dependent on, 
the lowering of the pulse. The beneficial effect on the tongue is 
very marked, almost immediately alleviating the distressing dry- 



1 62 The Peoria Medical Monthly. 

ness so universal in typhoid, and removing the thick hrown coat- 
ing, leaving but proportionatelv little fur, and frequenth' cleaning 
the tongue entirelv in a very short time. Fourthlv, the skin, 
along with the reduction in its temperature, becomes moist and 
soft in contrast with the harsh, dry, hot skin so frequent and per- 
sistent, conferring a corresponding increase of comfort to the 
sufferer, who has frequently felt as if his skin had been drawn 
tight all over his body. This alone is a boon to the patient of 
no small import." 

Concerning diet and general treatment the author sa3's: 
" In all severe cases I order whisky from the commencement of 
the case until normal temperature is attained, giving on an aver- 
age five to ten ounces per diem, usually in milk and soda-water. 
In ordinary cases I feed the patient on milk thickened with isin- 
glass, beaten-up eggs, milk and soda, coca, and — where diarrhoea 
exists — ground rice and milk. In asthenic cases chicken-broth 
(concentrated to ten ounces of clear broth from a whole fowl) 
given in ounce doses to avoid tilling the stomach with too large 
a quantity of fluid for weak digestion, the juice of half-cooked 
mutton, or beef tea made in a pot without water and strained 
through tine muslin. For the abdominal tenderness frequently 
changed ice-cold compresses, and ice to suck ; ice to the shaved 
head for cephalagia; and frequent cold packs from the head to 
the knees at an)^ rise of temperature. All the linen is changed 
morning and evening, without ever altering the patient from the 
horizontal position. All nourishment is given in small quantities 
at short intervals, thus receiving better digestion than when given 
in larger quantities at longer intervals." — Medical Record. 



EMMET'S OPERATION: WHEN SHALL IT AND 
WHEN SHALL IT NOT BE PERFORMED ? 

1. It is evident that the operation has been performed un- 
necessarily for symptoms similar to but other than those arising 
from lacerations of the cervix. Further, that it has been done 
imperfectly, even without preliminary treatment, in many more; 
and the failure to give relief as reported b}^ several, is due to 
these two causes. 

2. That from our present knowledge we cannot, at this 
time, arrive at any delinite conclusion, from the fact that many 
of the so-called consequences of lacerations of the cervix uteri are 
not settled beyond doubt. 

3 That ever}' one engaged in this department should care- 
fully select his cases, and try every known means to give relief 
before recourse is had to operation. 



Periscope and Abstract. 163 

4. The operation should never be performed co ipso in cases 
of simple fissures or lacerations of first and second degree. 

5. In cases of aversion and disease of the cervical or cor- 
poral cavity, or both, although attended by hyperplasia and dis- 
placeinent, it has been observed that all the symptoms abated 
and the parts returned to their natural condition, and that no 
laceration was discoverable after alleviative measures were insti- 
tuted first, which alone caused the parts to return to a normal 
condition. 

6. There are some 'cases of extensive laceration of cervix 
that seldom give rise to any inconvenience, and that, therefore, 
an operation should be deferred until S3'mptoms arise that will 
call for its performance. 

7. The operation, although indicated, should never be per- 
formed until, by preparatory- treatment, the parts have been 
brought into a healthy condition. 

8. Near, and during the climactetic period, the operation 
should be posponed as long as possible, and the patient not ex- 
posed to any risks, since in many cases all the symptoms subside 
under proper treatment, and never return under senile involution. 

9. The operation is justifiable in cases of lacerations of the 
third and fourth degree without complications, if there is a his- 
tory of malignant disease in the family. 

10. The operation may be performed with perfect propriety 
in 3-oung women, as a preventive, if the laceration is bilateral 
and extends up to the cervicovaginal junction, or beyond it even 
though there are no pathological changes; indeed it seems to be 
the duty of every one who observes a lesion to that extent, to 
urge the operation. 

11. The operation is justifiable in any degree of laceration, 
and in rare instances even in fissures, when there exist cicatrical 
tissues productive of reflex disturbances, annoying in character, 
and not tractable to any other treatment. 

12. The operation is absolutely indicated in all extensive 
tears of the os, or in which the cervix is everted, its mucous 
membrance and Nabolical follicles diseased, and especially if 
there be granular or cystic degeneration present, provided the 
parts have first been restored to a healthy condition by palliative 
treatment. — D}\ Zinke. 



MANGANESE IN AMENORRHCEA. 

My attention was arrested some two years ago by an article 
on the use of binoxide of manganese in amenorrhoea due to hy- 
giene imprudence at the menstrual nisus, disturbances, etc. A 



164 The Peoria Medical Monthly. 

short time thereafter a Miss N., aged seventeen, came under my 
care. She had taken a severe cold at a dancing- part}^ from the 
effects of which her menses, which were then on her, became 
suddenly suppressed. She presented svmptoms of decline, with 
hectic, nervous chills, dry cough, and general malaise. After 
• having for a reasonable period tried the usual remedies without 
result, I concluded to test the virtue of manfjanese pills. I had 
an impression that the grave S3^mptoms were due to the sup- 
pression of the menses, and that with these re-established, im- 
provement would ensue. I ordered one pill to be taken at bed- 
time every night. After five pills had been thus taken the cata- 
menia appeared and under the use of wine and iron the patient 
was soon restored to her oricjinal g^ood health. 

I have since had two similar cases, which I treated in a 
similar manner wdth similar results. In one of these the sup- 
pression had existed for several years, and had been treated by 
eminent physicians both of Michigan and of the West, whither 
she had Ipecn sent in the hope of benefit from the change of cli- 
mate. In this latter case fifteen pills taken nightl}^ in the course 
of two weeks, in combination with tonic diet and medicines, 
wrought such a change that the patient became a regular patron 
of the roller skating rink, where she would exercise for two 
hours at a time without fatigue. The remedy is certainly one of 
great power in amenorrhoea. — Dr. A.R. Hicks, in Medical Age. 



TREATMENT OF ANGINA PECTORIS BY THE 
IODIDE OF SODIUM. 

Angina pectoris since the davs of Gintrac and Lancereaux 
has been considered as a cardiac neurosis. Although in many 
cases a diseased condition of the coronary- arteries and the aorta 
has been found, still the symptoms have been ascribed to a nerve 
disturbance dependent more or less on the innervation of the 
heart muscle or upon some de"generative change of the nerve 
fibres. M. Henry Muchard, from a studv of twentv-five post 
mortem examinations made at " Hospital Vichart,"' objects to this 
view and ascribes the symptoms directly to degenerative changes 
wath obstruction of the coronarv arteries. He claims that true 
angina pectoris is the result of a disease of the arteries and not 
of the nervous system. 

In accordance with this theory he advises remedies which 
have an effect on the arterial system. The iodide of sodium is 
especially recommended, given in doses of sixteen to thirty 
grains daily. He continues this medication during months and even 



Periscope and Abstract. 165 

years, and claims to have given complete relief and to have pro- 
duced a cure of this dreaded disease in many cases. He thinks 
that the iodide of sodium probably acts by lowering the blood 
tension, relieving the walls of the artery and favoring the disap- 
pearance of the pathologic exudation. For the relief of the 
paroxysm he recommends the inhalation of the nitrite of amyl in 
four to six drop doses. 

Although true angina pectoris had been assumed to be a 
neurosis, the remedies which have been mostly successfully em- 
ployed have been those acting upon the arterial system. Occur- 
ing as it does at the ages when degenerative changes in the 
arteries are found and in subjects of such degeneration, it would 
seem that the theory advanced by Huchard should be carefully 
considered. That it is generally accompanied by high arterial 
tension has been already recognized, and the drugs have been 
most successfully used which reduced this tension. Dr. Lauder 
Brunton has loner since recommended the nitrite of amvl in re- 
ducing blood pressure, and we are indebted to Dr. Murrell for 
our knowledge of the value of nitro-glycerine as a remedy pro- 
ducing the same result. Both remedies have been successfully 
employed in relieving attacks of angina pectoris, but neither have 
been able to effect a permanent cure. 

That the iodides from their well-known action of lowering 
the blood pressure and at the same time favoring the disappear- 
ance of pathological exudations ma}- exert a healthy action in the 
earlier stages cannot be denied, but in cases connected with well- 
developed atheroma more evidence is needed before it can be 
positively accepted. — Courier of Med. 



ON CARDIAC WEAKNESS. 

The functional disorders of the heart presenting themselves 
so frequently and in so varied expressions to the practitioner are 
are not infrequently a severe tax upon his diagnostic acumen and 
his capacity to afford relief. 

Aside from the cardiac depression resulting as an expres- 
sion of svmpathy from some existing pathological condition in 
the svstem, or some definite organic lesion, there is a functional 
weakness of the heart, due to faulty innervation of that organ. 
Dr. Seeligrnuller, of Halle, speaking before the last meeting of 
German phvsicians in Madgeburg, held that this form of cardiac 
weakness could always be traced to two causes, viz., habitual 
sexual excitement without corresponding satisfaction, and con- 
tinued intense brain-work with insufficient allowance of sleep. 



i66 The Peoria Medical Monthly. 

In the more definitely developed cases we find general 
Aveakness, excitement, and palpitation of the heart, pains in the 
epigastric region, profound reaction after even moderate physical 
or mental exercise, deepening occasionallv almost into coma, 
persistent insomnia, hyperchondrical depression, failing nutrition 
in spite of good appetite, pallor, and slight cvanosis of the ex- 
tremities and naso-labial region, and occasional fomication in 
hands and feet. If we examine the heart at different times of the 
day we can alwas note the weakness of the apex-beat and the 
heart-sounds, and the smallness of the pulse. The state of inan- 
ition is most favorable to present all svmptoms of cardiac weak- 
ness. After arising, such patients usuallv have a pulse of about 
40, after breakfast of about 50, and do not obtain a pulse of 60 
before taking some wine or eatino- some meat. The normal fre- 
quenc}' of the pulse is scarcely ever or only transientlv reached. 
In very pronounced cases we meet with steno-cardiac paroxysms. 
Next to this persistent extreme cardiac weakness there is a mild, 
intermittent form often connected with great excitability of the 
heart (irritable weakness). Everv excitement causes palpita- 
tion, tea or coffee insomnia, in these patients. It is difficult to 
decide in the single cases whether the seat of the neurosis be in 
the pneumogastric or sympathetic nerves or in the medulla ob- 
longata. Intense mental impressions, no matter whether of a 
pleasant or unpleasant nature, tend to aggravate the existing 
evil. Persisting pains, neuralgic in especial, and traumatic acci- 
dents, cause likewise a frequent aggravation of the affection. 
Women having passed through confinements often complain of 
this ailment, possiblv on account of the concentration of the blood 
in the abdomen. Impro.vement is generallv obtainable in these 
cases by the wearing of a suitable abdominal bandage. In per- 
sons of an advanced age abnormal dilatation of veins in the lower 
extremities often leads to cardiac weakness. 

The therapeutical measures to be employed are chiefly re- 
lated to proper physical exercise, regulation of diet, and change 
of air. A sufficient allowance of sleep, especially before mid- 
night, is to be insisted upon, and resting during davtime, even if 
sleep is not obtainable, is to be recommended. All violent phys- 
ical strains are to be strictlv avoided, while methodical, mod- 
erate gvmnastical exercises, especiallv walking, are salutary. 
Forced cold-water cures are injurious, while warm baths, taken 
several times a week, are indicated. The diet ought to be 
strengthening and abundat. Coffee, tea, alcoholic stimulants, 
and tobacco are to be entirely avoided. A prolonged stay at the 
sea-shore or in the mountains has often proved a benificent mea- 
sure. The thermo-baths of Gastein enjoy an especial reputation 
for this affection. — Therapeutic Gazette. 



Periscope and Abstract, 167 

PARALDEHYDE IX PLACE OF CHLORAL. 

A correspondent to the Lancet states he has used paralde- 
hyde as a hypnotic in place of chloral, and prefers it to chloral 
for the following reasons : 

1. There is no excitement preceding its hypnotic action. 

2. It has no paralyzing effect on the heart. 

3. It acts more quickly. 

4. The sleep produced is more natural ; it is dreamless and 
refreshing : the patient is easily aroused, and when left alone 
readily goes to sleep again. 

5. There are no unpleasant symptoms; no confusion of ideas 
when the patient awakens: no headache: no loss of appetite, 
eyen when the drug is long continued in large doses. The 
writer had used the drug about 150 times. The dose is from 
thirty to ninety minims, but the maximum dose is seldom needed 
to produce sleep. Smaller doses repeated eyery hour are pre- 
ferable to large doses not so frequently repeated. — Chicago Med.. 
Times. 



BROMIDE OF ETHYL IN OBSTETRICS.. 

If possible to obtain some remedy with which to lessen the' 
pains of the woman in labor and less dangerous than chloroform^ 
it certainly should be done — and all inyestigations in this direc- 
tion have a worthy object. 

Nunnely, as early as the year 1849, used the bromide of 
ethyl in surgery. He appears, however, soon to have abandoned 
it, subsequently it was used in America. 

E. Rose, on the recommendation of Tumeyille, had used it 
to complete narcosis. He, however, did not especially recom- 
mend it. M. Lebert (Arch de Tocologie,. 1882) w^as the first 
person to use it in obstetrics. C. Wiedeman investigated later 
concerning hydrobromide of ethyl as an anesthetic in child-bed 
(Petersberger Med. Wochenschrift^ No. 11, 1883) also Haecker- 
mann { Gvnakol-Centralblatt, No. 34, 1883).. Both testified that 
the bromide of ethyl lessened or entirely dispersed the labor 
pains. This, too, without danger to the mother or child, and 
without influence on the course of the labor and without loss of 
consciousness. As to the physiological action of the bromide of 
ethyl. From the investigations of Rabuteau, it is better borne 
than chloroform. It works faster, but does not continue so long- 
in its effect, as it passes off from the lungs very rapidly. 

Prof. Dr. Muller in Berne (Berlin Klin. Wochenschrift xx: 
44, j. 73, 1885,) had used this remedy in twenty-two cases of 



i68 The Peoria Medical Monthly. 

labor. He was quite contented with liis success, does not, how- 
ever, keep the imperfections of this medicine a secret. The cases 
consisted of sixteen primipara and six multipara. Inhalation was 
conducted in the same manner as with chloroform — on an average 
60 grammes was used. The patient showed no disturbance 
from the smell of the medicine, and after the inhalation suffered 
from neither vomiting or nausea. With smaller doses conscious- 
ness remained undisturbed. In nine cases M. observed a slight 
acceleration of the pulse and respiration. He frequentlv observed 
rapid dilatation of the* pupil and flushing of the face. From this 
fact, anaemia of the brain, as in chloroform narcosis, was not to 
feared from this remedy. It is peculiar that the anaesthetic acts 
quite promptly on the foetus. It does this, however, without oc- 
casioning anv harm. The peculiar smell of the bromide of ethyl 
can be noticed on the breath of the child. The anaesthetic action 
of this remedy is often surprising, and the benefit from it ^in re- 
straining abortion in multipara is remarkable. 

The imperfections of this remedy were observed bv M. to be 
of three kinds. Insufficient labor pains occurred in five cases, 
which must probably be laid at the door of the remedy. This, 
however, was caused onh^ to a slight degree, as it was not found 
necessary to complete the labor in any of these cases artificial!}^, 
and that there was no post-partal haemorrhage. Disturbance in 
the respiration was also observed in two cases. The symptoms 
were those of an acute bronchitis, which was especially severe in 
the second case. For all that both patients were discharged 
well, one in ten days, the other in fourteen days. 

It appears that with this remedy also the individual sensitive- 
ness is different. The third objection is that in many cases 50 
per cent, of those observed b}- M., the remed}' did not. act, so that 
one cannot reckon on it. This failure was observed in using it 
in the period of expulsion as well as in that of the dilatation. M. 
thinks further observations very desirable. 

In the article by Hfeckerniann ( Zcifsc/in'ft fur Gch/i. u 
Gyjiccol -K. p. 122), we learn that he has used the bromide of 
eth}'! in same manner as chloroform in fifty parturient women. 
The stage of excitation which Haeckermann, differing from other 
observers, says is increased, precedes the stage of an^t^sthesia or 
analgesia. 

After about fifteen inspirations had been taken, prickings 
with a pin in different parts of the body were not noticed at all, 
or very little. The senses remained completely preserved. The 
bromide of ethyl appeared, according to Haxkermann, to have 
no influence on the activity of the pains. The quickest power 
to quiet and ease pain was often noticed toward the close of the 
period of expulsion. This also insures the mother freedom from 



Periscope and Abstract. 169 

pain on the passage of the child's head through the vulva. With 
a little deeper nar'cotization the patient had no feeling whatever, 
and gave no answers to questions, ha-ckermann used this grade 
of narcosis when he used the forceps. Consciousness returns 
very soon, so that the woman often believes she has not yet been 
delivered. Nausea and vomiting never occurred. Post-partal 
flooding w^as never observed. The deep narcosis which he pro- 
duced in three cases is not to be recommended. He thinks 
that the bromide of ethyl can serve only to conduct a painless 
deliver3\ 

Parnemann, of Elspe Med. Cent. Zeifung; No, 86, 1883, 
used the bromide of ethyl with a normally built primipara in this 
manner : She was allowed to breath it in the one breath and 
omit it in the other. At the first inhalation about ten inspira- 
tions were necessar}- to induce local anaesthesia. In a later trial 
two deep inspirations were sufficient to render the pains imper- 
ceptible. Parnemann was convinced that the pains averaged 
longer in duration and w^ere of normal strength, and that no 
special rise in the pulse rate was noticed, while the number of 
pains per minute without the bromide of eth}^ was 2, i)^, 2, 1^3, 
they rose after inhalation to 23^, 2, 2 >^, 2%. The delivery was 
completed with the forceps without increased pain. The patient, 
during the whole deliverv was conscious, and no untoward re- 
sults followed. How long the bromide of ethyl should be inhaled 
as well as the indication for the laying on of the forceps is not 
given. 



CREASOTE WATER IN BURNS. 

Creasote water is a simple i p. c. solution of w^ood creasote 
in water, and like similur solutions of carbolic acid and of cresol, 
it is a. most effective local anesthetic, and topical dressing to 
burns and scalds. This creasote water — or diluted with an equal 
volume of water, or with more water for dehcate surfaces in 
women and children, and applied by means of a single thickness 
of thin muslin, or worn out cotton or linen, such as handkerchief 
stuff, and the application renewed from time to time, as the re- 
turn of pain requires it, will relieve the pain of burns and scalds 
in five to ten minutes, and will maintain the relief as long as the 
applications are properlv renewed, or until the painful stage is 
over. 

It is also verv effective as a local anesthetic for general use 
in all painful conditions which effect the surface onl}', such as the 
pain of er3^sipelas. The benumbing effect of these phenols upon 
the skin is very promptly reached, and can be carried to almost 



lyo The Peoria Medical Monthly. 

any degree that is desirable, by simple management of the 
strength of the solutions and the mode of application. They are 
true anesthetics to the skin, while the much lauded cocaine 
is not. 

The statement has been published so often during the past 
twenty years, and the treatment has been so effective in so many 
hands, that it is w^onderful to notice how the common practice is 
still to use the old and comparatively useless and hot dressings, 
such as carron oil, white lead ground in oil, flour liniments, etc., 
or the newer application of solution of bicarbonate of sodium. — 
Sqttibb's Ephcnicris. 



TREATMENT OF CARBUNCLE BY OLEATE OF 

MORPHIA. 

In the course of a paper read before the Indiana State 
Medical Society, 1SS5, by Dr. James F. Hibberd, of Richmond, 
Ind., and published in the Indiana Medical 'Journal^ May, 1885, 
the author makes the following remarks : 

At the late meeting of the American Medical Association at 
New Orleans, Dr. L. D. Bulkley, a distinguished dermatologist 
of New York, read the first paper before the section on Practice 
of Medicine, entitled, " The Treatment of Carbuncle Without 
Incision." As his paper will soon be published,* it is not my 
purpose to rehearse his views here, but to simply sa\' that he an- 
nounced that the treatment of carbuncle by the orthodox crucial 
incision, poultices, other hot applications and ointments, had been 
so unsatisfactor}' that for several years he had abandoned them 
all and substituted soothing applications of special mixtures, the 
composition of which he detailed, for the most part applied on 
cotton or the pilr side of patent lint, and paid particular attention 
to the constitutional treatment, insisting upon the value of sup- 
porting measures, tonic medicines, and the sulphide of calcium 
as a means of limiting suppuration. Dr. Bulkley detailed a 
number of cases, some of them quite severe, w^hich he had man- 
aged under his new^ views with much better success than for- 
merly, though his patients still went through the usual phases of 
the malady, but not occupying the full time period of seven weeks 
as of old, nor did they suffer the former serious local pain, nor 
the general constitutional depression. 

As I had had a new experience in the local treatment of 
these painful and exasperating tumors within the last twelve 
months with a preparation to which he made no allusion, al- 
though exactly in line wath his advanced views of the best man- 

*See Peoria Med. Monthly, Vol. vi., No. 1. 



Periscope and Abstract. 171 

agement, I ventured, in the discussion of the paper, to make a 
plain statement of mv experience in this behalf, and while it is 
not of sufficient extent to lay claim to an established treatment, it 
seems to me of sufficient importance to repeat here that practi- 
tioners may make trial of the remedy and determine whether my 
cases were happy co-incidences or a substantial advance of our 
knowledge in the local treatment of carbuncle. 

The application I desire to call attention to is the oleate of 
morphia, and to illustrate my experience I will present the de- 
tails of the first and the last cases where I made use of it : 

On the 30th of April, 1883, T. N., an active business man 
of general good health, about sixty years old, applied to me for 
a painful swelling on his neck to the left of the ligamentum 
nuch£e, a little below the line of hair. 

Telling my patient that he had carbuncle, and was likely to 
have several weeks of great local suffering and much general 
depression, I gave him some oleate of morphia, with careful in- 
structions how to apply it, expressing the hope that it would do 
something to mollify the pain if nothing more, and this I did be- 
cause of my experience in alleviating other painful conditions of the 
skin and subcutaneous tissue with this preparation of morphia. 
It was also to be applied to the nodules forming near the prin- 
cipal swelling. The patient returned the next day, and quite to 
my surprise and gratification, stated that nearly all pain had 
ceased in the large tumor, all was gone from the smaller ones, 
and the soreness and stiffness of the neck had greatly dimin- 
ished. On examination the smaller tumors were shrunken and 
no longer irritable, and the larger one had lost something of its 
boggy feel, was apparently smaller, was but slightly sore, and 
the skin over it was more natural in appearance. The applica- 
tion was continued, and at the end of three days all pain and ten- 
derness had left the neck, the smaller tumors disappeared, and 
the larger ones had the characteristics of a calloused indurated 
swelling under the skin, about half the dimensions of the original 
tumor, and this was absorbed in about a week or more. 

Two or three months subsequently the patient had another 
disturbance near the same spot, beginning in an irritable pimple 
as the former one had begun, but a few applications of the 
same remedy applied by my direction arrested all further devel- 
opment. 

On the 24th of April, 1SS5, ^Ir. J. \V. G., aged eighty-six ' 
years, sought my advise for a tumor on the back of his neck, to 
the right of the ligamentum nuchae, which was giving him much 
pain and anxiety. It proved to be a carbuncle an inch and a 
half in diameter, with a point of superficial suppuration on top. 



172 Tup: Feouia Medical Monthly. 

An inch below the main tumor was a smaller one. an irritable 
pimple such as the larger one was in the beginning. 

The swelling was of several days standing, and a part of the 
skin covering it so inflamed that I feared the oleate of morphia 
could not be used with the success that otherwise I should have 
hoped for. Howe\er, I gave him the preparation, with instruc- 
tions for its diligent and proper use, but explained to him why it 
might fail, and advised him, if he had no relief after a fair trial, 
to consult another practitioner, as I should leave for New Orleans 
on the afternoon of the next dav. But at noon the next day the 
old gentleman reappeared at my office with a smiling counte- 
nance to give me some good news, as he averred, before I left, 
stating that the soreness of the tumor was nearly gone, the stiff- 
ness of his neck but trifling, and the pain so promptly relieved 
that he had had a good night's rest, the first of the kind since 
the swellincr be<ran. On examination the soreness of the smaller 
tumor was removed, and that of the larger one greatly dimm- 
ished, and its appearance and feefing altered for the better, while 
the superficial point of suppuration was discharging but little and 
the surrounding inflammation of the skin greatly subdued. 
Treatment was directed to be continued, and when I returned 
and examined the seat of disease ten days later, there still re- 
mained a small indurated nodule under the skin, but no soreness, 
no pain, nor other inconvenience, and to this condition it had been 
steadily approaching since my last previous examination. * * 



ULCERATION OF THC BOWELS IN YOUNG IN- 
FANTS. 

The author uses as diet, where milk is not borne, even with 
lime water, one part of cream, two parts of barley water, two 
parts of whey, with the addition, from time to time, of white of 
egg mixed in water with beef essence. When the secretions are 
mainlv mocu-purulent, small doses of castor oil (8 min. ) with 
tincture of opium. After this character is lost and they are 
simplv thin w^atery passages — astringents are indicated. He 
emphasises the beneficial results obtained during convalescence 
from the administration of the lactophosphate of lime and iron. 
Of this he give 10 min. of the syrup three times a day. — Prac- 
titioner. 



The sum of 25,000 francs has been gi\en to the Adademy 
of Medicine of France, to be awarded as a prize to any one dis- 
covering a remedy recognized by the Academy as efficacious in 
diphtheria. Until the award, the interest is to be paid every two 
years as awards for the best research on the disease. 



Periscope axd x\bstrac'T. 173 

FOR DYSPEPSIA. 

Professor Pancoast likes a combination as follows: 

R. Elix pepsin, et bismuth., 3 ozs. 

Ext cinchonre fld., 1 oz. 

Elix. zingiberis, 1 oz. M. 

Sig. — Dessertspoonful at meal time. 



ITCHING OF THE SKIN. 

Professor Bartholow savs that itching of the skin, from any 
cause, can be allayed bv sponging the patient with — 

R. Acid, carbol., 2 dr. 

Glycerin! , 1 oz. 

Aqua? rosse, ad 3 ozs. M. 

Sig. — Lotion. 



SUPERFICIAL NEURALGIA. 

For superficial neuralgia, the following will often often be 
found of benefit. (Prof. Bartholow.) 

R. 01. caryophylli, 
01. gaultherite, 

01. thymi, aa 1 dr. 

Tinct. benzoini, 

Tinct. cinnamomi, aa 4 ozs. 

Sig. — External use. 



MEMBRANOUS ENTERITIS. 

Several cases of membranous enteritis were shown in Prof. 
Da Costa's clinic. The treatment consisted in keeping the fecal 
accumulation in a soluble state by — 

R. Magnes. sulph., 2 ozs. 

Ferri sulph., 2 di. 

Aquse, 2 pints. M. 
Sig.- — Take every morning ^ ounce. 

Also— 

R, Liq. potassi arsenitis, 2 drops. 

Tinct. ignat. amariB, 6 drops. 

Tinct. cinchon. corap., 1 dr. M. 

Sig. — Ter die. 



THE 

Peoria Medical Monthly. 



THOS. M. McILVAIXE, A. M., M. D., 

Editor and Publisher. 

204 S. Jefferson St., Peoria, III. 



*»*The Editor is not responsible for the statements or opinions of contributors. 

***Short original articles are invited from any reader, whether a subscriber or not. 

***If extra copies are desired by a contributor, the number must be specified when the 
article is sent to the Editor. 

***A11 exchanges, books for review, and communications must be addressed to the Editor 
and Publisher. 

***The publication day of this journal is on or about the 25th of each month. 



EDITORIAL. 

THE LATE PROPOSED MEDICAL CONGRESS. 

The war continues, and the breach between the opposing- 
forces widens with each successive week. So far as we know- 
actual blows have not been passed, but the amount of wind ex- 
pended will soon be sufficient to blow the whole craft out of the 
water. (That may not be very elegantly or correctly stated, but 
you know what we mean and the weather is too hot, 98 ^ in the 
shade, for further correction ) . 

The Philadelphia protest and withdrawal contained twenty- 
eight names, that from Boston nineteen, and Baltimore twelve 
with more to hear from. Twenty-seven from New York were 
ignominiouslv bounced, and the Hst of officers and committees as 
it now stands is bereft of such names as Loomis, Emmet, Bulke- 
ly, Keyes, Lefferts, Munde, Knapp, Bosworth, Packard, Da 
Costa, Bartholow, Pepper, Mitchell, Gross, Hays, Agnew, Par- 
vin, Goodell, Leidy, Stille, Yandell, WilHams, Blake, Chadwick, 
Chisolm, Johnston, Mackenzie, Lee. Tiffany, Theobold, Johnson^. 
Burnett, Prentiss, Baker, Huntington, Engelmann, etc., etc., etc. 

Poor Congress! it looks as if it had "died abornin',"" or at 
least was having a awful hard time to get started into this world 
(western part of itj of sorrow and contention. The office of 



Editorial Department. 175 

Secretar^'-General is vacant. The sections of Therapeutics, Med- 
icine, Anatomy and Surgery are without heads, and other sec- 
tions are partially dismantled. And still the fight goes on. 

The " Father of the American Medical Association," if not 
of American medicine, has not been acting as he should have 
done in the premises. Instead of taking the rebellious children 
over his paternal knee, and spanking sense into them, he has 
been poking fun at them, and joking them over their discom- 
fiture, thereby only adding to their grievances. It is too hot 
weather to record more of the " squabble " for that is hot enough 
itself for midsummer, so will refrain from making any remarks, 
and simply give the facts as we have done above. Another 
chapter will follow, but the history will not be completed for 
manv months to come. 



A NEW STAR. 



Daniel's Texas i^Star') Medical 'Journal has made its ap- 
pearance in flaming red, and will sweep the western medical sk}- 
like a comet of the first order. No, that will hardly do, for a 
comet is transitory while the Star has come to stay, and we 
hope it will stav: long and bright may be its career. May it 
shed light into the bentghted State that has but one other med- 
ical journal, and produces a million and a half bales of cotton a 
year. Shake, Brother Daniels, and accept our sincere congrat- 
ulations on the contents and appearance of 3'our handsome 
monthly. 



I 



" A LIVELY AND NEWSY MEDICAL JOURNAL." 

One of the solid medical journals of the West, the Cincin- 
nati Medical JSfeivs^ pays the following compliment to a certain 
cotemporary in which we are somewhat interested. Modesty 
forbids our commenting upon it: 

" A lively and newsy medical journal is always interesting 
" to us, and we always take pleasure in reading such a one. It 
^' may not always contain as large an amount of solid scientific 
*' information as some slow-plodding medical publication, like the 
" Boston Afedical and Surgical Jonrnal and the American Jour- 



176^ The Peoria Medical Monthly. 

« nal of Medical Sciences, but, notwithstanding, it subserves a 
" useful purpose. It stimulates the mental energies, directs the 
*' thoughts into new channels, and often discovers facts of prac- 
" tical importance that might have remained concealed. One of 
" the liveliest and newsiest medical journals \\\\\\ which we are 
" acquainted, is the Peoria Medical Monthly. We propose 
" to make a few selections from it." 

And it makes good its word bv liberal extracts from our • 
'" Notes and Comments." 



IS FERRAN A CHARLATAN? 

The idea of inoculation for the prevention of cholera pro- 
duced considerable stir in the medical world when it was an- 
nounced that a Dr. Ferran had discovered the true method and 
was successfuUv practicing it in the cholera-stricken provinces 
of Spain. There was little in the nature of his claims to war- 
rant anything more than a hope that his assertions might be 
based upon truth, and that the world was to be enriched by a 
second Jenner or Pasteur. Still, the fact that one attack of chol- 
era dones not give immunity from other attacks made it impos- 
sible that any system of vaccination or inoculation would offer 
any protection against the disease. 

An American plwsician writing to the Chicago Daily Tri- 
hnne gives the results of his visit to Ferran at Alcira in wSpain 
and the results of his investigatious into the methods employed. 

He found the people enthusiastic about inoculation, and 
fighting for the privilege of being inoculated. 

The first observation made was as follows: 

I at once sought out an inoculated person and opened up a 
clinical study of his symptoms. He had been "touched" at 9:30 
A. M. of a Monday and I say him the next day at noon. There 
was great and intense constitutional disturbance, with fever, vom- 
iting, and diarrhoea. But the symptoms were not choleraic, 
though bacilli were found in the blood and evacuations. There 
was a notable nausea, with heat and pain in the stomach, and ex- 
quisite intestinal tormina following. Restlessness, palpitation, 
and headache were marked, and within twelve hours from the 
time I met him the patient had the objective phenomena of true 
choleraic collapse, and the discharges resembled those of cholera. 
But there was no cholera about it. The diarrhoea of cholera has 



Editorial Department. i77 

the merit, of being painless, and this was not. Moreover, there 
were really no signs of what cholera should be. There was some 
^'omiting. and much hebetude, great weakness, and considerable 
fever. In tine fact of deed something of a "state '' had been pro- 
duced, but I would have defied any one to have diagnosed it as 
cholers or as a semblant state. The observations settled nothing 
in my mind. 

He then sent his card to Dr. Ferran but it was not noticed. 
A note asking for an interview met with ahke silence. He then 
feed an otiicer to give him admission and introduced himself as 
an American student of Koch, stating that he wished io learn 
something regarding inoculation. 

•' I do not propose to acquaint you or anyone else with my 
secret" was Ferran's reply; •• it is my property and is not to be 
revealed, though ultimately I may sell the right to use it in other 
countries than Spain. You would steal my secret,"' and tht- in- 
quisitive American was shown the door. 

This aroused his ire and he was determined to know more 
about it or perish in the attempt. 

Accordinsrlv he disp-uised himself as a countrvman and 
and crowded again into the reception hall, presenting himself for 
protection bv inoculation. What was done and how, we let him 
tell in the following extract from his letter: 

He jabbed a sharp bistoury under m}- skin at a point just 
above mv left elbow in a business-like manner. Then he took a 
bit of brownish unguental substance and inserted it under the in- 
tegument, covering the wound up with a wafer of sticking- 
plaster, the whole proceeding reminding me of a rude way of 
vaccinating to protect from small-pox. The operation com- 
pleted, the fellow told me that an eruption would appear at the 
seat of the vaccination, and that violent catharisis ("induced 
cholera" he called it) would follow. As an adjuvant to this, he 
gave me three little pills, bidding me take one after thn-ty-six 
hours, and the others after the seventy-second and loSth hours 
respectively. 

Though I hastened to gent out of the crowded hospital and 
to mv hotel, that I might there examine the wonderful culture- 
fluid that I carried in mv arm, some twenty minutes necessarily 
elapsed, and later I had the " symptoms." rVs soon as my door 
was closed I tore off the plaster and extracted as much of the 
unguent as I could. There mav have been microbes in the stuff. 
I hope so. My analysis showed' that it was a compound of some- 



178 Thk Peoria Medical Monthly. 

thing more than cuhure fluid. It was chiterium, and croton-oil, 
and vasehne, 'and perchance other ingredients. In the three 
little pills were the same drugs — both of them the most violent 
of cathartics. Subsequently I found that all who are vaccinated 
have to take the pills. The resultany physician or druggist can 
tell you. 

The Doctor wonders at the smartness of Ferran in conceiv- 
ing such a stupendous fraud, and humbly hopes he is not a ''Yan- 
kee " in disguise. 

Those who wasted so much admiration over the " Spanish 
student , studying amidst adversities and achieving that which 
would stamp out the plague and save millions of lives," etc., will 
now refrain from raising a fund for him, or erecting his statue. 
He is sharp enough to take care of himself. 



FAMOUS LONDON DOCTORS. 

We take the following chit-chat about famous London doc- 
tors from a little book recently published, called " London Soci- 
ety." The only trouble is, that the list of these delightful pen 
portraits is so short : 

I suppose there is no one who has terrified more persons 
into total or partial abstinence from intoxicating fluids than Sir 
Andrew Clark. Yet that distinguished doctor is frequently to 
be met with at the dinner-tables of the great and wealthy. Nor, 
so far as I have been able to observe, does he exclusively restrict 
himself to some aerated water, qualified by the most trivial infu- 
sion of Scotch whiskv. He is a shrew^d student of human na- 
ture, as well as, I doubt not, a considerable man of science — this 
canny Abderdonian. 

Some years ago he conve\'ed to Mrs. Gladstone a deep im- 
pression of his powers. Mr. Gladstone recognized in him a 
careful doctor and a good High Churchman, The combina- 
tion pleased the present Prime Minister, and Mr. Clark's fame 
and fortune were as good as made. His happy faculty of or- 
acular utterances, the solemn aphorisms with which he clinches 
his counsel to his patients, the sonorous platitudes with which he 
emphasizes the simplest of sanitary maxims, his quick eye, the 
kind severity of his manner, the air of judicial sympathy with 
which he interrogates those who come to see him upon their 
maladies, the calm deliberation, the systematic shunning of the 
semblance of haste — these are the qualities which cause London 



Editorial Department. i 79 

society to repose confidence in Sir Andrew Clark. Moreover, 
he is, when encountered in the dining-rooms of the metropoHs, 
an agreeable and companionable person, with plenty of anecdotes 
and a gift of humor, the point of which is heightened by his Scotch 
accent. Sir x\ndrew Clark is a typical physician of his period, 
justlv confident, doubtless, in his acquaintance with the British 
pharmacopoeia, but confident rather in, and accomplishing more 
bv, his comprehensive and microscopic knowledge of human na- 
ture. 

Sir William Gull is endowed with all Sir Andrew Clark's 
command of noble and sagacious sentiments. If his prescrip- 
tions could be sometimes dispensed with it is worth paying a 
couple guineas for them, in order to store one's memory with the 
wise saws and mondern instances of which he is full. His pres- 
ence is more that of the ideal doctor than Sir Andrew Clark's. 
You could not, where\er vou might see him, mistake him for 
anything but a doctor: whereas Sir Andrew might well be a 
lawyer, a farmer, a schoolmaster, or a parson. He plumes him- 
self on his power of probing the secret hearts of his patients to 
their lowest depths bv eagle glances and by pregnant and pithy 
pieces of professional sententiousness, enunciated in a melodra- 
matic undertone. His manner is as perfectly calm and collected 
as is to be found in phlegmatic England itself. He can be kind 
and well as courteous: but whether he is simply the latter or 
whether he infuses into his demeanor something of the former, 
nothing appears to proceed from the spontaneous emotion of the 
instant — everything is prearranged. If he is not a great doctor 
as many hold him to be, he is a marvelous piece of human ma- 
chinery. 

The more purely social side of the medical profession is dis- 
played by men like Dr. Quain and Sir Oscar Clayton. The 
latter of these I should pronounce without hesitation the nearest 
approach to the court physician of a century since, now extant. 
He is attached in his professional capacity to the household of 
the Duke of Edinburg, but as it was once said of an historical 
head master of Eton, that one could not help having a respect 
for a man who had whipped in his dav the whole bench of bish- 
ops, so one's admiration for Sir Oscar Clayton is increased by 
the circumstance that he has physicked, for more or less serious, 
more or less noble, or ignoble, ailments the principal members of 
the aristocracy of England. It often occurs to me as I look upon 
this little knight of the lancet — well stricken in years, well made 
up, radiant in hair dyes and cosmetics, the secret of which rests 
with himself alone, deferential and insinuating in manner, with 
all sorts of stories calculated to suit every variety of audience, 
from a prelate to a demirep, at his disposal — that the spirit of 



i8o The Peoria Medicai. Monthly. 

the courtly leech of the Grand Monarch or of the Caroline res- 
toration in England must be enshrined in him. 

Of Dr. Quain, certainly one of the most distinguished chil- 
dren of ^Esculapius — alas! that the child should now be march- 
ing- toward the goal of septuagenarianism — it may be said that 
he is a cheery, kindly, genial, and a gifted Irishman first and a 
great physician afterward. Heaven forbid that when I say this 
I should hint anything like disparagement at that most worthy 
of doctors, that most staunch, omniscient, and fluently conversa- 
tional of friends! hideed, Dr. Quain is not only a Hippocrates 
of vast experience and profoundly scientific attaininents, but a 
medical writer of the highest authority. He has produced within 
the last few years an encyclopaedia of medical knowledge. How 
he found time for such a chef d\ruz'rc is the standing wonder to 
his friends. The explanation doubtless is that the doctor has an 
extraordinar}' appreciation of the value of time and diet for in- 
dustrial purposes. He never loses an hour or a minute. The 
evenings that he gives to society recruit his energies for toil, and 
there is, I am informed, authentic testimon^• on record that Dr. 
Quain, after an evening spent with convivial friends, prosecutes 
his editorial labors, literary or scientific, until the bell rings for 
matins — a religious seryice that he usually makes a point of at- 
tending. 

'He is a perfect treasure-house of miscellaneous anecdotes, 
equall}' charming and various as host or guest, with a profes- 
sional acquaintance of men who have made their mark in all de- 
partments of life, which has usually ripened into a personal 
friendship unprecedented, I should think, in the history of the 
Ro3'al College of Physicians. Several decades of London life 
have not destroyed his rich native brop-ue, but rathor chastened 
It. He takes that easy view of life peculiar to prosperous, and 
for that matter unprosperous, nati\-es of the Emeral Isle. He is, 
in a word, a medical philosopher of the epicurean t\pe. 

Dr. Morell Mackenzie is too entirely devoted to his profes- 
sion to have much time to spare for the social distractions of Sir 
Oscar Cla3'ton or Dr. Quain. He is probably one of the most 
gifted specialists in Europe, with one of the shrewdest heads on 
his shoulders. For these reasons he is not too much beloved by 
the members of his own fraternit\'. He is, however, as kindly 
as he is clever, and hospitable upon a big scale. This hospital- 
ity he shares in common with — though between the entertain- 
ments of the two there is no similarity — Sir Henry Thompson. 
The former is renowned for his big banquets; the latter for his 
small select parties, at which the number is strictly limited to 
eight. He calls them his octaves. At these you will find a 
company well assorted and easily amalgamated, dishes judiciously 



\ 



NON-AICOHOLIC. NON-RESINOUS 

BLAND AND UNIRRITATING. 

FLUID HYMASTIS. 

A definite and permanent solution of the Alkaloids of C4olden Seal Root, 
viz: 

BERBERINA— Of a bright yehow color, the salts of which are known in com- 
merce as Sulphate, Muriate and Phosphate Berberina (Hydrastia.) 

Hydrastia, crystallizing in wJiite prismatic forms and insoluble in water. 

Xanthopucclna, or the unknown third alkaloid, of a dark yellow color, but 
which has never been carefully isolated, ahd is unknown in commerce. 

The use of Fluid Hydrastis is suggested in all affections of the mucous sur- 
faces; correcting abnormal conditions characterized by profuse discharge of tenacious 
mucous, subcute inflammation, erosions and superficial ulcerations. 



McDade^s Prescription 

FOR 

VENEREAL AND CUTANEOUS DISEASES. 



FORMULA. 

Fluid Ext. Smilax .Sarsaparilla, 
Fluid Ext. Stilliugia Sylvatica, 
Fluid Ext. Lappa Minor. 

Flu d Ext Phytolacca Deeandra, a a, two ounces. 
Tinct. Xantho.tyllum Carolinianum, one ounce. 
Mix— Take a tcaspoonful in water three times a day before meals, and gradually 
increase to tablespoonful doses. 

CAUTION. 

"In making the Fluid Extracts there is great risk of getting a remedy lessefllcient 
than the original Indian decoction, because the manufacturer may use roots that have 
been kept too long and lost some of their active principles; while the decoction used 
on the plantations was always made of Fresh Roots just gathered from the 
•woods. In making the Fluid Extracts we should, therefore, be caretul to have them 
made from roots recently gathered." 

REMARKS. 

The \Vm. S. Mekrell Chemicai. Co. of Cincinnati offer the formula of Dr. 
McDade, prepared in accordance with the principles so strenuously held by them for 
more than thirty years, viz , that the volatile elements of many plants are dissipated 
by the drying process, thereby injurihg, if not wholly destroying, their medical proper- 
ties. 

PRICE, $12.00 per Dozen. $1.25 per Pint. 

Green Plant and other Fluid Extracts.— Merrell* 

These remedies are positive Medicinal ngerxXs:— positive, not because they wiU 
invariably cure disease, but because their sensitive properties are definite, u/uformfand 
certain. Send for our paper on the subject of '-Green Plant Fluid Extracts." 



Agents for Peoria and Central Illinois. 

SINGER & WHEELER, 1 
COLBURN. BIRKS & CO., \ p. •. xii 
SUTLIFF,SHULTZ &;C0., f ^®°™' ^^^• 
ROBT. A. KING. J 



THE HIGHEST AWARD, 

GOLD MEDAL, 

Has been granted to 

MELLIN'S FOOD 

FOR INFANTS AND INVALIDS, 

At the World's Exposition, New Orleans. 

1885. 



Dolibar, Goodaie & Co., 

40, 41, 42 & 43 Central Wharf. BOSTON, MASS. 



A Sample of MELLINS FOOD. Sufficient for trial, will be sent free 
to any Physician desiring it. 



Editorial Department. i8i 

chosen, and sound wine. Sir Henry Thompson, who is indebted 
for his knighthood to the surgical skill he exhibited in operating 
on the august person of the King of the Belgians, is also an ac- 
complished artist, and mr.rv of the most pleasant pictures which 
adorn the walls of his house are from his own brush. He is an 
aesthete rather than an apolaust. He delights in whatever lends 
charm and elegance to life. He takes the same sort of pride and 
care in his cellar, although he never touches wine, that a scien- 
tific floriculturist might take in his greenhouses though their 
contents never had a place in his drawing-room vases. 

Each of the four doctors whose names I have last men- 
tioned discharges distinct social services by bringing the members 
of various social sections into mutual communication. Politicians, 
litterateurs^ artists, actors, journalists, professional men of all 
grades find themselves in each other's company under the aus- 
pices Quain and Clavton, Mackenzie and Thompson. Thus we 
have a quaternion of doctors who, in addition to the benefits they 
confer upon humanity by the exercise of the healing art, supply 
in the plentitude of their amiable thoughtfulness that social ce- 
ment which causes society's various parts pleasantly to cohere.. 
Such masters of medical science as Sir William Jenner and Sir 
James Paget constitute a more solemn class in the hierarchy of 
physicians. The latter is especially in favor with the Whig 
aristocracy, and the former is much occupied with the Queen. 



A CIRCULATORY RIOT. 

The piles! aha! I knew them well, each feature, though I 
may not see 'em; old foes, which fume, and fret, and swell, and 
vex and plague my perineum. You blush at mention of a "pile," 
and would, perhaps, the theme avoid; well then, suppose, for 
style, we call the thing a hemorrhoid. ■ Though bearing an ill- 
omened name, it seemed as if they might not pain us, when first,. 
as visitors, they came and took up lodgings in the anus. But 
now, at each succeeding bout, the pelvic pains appear distincter, 
and there can be no longer doubt of their relations with the- 
sphincter. You ask me, by what obvious signs one may with 
certainty detect 'em. Well, I can only say that mine are like a 
hornet in the rectum, which, having wandered from the way, 
and angry at the situation, stings right and left while yet it may, 
and tortures one in defacation. "Avaunt! it is a vulgar rhyme." 
Yet stay, there must be means to cm^e 'em? Oh, yes, if you but 



i82 The Peoria Medical Monthly. 

give them time, and meantime patiently endure "em, there are a 
thousand cures you know, all certain sure, as dead-shot cand}'; 
'tis \^■ell to buy a score or so, and lay them bv to have them 
handy. And when the hornet's rage is spent, and things assume 
their wonted quiet, the cure — though it mav not prevent — will 
quickly quell the painful riot. — Canadian Practitioner. 



NOTES AND COMMENTS. 

Dr. John Murphy, of this city, is making his sixteenth an- 
aual visit to Lake Minnetonka. The fish quake when the time 
for Dr. M's visit arrives. 

There have been about fifteen cases of variola in Peoria 
during the past month. The cases are all mild and no fatal 
results have yet occurred. 

We would call especial attention to the article of Dr. Curtiss 
in this issue on the Immunity from Disease. His theory is cer- 
tainly ingenious and well supported. 

Dr. Chenoweth's essay on " Man," though lengthy will 
repay a careful reading, as it is a condensation of the evolution 
theory, and presents that theory in its clearest light. • 

The offer of Hayncs Electro-Therapeutics, and this journal 
for one years for $2.50 will be withdrawn after August 15th. 
Any one wishing that valuable book at a nominal price must 
send in their cash before that date. 

The cholera is spreading rapidly in Spain, about 2,000 new 
cases being reported daily, with nearly 50 per cent, of deaths. 
It has also invaded France, and almost any day may herald its 
arrival in England or the United States. 

Say, Doctors! at least a good many of you, vou have fre- 
quently promised to write for this journal, report a case or some- 
thing. Now is the time to fulfil your promises. There is no 
danger that we will let you forget them. Short and to the 
point. 



Editorial Department. i8 



o 



The Brookh'ti doctors have not withdrawn from the Con- 
gress. Why? Because there were only three of them ap- 
pointed, and that was not enough to kick about. It does seem 
strange that a city of nearly three quarters of a million inhab- 
itants should have so few appointments. 

Genkin in Wratsch reports the use of oil of turpentine, in 
doses of ten drops to a drachm of castor oil, in the treatment of 
d3'senterv. There was seldom any disturbance of the urinary 
organs and the results were better than those obtained by the 
use of opium. — ^'V". 1". Med. yoiir)iaI. 

It is currently rumored in this city that the International 
Medical Cong-ress and the American Medical Association have 
been captured by one of the New York schools and will be run 
under its exclusive patronage. "Madam Rumor" is not alwa3'S 
a nunreliable witness. — Maryland Med. Moiithlx. 

Dr. N. Senn, of Milwaukee, Wis., has accepted the chair of 
Principles and Practices of Surgery in the College of Physicians 
and Surgeons, Chicago, and Dr. C. Fenger takes the chair of 
Clinical Surger}- in the same institution. The College is io be 
congratulated upon securing such able men for its faculty. 

A famous surgeon advises one of his patients to undergo an 
operation. "Is it very severe ?" asks the patient. "Not for 
the patient," sa3'S the doctor: "we put him to sleep; but very 
hard on the operator." "How so?" "We suffer terribly from 
anxiety. Just think, it only succeeds once in a hundred times." 
—Old Joke. 

Dr. A. M. Duncan, of Hamler, O., reports the case of a 
retired practitioner suffering from glycosuria, who finds the 
greatest benefit in the use of buckwheat flour. The sugar 
almost entirely disappears from the urine, and other symptoms 
are removed when he uses this kind of flour. — Canadian Prac- 
titioner. 

Dr. N. S. Davis, Jr., Lecturer on Pathology and Pathalo- 
gical Anatomy, will fill the place vacated by the resignation of 
Professor Fenger. He has just returned from a few months stay 
in Vienna and Heidelberg, where he devoted his time almost ex- 



184 The Peoria Medical Monthly. 

clusively to the study of morbid anatomy and pathological his- 
tology. 

The ^A . }. Med. /Record sa^s: "Only t\yt;nt\-nine physi- 
cians of this city, nearly half of whom are connected with the 
same medical school, occupy official positions in the preliminary 
organization of the proposed Congress. Philadelphia, with fewer 
physicians, \\ as giyen forty-eight positions, and Boston, with one- 
fourth the number of doctors, \yas giyen twenty positions." 

The Ciniadian Practitioner complains that seyeral prom- 
inent physicians consult with homoeopaths. Well, how^ are you 
going to help it? Here in Peoria probably half of our regulars 
meet with homoeopaths in consultation, and w-e belieye the same 
is true in all of our large cities. Talk about ethics ! but our ob- 
seryation is that the majority of doctors will go when the 
almighty dollar leads the way. 

A death is reported from a druggist's mistake in putting up 
grammes of atropia when milligrammes \yas intended. The 
prescription w^as writted 1.5, instead of 0.0015, as it should have 
been. This comes from fooling with the metric system. Had 
the prescriber written grains J^ the mistake could not have oc- 
curred. We do not believe in the metric system, and will not 
give in until we have to. 

The Peoria City Council appropriated $2,500 to prepare for 
cholera, and from this amount pays three members of the Board 
of Health $100 a month each to superintend three inspectors at 
$65 per month each. This takes over one-half, and leaves but 
a small margin wherewith to put the city in a good sanitary con- 
dition. But this is about the wisdom of all city councils, and we 
ought to be thankful for what we get — only we are not. 

In the Chicago Medical College, Medical Department of 
the Northwestern University, Professor E. O. F. Roler has been 
transferred to the position of Emeritus Professor on accout of 
continued ill health, and Dr. W. J. Jaggard has been appointed 
Professor of Obstetrics, the duties of which position he had dis- 
charged for the last two years with the highest degree of satis- 
faction on the part of both Faculty and students. 



Editorial Deqartmext. 185 

Mr. Ernest Jacob {British Medical your)iaI] has collected 
all the cases in which death was caused by anesthetics during the 
year 18S4 in England and Scotland. The number of deaths 
from chloroform was nine: from a mixture of chloroform and 
ether, two: from methylene, three: from ether, six. In reyiew- 
ing the cases he says one is struck by the difference in the char- 
acter of the operations. The deaths from chloroform occurred 
in comparatively healthy persons: those from ether in persons 
severely debilitated by disease. — Louiizillc Med. JVczt's. 

The Supreme Courts of New York and Massachusetts have 
settled the matter as to who owns a medical prescription. The 
substance of the decisions is that the physician in prescribing 
gives the patient a written order for drugs, and their delivery 
terminates the operation. The druggist may, on his own respon- 
sibility, renew the drugs, for he is a merchant and has a right to 
sell goods in any shape. He is not bound to give a copy of the 
prescription, nor even to keep it, though he usually retains it as 
a protection in case of error on the part of doctors or patients. 

Dr. H. C. Wood regards the following as the most efficient 
sedative cough mixture that he has ever used: 

R Potassi citratis. 1 dr. 

Succus limonis, 2 ozs. 
Syrup, ipecac, \ oz. 

Syrup, simplicem. q. s., ad, 6 ozs. 

M. Sig. — A tablespoonful from four to six times a day. 
When there is much couifh or irritability of the bowels he 
adds paregoric in suitable quantity. — Med. Age. 

The squabble in New Orleans over the appointment of the 
various committees of the congress to be held in this country in 
1887, was about_^the most ^ exciting_^ feature of the meeting. It 
looks to an outsider,^like a fight between the -'ins and the^outs." 
We believe that the committee appointed last year had full power 
to do as they have done. Whether they have acted wisely or 
not in their selections is another question.' We hope the new 
and additional members of the committee will act slowly in re- 



1 86 The Peoria Medical Monthly. 

vising the work of the old committee. The greatest omission 
from the list seems to be, that Dr. J. V. Shoemaker is not named: 
and that the Empire State of Texas has but one representative. 

The distribution of officers for the next International Con- 
gress does seem a little one-sided. The following analysis of the 
committee appointing tliem, is take:! from the Detroit leaned. 
Of 315 officers New York State has 6%, New York City 55' 
Brooklvn has only 2, Philadelphia has 48, Boston 34, Chicago 
19, with but I from the rest of the state; Washington 19, Cin- 
cinnati 13. The United States Army 8, the United States Navy 
6, Canada 6, all from Montreal; Charleston, S. C, has 6, St. 
Louis 6. The states of Iowa, Texas and Minnesota have but i 
each, and quite a number of states and all the territories have no 
representation at all. The first three cities named have over 
two-fifths of the entire number, but we suppose more than that 
proportion of the medical brains of this country is to be found in 
them. The nominating committee got a severe overhauling at 
New Orleans, and the " fun "' is not over yet. Let the good 
fight go on, it will furnish manv an item yet for the medical ed- 
itor ere the Congress is over. 

The wife of Dr. Frank H. Hamilton, who died on the 4th 
inst., w^as of such an unobtrusive disposition that few^, even of 
her most intimate associates, have ever known to what an extent 
she has aided her husband in his literary and scientific labors. 
Without special technical training, she yet kept herself familiar 
not only with her husband's famous cases, but with the literature 
of the profession, and was his constant adviser and confidant in 
the preparation of his volumes, as w^ell as his most valuable aid 
in the work of proof-reading and revising. Not a page of any 
one of the seven revised editions of his work on " Fractures and 
Dislocations" (a book of one thousand octavo pages), but had 
the benefit of her suggestions in the manuscript and her trained 
eye in the correction of technical, as well as typographical errors; 
and the same may be said of his " Treatise on Surgery," and 
" Military Surgery and Hygiene." — Med. Record. 

The following is from an epitaph on the grave-stone of Mrs. 
Arabella Greenwood, who died in childbed during the last cen- 



Editorial Department. 187 

tury. It was written by her husband, and evidences alike the 
depth of his love, his great humilit}', and his disapproval of the 
treatment she received: 

Such was her condesensione, and such her humilitie, 
Shee chose to take me. a Doctor of Divinitie. 
Above all other the Phoenix of her sexe, 
And like that birde one vounjj shee did beo-ette. 
That she might not leave her sex disconsolate. 

My griefe for her is verie sore 

I can onlie write two lines more: 
For this, and everi good woman for her sake. 
Never let a blisterre be putCe on a Iving-in woman's backe. 

— J/t^d. Aor. 



BOOK NOTICES. 



A Treatise ox x\siatic Choeera. — Edited and prepared b}- 
Edmund C. Wendt, M.D., in association wfth Drs. John 
C. Peters, Ely McClellan, John B. Hamilton, and 
George M. Sternberg. Illustrated with maps and en- 
gravings. Cloth, pp. 404. Wm. Wood & Co., New York. 
1885. 

The subject of Asiatic cholera has received considerable at- 
tention during the present year, and the interest has bv no means 
abated. The possible and probable invasion of this country by 
the plague that is now raging in Spain, gives peculiar interest 
at this time to everything written upon this subject. The vol- 
ume before us is the most satisfactory and complete that we have 
ever seen, comprising as it does chapters on a historv of Asiatic 
cholera. The etiology of cholera. The svmptomatologv. course, 
duration, mortalitv, complications and sequela? of cholera. The 
morbid anatomy and pathological histology of cholera. The di- 
agnosis, differential diagnosis, and prognosis of cholera. The 
prevention of cholera. The prevention of the spread of cholera. 
Cholera hygiene as applied to militarv life, and hnallv the treat- 
ment of cholera. These parts of the subject treated bv the dif- 
ferent gentlemen named, make the work a particularlv valuable 
one, and it should be in the hands of everv phvsician. It forms 
the May volume of Wood's. Library for 1S85. 



i88 Thr Peoria Mr:DiCAL Monthly. 

Poisons — Their Effects and Detfxtion. A manual for the 
use of analytical chemists and experts. With an introductory 
essay on the Growth of Modern Toxicoloi^}-. By Alexan- 
der Blyth, M. R. C. S. F. C. S., etc. With tables and 
illustrations. \^ol. I. Cloth. 8 vo: pp. 533. Wm. Wood 
& Co., New York. 1885. 

An excellent addition to this popular " LibrarY" series; one 
that will be of great service to many subscribers, and of useful- 
ness as reference to all. The tirst chapter, " The Old Poison- 
lore," is one of great interest and full of curiosities of the history 
of poisoning. 

Transactions of the Medical Society of the State of 

Tennessee. 1885. 8vo.: paper, pp. 144. 

One of the most valuable papers in this volume is that of 
Dr. D. F. Wright, of Clarksville, " The Therapeutic Effect of 
the Ligation of Great Arteries," in which he revives the discov- 
ery of Dr. H. F. Campbell, which consisted in the tying of the 
main artery of a member affected with gangrene, erysipelas, or 
other sequelae of traumatic inflammation. During the late war 
Dr. Wright resorted to this procedure in five cases with the hap- 
piest results in all. 

The procedure is too valuable a one to be forgotten. 



RECEIPTS. 



The date following each name, indicates where the amount 
credited extends the subscription: 

Illinois— Drs. H. Schaefer (2.00). July, 1886; Wm James (2.00), 
May, 1886; F. C. Vandervort (2.50), May/ 1886; J. C. Charles (2 00), 
May, 1886; Jno. Stout (4 00). May, 1886; D. F. Rupp (2.50), June, 
l.SSij; L. P. Walbridge (2.00); May, 1886; H. M. Bokit (2 00). May, 
18«6. 

Wisconsin— Dr. H. D. Hill (2.00), July, 1885. 

Texas— Dr. H H. Darr (2 50) January, 1886. 

Minnesota — Dr. W. H. Howe (1.00) January, 1884. 

Iowa— Drs. J. D. Elliott (200), March, 1886'; Thus Garth ( .75), 
.M:iv, 1885; L. L. Bond (2.00), February, 1885 

" AiMZONA— Dr. J C. Preston (2.00),\June, 1886. 

Kkntucky— Dr. W. N. Bailey (2.00), July, 1886. 

Michigan -Dr. A. Garwood, (2.00) June", 1-^86. 



The Peoria 
MEDICAL MONTHLY. 



Vol. VI. : : AUGUST : i88=; : : No. IV. 



I 



ORIGINAL COMMUNICATIONS. 
TYPHO-MALARIAL FEVER. 

BY E. L. LARKIXS, M. D., TERRE HAUTE, IND. 

Read before the Vigo County Medical Society, Terra Haute Ind., Aug. 6, 1885. 

This term, first introduced bv Dr. Woodward in the Med- 
ical History of the War of the Rebellion, and since generally 
adopted by the profession of this country, is used to designate a 
form of typhoid fever which occurs for the most part in the open 
countr}', but does not seem to be of common occurrence in the 
city. When introduced by Dr. Woodward he supposed the an- 
atomical lesions would be found to differ from those in typhoid. 
Later researches, however, seemed to convince him that he had 
been mistaken and led him to retract his original observations. 

Dr. Hartshorne, in his description of the disease, recognized 
three morbific elements as causative agents in this form of fever. 
His experience was confined pnncipally to the Philadelphia Hos- 
pital with soldiers brought there from the South during and im- 
mediately after the war. These, of course, were broken down 
ph3^sically from the combined influences incidental to armies, and 
many of them were suffering from the effects of recent or ancient 
wounds. These causes were malaria, camp or " crowd poison '»• 
and dietetic deficiencies which produce scurvy, and give the scor- 
butic taint to other diseases. 

In the malarial form there was more gastric disturbance. 
An icteroid hue of the skin and tongue, and the remissions were 



ipo The Peoria Medical Monthly. 

more distinct. The rose-colored spots, and sudamina, and t3-m- 
panites were often altogether wanting. 

In that form produced by camp or crowd poison the remis- 
3sions were less marked, a slower onset, more cerebral disturb- 
ances and diarrhoea, with epistaxis and bronchitis sometimes, but 
■with both less constantly than in private practice, were predom- 
inant symptoms. Deafness less frequent than in civil practice, 
lout other symptoms about the same as in ordinary typhoid fever^ 

In the third group of cases a peculiar mental and bodily 
prostration preceded and followed the disease. There was great 
arritability of the heart, a tendency to mucous hemorrhages, dis- 
colorations and petecia, palid large and smooth tongue, and 
extremely protracted convalescence. 

Dr. Woodward found the intestinal ulcers of a different 
•character from those of ordinary typhoid fever. He found the 
swelling over the glands of Peyer prior to ulceration in typho- 
malarial fever to rise gradually from the surrounding mucous 
membrane, and never umbilicated as in typhoid fever, w^hereas 
in the latter the tumefaction rises abruptly and has a constricted 
l)ase. 

While the term may not be strictly scientific, it is conven- 
ient, and if it does not designate a specific and separate disease, 
applies with especial force to a distinct form of ordinary typhoid 
lever. 

During the past six years I have observed and treated quite 
a number of cases of this disease, and in all of them most of the 
S3miptoms were different from those of typhoid. While can not 
say that malarial symptoms predominated — were not in fact 
prominent factors — but it did seem to me that the destructive 
characteristic symptoms of true typhoid fever were wanting in 
many respects. 

During the months of August, September and October, '8i, 
J treated in all about thirty-five cases of this disease, two of 
lyhich proved fatal, one a girl aged about 14 years, who died on 
the eighteenth day from congestion of the brain, and the other a 
■•"woman aged about 25 years, who died in the fourth week from 
abortion. In that year typhoid fever was epidemic in many 
parts of this country and Europe. Several cases occurred in my 
practice in the years '79 and "So, and a number since, but in no 



Original Communications. 191 

one year other than '81 did so many as stated occur. The sum- 
mer was remarkable, as you all remember, for its early, long 
continued and excessive heat and dryness. 

The town where I then resided is small, containing about 
600 or 700 inhabitants. The soil is clay underlaid by a strata of 
what is known as " hard-pan." This strata occurs in all that 
country at about a depth of from 15 to 20 feet from the surface. 
The wells are dug only to the hard-pan, as it is about impossible 
to dig through it. During the drought many wells failed en- 
tirely, and the remainder supplied only a limited amount of water 
which contained a large amount of organic matter, as shown by 
the permanganate pot test. The country slopes gradually to 
the west, and the wells are supplied by veins of water coming in 
from the east side. 

If we consider the town a square, and divided in four equal 
parts, it will be found that most all the cases occuring there 
during the epidemic (twenty-seven in number], were confined 
to the south-west quarter, only one or two cases in the remain- 
der. This quarter of the town contains about one-fourth the 
inhabitants and is scattered over eight or ten acres of land. 

So far as I now recollect there were only two instances 
where more than one case occurred in a family, and in each of 
those but two cases. Two deaths occurred in the town from 
causes above stated. If the poison was taken into the system 
with the drinking water, it seems to me more cases ought to 
have occurred in the same families. 

So far as could be discovered, the sanitary condition of that 
part of the town was as good or better than the rest. There 
were a number of cases scattered throughout the country, but 
the mortality was light. 

The duration of the disease was on an average twenty- 
three to twenty-seven days. The longest one of my cases was 
thirty-one days. The shortest eleven days. This does not 
include relapse or complications which occurred in several cases. 
I counted the duration of the disease from the time the patient 
took to the bed until the temperature returned to the normal. 
All the cases occurred from July to November, inclusive. The 
youngest in whom the disease occurred was 9 years and the 



192 The Peoria Medicai. Monthly. 

oldest 52, and so far as sex was concerned were about equally 
divided. 

The disease was usually ushered in b}' a prodromic stage 
lasting from one to two weeks. There was slight headache, 
great muscular weariness, broken rest at night, loss of appetite, 
bad taste in the mouth in the morning, tongue covered by a white 
coating which could not be removed by washing, and which I 
could only compare to the down on a peach. This condition of 
the tono-ue was characteristic of the disease. As the disease 
advanced it would sometimes, for a day or two, change, but 
would return again. The tip and sides of the tongue were some- 
times red, but not so marked as in true typhoid. During this 
stage there were in the great majority of cases irregular chills 
followed by slight fever, and night sweats for which symptoms 
they usually applied for treatment. 

After the fever had become continuous there were in manv 
cases great irritability of the stomach, so great indeed in most of 
them as to seriously interfere with nutrition and medication. 
This subsided in the course of the first week. In cases of great 
prostration this often returned in the third or fourth week, and 
was alwa3's a grave symptom, and was best controllee by the 
free use of the sparkling- wines^ and beef-tea as hot as could be 
taken. Constipation was present in most cases. Diarrhrca oc- 
curred in two or three, which may, perhaps, have been due to a 
cathartic taken some da3'S before coming under observation. 

Instead of pain in the lumbar region often complained of in 
typhoid there was none, and when complained of at all in the 
spine, it was referred to the cervical and upper dorsal regions. 
Pain in the head was not a characteristic or constant symptom. 
Pain and tenderness in the splenic region was present in most 
cases, but no constant enlargement of the organ was found. 

Tympanites was sometimes present, but in no case was it 
a symptom of an}' consequence. The rose-colored spots were 
never present, but a peculiar flushed condition of the sides of the 
neck and upper part of the breast was an almost constant S3'mp- 
tom during the first two weeks of the disease. Whether the 
cause of the pain in the cervical region produced disturbance of 
the s}-mpathetic S3'stem there, and the above S3'mptoms a result 
of such disturbance, I can not sa3', though certainly the3' were 



Original Communications. 193 

associated. Epistaxis occurred in only one or two cases. De- 
lirium was present at night in a few cases, but in all of them after 
recover}' their sickness appeared to them as an indistinct dream. 

The temperature, after the fever became continuous, varied 
from night to morning from one to two degrees, and in no case 
where no complication existed did it exceed 104. In the ma- 
jority it averaged about 103^ in the evening and 102 in the 
morning. In uncomplicated cases the convalescence was rapid. 

Quinine had no effect in aborting the disease. Calomel 
given in 8 or 10 grain doses on alternate days the first w^eek was 
found to have a good effect, and I was led to believe from its use 
that it rendered the course of the disease milder. The continued 
use of the dil. mineral acids, with an occasional change to the 
oil of turpentine for a few da^'s, especially if the tongue had a 
tendency to become dry and red, and a sedative dose of quinine 
on the evening of every second or third day was found in the 
main to constitute the best line of treatment. 

May not the cause of typho-malarial or typhoid fever be due 
to the same or kindred poison which produces intermittent and 
remittent fever, in the former producing lesion of substance and 
in the latter lesion of function, and amenable to the action of quinine 
in proportion to the extent of such lesion? In intermittent fever 
the prompt action of quinine is certain; in the remittent form the 
effect of the drug is not so marked owing to the functional de- 
rangements of the stomach, spleen and liver. When these are 
removed the specific action of quinine is as prompt in the intermit- 
tent variet3^ 

Malarial fevers, so called, were very prevalent in this country 
when people used buckets with which to draw water from the 
wells, especially from shallow ones, but since the almost univer- 
sal use of pumps, they are rarely seen. This may in part at 
least be accounted for on the -ground that by the use of buckets 
water is used from the surface of the well, water which may be 
impregnated with malaria, and when pumps are used water is 
taken from the bottom of the well, and free from the poison. 
That malaria is a poison and not a virus is shown by the fact 
that one attack does not confer immunity from the disease, but 
on the other hand the best condition in which to contract the dis- 
ease is to have had a previous attack. From this it follows that 



194 The Peoria Medical Monthly. 

continuous remittent fever is not of malarial origin, as one attack 
confers relative immunity from the disease. May not this fever 
be protective from the typical form of tvphoid through some 
modification of the tissues of the bod}-, as the hvbrid, induced 
disease, vaccina is of that once terrible scour n;e variola? There 
are no hard and fast lines in nature, and it mav yet be found that 
those who suffer from continuous remittent fever have typhoid 
in a modified form. 



IMMUNITY FROM DISEASE. 

BY C. B. MACLAY, A.M. M.D. DELAVAX, ILL. 

A writer in the July number of the Peoria Medical 
Monthly, declares that "there can be no science on the subject of 
immunity from disease until the law is found which will explain 
everp thing that any man knows on the subject." It is to be 
feared that we shall have to wait a long time for that discovery. 
To propose the Darwinian law of natural selection is to offer 
what Darwin himself confesses, does not explain, without some 
considerable uncertainty, the theories he prrposes, and which 
have been adopted as true by so many noted scientists. The 
examples given by the writer alluded to, (maybe, thrown in by 
way of fun) are not Darwinian. 

When a human hand is calloused by "rowing" there is not 
a true variation of the cells of the integument, and when the 
doctor ceases rowing the integument does not bv atavism return 
to its former condition. The thickening is a ver}' speedy pro- 
cess and the facts in the case require no astute reasoning to 
make them readily understood. The variation, if any, and the 
atavism, if any, can come only in rare cases and at long intervals 
of time, and that through growth of bone and development of 
of muscle or the retrograde measure. If the oarsman trans- 
mitted his callosities, we should have been long ere this a race 
of beings with hands cushioned far to exceed the camel's feet in 
their rotundity. Darwin lays down this declaration to be noted 
very carefull}-, to his followers, '■'■natural selection acts very slo'wlv, 
and only on a fezv of the inhabitants of t/ie same r co-ion.'''' If 
that is true, it looks decidedly bilious for our new theory of 
disease. Mr. Darwin further asserts with particular emphasis, 



Original Communications. 195 

" jVatural select ion zuill soon banish the belief of any sudden or 
great modification of striicture.'''' 

The writers, lecturers and quasi-scientists who talk about 
the marvelous changes in structure of the bee, the caterpiller, the 
musquito and the frog and call these Darwinian developments, 
reckon without their host, for they enter not into Mr. Darwin's 
theory at all, and are outside of natural selection. They are, so 
to speak, in the every day hum-drum round of animal metamor- 
phosis from which there must be variation to give a chance for 
natural selection to play its part. If on the contrary these de- 
partures were rapid or declared to be rapid, then we might ex- 
pect to find many forms in actual transition; but reall}' one theory 
is as good as another since Mr. Darwin takes his fundamental 
basis for granted, and all other theorists may do the same. It is 
then a question of probabilities, and in its very essence unscien- 
tific. No half-way developed animals are found on the earth 
alive, nor are any such found in the rocks. Moses is said to have 
made mistakes, but so far science is with him, " and God saw 
every thing that he had made, and behold it was very good." 

The writer referred to above certainly has taken up an erro- 
neous idea in regard to the law of natural selection. He says, 
" So the wolf chases the antelope, if happily he may catch him. 
This is called natural selection. The wolf selects the antelope 
for the reason that he can't select anything else." 

This may be a natural selection but it is not the natural 
selection that has made Darwin famous. Neither does this give 
" the whole story of natural selection, atavism and transmission 
by hereditary descent, and the sequent survival, immunity and 
atavism." Scientific phrases have a lovely captivating sound, bu^ 
often they are sounding brass. Darwin teaches that nature 
selects from the mass of beings those best fitted for the spheres 
they occupy, and by very small variations the fittest that survive 
the physical changes are adapted to new circumstances, and thus 
in all nature there is an onward and upward march toward per- 
fection. The selection that a flea makes of a tender skin, the 
choice that a louse makes of a dirty scalp, and the bedding that 
the microbe secures in the corner of the lungs or bowels, have 
no relation whatever to Darwin's famous law, except in so far as 
the most mature and efficient operative is supposed to " win his 



196 The Peoria Medical Monthly. 

spurs," or to receive higher endowment on account of his effect- 
ive action. According to Darwin's law the microbe showing the 
greatest pertinacity and the supremest fitness for the work done, 
may in a thousand generations receive from nature new and 
especial endowments. The fight' between the tissue cell and the 
microbe, if fight there be, is of no more scientific relation to the 
new philosophy than a dog bite. Giving a title to an essav does 
not go far in explanation, and bestowing a sonorous term on a 
disease does not explain anvthing. 

From a consideration of the numberless varieties of temper- 
ment, the constituate pecuharities of tissue, and the continuouslv 
modified fluids of the system, it should not be verv hard to un- 
derstand the subjection to or immunitv from a great many forms 
of disease. Whether the maicries morhi is chemical in its rela- 
tions, or whether it is a living cell is a matter of some scientific 
interest, but the tolerance of resistance to, or the complete over- 
throw of the vital powers by it, may be at least partially under- 
stood by considering analogies which are evident on all sides. 
Any physician of experience could give a verv good guess as to 
what persons would be most likely to be affected bv different 
kinds of weather; by warm or cold seasons; by dr}- or wet ex- 
tremes; by times of great excitement or extreme quiet; by suc- 
cess or failure in business. When certain diseases are rampant, 
we fear for the constitutions of certain persons because we know 
they are peculiarly endowed. Give the color of skin, hair, eves, 
the chest, abdominal and head measurements, their place of birth, 
sex, residence and occupation, and a little of their personal historv 
and it is not hard to forecast their morbid future. 

That great changes occur in tissues is certainly true. Cli- 
mate, age, food and occupation may each materially alter phvs- 
ical peculiarities, and it is not to be wondered at that continued 
exposure to destructive agencies, while at the same time the vital 
energies are sustained, may result in such changes of tissues as 
to secure entire immunity. When the exposure ceases it is not 
unreasonable to believe that the tissues will return to their nor- 
mal condition. By what process? The law of adaptation, or if 
you will by the old philosophy, "the eternal fitness of things." 



Original Communications. 197 

CASE OF ICHTHYOSIS. 

BY F, C. VANDERVORT, M. D., TONICA, ILL. 

I reported a genuine case of this affection in the Peoria 
Monthly, Vol. II. No. 6, and gave a description of the disease. 
The first case was lost sight of for nearly three years, but has 
turned up once more, the scales having fallen from his eyes, but 
not from his head, neck and trunk. When the family returned 
from the west, they had not one but two scaly boys. The sec- 
ond is now nearly three years old, and looking at his back re- 
minds you of seal skin without any fur. The boys are both 
stout, bright, healthy lads and are never sick. August is their 
worst month, for the heavy brown scales prevent transpiration. 
Later on they will peel off and appear as fresh as locusts just 
emerged from their cast off shells. This process of scaling and 
peeling goes constantly on. 

July 20th the mother of these two boys was delivered of a 
third child by myself. It was a girl, but alas, ere it had breathed 
the breath of life five minutes, its skin began to drv and crinkle, 
and feel very much like parchment. The child is now about a 
week old and is scaling off for the first time. It is very humili- 
ating to the parents to have such children, and it is with great 
reluctance they give up the curability of the disease. When the 
first child was born, I cautioned them against wasting time and 
money tr^ang new doctors for relief. They felt thev could not 
give up and have tried many physicians and some of high repu- 
tation. 

Nothing but cleanliness and " extreme unction " has done 
any good. I have never been able to find any clew to the cause 
of the disease in those children until just lately, and perhaps in 
the minds of many, none vet. 

The mother showed me a vaccination scar upon the right 
arm over the deltoid muscle. She said it was a vaccination scar, 
but it had not the slightest resemblance to one. It is a tumor in 
the skin, of deep red color, raised up, and about the size of a 
man's middle finger. It is rather hard and tender to the touch. 
She was inoculated in St. Louis when she was five years old, 
which was many years ago when humanized virus was mostly 
used. My theory is, she was inoculated with the lymph from 



ipS The Peoria Medical Monthly. 

some person having a skin disease; it might have been ichthv- 
osis, eczema, or psoriasis, it matter not. 

It has affected her system just sufficienth- for lier offspring 
to inherit it, but not enough for her to develop the disease in 
herself. It is impossible, from all knowledge of the cases for 
there being present any syphilitic taint. Remedies for such have 
never produced any effect upon the disease. I believe such 
cases are very rare, and I report them for the same reason I 
would report a freak of nature. 



CUTANEOUS POISONING WITH RHUS TOXICO- 
DENDRON. 

BY W. H. TATE, M. D. , GREENSBURG, OHIO. 

Rhus Toxicodendron is a very common shrub in this coun- 
try, and well known by its property of inflaming the skin to a 
very alarming extent, simply on coming in contact with its leaves, 
or b}' a close approach to it, in persons who are particularlv 
sensible to its influence. When touched or handled, it produces 
in the course of two or three days very serious symptoms. 

The skin inflames and swells, being attended with a very 
distressing burning pain. In severe cases, if the face be affected, 
the e3^elids are so tumefied as to close up the eyes; the whole 
head is sometimes swollen and covered with little blisters con- 
taining serum. Sometimes the whole body is enormouslv 
swollen and covered with serous vesicles. When the inflamma- 
tion and swelling have in some degree subsided, the epidermis 
begins to separate in little squamae, and an intolerable itching is 
felt for some days longer. The arterial S3^stem during an affec- 
tion of this kind is very considerabh' excited. These symptoms 
bear a very strong resemblance to erysipelas; and it has been 
observed by some of the writers on dermatology, that they vield 
to the remedies commonly emplo3'ed for the cure of this latter 
affection. 

Aqua ammonia, diluted with water is a useful application, 
and an aqueous solution of corrosive sublimate has also been rec- 
ommended; but recently I attended an extreme case which did 
not seem to yield to any of the popular remedies commonlv rec- 



Original Communications. 199 

ommended for such cases. I used a drug which I had never 
before applied for affections of this kind, although it may have 
been prescribed by others, viz : Sulphate of copper in the follow- 
inpf manner: 

R. Cupri Sulph. 2 drs. 

Aqua 8 ozs. 

Dissolved. 

Sig. — Applv to the surface of the body with a piece of 
sponge or soft linen three times a day. 

After one or two applications of this preparation, the pain 
and burning begin to subside, and in a few da3's all of the alarm- 
ing symptoms disappear. I have since used the same prepara- 
tion on similar cases with ijood results. 



ECLAMPSIA CAUSED BY PHIMOSIS— OPERATION- 
RECOVERY. 

BY FRANK L. HINSDALE, M. D., TOLEDO, IOWA. 

On July 20th, 1885, G. McC, five years of age, was brought 
to my office and the following history given: When eighteen 
months of age he had scarlet fever, and since that time had had 
convulsions. Some six months ago he had measles, and since 
that time the convulsions had been more frequent and severe. 
He had been treated by several physicians in the three and a 
half years that he had been afflicted, but had steadily grown 
worse, and was then having from twelve to fifteen convulsions a 
day. 

The convulsions were always preceded by premonitory 
symptoms, and the pain was always referred to the teeth. While 
I was examining him he cried out " My teeth hurt." His mother 
said, " He will have a convulsion now." In a moment he was 
writhinp- in a clonic convulsion. The muscles of the left side 
were principally affected. The mouth was drawn out of shape 
by the muscular action. The teeth were firmly pressed together. 
The eyelids were open and the e3^es were turned so that the 



200 The Peoria Medical Monthly. 

pupils were hidden beneath the upper lid. The arm, fingers and 
thumbs were fixed. The thumbs were drawn across the palms 
of the hands. The leg was also forcibly flexed. The duration 
of this attack was about five minutes. His mother said that the 
attacks usually lasted about that long, but occasionally longer. 

His mother also informed me that there had been some 
trouble in micturition for quite a length of time. She though for 
a year or possibly longer that he had complained of pain while 
urinating. I noticed that during the convulsion he tugged at his 
penis with his right hand, and this together with the mother's 
statement that he had had some trouble during micturition led 
me to examine carefully that organ. 

I found upon examination that the prepuce was very tight 
and internally adhered to the glans penis, in fact, it was so tightly 
adhered that it could not be drawn over the glans. 

I could find no other cause for the eclampsia than the phi- 
mosis. He was as bright and intelligent as boys of that age. 
No history of any mental or nervous disease in the family, 
although his mother is of the " nervous temperament." 

My opinion was that the phimosis dated from the attack of 
scarlet fever and that it must have been caused by the inflamma- 
tion of the mucous surfaces followed by adhesion of the two sur- 
faces. I advised an operation and told the mother that I believed 
the phimosis was the cause of the convulsions. I operated the 
next day, removed a portion of the redundant prepuce and sep- 
arated the glans from the prepuce. In the cervix behind the 
corona glandis there was collected a quantity of ill smelling seba- 
ceous matter. This was removed and the parts thoroughly 
cleansed and dressed. In ten days the parts had entirely healed. 
The afternoon of the day of operation the boy had one convul- 
sion and since that time has had none, while before the opera- 
tion he was having twelve to fifteen convulsions each day and 
was quite weak and emaciated. He is growing stout and gain- 
ing flesh rapidly. It is the only case of the kind that I have 
ever seen and don't remember to have ever read an account of 
a case similar to this. 



Society Transactions. • 201 

SOCIETY TRANSACTIONS. 



CHICAGO MEDICAL SOCIETY. 

ASPERGILLUS GLAUCUS FROINI THE EAR — OSTEOMA — MYCELIA FROM 
A TONSIL TREATMENT OF ACUTE CORYZA. 

Stated Meeting, July 6, 1885.— ThQ First Vice-President, 
C. W. Purdy, M. D., in the chair. 

Dr. Robert Tilley exhibited to the society microscopical 
specimens of the fungus, aspergillus glaucus, taken from the 
human ear, an osteoma developed from the crusta petrosa of a 
canine tooth, and filaments, or mycelia, from the body of a tonsil. 

While exhibiting the specimens, Dr. Tilly spoke as follows: 

In describing to you the three specimens which are exhib- 
ited under the microscope, I will refer in the first place to the 
fungus — aspergillus glaucus — taken from the human ear. I 
have had this in my possession for about three years and 
have shown it to several of my acquaintances, but did not deem 
it of sufficient interest to exhibit before. It is however an object 
which many have not been seen before, although it is mentioned in 
every text-book on the subject. I have no intention whatever of 
entering into the question of the aspergilli in general relative to 
their influence when found in the ear. But I must say that my 
experience relative to the question leads me to think that its in- 
fluence as a source of pain in the external ear is greatly exagger- 
ated in the books. This specimen was taken from the posterior 
wall of the meatus of a Httle girl who had for some time pre- 
viously been afflicted with otorrhoea. The otorrhsea had, how- 
ever, ceased, and the fungi were readily recognized in lusty 
growth immediately on looking into the ear. There was, how- 
ever, no pain complained of, the patient was brought rather for 
inspection than for the expection of relief. You will observe that 
the fungus consists of one straight long stem surmounted by a 
round ball, very much like the top of an onion which has run to 
seed. It is commonly said, I think rather on theory than on ob- 
servation, that they are caused by sleeping in low, damp apart- 
ments. The child from whom this was taken belonged to people 
in good circumstances and was well taken care of and v/as not 
living in damp quarters. 



202 , The Peoria Medical Monthly. 

The next specimen, to which I will now refer, is the osteoma 
de\-eloped from the cementum or crusta petrosa of a canine tooth. 
I am very sorry that I cannot i,nve you an3'thing of the clinical 
history, because I believe it would be interesting, if known. In 
consequence of this, it is perhaps necessary that I should give a 
word of explanation as to how it came into my hands: A friend 
was speaking to me of some one who had been subjected to the 
operation of drilling through the fangs of six teeth on account of 
what was called " ossification of the nerve." In speaking to one 
of mv acquaintances among the dentists about such a condition, 
I was presented with a tooth a section of which I exhibit to you. 
You will see, both macroscopically as well as microscopically, 
that the line of demarcation is well defined. You will further 
see that the general appearance of the tumor is that of bone, and 
that it differs greatly from the general appearance of the tooth 
proper. It is interesting to observe moreover that the canal, 
through which the nerve and vessel enter, is greatly diminished 
in its course through the tumor, consequently great pressure 
must have been exerted on the nerve. Before making the sec- 
tion, I had supposed that the canal was completely obliterated, 
so small is its opening at the end of the tumor. On looking at 
the specimen through the microscope, you will see ver}' clearly 
that while the line of demarcation between the dentine and 
the dentine proliferation of the crusta petrosa is well marked, 
and the lacunar and canalicular of the bony structure of the tu- 
mor are well demonstrated, there are also a number of contorted 
tubules in the bony tumor which resemble, somewhat, the dental 
tubules. Haversian canals are of course not present, they never 
are in such growths. 

Although I have no clinical history to present, I may add 
that the usual clinical histoiy is one of severe pain, which noth- 
ing but extraction seems capable of relieving. The last speci- 
men is one which I obtained from one of those little pockets 
which are often found in the tonsils. They seem to come and 
go, sometimes without giving any more inconvenience than a 
little discomfort. They are frequently associated with foetid 
breath, and in some cases the masses themselves are very offen- 
sive (in odor). In the present case, however, this was not so, 
thero was no foctor. There was, however, an unpleasant sensa- 



Society Transactions. 203 

tion amounting to a positive discomfort running down the neck 
externally, in the direction of the sterno-cleido-mastoid (muscle). 
On pressure around the base, the little mass popped out, sudden- 
ly, so that it came near going down the patient's throat. In ex- 
amining it, under the microscope, it proved to be one mass of 
filaments, ver}* line and containing spores in the body of the fila- 
ments, and associated with fat crystals. 

I succeeded in staining them with methyl violet, but only 
after first extracting the fat with ether. 

I have no theorv to present, gentlemen; I simply exhibit to 
you what has been interesting to me. After the removal of the 
small mass I did not think any treatment was necessar}', but as 
there was a little bridge of tissue more or less dividing the cavity 
into two sections, I divided the bridge with the electro-cautery. 

The Treatment of Acute Corvza, was the subject of a paper 
by Dr. J. A. Robinson,. He said the literature on the subject of 
the treatment of acute corvza is scanty and of a stereotyped na- 
ture. The profession seems to have arrived at two conclusions, 
first, that it is not a disease of sufficient severity and importance 
to command especial attention; second, that no plan of abortive 
or curative treatment has been sufficiently successful to cause 
them to investigate the subject further. However, in view of 
the fact that repeated attacks of acute corvza undoubtedly have 
a causal relation to pathological changes in the nares which it is 
difficult to remove, and that we are so frequently consulted by- 
public speakers and singers who beseech us to abort or rapidly 
cure such acute attacks, it certainly deserves more than a passing 
notice. 

The time-honored plan of aborting an acute coryza by the 
administration of a full dose of opium, an active purge and a po- 
tent diaphoretic has proven more disagreeable than efficacious. 
The plan, advocated by Dr. Ferrier, of blowing into the anterior 
nares a powder composed of morphia, bismuth and acacia, has 
been quite satisfactory in a few instances, but it is not free from 
the objection that, when successful, it often produces an unpleas- 
ant nausea. Its success is undoubtedly due to the sedative and 
astringent effect upon the inflamed mucous membrane. 

What are the pathological conditions in the first stage of 
acute coryza? Briefly, there is dilatation of the capillary vessels. 



204 The Peoria Medical Monthly. 

the arterioles being dilated and the venules engorged, inducing 
tumefaction of the mucous membrane. This is accompanied by 
dryness and pain. Secretion is abolished. In reflecting upon 
these circumstances the thought naturally arises, whether, if we 
can employ such measures and drugs as will antagonize these 
abnormal states, we will succeed in aborting the disease. We 
have recently had added to our armamentarium a drug w^hich 
more completely antagonizes in its physiological actions these 
pathological conditions than any other. It is the hydrochlorate 
of cocaine. 

Its physiological actions have been demonstrated to be con- 
cisely as follows: when applied to a mucous membrane it is a 
potent although transient anaesthetic, a vaso-motor constrictor 
causing contraction of the arterioles and depletion of the venules, 
thus rapidly emptying congested tissues of a surplus of blood. 
This drug is also an astringent and has the property of lessening 
the secretion of muciparious glands. On studying the relation 
between the state of tke nasal mucous membrane in the first 
stage of acute inflammation and after an application of cocaine,, 
the theory was formulated that cocaine should prove useful in 
aborting acute coryza, and it was determined to try it on the first 
opportunit}'. The details of the experiment are as follows: 

Miss S , a soprano singer in one of our citv churches, 

applied to me on the morning of February 2 2d, and desired im- 
mediate relief from a " cold in the head." She complained that 
the previous night she had been exposed to a draft and aw^oke 
that morning with a cold, as evinced by the fact that she could 
not breathe through the nose, and that her nose felt dr}- and 
painful, and she had lost the sense of smell. Inasmuch as she 
had to sing that night at a special service, she must have imme- 
diate relief. 

Upon examination I found all the conditions incident to the 
incipiency of an acute coryza. Her temperature w^as 102 F- 
w^ith some acceleration of the pulse. 

Febrifuges and a mild diaphoretic were prescribed. A local 
application of a four per cent, solution of hydrochlorate of cocaine 
was applied, as thoroughly as possible, to the congested mucous 
membrane, and the parts were sprayed, also, for some time with 
a warm alkaline sprav, hoping thereby to reduce the h}'peramiia. 



I 



Society Transactions. 205 

After having made another appHcation of the cocaine, the pa- 
tient was instructed to return home and follow the same line of 
treatment and to return the following daw She did not return 
until three days later, when she reported, to my surprise and 
gratification, that she had been able to sing as desired, and that 
no S3'mptoms of the disease had returned. 

The success which attended this new departure, induced me 
to try it in other cases of acute coryza which were seen early, 
and it has almost always been successful. Of course, the num- 
ber of cases which we see in their forming stage are few, on 
account of the fact that the patients do not seek medical advice 
for this affection until the disease is well advanced. 

In the use of cocaine for the purpose of aborting an acute 
cor3'za there are some objections: it has to be applied often in 
order to maintain its action on the inflamed mucous membrane, 
and it is an expensive drug. I have found that the use of a 
warm alkaline spray serves to prolong the sedative action of the 
cocaine. 

Of course dependence is not to be placed on local measures 
alone, but in addition proper attention is to be given to constitu- 
tional and hygienic treatment. 

Dr. Tilley said he had used the hydrochlorate of cocaine in 
two or three cases of acute coryza with much satisfaction. Ac- 
cording to one patient, an attack had ended with a single appli- 
cation. While he did not look upon cocaine as a sure cure for 
acute cor^'za, he thought it almost always did good. He referred 
to a serious accident which occurred to one of his patients during 
the use or cocaine. The patient was a boy aged twelve years, 
in whose nose a little cocaine had been used. x\fter the first ap- 
plication he suffered a little nausea, which was not regarded as 
serious; after the second application the nausea was worse, but 
it was not until a third application had been made that the symp- 
toms became alarming. These symptoms were difficulty of 
breathing, syncope, irregular action of the heart, cjld perspira- 
tion and loss of sensation in the extremities. Notwithstanding 
these symptoms were alarming, the boy recovered quite rapidly. 
He had noticed reports of eases in the papers where the same 
symptoms had appeared. 



2o6 The Peoria Medical Monthly. 

Dr. Weller said that he had had a good deal of experience 
in the use of coca, especially in the form of the fluid extract. 
He had taken large doses, in his own case he had used two 
pounds in a short time. Formerh" he had considered it as harm- 
less as tea, but latterly he had arri\ed at the conclusion that it is a 
powerful narcotic. The strange phenomena which follow use of 
cocaine in some cases, he believes to be due to the narcotic action 
of the drug, and that they would not appear if the drug was not 
given in large doses. He belie^■ed some patients to be peculiarly 
susceptible to the action of coca or cocaine, similar to the idiosyn- 
cracies of patients in the use of belladonna, opium and alcohol. 
In the case mentioned, he believed the symptoms to heve been 
the result of an over dose of cocaine. In his experience, he had 
found a two per cent, solution of cocaine strong enough, and 
urged the tentative use of the drug in the same manner as in the 
use of morphia. 

Dr. Webster did not wish to be considered skeptical, but he 
had some doubt as to the alarming symptoms in the cases men- 
tioned having been due to the drug. Is it not possible they were 
the result of reflex processes in over-sensitive patients? He had 
a patient recentlv who vomited after holding a fever thermom- 
eter under her tongue. 

Dr. Paoli believed that the old treatment of acute coryza by 
giving the patient a hot bath, muriate of ammonia internally, and 
inhalations of camphor in hot water, or the oil of eucalpytus, 
combined with borax, to be the best, although he w^ould acknowl- 
edge that cocaine would often relieve severe attacks in a short 
time. 

Dr. S. J. Jones asked the author of the paper if he had used 
cocaine with a steam atomizer in acute pharyngitis, tonsilitis and 
laryngitis; also, if the applications of cocaine to different patients 
were from the same solutions and at brief intervals, so as to be 
able to state how a reliable solution acted on different patients. 

Dr. Robinson, in closing the discussion, said he did not ad- 
vocate the plan of treatment as infallible or free from objections, 
nor did he neglect to use other means of cure if he thought they 
were advisable. As to the effect of cocaine on certain patients, 
he had a similar experience to Dr. Tilley in the case of a woman 
who had twice been operated on without cocaine for nasal polyps. 



Society Transactions. 207 

No unfavorable symptoms occurred during these operations. 
At the third and fourth operations, cocaine was used and the pa- 
tient was troubled with nausea, vomiting, palpitation of the heart 
and svncope. He had not used cocaine with the steam atomizer, but 
he thought it feasible, if the drug were not so expensive. He pre- 
pares fresh solutions for each patient so as to preclude all possi- 
bility of failure of action by reason of deterioration of the 
solution by age. He had found the same package of cocaine to 
varv in its local and constitutional effect on different patients, 
affecting some more rapidly and profoundly than others. 
Society then adjourned. 



MEMBRANOUS OCCLUSION OF POSTERIOR NARES. 

Stated Meeting, yuh' 20, i88j, S. J. Jones, Chairman, pro 
tern. 

Dr. W. E. Casselberrv read an interesting paper detailing 
the surgical procedures in a case of membranous occlusion of 
the posterior nares. His patient was aged about fifty, a native 
of Russian Poland, and had suffered from obstruction of the 
left nasal chamber for the last thirteen years. Thick, viscid and 
foul muco-purulent crusts accumulated in the nares and naso- 
pharvngeal space which he could neither expectorate nor expel 
through the nose on account of the impenetrability of the nostril 
to currents of air. Partial occlusion, also, of the right nasal 
chamber necessitated frequent and prolonged mouth-breathing, 
and consequently he has suffered from atrophic pharyngitis and 
laryngitis, with painful deglutition, cough, suffocative paroxysms, 
etc. Deafness in the left ear and annoying tinnitus aurium have 
long been prominent symptoms. Most violent paroxysmal 
headaches, constant soreness on the top of the head, vertigo, 
especiallv upon stooping, and various indescribable cephalic 
sensations of a most distressing character, have served to render 
life miserable. 

Bv a rhinoscopic examination the pharynx was seen to be 
covered with a foul, viscid, muco-purulent substance, continuous 
in descent from the naso-pharyngeal space, and imparting to the 
expired air a disgusting!}- fetid odor. The naso-pharynx was 
filled with rotton crusts which necessitated removal for further 



2o8 The Feoria Medical Monthly. 

inspection of the part. Having thoroughly cleansed the parts 
and accustomed the patient to instrumental manipulation, b}' 
using \'oltolini's uvula holder, a good rhinoscopic image was 
obtained. All previous efforts to pass a probe from in front had 
failed, and passing the linger behind the palate through the 
mouth, an obstruction was encountered. The rhinoscopic image 
revealed a tense membrane covering the left choana almost com- 
pleteh'. Its free edge was thin and sharp and approached so 
near to the septum, that only a small slit or opening remained 
between it and the septum narium. The left ostium tubae could 
not be seen, the membrane evidently lying behind the Eustach- 
ian orifice, and so intecepting its image. On passing a probe be- 
tween the membrane and septum the edge of the membrane could 
be pushed backward. It felt tense and was from one to two 
millimeters in thickness. 

The right choana was partially covered by a membrane 
extending half across the aperture and intercepting the view of 
the superior and outer half of the middle turbinated bodies, and 
the right ostium tuba;. This membrane was much thicker and 
less tense than that on the left side. 

In order to prepare the patient for treatment, he was trained 
daily for one week in the introduction of mirrors and instru- 
ments. A flexible silver probe v.as bent, after many trials, to 
exactly the proper curve to pass readily bv way of the mouth 
and naso-pharynx into the opening on the left side and to pick 
up the membrane. A straight knife electrode was then made to 
conform to the same curve, and lastly this instrument, with the 
attachments complete, made several trial trips to the desired 
locaHt3\ All being in readiness, December 13, 1884, the knife- 
electrode was introduced through the opening between the 
membrane and septum and its edge pressed backwards against 
the membrane. At this moment the patient retracted the soft 
palate and shut off all vision. But, thanks to previous training 
when instructed to relax all the parts the velum fell and the 
rhinoscopic image was perfect. Having adjusted the electrode 
properly the current was turned on, the knife end became red 
hot in an instant and the membrae was incised without bleeding, 
and without suflicient pain to cause the patient to wince. In 
another instant the current was broken, the electrode cooled in a 



Society Transactions. 209 

few seconds and was withdrawn. An examination revealed that 
the work had been wonderfully efficient. The membrane hav- 
ing been tense, when it was incised, each part retracted leaving 
an opening sufficiently large to bring into view the middle and 
inferior tubinated bodies, and to the delight of the patient to 
allow a free passage of air through the left nostril, and from that 
moment he has had none of the distressing cephalic symptoms 
mentioned. The floor of the nose, the septum and the tubinated 
bodies were thickly incrusted with horribh' fetid, cheesy masses, 
decomposed and dessicated secretions accumulated for years, 
which were removed with great difficulty. The catarrhal symp- 
toms then gradually became less distressing. After two similar 
operations the left ostium tuba? became visible in the rhinosco- 
pic mirror, and two or three touches with the knife served to 
entirely obliterate the membrane. Four similar operations served 
to obliterate the membrane in the right side, and now both pos- 
terior nares are widely patent and in an approximately natural 
condition. 

It is probable that atresia of the posterior nares is by no 
means so rare as the few reported cases and the omission of all 
mention in man}- treaties might lead us to suppose. The reporter 
had seen reports of two cases only occurring in the adult, one 
by Voltolini and another by Pomeroy. Records of cases occur- 
ring in infancy are more common, doubtless because the nursing- 
function necessitates either a correct diagnosis and operation for 
relief, or death ensues and an opportunity for a fost inortein ex- 
amination. Reports of such cases are recorded by Ronaldson, 
Luschka, Betts, Cohen and Emmerts. In all these cases the 
malformation was congenital and it was probably so in the case 
above reported. This patient has never suffered from any illness 
which would act as a cause for the development of such a mem- 
brane. It ma}' be possible that in earlier years the membrane 
was relaxed and less complete, similar to the condition found 
on the right side, and later it underwent contraction, became 
thinner, more tense and sufficiently extended to cover the choana. 
The left membrane was composed chiefl}- of a reduplicature of 
mucous membrane, with possibly some connective tissue and 
muscular fibres interlying in the thicker portion toward the outer 
border. The right structure contained considerable muscular 



2IO The Peoria Medicai. Monthly. 

tissue. There was no osseous malformation. Upon the left, the 
attachments were, apparently, to the mucous lining of the su- 
perior posterior edge of the vomer, the inferior surface of the 
body of the sphenoid bone, the left pharyngeal wall behind the 
Eustachian orirtce and the superior posterior surface of the palati. 
Lpon the right the attachments included only the inferior sur- 
face of the body of the sphenoid, and the right pharyngeal wall 
behind the Eustachian orifice. 

The galvano-cautery is more useful in such operations be- 
cause it is a dull instrument : can be introduced or withdrawn 
without harm: can be used when applied to the proper place, 
and almost no bleeding or pain ensues. 

The Society adjourned immediately after the paper was read 
and Dr. Casselberry had exhibited a Fleming galyano-cautery 
battery with electrodes — as modified by Carl Seller. 



OLEATE OF MANGANESE DOES THE USE OF TOBACCO INJURE 

SIGHT.' LACERATION OF THE CERVIX UTERI. 

Stated Meeting; August j, iSSj. — President Charles T. 
Parkes, M. D., in the chair. 

Dr. Franklin H. Martin read a paper on the " Oleate of 
Manganese," He said : There is little doubt left in the minds of 
therapeutists in regard to the value of manganese as a remedy 
in certain forms of menstrual trouble. The remedy, in the form 
of permanganate of potash, was first brought to the attention of 
the profession by Ringer and Murrell, of London, in the spring 
of 1883. They recommended the drug in functional amenorr- 
hoea. Soon after this he commenced experiments with the same 
preparations, and published the results in T/ie A^en' York Med- 
ical Record^ September 29, 1883. To his knowledge, that was 
the first that anything on the subject was published in this 
country. 

In the course of his experiments, acting on the theory that the 
drug produced menstruation by stimulating the menstrual organs, 
he was induced to give the remedy in menorrhagia and metrorr- 
hagia dependent upon an atonic condition of the organ. He found 
to his gratification that it acted equally well in these condifions, 
as in the opposite. He also has obtained good results from its 



Society Transactions. 211 

administration in irregularities incident to approaching mone- 
pause. He has received very gratifying letters from man}- mem- 
bers of the profession throughout the countrv, who have used 
the drug in one or more of the conditions mentioned above, with 
CTood results. 

Dr. Thomas, of New York, says of the remedv: "I think 
it is the best emenagogue which has vet been discovered." 

Dr. Roberts Bartholow not only recognizes its power as a 
remedial agent in amenorrhcea, but also considers it a general 
stimulant, making it equally efficacious in other menstrual diffi- 
culties dependant upon an atonic condition. 

After publishing his second report on this subject, the author 
received a letter from Sidney Ringer, of London, in which he 
expressed his gratification at the result of his experiments, and 
in wnich he said: 

" Like you, I have found the permanganate most useful in 
atonic conditions," and further remarked, " I was quite prepared 
to learn that the permanganate is useful in menorrhagia." 

Since there is no longer anv doubt about the great value of 
this drug in the distressing menstrual difficulties, the next formid- 
able problem for the therapeutist to solve is, How shall it be ad- 
ministered? The permanganate of potash, the original prepara- 
tion used for experiments and administration, in any form is liable 
to act as an irritant to the stomach. It has in many ingenious 
ways been made into pills, but as these pills must from necessity 
have for their basis kaohn, or some other inorganic substance, 
the drug in this form is not satisfactorilv absorbed. The com- 
pound tablets of Wyeth & Brothers, and other druggists, are ob- 
jectionable, in manv cases of irritable stomach, because the irri- 
tating undiluted drug comes in direct contact wdth its mucous 
membrane. On account of the many difficulties of administra- 
tion, therefore, this valuable remed}- has not met with the recep- 
tion that is its due. Following the suggestion of Dr. Lewis L. 
McArthur, of this citv, he succeeded in having an oleate of man- 
ganese prepared. This oleate was made for him by Edward 
Kreyssler, of the firm of Forsyth & Schmidt, of Chicago. He 
sa^'s he is indebted to Mr. Krevssler for the follow'ing statement 
of the mode of preparation and of the -physical and chemical prop- 
erties of the oleate of manganese : A solution of sulphate of man- 



212 The Peoria Medical Monthlv. 

ganese was made in distilled water and to it a solution of sodium 
oleate was added. On mixing these two solutions gradually, and 
with constant stirring, a precipitate of oleate of manganese re- 
sulted. This precipitate, upon heating, changed to a putty-like 
mass. Tills was washed seyeral times with warm distilled 
water, to remoye the sodium sulphate, and the resulting mass 
was the pure oleate of manganese. It is a light-gray color, hay- 
ing a pinkish hue, of a sweet musty taste and peculiar clay-like 
odor. It is sparingly soluble in alcohol, soluble in ether, chloro- 
form, oliye oil and oleic acid. 

The Metliod of Application. — He recommends that one 
drachm of twent}' per cent, solution of the oleate of manganese in 
oleic acid be applied to the abdomen of the patient, and its ab- 
sorption promoted by friction of the hand. 

In amenorrhcea it should be applied, if possible, every night 
for a week preceding the expected menstrual period, or at the 
time menstruation is due, and until it makes its appearance. In 
menorrhagia or metrorrhagia it should be applied in smaller quan- 
tities, eyery night, until the desired effect is produced. 

Of about a dozen cases in which the oleate has been pre- 
scribed by him, but four had reported. The success in these 
four was all that could be wished. Three of the four were cases 
of atonic amoiorrha'a, the fourth, irregularity due to approaching 
menopause. 

In the discussion. Dr. Etheridge thought much advance 
would be made in the use of drugs if we were more careful to 
discover in what conditions they were beneficial. He had found 
this remedy useful in cases of atonic amenorrhoea, with the uterus 
in its normal position. He had found the aqueous solution an 
eligible preparation, and had also used it in the form of a sup- 
pository. 

Dr. E. J. Doering said he had used this remedy in some 
cases of atonic amenorrhcea with good results. He asked the 
effect of the drug upon the pregnant uterus. 

Dr. Paoli had used manganese somewhat for several years, 
in cases of menstrual disorder, with varying degrees of success. 
It was a useful remedy in many skin diseases. He had not used 
the oleate, and could not see how it acted upon the uterus, unless, 
possibly, by being applied at once after being freshly prepared . 



Society Transactions. 213 

Dr. Martin closed the discussion b}^ saying he had used the 
aqueous solution in very small doses, also had had the remedy 
put in dry powders and swallowed with a glass of water. He 
had never used it in the form of a suppository. jManganese has 
no effect on the pregnant uterus. The drug seems to act as a 
general stimulant to the uterus, causing it to perform its normal 
function. It might be absorbed as the oleate and so produce its 
effects. 

^^ Does the Use of Tobacco hi jure Sight P" was the subject 
of a paper read by W. Franklin Coleman, M. D. The question 
was answered affirmatively by the author. 

In the discussion. Dr. Paoh said while the excessive indul- 
gence in tobacco might be harmful, the fact of its almost univer- 
sal use and continued use in many cases for years resulted in no 
deleterious effects, would seem to show that its narcotic power, 
used in the ordinary wa}-, was very slight. He had used tobacco 
for fiftv-five vears and felt no ill results. The Germans use large 
quantities of it, and do not suffer. This seems to be a case of 
excess of zeal on the part of the ophthalmologists to discover a 
cause for amaurosis. We ought to be conservative on this point. 

Dr. Coleman closed by saying that only in certain suscepti- 
ble conditions was tobacco liable to cause disorders of vision. 
But that so few suffered was no proof that it had not this baneful 
influence when acting with other causes. 

Laceration of the Cervix Uteri. — 13r. John Bartlett read a 
paper in which he said his object in addressing the Society was 
to suggest a way and a time in which laceration of the cervix 
uteri may be easily and certainly detected soon after its occur- 
rence. 

Directly after delivery, if the fingers be introduced deeply 
into the vagina up to the contracted os uteri internum, and then 
carried in any direction a little outwardly, the flabby and floating 
ring formed by the non-contracted cervix ma}' be felt, as Guille- 
meau described it three hundred years ago, "like a section of 
large intestine." 

By very carefully following the entire circumference of this 
ring an existing rent may be discovered. But this examination 
is attended with some difficulties. The patient is exhausted with 
her labour, fatigued with attentions, and just now, since " it is all 



1 



214 The Peoria Medicae Monthly. 

over," longing for rest. She is impatient of, and perturbed, by 
the fost fcctiim inquiry. Her state of mind, and possible ex- 
pression of complaint, are apt to render an examination, which 
the physician cannot regard as absolutely necessar}-, less exact 
and thorough than it would be otherwise. And then, the soft 
and floating margins of the cervix have often somewhat of an 
intangible feel, if the expression be permitted, gliding past the 
fingers like a detached clot of blood, and occasionally, in some 
portion of their circumference, passing out of satisfactory reach. 

On this account it is not surprising to hear an obstetrician 
say tliat he cannot tell whether the post-partum cervix is lacer- 
ated or not. The error of the accoucheurs who fail to recog- 
nize such a condition is, that they do not make their observation 
of the suspected cervix at the proper time. They examine the 
neck actually, as has just been done mentally — after the clear- 
ance of the uterus. The favorable moment for the examination 
— and that he said was the special point of his remarks — is just 
as the placenta is beginning to occup}' and distend the cervix. 
The collar of flesh is then not floating and uncertain in feel, but 
stretched and expanded, forming a distinct ring, easily followed in 
its entire circumference. At this 'moment then, just as the cer- 
vical tube is being rendered tense by the placental mass, any 
laceration in it may be detected with ease and certainty. 

Dr. Etheridge asked the author of the paper whether he had 
verified a case by speculum examination after discovering it in 
the way he had in his remarks. 

Dr. Parkes said he had great difficult}' in detecting lacera- 
tion after deliver}-, on occount of the relaxed condition of the 
parts. He thought the suggestion of Dr. Bartlett as to the way 
to obviate this difficulty was a good one. 

Dr. Doering inquired as to the size of lacerations he had 
found. 

Dr. Bartlett concluded by saying that he had verified cases 
of laceration discovered in the manner proposed by him. The 
largest laceration he had found was one and a half inches in 
length, and the end of the little finger could be passed into it. In 
one case he encountered considerable hemorrhage from such a 



Periscope axd Abstract, 215 

rent, and this may be the cause of continuous loss of blood when 
the OS is well contracted. 

Dr. Bartlett illustrated his remarks with earthenware mod- 
els, turned bv a potter, under his immdeiate diretion. 

Society then adjourned. 



PERISCOPE AND ABSTRACT. 

SURGERY OF THE SPINAL CORD. 

Dr. J. Campbell thus writes in the Canada Lancet^ May 
18S5: The very interesting and important subject of what now 
generally goes by the name of '• Railway Spine," has during the 
past year been attracting renewed interest. This has been owing 
in a great measure to the publication of Page's work " On the 
Injuries of the Spine and the Spinal Cord." Mr. Page has been 
for a number of years surgeon to one of the greatest railway cor- 
porations in England, and, therefore, had a yery extended ex- 
perience of all possible railway injuries, and particularly of cases 
of so-called " Railway Spine."' He contends that cases of what 
are commonly called " concussion of the spine,"' do not exist, ex- 
cept in the imagination of the surgeon making the diagnosis. 
By concussion, he means the cord receiying an injur^' of such a 
nature as to giye rise to pronounced symptoms, without, at the 
same time, the yertebras, ligaments or membranes receiying any 
hurt. 

It is well known that Mr. Erichsen has been a strenuous 
adyocate of the theory that the great majority of cases of railway 
injuries haying for their symptoms spinal symptoms, are due to 
concussion of the spinal cord. The first one hundred pages of 
Mr. Page's book are taken up with combating this yiew of Er- 
ichsen, and it appears to me that Mr. Page's attempt has been 
successful. He, at least, conclusiyely shows that the yast major- 
ity of cases of concussion of the spine are nothing more nor less 
than cases where the lumbar muscles or ligaments of the spine 
haye been sprained or ruptured. Erichsen contends that many 
cases of " concussion of the spine " receiyed in railway accidents, 
neyer recover, while Page, on the other hand, maintains that 
these cases of so-called spinal concussion always do recover. 
While representing the reaction, Mr. Page's recent work cer- 
tainly favors a due belief in the certainty of recovery of cases of 
this sort. 

Erb presents the matter more fairly than either of these 
writers. Accidents which occur in railwa}' collisions, as other 
accidents ma.}' lead to a long train of nervous S3'mptoms, and 



2i6 The Peoria Medical Monthly, 

when death has resulted, a post mortem examination may show 
little apparent cause for the fatal result. In the greater number 
of these cases the pathology is a riddle, which, for its satisfactory 
solution will need a great deal of experiment and careful and ex- 
tensive post mortem investigation. The great trouble in coming 
to an opinion as to the nature and cause of a train of nervous 
symptoms following a railway injury is not whether we have to 
do with an actual or feigned train of symptoms. Usualh* the 
patient's symptoms are of such a nature that the physician can 
come to a conclusion without much trouble, but where he has to 
do with an intelligent and unscrupulous man who expects a large, 
sum from a railway compan}', the case is one of extreme diffi- 
culty. In many of these cases it is almost impossible to come to 
a certain diagnosis. 

In the words of a recent writer, the " needed clinical work, 
it seems to us, in the case of railway ' spine ' is the determina- 
tion of clearly defined types of the disease and the investigations 
of the variations from this type, and the certain relation to ob- 
jective symptoms of the disease." That serious and even fatal 
effects may arise from changes in the cord where it has not re- 
ceived any direct injury has been abundantly proved. In the 
current number of one of our periodicals there is a very interest- 
ing case reported by Dr. Edmunds, of a soldier who was struck 
in the back with a bullet. He fell immediately and had to be 
carried out of action. The bullet entered the back two or three 
inches from the spine, and the physician who first attended him 
considered that the spine was severely injured, because the pa- 
tient had lost complete control over both lower extremities. Pa- 
tient had paralysis of the bladder and rectum also. There was 
cystitis and a bedsore over the sacrum before death which oc- 
curred five months after the injury. At the autopsy there was 
no fracture or indication of fracture or dislocation of the ver- 
tebras to be found. The cord was seen to be much atrophied 
and softened about the level of the wound. On hardening the 
cord in Muller's fluid, it was seen that there was universal mv- 
elitis and softening about two inches opposite the wound, this 
gradually passing below into sclerosis of the lateral and anterior 
pyramidal tracts, and above into sclerosis of the posterior column. 
There was no indication of hemorrhage, either external or into 
the substance of the cord. Its surface was uninjured. This vvas 
undoubtedly a case of pure " spinal concussion." The immediate 
parphlegia following the injury could not have been due to any 
other cause. The case is then one of very great importance, as 
it p)roves most conclusively that we can have from a severe shock 
sufficient changes brought about in the spinal cord to cause death. 



Periscope and Abstract. 217 

and that these changes were in the first place nothing more nor 
less than " concussion of the spine." 

Very recently the opinion seems to be gaining ground that 
we ma}' have tabes dorsalis arise from peripheral causes. That, 
in fact, an ulcer in the foot may be the Jons et origo mali of this 
formidable disease. The orioin of the disease in such cases is 
explained bv first a peripheral neuritis gradually extending along 
the course of the nerves until it reaches the posterior roots, and 
there a similar process gives rise to a subsequent sclerosis of the 
posterior columns. 



EXPERBIEXTS IX THE USE OF PASTES IX THE 
TREATMEXT OF SKIX DISEASES. 

Unna, of Hamburg, an ingenious and practical worker in 
dermatology, has of late years brought forward a number of new 
methods of treatment, among which is the use of pastes instead 
of ointments. The employment of ointments, particularly in dis- 
pensary practice, and in cases where fatty matters disagree with 
the skin, being often inconvenient, Unna has conceived the idea 
of using pastes of gum, dextrine and rubber, which are much 
cheaper than ointments, and which, in his opinion, are calculated 
to be particularly useful in moist eczema. 

The results of Unna's experiments, with his formulas, have 
been so frequently translated and copied that I shall not repeat 
them, but shaU only give the results of my own experiments. 

The first paste of which I made use is the following: 

Kaolin Paste, Xo. i. — 

E,. Pulv. Kaolin, 

Glycerinre, aa 12 dr. 

Pulv. zinci-oxid., 1 oz. 

Liq. plumbi subacetat., 1 oz. M. 

This makes cream v-white fluid, which, applied with a large, 
soft brush, soon dries, leaving a coating on the skin, which can 
readilv be washed off with water. 

Case I. — Mrs. J. G., 66 years of age, a large, heavy woman 
with some tendency to varicose veins, came to the Polyclinic on 
Juh' 9th, 1884, with an extensive eczema rubrum involving both 
legs, from the feet to above the knees; the eruption was red 
dry, and slightly scaly, though it had been moist and weeping at 
one period. It was acute, being of three week's duration. The 
kaolin paste Xo. i was applied with a brush thickh*, over both 
limbs, and a bandage was applied from the toe to mid-thigh. 
The next day the patient returned, alread}' much improved. At 



2i8 The Peoria jNIedical Monthly. 

this time another paste (kaoHn and linseed oil No. 2) was ap- 
plied to the right leg; but this did not seem to agree and was 
stopped. The patient was then once more placed upon the use 
of the first paste, under which she impro^'ed rapidly, but soon 
disappeared. She reported again, nine months later, with a lim- 
ited chronic eczema rubrum of the leg, with some shallow ulcers, 
and she said at this time that she had gotten practically well 
under the employment of the kaolin paste. 

Case 2. — Mary P., 42 years of age, well marked ezcema ru- 
brum of right ankle, back of foot and toes, seyere and painful. 
Some weeping, six months' duration.* July 11, 1884. Placed 
upon the application of kaolin paste. No. i. Did well for a while, 
then hung fire. Paste changed to that of (kaolin and linseed oil, 
No. 2), under which a marked improyement took place, but the 
eruption went on yery slowly toward recoyery, until October 7, 
when ointments of yarious kinds were employed, and the disease 
disappeared about tne end of January-, 1885. Though a stub- 
born case, this was calculated to try the efficacy of the pastes, 
which cannot be said to haye proyed themselyes unusually 
effectiye. 

Another somewhat similar paste is that to which I haye 
giyen the name of Kaohn Paste. 

iVo. 2. — 

R. Pulv. kaolin, 28 dr. 

Glycerinie, 12 dr. 
Pulv. ziiici oxidi, 1 oz. 

Liq. plumbi subacetat., 1 oz. M. 

This forms an ointment-like mixture, which solidifies after 
a few weeks to a tough, putt^'-like consistency. By beating up 
\yith a spatula, howeyer, the mixture returns to a workable con- 
sistency for a time. This was used in — 

Case J. — Mrs. B. B., 47 years of age, an enormousl}- fat 
yv'oman, presented herself on August 24, 1884, with a severe, 
^yet eczema rubrum of the right leg, of two years" standing. 
Kaolin paste No. 2 was applied, but seemed to disagree, and its 
use was stopped. As the only difference between this paste and 
No. I is, that it contains a larger proportion of kaolin. I cannot 
imagine why this should disagree. Another paste (kaolin and 
linseed oil. No. 2 ) was substituted for it, under the use of which 
the leg slowly healed, in spite of the patient's unwieldly shape, 
and the probable great yenous pressure on the lower limbs. On 
December 5th the paste was stopped, and a solution of tannic 
acid in collodion was substituted, for the purpose of hardening 
the recently formed skin, and in a week more the patient was 
discharged cured. 



Periscope and Abstract. 219, 

The following paste contains linseed oil, and is designated 
in my notes Kaolin-linseed Oil Paste, No. i : — 

R. Pulv. kaolin,, 22- oz. 

01. lini, li oz. 

Lix. lilumbi subacetat, 1 oz. M. 

This forms a convenient ointment-like mixture, having the 
consistence of ver^- soft putt}'. It dries quickly, leaving a yellow 
crust. 

Case ^. — ]Mrs. M., 60 vears of age, eczema of the leg, mostly 
erythematous, but some exzema rubrum; considerable swelling^ 
of limb. After getting nearly well under other treatment re- 
turned June 20, 1884, as bad as ever. She was then directed ta 
use kaolin-linseed oil paste, No. i, applving dailv and bandaging. 
Within a week a marked improvement was manifest, and within 
six weeks the patient was getting well. 

Case 5. — James K., 65, marked case of eczema rubrum, in- 
volving the left leg and foot, of three months' standing. Several 
methods of treatment were employed, without a verv satisfactory 
result, for about a month. On May loth the leg was dressed 
with kaolin-linseed oil paste. No. i, under which it improved 
steadil}' to August 29th, when the skin was reported brown and 
well at all points. A little thickening over the instep remained, 
for which a dilute tar ointment was employed. 

Case 6. — John K., four years of age. Large patches of 
postular eczema, wnth considerable discharge and crusting, about 
six weeks' duration, following an attack of measles. Ordered 
well washed, and kaolin-linseed oil paste, No. i, applied. Syrup 
of the iodide of iron internalh". In two weeks well. 

Kaolin-linseed oil paste. No. 2, is composed as follows: 

R. Pulv. kaolin, H oz. 

01. lini, 1* oz. 

Pulv. ziuci oxidi, 1 oz. 

Liq. plumbi subacetat., 1 oz. M. 

This paste, as will be seen, differs from the previous one in 
the substitution of powdered oxide of zinc for a portion of the 
kaolin. It is a soft, puttv-like ointment, resembling a rather 
tenacious, diachylon ointment. It is smooth and spreads easily. 

Case 7. — Nicholas G., nine ^-ears of age. Patches of ecze- 
ma squamosum and dry eczema rubrum on the front of the leg, 
below the knee, and elsewhere, of three months' duration. On 
July 15th, 1884, he was o dered to have kaolin-linseed oil paste. 
No. 2, applied. He was brought back three weeks later, very 
much improved. Later in the autumn a relapse occurred, for 
which other means of treatment were employed. 



220 The Peoria Medical Monthly. 

Case 8. — Margaret M., 45 years of age. Eczema rubrum 
outside of right ankles, with a number of shallow, painful abra- 
sions. Simple kaolin paste. No. i, having been used for some 
time without effect, this kaolin-linseed oil paste, No. 2, was ap- 
plied, but without relief. An ointment of opium and belladonna 
was then substituted, bv the use of which the pain and inflam- 
mation were much alla3-ed. 

Case g. — Minnie H., 16 years of age, applied July 26th,. 
1884, with postular eczema of the forehead. Kaolin-Hnseed oil 
paste, No. 2, was applied, with ver}- good results. A relapse, 
in the form of squamous eczema, took place later, for which 
other treatment was employed. 

Cases I, 2 and 3, all improved under the use of this paste 
after the simpler kaolin pastes had failed. 

A paste of somewhat different character is the following: 

Sulphur Paste, ^^o. i. — 

R. Sulphur precipitat., 2? oz. 

Pulv. calcii carbonat., 1 dr. 

Pulv. zinci oxidi, 10 oz, 2 dr. 

PuJv. aniyli oryzre, 5? dr. 

Glyoerinfe, 1 oz. 2 dr. 

AquiB, 9 oz. 7 dr. 

This is Unna's formula, but I found that it " set " almost at 
once to a tough mass, sometimes almost as hard as plaster of 
Paris, which made it perfectlv useless. The addition of glycerine 
to the proportion of about 20 minims to the ounce, or more, 
makes a soft and useful paste. 

This was employed in half a dozen cases of acne, and always 
with advantage. But this preparation possesses no superiority to 
the washes and oinments commonly employed in acne, though, 
if regularly applied as a mask at night and washed off in the 
morning, it exercises a happy effect in severe cases. Like the 
other pastes described, it merits further trial. 

I think the facts above given point to the emplo3-ment of 
Unna"s pastes as of advantage in hospital practice. They are 
cheaper than ointments, but must be made extemporaneously, or 
nearh" so. I found in practice at the Polyclinic, that the pastes 
were more troublesome to have made than ointments. So long as I 
applied them myself, the patients did well, but when placed in 
the patients' hands to apply at home, the result was highh- un- 
satisfactory. I intend to make seme future investigations of 
other pastes devised by Unna, with the view of ascertaining their 
practical value. — Arthur ]\jii Ilarli')ige)i, J/.JJ., in Polyclinie. 



Periscope and Abstract, 22r 

H.^:vIATURIA. 

In an article published in the Detroit Lancet, Dr. L. E. 
Maire gives the following suggestions on treatment: 

The treatment of ha^maturia will depend to a large extent 
upon the cause. If due to external injury, rest must be enjoined; 
indeed, this will be found necessary in all cases of ha^maturia. 
Opiates, if required, and reheving the bladder of accumulated 
urine, so as to prevent fermentation. In active hypera^mia of the 
kidnevs local depletion by the use of wet or dry cups over the 
region of the kidneys will be found useful, together with active 
purgation. In the passive form of congestion, general stimulants 
and tonics will be found more useful, such as sulphuric acid, 
tincture ferri mur., and the careful use of turpentine. 

In cases of cancerous or tuberculous degeneration not much 
can be done, our attention being directed to prevent hcemorrhage 
as much as possible. The agents we use to attain this are rest, 
cold apphed to the region of the diseased part, either in the way 
of external appHcation or injection into the bladder, and the use 
of astringents or hfemostatics, such as ergot, gallic acid, digitalis, 
plumbi acetas, tr. ferri mur., alumen in solution and injected into 
the bladder, and turpentine where the haemorrhage is not of renal 
origin. In one case I have been treating recently there seems to 
be a weakened condition of the sphincter vesic£e attending the 
hasmaturia, which was due to varices of the vesical veins. I 
added to the above remedies strvchnine and belladonna in appro- 
priate doses with marked advantage. 

In the treatment of ha?matura due to entozoa, I have no ex- 
perience. The treatment recommended by Dr. John Harley, 
who studied the disease among the inhabitants of the Cape of 
Good Hope, is the one used. He recommends a draught con- 
sisting of 15 minims each of oils of turpentine and male fern, 
with five minims of chloroform in two ounces of tragacanth mu- 
cilage, to be given every morning. Where these entozoa were 
located in the bladder, he injected a solution of twenty to thirty 
grains of iodide of potash to live ounces of tepid water, every 
second or third day. 

In haemorrhage of the urethra verv little difficulty, as a rule, 
will be encountered. Astringent injections, the application of 
cold and compression bv means of card-board held in place by a 
number of elastic bands, will be found all that is required as a 
rule. — Am. Med. Dio-est. 



ABSCESS OF THE LIVER. 

In a paper read before the Xew York State JNIedical i\sso- 
ciation, and published in the ^czv Tork Medical yoitrnal, Dr. 



222 The Peoria Medical Monthly. 

Janeway says abscess of the liver is more common in this coun- 
try- than is generally supposed. The S3'mptoms are generally 
misleading, and good clinical observers often fail to detect its 
presence. Within the past year seven cases have come under 
m}- notice. In summing up attention is drawn to the following 
points in reference to the subject: 

1. Abscesses of the liver can practically be divided into 
those affecting the left lobe, or the low^er part of the right lobe, 
so that the abscess, when formed, produces an elastic or fluctu- 
ating tumor below the free borders of the ribs, and of those sit- 
uated in the upper or posterior portion of the right lobe. The 
reason for this division is that abscesses in the two former situa- 
tions are easy of access, of diagnosis, and of operative interfer- 
ence. The abscess in the last mentioned situation is the one 
which more often rise to dilhculty in diagnosis, or, if diasnosti- 
cated, to doubt as to the best and safest methods of interference. 

2. There are several methods by which the existence or 
non-existence of adhesions between the liver and abdominal wall 
«can be made out. The presence of hepatic friction, audible or 
tactile, shows the absence of adhesion, but the probability that 
the}^ will soon be formed. If, on palpation, the edge of the liver 
remains fixed, and does not descend with respiration, adhesions 
have, in all probability, taken place. Again, a long needle — that 
of a hypodermic syringe or aspirator — introduced into the liver 
will, if the outer end is left projecting some distance, move up- 
ward as the liver descends, and downward as the liver ascends, 
if no adhesion exists. But if these have formed, then the needle 
does not move. 

3. The difficulties which arise in the diagnosis of liver ab- 
scess may, in many cases, be surmounted by a careful survey of 
the history of the condition of the liver, and by exclusion of the 
existence of sufficient disease in other organs to account for the 
symptoms. 

The mistakes which I have seen made have been: a. To 
consider a liver abscess some other disease, as malarial fever 
'(remittent and intermittent), typhoid fever, or tuberculosis, b. 
To consider an abscess of the liver some other disease of the 
liver, as hydatids, cancer, congestion, fatt}' liver, h3-perplasia. r. 
To consider the swollen liver an aneurism of the aorta, especialh' 
in case of abscess of the left lobe of the liver, where pulsation 
was communicated to it by the aorta, d. To consider an ab- 
scess of the gall-bladder as abscess of the liver, and vice versa. 
e. To consider a supra-hepatic abscess an abscess of the liver. 
y. To consider an abscess of the liver one of the abdominal wall, 
and vice versa. 



Periscope and Abstract. 223 

.Some years since the writer had supposed that a distinction 
could be made between hver abscess and cancer of the Hver by 
careful attention to the patient's temperature; but subsequent 
investigation has shown that in cases of rapidly growing or dis- 
seminating cancers a hectic type of temperature may exist. 

4. As regards the etiology of liyer abscess, I believe that 
many of the apparently idiopathic are of traumatic origin. I 
have, in several instances, ascertained its occurrence in persons 
who were in the habit of lifting heavy weights, particularly those 
who did so in hot places, as firemen, those unloading vessels, etc., 
by placing the right elbow firmly against the side, and then 
having the weight raised in this way. By this statement I do 
not mean to deny the probable influence of bacteria in the orig- 
ination of abscesses, but to attribute to traumatism the establish- 
ment of that favorable condition which will allow of abscess 
formation. 

In concluding, I may add to this paper, which is intended to 
present the subject in a practical manner, and as it has occurred 
to the writer, a few remarks on treatment. I believe that all 
accessible abscesses associated with an adherent liver are best 
dealt with by free incision, washing out with an antiseptic fluid, 
the introduction of a drainage tube, and by antiseptic dressing. 

The use of the abdominal bandage is sufficiently manifest as 
a means of preventing motion of the liver, and of holding it fixed, 
and needs no special comment. The medical treatment must be 
symtomatic. The wricer believes that rest, a cool climate, and 
strength of the patient, are the main ends to be attained. The 
most important point is to secure an early and safe exit for the 
pus. — Am. Med. Digest. 



RESULTS OF OPERATR'E TREATMENT FOR EPI- 
THELIOMA. 

Dr. C. Patsch, in a recent work, gives the results of his ex- 
perience with epitheliomata in his surgical clinic, especially with 
the view of showing what changes in results treatment has ac- 
complished in the last few years, since antiseptics have been used 
in their removal. His tables so far g-ive the results of cases of 
carcinoma of the lip and external genitals operated upon between 
1875 and 18S2. 

This work represents but a small portion of what the author 
has in contemplation: that is, the analysis of 580 cases of cancer 
of all parts of the body, operated upon between 1875 and 1882, 
and the condition of these patients at the end of March, 1884. 

Cancer of the lip was observed in 98 cases; 88 were men 
and 10 were women, more than the usual percentage of female 
cases. In only two cases did it occur in the upper lip. 



2 24 '^'^^ Peoria Medical Monthly. 

The average age of these patients when they presented 
themselves at the clinic was 57.3 years, and most of them had 
suffered a vear or longer: 22 patients had suffered but half a 
vear. Half of the entire number had infected glands when they 
came under treatment. 

The disease began in most case between the 50th and 51st 
vear, more seldom between 60 and 80, and only twice between 25 
and 30 ^-ears. 

Seventv-three per cent, of the men were exposed b}' their 
occupation to " wind and weather." Thiersch has also observed 
the disease to arise frequenth- under such circumstances. 

Tobacco-smoking had but little influence in its production. 
In 12.2 per cent, of the cases it certainly arose from an injurv to 
the lip. Many times the cancer was preceded b}' a suppurating 
wound. One patient had his lips wounded in the extraction of a 
tooth; this was immediateh' followed by a cancerous tumor, 
which had to be removed eight \veeks later, but in spite of the 
earlv operation he soon succumbed to a return of the disease. 

In some cases operation was refused, as the base of the 
month and the root of the tongue had become involved. 

Four died soon after the operation: 8.3 per cent, later, from 
intercurrent disease: and 32.2 per cent, from a return of the 
cancer. Metastasis into the internal organs was not observed. 
The lirst return generally occurred between one and two vears. 
If tli's \\'as removed it generally returned in a few months: a 
third operation was usually immediately followed bv a reappear- 
ance of the cancer. 

In ]March, 1S84, four of these patients were living with a 
secondary cancer; death had occurred in 28 cases, in the average 
period of 17.1 months after the operation. Some of these pa- 
tients had had a second operation performed, and thev died 13.6 
months, on the average, after the last operation. The average 
duration of life after the lirst appearance of the cancer was 3.72 
3'ears. 

There were living without any return of the disease 35.4 
per cent.; five were still sick, as the removal had been followed 
by an extensive plastic operation. Six patients have remained 
free from disease between five and six 3-ears, and eight patients 
were still without return, though from seven to nine vears had 
elapsed since the operation. On the average, 28 per cent, of 
those operated upon had remained free from the disease more 
than three, and 10.4 per cent, between one and two years. We 
onlv speak of a cure when three years have passed since the op- 
eration. In four cases the glandular involvement began only 
between two and two and a half years. 



Periscope and Abstract. 225 

The prognosis in extirpation of the lip for cancer is mod- 
erately favorable, except where there is intiltration of the jaws or 
of the glands, especially so when a secondary operation is the 
one consideration. From the study of the clinical history of 
these cases the author tinds that the period of lymphatic involye- 
ment depends more upon the character of the original growth 
than upon its duration. 

The history of four cases is worthy of mention. In two the 
disease invaded the lower jaw, filled the alveolar canal, and 
pressed upon the mental and alveolar nerves. The other two 
cases had remained free from disease for eight or ten years after 
operation before a new malignant growth appeared. 

Cancer of the penis was observed in twenty-one cases, nearly 
always between 40 and 60 years, once only between 20 and 30 
years. Twice there was a congenital phimosis, and three times 
the disease was of traumatic origin. 

]\Iost of the growths sprang from the sulcus coronarius 
glandis, a few from the pr^eputium. One case of direct infection 
from the prepuce to the contiguous head of the penis by a sort 
of vaccination is noted. Most of the cases presenting themselves 
were of long standing, any many of them had glandular involve- 
ment. 

In one case a great thickening of the dorsal lymphatics could 
readily be perceived. 

In some cases where there was decided glandular involve- 
ment a simple amputation of the penis without extirpating the 
glands sufficed for a cure: the glands decreased in size and did 
not afterwards become carcinomatous. 

Amputation was performed as soon as the head of the penis 
became involved: the compression of the vessels was intrusted 
during the operation to the fingers of an assistant: the hemor- 
rhage from the corpora cavernosa was controlled by deep stitches 
after the mucous membrane of the urethra had been stitched to 
the skin. 

Two patients died from the operation, one from blood- 
poisoning: 14.6 per cent, remained healed at the time of making 
the report. Some cases had a return of the disease after an im- 
munity of two and a half to three 3'ears. The secondary opera- 
tions were usually unsuccessful. Nine cases in which the dis- 
ease returned died, on an average, in 13.2 months, from inani- 
tion, hemorrhage, etc. 

Carcinoma of the vulva was observed in nine cases, the av- 
erage being 47.1 years; one patient was only 27 years old. In 
three cases it had existed for one year: in one case a small nodule 
had been present for eight years. The disease appeared mostly 
on the inner side of the labia majora, and on the posterior com- 
missure. 



2 26 The Peoria Medical Monthly. 

Two cases were past operative procedure: one patient op- 
erated upon is now free from disease for three years: two died 
from recurrence, and one from some intercurrent disease. The 
author warns against the use of iodoform in patients who use 
stimvilants to excess. — PJiil. Med. Tniics. 



DIARRHCEAS. 

As the season is upon us in which diarrhoeas are abundant, 
it has seemed to us that a few remarks concerning their treat- 
ment ma}- not be amiss. Of course we do not intend to give 
our readers a lecture on so familiar a subject as this, but there 
are certain points which we think are not generallv appreciated 
by the profession, although thev are not novel. The first of 
these is the value of sulphuric acid in the treatment of diarrhoeas 
of relaxation. ^Nlanv vears ago we learned from the late Prof. 
Francis Gurney Smith the value of this remedv. especially in 
combination with the extract of ha^matoxylon. The following 
prescription we have tested almost innumerable times. It makes 
a very agreeable and etiicient mixture, and mav be criven' if nee- 
essary every two hours. Of course it should be varied, espec- 
ially in the opium it contains, to suit individual cases: 

R. Acid, sulphur, aromat , 3 dx*. 

Extr- hiematoxyl., 3 dr. 

Tr. cinnamon. 

Tr. opli camp., aa Ij oz. 

Syr. q. s., ad 6 oz. 

SiG. — Tablespoonful , as required, in a little water. 

A second remedv, still less frequenth- used than sulphuric 
acid, but of great service in non-inflammatorv diarrhoeas, is car- 
bolic acid, or, perhaps preferably, creasote. This remedy is es- 
pecially useful in cases of lientery, with which there is such ex- 
cessive nervous irritability of the bowels that food when taken 
passes right through. But it is also often verv serviceable in 
ordinary summer diarrhoeas. A very valuable combination, use- 
ful especially in sudden violent attacks, is afforded bv the follow- 
ing perscription. It may be administered everv half-hour at 
first; of course care must be exercised not to give the maximum 
dose too frequently: 

R. Chloroform., I oz. 

01. caryophylli. 

Creasoti, aa 1 dr. 

Tr. opii, h oz. M. 

SiG.— Shake well. Dose, 20 to 30 drops. 



Periscope and Abstract. 227 

In some cases, especialh' of more chronic or persistent 
diarrhoeas, of which we have been speaking, where there is ex- 
cessive acidity of the intestines, a combination of creasote with 
chalk or bicarbonate of sodium is very useful. Not rarely the 
addition of the creasote to an ordinary astringent cough mixture 
affords excellent results. 

In regard to dysenteries, there are only two remedies which 
have in our hands given satisfactory results. One of these is 
calomel and the other ipecacuanha. Of the two the vegetable 
drug is the more universal in its application, although in the 
sporadic dysenteries, as seen in. this climate, calomel is usually 
efficient. The objection to the use of ipecacuanha is the dis- 
tressing vomiting which it is so prone to produce. The amount 
of vomiting is, however, ver}' greatly affected by the method of 
administration. Some practitioners are accustomed to begin the 
treatment of dysentery by a large dose of the ipecacuanha in 
powder and endeavor to obtain tolerance after repeated vomit- 
ing. We have found that in man}- cases vomiting can be alto- 
gether avoided and the desired results achieved by giving the 
ipecacuanha in doses of 5 grains every half-hour, in pill form in 
combination with opium, or, better, by preceding each pill fifteen 
minutes by a dose of opium. In very bad cases with pronounced 
so-called bilious S3'mptoms, — /. c, excessively-coated tongue, 
epigastric tenderness or sense of weight, sick stomach and vom- 
iting, — it is probably preferable to begin the treatment by giv- 
ing the 5-grain pills every fifteen minutes until free vomiting is 
set up. — Therapeutic Gazette. 



MANGANESE IN AMENORRHCEA. 

My attention was arrested some two years ago by an article 
on the use of binoxide of manganese in amenorrhoea due to hy- 
gienic imprudence at the menstrual nisus, disturbances, etc. A 
short time thereafter Miss N., aged 17, came under my care. 
She had taken a severe cold at a dancing party, from the effects 
of which her menses, which were then on her, became suddenly 
suppressed. She presented symptoms of decline, with hectic, 
nervous chills, dry cough, and general malaise. After having, 
for a reasonable period tried the usual remedies without result, 
I concluded to test the virtue of manganese pills. I had an im- 
pression that the grave symptoms were due to the suppression 
of the menses, and that with these re-established, improvement 
would ensue. I ordered one pill to be taken at bedtime every 
night. After five pills had been thus taken the catamenia ap- 
peared and under the use of wine and iron the patient was soon 
restored to her original good health. 



228 The Peoria Medical Monthly. 

I have sine e had two simihir cases, which I treated in a sim- 
ihir manner with similar results. In one of these the suppression 
had existed for several years, and had been treated by eminent 
physicians 'both of Michigan and of the West, whither she had 
been sent in the hope of benefit from the change of climate. In 
this latter case fifteen pills taken nightly m the course of 
two weeks, in combination with tonic diet and medicines, wrought 
such a change that the patient became a regular patron of the 
roller skating rink, where she would exercise for two hours at a 
time without fatigue. The remedy is certainlv one of great 
power in amenorrhcea. — Dr. A. R. 'Hicks, in Medical A^-e. 



TREATMENT OF ANGINA PECTORIS BY THE 
IODIDE OF SODIUM. 

Angina pectoris since the days of Gintrac and Lancereaux 
has been considered as a cardiac neurosis. Although in man}- 
cases a diseased condition of the coronarv arteries and the aorta 
has been found, still the symptoms have been ascribed to a nerve 
disturbance dependent more or less on the innervation of the 
heart muscle or upon some degenerate change of nerve fibres. 
M. Henry Muchard, from a study of twent}'-five fast mortem 
examinations made at Hospital Vichart, objects to this view and 
ascribes the symptoms directly to degenerative changes with ob- 
struction of the coronary arteries. He claims that true angina 
pectoris is the result of a disease of the arteries and not of the 
nervous system. 

In accordance with this theory he advises remedies which 
have an effect on the arterial S3-stem. The iodide of sodium is 
especiall}^ recommended, given in doses of sixteen to thirty grains 
daily. He continues this medication during months and even 
3'ears, and claims to have given complete relief and to have pro- 
duced a cure of this dreaded disease in many cases. He thinks 
that the iodide of sodium probably acts by lowering the blood 
tension, relieving the walls of the artery and favoring the disap- 
pearance of the pathologic exudation. For the relief of the par- 
ox3-sm he recommends the inhalation of the nitrite of amvl in 
four to six drop doses. 

Although true angina pectoris has been assumed to be a 
neurosis, the remedies which have been mostly successfully em- 
ployed have been those acting upon the arterial system. (Occur- 
ring as it does at the ages when degenerative changes in the 
arteries are found and in subjects of such degeneration, it would 
seem that the theory advanced by Muchard should be carefully 
considered. That it is generally accompanied by high arterial 



Periscope and Abstract. 229 

tension has been already recognized, and the drugs have been 
most successfully used which reduced this tension. Dr. Lauder 
Brunton has long since recommended the nitrite of am^'l in re- 
ducing blood pressure, and we are indebted to Dr. Murrell for 
our knowledge of the value of nitro-glycerine as a remedy pro- 
ducing the same result. Both remedies have been successfully 
employed in relieving attacks of angina pectoris, but neither 
have been able to effect a permanent cure. 

That the iodides from their well-known action of lowering 
the blood pressure and at the same time favoring the disappear- 
ance of pathological exudations may exert a healthy action in the 
earlier stao-es cannot be denied, but in cases connected with well 
developed atheroma more evidence is needed before it can be 
positively accepted. — Courier of Med. 



SHORTENING OF THE ROUND LIGAMENTS. 

x\t a meeting of the British Gynaecological Societv, held 
June 10, 18S5, Dr. Alexander {British Medical yotirual, ]vi\y ^, 
1885) read a paper on the operation of correcting some uterine 
displacements by shortening the round ligaments. He said the 
operation had now been performed in nearly all the prominent 
cities in the world, and by most operators with more uniform 
success than generally befell anv new operation. He never 
found anv difficultv in finding and drawing out the ligaments. 
An incision was to be made upwards and outwards from the 
pubic spine, in the direction of the inguinal canal, for one and a 
half to two or three inches, according to the fatness of the sub- 
ject. A considerable thickness of subcutaneous fat was then 
met \\'ith, which must be cut through b}" subsequent incisions, 
until the pearlv glistening tendon of the external oblique muscle 
was reached. Midway through the fatty tissue an aponeurosis 
sometimes appeared, so firm and smooth that it might cause the 
operator to think he was deep enough, but he would find no liga- 
ments at this spot. The first stage of the operation consisted 
simplv in cuttin£f down upon the tendon of the external oblique 
muscle until it appeared clean and shining at the bottom of the 
wound. The external ring was then found. The finger passed 
to the bottom of the w^ound detected the spine and the ring out- 
side. Having isolated the external wound and tied an}" little 
vessels, the next step was to find the end of the ligament. By 
everting all the structures upwards the round ligament could be 
seen, generallv at the lowest part, and with the white, easily dis- 
tinguished genital branch of the genito-crural nerve along its an- 
terior surface and close to it. The ligament at this stage was 



230 The Peoria Medical Monthly. 

more or less rounded in shape. It was an easily recognized 
flesh-colored structure. When the ligament was identified the 
small nerve on its surface was to be cut through without dividing 
any of the ligament. Then gentle traction was to be made, 
either by the lingers or by broad blunt-pointed forceps. Bands 
holding it to neighboring structures were cut through with 
scissors. As soon as it began to peel out, it was left and the 
opposite side begun. The final stage of the operation consisted 
in placing the uterus in position by the sound and pulling out the 
ligaments until they were felt to control that position. A curved 
threaded needle, with fine catgut, was used to stitch each liga- 
ment to both pillars of the ring, and the external abdominal ring 
was closed without strangulating the ligament as it lay between 
it. The ends of the ligaments were now cut off, and the re- 
mainder stitched into the wound by means of the sutures that 
close the incision. A fine drainage-tube was inserted, and the 
wound washed out with carbolic or other lotion before these 
sutures were tied. The after treatment consisted in rest. The 
tubes were removed on the second dav, when the wound was 
dressed. The mortality of the operation might be set down as 
none. Three deaths had occurred but they were due to pre- 
ventable causes. As mortality did not seriously enter into any 
consideration of the results of this operation, the real question at 
issue was whether it fulfilled the intentions of the operator and 
satisfied the expectation of the patient. The operation was de- 
signed to correct certain uterine displacements, and these alone. 
Whether the discomfort of the patient would be thereby relieved 
entirely depended on whether or not the symptoms were due to 
the displacement. To secure success the operation must be 
properly performed, and the after-treatment must be rational, so 
that no strain might be placed on the ligaments until sound union 
had taken place. — Thera;pcutic Gazette. 



GASTRIC AFFECTIONS WITH A MALARIAL BASIS. 

Rosenthal, of Vienna, observed seven cases of stomachic 
affections clearly traceable to a malarial element [Deiitsc/ie Med- 
Jzinal Zeitinio;lsi?\\ 21, 1S85). 

Several months usually pass before the latest malarial virus 
manifests itself in gastric difficulties. The absence of heightened 
temperature, febrile paroxysms, and splenic engorgement often 
leads to diagnostic and therapeutic errors. The marked inter- 
mittent fever which is often associated" with neuralgia mav also 
produce pains in the epigastric region ; in other cases malaria as- 
sumes the mask of dyspepsia, intermitting vomiting, typical gas- 



Periscope and Abstract.* 231 

trie and intestinal pneumatosis, and of intermittent colic. This 
dA'spepsia is usually mistaken for intestinal* catarrh or enlarge- 
ment, or if associated with emaciation and cachexia, for gastric 
ulcer or carcinoma. The more frequent accurrence of this form 
of dyspepsia in nervous persons, and the long-remaining nervous 
symptoms and ps3'chic depression after the reappearance of the 
more urgent S3'mptoms, point to the nervous element as an im- 
portant etiological factor of the affection. Such at least is 
Leube's view, while others believe in local alterations, such as an 
oedematous infiltration of the o-astric mucous membrane. Rosen- 
thai gives some further diagnostic suggestions : cachectic, sallow 
appearance, and a rapid emaciation in young individuals with 
cardialgic and dvspeptic troubles, point more to malaria than to 
carcinoma, but mav also indicate nervous d3'spepsia. Intercur- 
ring neuralgia (chiefly intercostal) corroborates the diagnosis of 
malaria. 

The question of the origin of this malarial cardialgia is not 
yet definitely settled. Rosenbach regards the affection as an ir- 
ritation phenomenon emanating from the engorged splenic cap- 
sule, while Rosenthal leans toward the assumption of an irrita- 
tion of the bulbous vagus-centres, as also known to exist in the 
cardialgia of tabes and vomiting, in h3'steria and neurasthenia. 

As to the therapeutics of the affections, Rosenthal holds that 
quinine is not contra-indicated, but, on the contrary, acts well, 
provided large doses are given, and it is given, if necessar}', as 
enema, suppositorium, or hypodermically. Besides quinine, 
Fowler's solution (5 to 8 drops three times daily), and tincture 
of eucalyptus globulus (i dr. t. d. ) are recommendable. Quinin. 
bor., internally (7 to 15 grains t. d.), or subcutaneously with 
ghxerin and water, are also well borne, while quinin. salicyl. is 
worth trying. In chronic cases faradization of the spleen and 
the springs of Karlsbad, Kissingen, and Ems suggest themselves. 



COLLES' FRACTURE. 

John B. Roberts, M. D., Professor of Anatomy and Surgery 
in the Philadelphia PolycHnic, writes on the practical treatment 
of fractures of the lower end of the radius in the Polyclinic : 

The essential point in the treatment of this fracture is early 
and complete replacement of the lower fragment. The pro- 
tracted convalescence and frequent stiffness of the wrist and 
fingers, seen often in this injury, are, I am convinced, due to im- 
perfect reduction of the fracture and to the confinement of the 
fingers during the use of the fracture dressing. When there is 
neither comminution nor loss of tissue by crushing, the fracture 



232 The Peoria Medical Monthly. 

can usually be cured in four or five weeks, with little or no diffi- 
culty, and without stiffness of the fingers. When comminution 
and crushing exist, cure without impairment of motion, though 
probably with more or less persistent deformity, is nearly always 
possible, and in the same time. When I say " cured," I do not 
mean that every vestige of swelling and of osseous thickening 
disappears so soon, but that the limb is capable of performing its 
ordinary functions. Old and rheumatic patients may perhaps 
exhibit a greater tendency than others to rigidity of the joints; 
but I cannot insist too strongly on my belief that stiff fingers are 
usually an indication of imperfect reduction of the fragments, 
which, by their projection, interfere with the extensor and flexor 
tendons, and cause adhesive inflammation. 

No apparatus should be applied that restricts, at any period 
of the treatment, full and free motion of* the fingers. In uncom- 
plicated cases the splint need not be worn more than about ten 
days, provided that the patient is sufficiently intelligent to avoid 
submitting the arm to unexpected strains and blows. This is 
because of the slight tendency to reproduction of deformity in 
the properly reduced uncomplicated fracture. In careless pa- 
tients, and in comminuted or other^yise complicated fractures, 
support by the splint should be continued for three weeks. I 
should be willing to treat many uncomplicated patients in intelli- 
gent persons without any splints, merely substituting a band of 
adhesive plaster firmly placed around the seat of injury. Passive 
motion is probably never necessar}' if the fracture is properly 
reduced, and the play of the fingers not restricted during the use 
of the splint. 

Reduction is always painful, but is usualh' so quickly ac- 
complished that I seldom use an anesthetic. Ether or nitrous 
oxide should be employed, however, if there is likelihood of the 
pain preventing perfect coaptation of parts. The surgeon must 
employ force directly to the fragments. Let him put the pa- 
tient's hand in the prone position, grasp the middle of the fore- 
arm with one hand, and take hold of the patient's palm with the 
other hand in such manner that his thumb can make strong pres- 
sure upon the apex of the dorsal prominence. By making trac- 
tion on the hand of the patient, and then suddenly flexing the 
patient's wrist, while at the same time he presses with his thumb 
strongly upon the projection at the back of the wrist, he can 
nearly always force the lower fragment into its proper position 
without difficulty. A repetition of this maneuver is sometimes 
requisite before accurate replacement is obtained. The grating 
produced as the fragment, which may have been impacted, is 
driven into its normal position can at times be distinctly heard by 
bystanders. The limb at once assumes its normal contour. The 



Periscope and Abstract, 233 

disappearance of the bon}- edge, or shoulder, previously percept- 
ible to the touch, where the upper margin of the lower fragment 
was elevated above the level of the shaft of the radius, is an indica- 
tion that reduction of the backward displacement has been ac- 
complished. Still further manipulation may occasionally be 
necessar}- to reconstruct the normal outline of the radius, which 
has at the wfist, it will be remembered, a concave palmar sur- 
face. 

If great comminution or crushing has been incidental to the 
fracture, perfect restoration of shape ma^^ be impossible, although 
the deformity can be greatly diminished. In such cases also, 
retention of the fragments in good position mav be difficult. 
Firm impaction, or entanglement of the fragments in the tendons 
or in dorsal periosteal bands, may require that the hand and 
attached lower fragment be first bent strongly backward, in 
order to relieve the interlocking before making traction, flexion 
and pressure. This preliminary measure is very seldom neces- 
sary. After reduction has been accomplished, any form of dress- 
ing is allowable, provided it immobilizes the limb, does not tend 
to obliterate the normal curve of the palmar surface of the radius, 
and permits the patient to move his fingers. It was formerh' 
thought that- splints deflecting the hand to the ulnar side exerted 
traction on the radial side of the wrist, and were therefore indi- 
cated. This is incorrect teaching. Such splints are unnceces- 
sar\-, as the deflection only causes the carpus to roll in the artic- 
ular surface of the radius. 

The hand should be placed in the prone or semiprone posi- 
tion, and a single splint extending from the elbow joint to the 
middle of the metacarpus, applied either to the dorsal or palmar 
aspect of the forearm. It is essential that the palmar splint, if it 
be chosen, should be convex on its upper surface at its carpal 
extremity, so as to preserve the integrity of the radial concavity, 
and not to make the palmar surface of the radius flat b}' forcing 
upward the lower fragment, which has just been pushed down 
into proper position by the surgeon's manipulations. This con- 
vexity of the splint ma}" be obtained by using the moulded splint 
of Levis, which I employ, or a splint with a hard convex pad, 
such as that of Carr. It should be seen that the pad properly 
fits. The surgeon can readily make a pad out of soft wood and 
fasten it with screws to a straight splint. No dorsal splint is 
needed with either the Levis or Carr palmar splint. If it is in- 
convenient to obtain a proper form of curved palmar splint, a flat 
splint may be applied to the dorsal surface of the radius, for it 
presents no curve, but is straight. Bond's splint, so frequently 
employed in Philadelphia, is dangerous to the future contour and 
utility of the limb, and should ne^•er be used. 



234 The Peoria Medical Monthly. 

After the splint has been employed for from ten to twenty 
days, varying, as above stated, with the kind of fracture and dis- 
position of the patient, it is well to substitute it by a strip of ad- 
hesive plaster two inches wide, applied circularly around the 
wrist, so as to give moderate support to the partially consolidated 
fracture. 

If union has already occurred in a fracture treated without 
proper reduction, I should be inclined to attempt refracture and 
adjustment, even after the lapse of several months; provided that 
the fingers were very rigid or the deformity very great. It is 
not likely that as much can be accomplished in such cases as was 
possible immediately after the receipt of injury; nor should it be 
forgotten that very good, if not perfect use of the hand finally is 
compatible with a considerable degree of deformity. Rigidity 
of the fingers, if permitted to occur, remains, however, for many 
jnonths. 



A VALUABLE REMEDY FOR HEADACHE. 

The Ph\'sicia}i's and Surgeoii's Investigator desires to call 
the attention to a simple, and at the same time wonderfully efli- 
•cient, treatment for many kinds of headache : 

We lay no claims to originality, nor do we know who the 
originator was, but having used it for a year or more, and in 
many cases with remarkable results, we feel disposed to give it 
our indorsement, and desire to make it more generally known. 
The remedy is nothing more nor less than a solution of the bi- 
sulphide of carbon. A wide-mouth glass-stoppered bottle is half 
iilled with cotton or fine sponge and upon this two or three 
drachms of the solution are poured. When occasion for its use 
occurs the mouth of the bottle is to be applied to the temple or as 
near as possible to the seat of pain, so closely that none of the 
volatile vapor may escape, and retained there four or five min- 
utes or longer. For a minute or so nothing is felt, then comes 
a sense of tingling, which in a few minutes — three or four usu- 
ally — becomes rather severe, but which subsides almost immedi- 
ately if the bottle be removed, and any redness of the skin that 
may occur will also quickly subside. It may be re-applied, if 
necessar}', several times in the day, and it generally acts like 
magic, giving immediate relief. 

We believe this was the basis of a once popular nostrum. 
The class of headache to which it seems especially adapted is 
that which may be grouped under the broad term of " nervous." 
Thus neuralgic, periodic and hysterical headaches are almost in- 
yariablv relieved by it. True, the relief of a mere s^-mptom is 
quite another thing from the removal of a cause, yet no one who 



Periscope and Abstract. 235 

has seen the distress and even agony caused bv severe and fre- 
quently recurring headaches (and who has not?) but will rejoice 
to be able to afford relief in so prompt and simple a manner; be- 
sides it is sure to secure the hearty gratitude of the patient if he 
has suffered long. As to the modus operandi we have nothing; 
more definite than a theory to offer, and that is that the vapor 
being absorbed through the skin produces a sedative effect upon 
the superficial nerves of the part to which it is applied. We 
know by experiment that its influence is not due to its power as 
a counter irritant. We however know that it does act, and if 
we do not clearly see in w^hat way it acts, that is no more than 
can be said of several other remedies which are firml}- established 
in professional favor and confidence. — Weekly Medical Rev/czif 



PERFORATING ULCER OF THE BLADDER. 

Dr. James Oliver thus writes in the London Medical Times: 
The type of ulcer I am about to describe as affecting the 
bladder, has hitherto been looked upon as more or less peculiar 
to the stomach and duodenum. When, however, we consider 
the probable cause of its formation, it is not to be wondered at 
that other parts of the intestinal canal, and even the bladder it- 
self, may become the seat of a similar necrotic change. In the 
Lancet^ March 7th, of this year, I recorded a case in which the 
ascending colon had been thus perforated, and doubtless careful 
pathological observation will prove that such are not uncommon. 
Perforating ulcer of the bladder is primarily always acute; 
if, however, there be extensive destruction of tissue, the functions 
of the organ are likely to be permanently disturbed, and the dis- 
ease to become one truly chronic in character. This ulcer is es- 
pecially apt to recur, a fact strongly in favor of a diathetic ten- 
dency or proneness to the affection. It usually develops with- 
out signs of inflammation or suppuration, and as in the stomach 
and other parts of the intestinal tract, apparentlv results from a 
plugging of the vessels which run in and nourish the coats of the 
viscus. If the blood supply to anv tissue of the bodv be sud- 
denly withdrawn — as happens when a vessel becomes occluded 
— and collateral circulation be not readily established, death of 
the part is inevitable. Embolism and thrombosis are the most 
frequent causes of softening in the brain and spinal cord, and it 
is more than likely that these play an important part in the pro- 
duction of perforating ulcer of the bladder. Round ulcers, sim- 
ilar to those we are now considering, have been produced in the 
stomachs of animals artificiallv by the introdviction of emboli into 
the gastric vessels. This form of necrosis is truly analogous 



236 The Peoria Medical Monthly, 

with diy gangrene occasionally seen in the extremities of the 
aged, where the arteries, because of the degenerative changes 
in their coats, have become impervious. The embolic theory of 
chorea is still tenable, and all who see much of this disease re- 
mark its frequent association with rheumatism or a rheumatic 
predisposition. Judging from those cases of perforating ulcer of 
the bladder which have come under mv notice, I am inclined to 
believe that the rheumatic diathesis augments the tendency to 
this affection, and favors embolism as a probable cause of its pro- 
duction. In one case the svmptoms attributable to perforating 
ulcer developed during an attack of acute rheumatism, and as 
the patient died sometime after, opportunity was afforded for ex- 
amining the bladder and verifying the diagnosis. The heart in 
this case showed no trace of valvular disease. Females, it would 
appear, are more prone to this affection than males, and espec- 
ialfy about the period of pubertv. No exciting cause can as yet 
be suggested. 

One or more ulcers may develop, according to the number 
of vessels occluded: some days, however, must necessarily elapse 
before disintegration is completed. Whether the necrotic change 
shall invade the whole thickness of the bladder wall or not, de- 
pends on the seat of- obstruction of the artery, the completeness 
or incompleteness of the plugging, and the period at which col- 
lateral circulation becomes established. Should, however, the 
destructive process attack all the coats of the bladder, and at a 
part covered by peritoneum, this coat tends to thicken and form 
adhesions v/ith neighboring structures, it may be the small intes- 
tine or omentum, thereby preventing rupture of the organ, ex- 
travasation of its contents, and death by shock or peritonitis. If 
the bladder forms adhesions with any part of the intestinal canal 
the ulcerative process may extend and invade this organ too; 
vesico-intestinal fistula, though fortunately rare, may therefore 
depend upon simple perforation. In such cases even a careful 
inquiry into the clinical history may fail to reveal the probable 
starting point. 

The symptoms and course of perforating ulcer of the blad- 
der are usually very insidious, and fatal peritonitis may result 
from destruction of all the coats ere the grave condition has been 
recognized. Pain more or less constant and referred to the 
hypogastrium is a frequent symptom — it is aggravated b}- 
pressure and bv anv slight distension of the organ. There is 
frequencv in micturition, and the pain, as a rule, becomes sharp 
and cuttinjj in character towards the end of the act. The most 
distressing symptom of all is tenesmus, which results from spasm 
of the muscular coat, and may continue for some time after the 
organ has completely emptied itself. Blood usually appears in 



Periscope and x\bstract. 237 

the urine about the third or fourth day, is small in quantity, and 
is expelled with the last drops of urine. The treatment is rest 
and bland food; opiates must be given to relieve pain and the 
intense bearing down. — Laiicct and Clinic. 



THE TREATMENT OF DIPHTHERIA. 

Dr. J. W. Alexander, of Newark, O., writes in favor of the 
constitutional treatment of diphtheria. He thinks that local ap- 
plications of any sort are of doubtful utilitv, although, as pallia- 
tive measures, antiseptic and disinfectant washes are not to be 
ignored. All caustics and irritants are injurious, he maintains, 
and should never be used. The following is the formula which 
he has used with success in many cases : R. Chlorate of potas- 
sium, 40 grains: simple svrup ( slightlv warmed), 2^ ounces; 
dissolve and add aromatic sulphuric acid and tincture of chloride 
of iron, of each one fiuidrachm. The dose for adults is a tea- 
spoonful everv two to four hours, according to the urgency of 
the case. As soon as the svmptoms begin to improve the dose 
should be decreased and the interval extended, but the remedy 
should not be discontinued until the throat is entirely free from 
the diphtheritic deposit. Dr. Alexander states that he has used 
this method of treatment constantlv for several years, during 
which time he has lost but one case of diphtheria, and that one 
was not seen until the disease was too far advanced to be stayed 
by any remedy. He writes in conclusion: "It may seem that 
there is nothing remarkable in the above combination, as chlor- 
ate of potassa and tincture of iron are used bv nearly everyone, 
but the union of the three articles combined in these proportions 
has produced very marked results. I will not attempt an ex- 
planation of the modus operandi of this medicine, but will leave 
it to those who are more competent: but if I can persuade any 
of mv professional brethren to give this simple remedy a trial, I 
shall have accomplished mv purpose.*' — Medical Record., 



H0USE:^IAID"S knee — recovery without RE- 
MOVAL OF THE SAC. 

Dr. Charles H. Carter, of Chicago, 111., relates the case of 
a plasterer, aged thirty-four, who had received a fall three weeks 
before coming under observation, strikinjj his knee against the 
edge of a board. No pain was felt until about a week after the 
injury had been received, at which time also a swelling was 
noticed. This tumor increased in size until it covered the lower 
two-thirds of the anterior surface of the patella, and was found 



23o The Peoria Medical Monthly. 

to contain pus. There being no time for temporizing, Dr. Carter" 
proceeded to operate as follows : " With a bistoury I made an 
incision from above downward on the external side of the swell- 
ing, carr^-ing it, with the aid of a grooved director, to the ex- 
treme lower hmit of the CA'St, so as to avoid leaving a 'pocket,' 
and to facilitate complete evacuation. The incision was made 
on one side, and from above downward, rather than from side 
to side, to prevent any gaping of the wound when the knee was 
flexed. 

"After thoroughh* emptving the sac bv gentle pressure and 
gravity, I washed out the cavity with a two per cent, solution of 
'Carbolic acid in hot water, continuing until the water returned 
perfectly clear and unstained by either blood or pus. The time 
consumed by this part of the operation was probablv ten minutes. 
I used hot water because that was more certain to dislodge any 
portion of pus which might, by its greater consistence, be re- 
tained around the edges of the sac, where the walls are reflected 
on the surface of the patella. 

" Gently pressing out the water, but not taking any pains 
to thoroughly empty the sac, I carefully brought together the 
edges of the wound and hermetically sealed it with strips of silk 
isinglass-plaster, moistened with a ten per cent, solution of car- 
bolic acid. Then, with the leg extended. I applied strips of 
moleskin plaster to the whole knee-joint. I used strips about 
half an inch wide, and long enough to go about three-fourths 
around the joint, leaving the posterior surface uncovered. 

'' Commencing above the patella, I applied the first strip, 
drawing the ends strongly downward. The second slightly 
overlapped the first in front, but nearly covered the ends of it on 
the sides. The strapping was continued in this manner so that 
the strips firmly compressed every portion of the emptied sac, 
keeping the walls accurately in contact. The patient did not ex- 
perience the least pain or discomfort in the part after the dress- 
ing was applied. 

"Using no further means, except complete rest and low 
diet, I removed the dressing on May 5th, four and one-half days 
after the operation, and found the sac perfectly closed and not' a 
drop of liquid to be found in it. 

"After remaining in-doors two days longer, the man went 
to his work, and has had no sign, as yef (' June 30th), of a return 
of his ' housemaid's knee.' " — Medical Record . 



Periscope and Abstract. 239 

THE EMERGENCIES OF SURGERY— INJURIES OF 
HEAD AND FACE. 

The following is the first of a course of lectures delivered 
at the Meath Hospital and County Dublin Infirmary by Lambert 
Hepenstal Ormsby, M.D., F.R.Cl^S.: 

Injuries of the head are at times followed by the most 
alarming symptoms, even when the appearance and size of the 
injury are of the most apparentl}' trivial character. The patient 
after a fall or blow may seem to recover the shock, and to suffer 
no bad effects. However, in the course of a few hours the pa- 
tient may become comatose. Mr. Guthrie mentions on this sub- 
ject " Injuries of the head affecting the brain are diflicult of diag- 
nosis, doubtful in their character, treacherous in their course, and 
for the most part fatal in their results." It must, however, be 
borne in mind that the truth of this observation does not always 
follow, for in some exceptional cases, no matter how severe the 
injury may appear, the patient may recover without a bad S3mip- 
tom, and in the whole course of medical practice no case presents 
itself to the surgeon read}" for any emergency so important as 
these forms of injur}'. No hasty diagnosis should be formed, no 
heroic line of treatment adopted more than an anxious careful 
attention to each symptom as it arises. Mr. Liston has also 
stated with reference to this subject " that wounds of the head 
of the most trivial character are not to be despised, or of the 
most severe not to be despaired of." 

Contusion of the scalp may result from falls or blows froirt 
blunt instruments, the immediate effect of such an injury is great 
swelling, tension and pain; the integument over the spot becomes 
glazed and tender, in a few hours it may become discolored by 
extravasation of blood into the subcutaneous tissue. Children 
are very liable to such injuries by falling off chairs or tripping 
when at play and their head coming in contact with some hard 
substance. Anxious mothers and nurses are in the habit of ap- 
ph'ing a variety of nursery remedies for such to keep down the 
swelling and prevent the skin turning black. 

Treatment. — Immediately after the injury the local applica- 
tion of a small piece of ice, or the application of a flat piece of 
steel or iron, or a flat stone. Almond oil or camphorated oil is 
also a favorite remedy to apply to the part at once. The appli- 
cation of vinegar and water or a spirit lotion on lint is also most 
useful. Where the skin is not broken, cleaning out the bowels 
with a mild saline purge, a non-stimulating diet and perfect 
quietness would be about all that need be done in slight cases. 
In severe contusions, where a large blood tumor immediately 
forms, the diagnosis and treatment ma}^ be more perplexing, for 
it must be remembered that this has frequently been mistaken. 



240 The Peoria Medical Monthly. 

for a depressed fracture of the skull, and vice versa. In general 
terms the diagnosis can be made out pretty well by the history 
of the case. In a bloody tumor of the scalp if it is carefully ex- 
amined with the finger, it is found that there is a circumscribed 
tumor present with a well-detined firm margin, and in the center 
of which the finger, as it were, sinks into a soft, depressed center. 
In a fracture with depression the circular margin is not at all so 
apparent, and the depression is hard instead of soft to the touch, 
and if the depression has existed for any time it is most probable 
symptoms of compression will be present. 

Treatment for severe contusions consists in the application 
of cold evaporating lotions to cause the extravasated blood to be 
absorbed. In other cases suppuration may take place in the tu- 
mor, and when this is evident an incision must be made, and a 
free exit given to the matter. Erysipelas and diffuse abscess of 
the scalp ma}^ occasionallv follow such injuries, whether trivial 
or severe, toirether with inflammation of the brain and its mem- 
branes. 

Pott's puffv tumor indicates the presence of a collection of 
pus situated between the dura mater and the cranium, with a 
puffy and swollen condition of the epicranial aponeurosis follow- 
ing a severe blow or contusion. When this condition is present 
probably slight symptoms of compression will begin to make 
their appearance. 

Treatment. — Keep the patient in bed in a dark room on light 
and non-stimulating diet. When evidence of compression appears 
the operation of trephining over the seat of the injur}- to give exit 
to the matter should be performed without delay. 

Wounds of the scalp are of common occurrence, whether 
the result of falls or blows with blunt or sharp-cutting weapons. 
As a rule these wounds bleed very profusely, in some instances 
the smaller branches of the temporal and occipital arteries are 
severed and require to be commanded either by pressure, liga- 
ture, torsion, or acupressure needle. A portion of the scalp may 
be considerably torn and partially detached, as after mill acci- 
dents or railway smashes. 

Treat 111 en f. — In a clean-cut incised wound remove all dirt or 
foreign matter that ma}' have found its way into the wound. Cut 
the hair very close about the edge of the wound, and evenly ap- 
proximate its edges with good adhesive plaster. Do not apply 
sutures is an old maxim you are expected to follow. Some part 
of the scalp mav slough, however. This will be repaired by 
healthy granulating tissue. Abscesses may form, which must be 
evacuated as soon as recognized. All hemorrhage stopped by 
pressure or other means; edges of wound brought evenly to- 
gether; the patient kept quiet; the bowels kept moderately open 



Periscope and Abstract. 241 

by saline purges, and light, non-stimulating diet ordered for the 
first few days — comprises nearly all that need be done in a case 
of the kind. 

Erysipelas of the Scalp. — A complication that occasionally 
arises after a contusion, a punctured or incised scalp. Much de- 
pends on the state and constitution of the patient at the time of 
the accident, as well as the sanitary and hygienic conditions, 
which may be at fault. The premonitory symptoms of erysip- 
elas coming on are as follows: Locally, wound becomes glazed 
and dry, no pus appears on edges; a deep red blush over the 
part is very apparent; also tingling, heat, and swelling, giving 
rise to much pain. Constitutionally, we have a high tempera- 
ture, a dry, furred tongue, a quick pulse, loss of appetite, high- 
colored and scanty urine, headache. 

Treatment. — A linseed poultice should be applied if the 
swelling is very great with a swollen and puffy condition of the 
epicranial aponeurosis. Incisions should be made with caution, 
to relieve tension, and warm fomentations. The bowels should 
be kept clear, and iron, quinine, opium, and strong beef tea ad- 
ministered internalh'. 

Fractures of the Skull. — Of this we have many varieties. 
Generally, however, it is divided into fracture of the vertex and 
fracture of the base. Of the vault, or vertex, we have depressed., 
a small portion of bone is driven inward, and non-depressed., 
where there is no separation or depression, but just simple linear 
fissure of the cranial bones in one or more directions. The outer 
table may be furrowed or grazed by the passage of a ball across 
the skull. Much of the scalp must necessarily be torn and sepa- 
rated from the bone, which will in all probability produce necro- 
sis, slouging, abscess, ulceration, and sympathetic inflammation 
of brain and membranes. 

Treatment. — The same as adopted in other head injuries. 
Wound treated on general principles. Contusion of the scalp 
with depressed fracture without a wound. This kind of an injury 
may "puzzle one what to do. But the general rule in surgery is 
to adopt the following course : Where you have no wound, no 
symptom of compression, but with depression, wait for symp- 
toms to arise before attempting to trephine or elevate, as before 
doing anything you must necessarily convert a simple 
fracture into a compound. 2. Where vou have a wound 
in the scalp communicating with the seat of depressed fracture 
elevate or trephine, whether vou have svmptoms of compression 
or not. Sir William McCormac mentions on this subject what I 
may be allowed to quote with advantage : " One point regarding 
which opinions vary somewhat is respecting the treatment of 
depressed fracture unaccompanied by symptoms and with an ex- 



242 The Peoria Medical Monthly. 

ternal wound. Where there is no wound he would be a hardy 
operator who should cut down upon a depression in the skull in 
the absence of any symptom of compression. When there is a 
wound, however, the case is different; but even here I question 
much if the surgeon ought to do more than simply remove such 
loose fragments as can readilv be got at." 

Fracture of one table singly without the other is sometimes 
spoken of as regards the inner table, but its frequency is a matter 
of considerable doubt, and Guthrie mention? he has never seen it 
occur without positive marks of injury on the bone of pericranium. 

Treatment for fractures of all parts of the vortex, it must be 
remembered, that as regards the result, recoverv is far more 
likelv to occur than those of the base. If it is merely a linear 
fracture the patient should be kept quiet, cold water dressing 
applied. Sometime profuse suppuration follows, when it is ad- 
visable to apply a light linseed-meal poultice. If a portion of 
bone has been driven in on the brain, together with the missile 
or bullet that produced the fracture, an attempt should be made 
to remove it. The fragments sometimes get displaced for some 
little distance under the cranium, awav from the opening, in 
which case the removal is difficult, and an}' undue manipulation 
or exploring may drive the foreign body farther in on the brain, 
to be followed bv greater injury and fatal cerebral mischief. By 
gentle manipulation with a probe, elevator, and forceps it is 
sometimes easy to remove the fragments. And in all cases 
elevation should be adopted and practiced in preference to tre- 
phining where feasible, as the operation is much more simple and 
much less dangerous to the patient. The operation of elevation 
is thus performed: If the wound is not large enough it mav be 
increased by incision with a scalpel. The epicranial aponeurosis 
should be gently raised ^^■ith a forceps, so as to see clearly the 
amount of depression and the line of fracture. A probe inay 
then be passed between the hssure so as to ascertain whether the 
depressed portion is movable or not. If it is, the elevator is then 
gently insinuated in the tissure and the hnger placed flat at edge 
of wound acts as a fulcrum for the elevator or lever to work on. 
If a sharp point of a spicula prevents the elevator being used, 
this portion may be sawn through with a Hey's saw. After 
removal all hemorrhage must be arrested, which generally wells 
up out of the wound, cold water dressing applied, and the patient 
carefully watched. Suppose this operation of elevation can not 
be adopted, he must then have recourse to the more severe form 
of procedure, viz: the operation of trephining. 



Periscope and Abstract. 243 

PERSONAL OBSERVATIONS OF THE WORK OF 
LAWSON TAIT. 

In no way can a clearer insight be gained into the methods 
and work of the surgeon than by a personal observation of his 
cHnical material. During the past few 3'ears Mr. Lawson Tait, 
of Birmingham, England, has given ample proof by his writings 
and statistics that his work in abdominal surgery was not onl}^ 
bold and original, but eminently successful. Mr. Tait works in 
his own private hospital, and his methods have not been so open 
to public inspection as those of surgeons who operate in large 
public institutions. Since Mr. Tait began to develop as the lead- 
ing abdominal surgeon in England, many statements have been 
made which were intended to cast discredit upon the operator's 
truthfulness, and upon the correctness of his statistics and meth- 
ods. It is but just to Mr. Tait to sa}- that he has lived down the 
injustice of these insinuations against his work, and to-day stands 
at the head of his profession as a careful, painstaking and skill- 
ful surgeon. 

Opportunities for the study of Mr. Tait's clinical material 
are quite limited, but now and then this privilege is accorded to 
an American surgeon. Recently Dr. A. Vander Veer, of 
Albany, New York, has enjoyed this privilege. Dr. Vander 
Veer now gives the profession the results of his personal obser- 
vations on the work of Mr. Tait, in the American 'Journal of 
Obstetrics, etc., for July, 1885. We are informed that Mr. Tait 
is not only an original thinker, but a careful, cautious and great 
surgeon. " His hospital is a model of all that we could wish re- 
garding quietness, cleanHness and perfect system, not onl}- in 
nursing, but in everything. The discipline is the outgrowth of 
years of hard work and close application, and yet Mr. Tait is 
scarcely forty ^^ears of age. He has described quite fully in his 
book the necessary preparations incident to an operation, and 
yet to witness all is a stud3^ Everything is arranged by the 
nurses after being told of the nature of the operation and the 
hour of operating. He selects young, intelligent and prepossess- 
ing women, whom he trains for the work he so much enjoys, 
and they in their desire to learn and please become true enthusi- 
asts in the struggle to save Hfe. He will not have morose, un- 
tidy, or homely women as nurses. Mr. Tait enters the room, 
and almost at a glance tells whether all required instruments are 
selected. He brings his bag of carefully prepared sponges, and 
counting them again, tells the assistant nurse their number, and 
she is held responsible for them. So also in regard to the num- 
ber of forceps and other instruments." Dr. Vander Veer next 
relates Mr. Tait's method of preparing the sponges, " New 



244 The Peoria Medical i\ - xt;ily. 

sponges are first put into a large quantity of water with sufficient 
muriatic acid to make the water taste disai;reeably acid. Thev 
remain in this mixture until all effervescenci has ceased and all 
the chalk is removed. For this purpose u may be necessary to 
renew the acid several times. The spon; cs are afterward care- 
fully and thoroughly washed to make t'.em as clean as possible 
and free from every rough particle. After being used at an 
operation, they are first washed free from blood, and then put in 
a deep jar and covered with soda and water (one pound of soda 
to twelve sponges). They are left in this about twenty-four 
hours (or longer if the sponges are very dirtv), and then they 
are washed perfectl}- free from everv trace of soda. This takes 
several hours' hard work, using hot water, squeezing the sponges 
in and out of the w^ater and changing the water constantly. 
Leaving them to soak for a few hours in very hot water greatl}- 
assists in the cleansing. When quite clean they are put in a jar 
of fresh water containing about one par cent, of carbolic acid, 
and after being in this for twenty-four hours they are squeezed 
dry and tied up in a white cotton bag, in which thev are left 
hanging from the kitchen ceiling (being the driest place in the 
house) till they are wanted." 

The true secret of Mr. Tait's success is found in the very 
close attention given to minute details. Neatness, system and 
order prevail throughout his hospital, which, from the descrip- 
tion given by Dr. "V^ander Veer, is a model of comfort and clean- 
liness. Mr. Tait looks after everything himself, and is so sur- 
rounded with trained and disciplined assistants that his work is 
executed in the most perfect manner. His sole aim has been to 
secure results, and to reach this end he brings to bear upon his 
work every prerequisite. The genius of the man flashes out, 
not only in his remarkable dexteritv and skill with the knife, but 
in the infinite pains and alert watchfulness given to ever}' case. 
Mr. Tait's success in abdominal surgery is an illustration of what 
can be achieved by any surgeon who is able to control the sur- 
roundings of his patients, and thus raise the practice of the 
science to the highest plane of art. — Maryland Med. journal . 



THE CHLOROFORM TREATMENT FOR TAPE- 
WORM. 

Dr. Alfred W. Perry, of San Francisco, reports in the Med- 
ical Record an obstinate case of taenia lata, successfully treated 
by the exhibition of chloroform. The patient, a stout man, aged 
forty, had had tape-worm for eight years, on which he had tried 
all the hitherto known remedies. He always vomited the rem- 



Periscope and Abstract. 245 

edv used within half an hour, retaining longest the French cap- 
sules of male fern extract. Dr. Perry had made two atteiiipts to 
dislodge the worm, without success, when he saw the chloroform 
treatment noticed in the Medical KclO' d. He used in the fol- 
lowing manner, with entire success: The patient was made to 
fast from 12 m. of the previous da}^, and only allowed to drink 
lemonade. At 7 a.m. he took one drachm chloroform in one 
ounce of mucilage; at 8 a.m. one ounce of ol. ricini. The entire 
worm passed about 10:30 a.m. The patient was in considerable 
stupor shortl}" after taking the chloroform, which stupor lasted 
three or four hours. He was a large man, weighing 180 pounds. 
Dr. Perry thinks that one drachm of chloroform should not be 
exceeded as a dose. 



GUNSHOT WOUND OF THE BRAIN— RECOVERY. 

Dr. Willis Butterfield, of Belvidere, 111., reports to the Med- 
ical Record an interesting case of a little girl, Gertie M , ten 

years of age, who was standing talking to a companion, and 
suddenly' sank down to the ground apparently lifeless. Her 
playmate heard a queer noise, which was the "spud" of the 
bullet, which struck the girl's head an inch above and behind 
the riffht ear. When Dr. Butterfield saw her, a few minutes 
later, she was wholly unconscious, and on the walk where she 
feel was a pool of blood containing about a teaspoonful of brain 
substance. Within half an hour an ecchymotic swelling appeared 
above the e3"eball in the outer part of the right orbit. Blood 
had flowed from the nose immediatel}^ after the injury was re- 
ceived. Dr. John Best, of Arlington Heights, was called in con- 
sultation. The opening in the skull was round and clean cut on 
the outside, but splinters of bone could be felt projecting from 
the inner table. An elastic catheter about the size of the exter- 
nal wound was use for purposes of exploration, as being less 
likely to injure the sound tissue. This passed about two and a 
half inches into the brain and pointed in the direction of the right 
orbit, but the ball could not be detected. On account of the 
swelling and discoloration about the eye it was thought that the 
ball had fractured the orbital plate, though no foreign bod}- could 
be felt in the orbit. The wound was carefully dressed antisep- 
ticallv, all spiculcC of bone projecting from the inner edge of the 
cranial wound being removed. The probing and removal of 
bone fragments caused no pain, but the patient moaned when- 
ever the scalp wound was touched. Two or three hours later 
the child spoke a few rational words, and the mental faculties 
were gradually restored during the next few days. The tem- 



246 The Peoria Medical Monthly. 

perature did not at any time rise above loi F. There was no 
paralysis, and slight headache was complained of during the first 
few days only. In three weeks the child was out-doors at play. 
The right e3'e remained more prominent than the other, and at 
times there was double vision. After having made a number of 
examinations without result, Dr. Buttertield at length discovered 
the ball in the right orbit, between the inner wall and the globe 
of the eye. The patient being anitsthetized, an incision was 
made in the conjunctiva, and a 32-calibre ball extracted. The 
eyesight soon became normal, and the little girl attended school 
the following autumn with all her mental faculties unimpaired. 



SCUTELLARIA LATERIFLORA IN THE TREAT- 
MENT OF ENURESIS. 

Dr. A. H. Winermark, of Cambridge, 111., writes to the 
Medical Record: " Having read the excellent article on enuresis, 
by Dr. Stein, and the remarks of Dr. Willeford upon its treat- 
ment by rhus aromatica, I wish to contribute from my store of 
experience in the treatment of the same difficulty. Some two 
years ago I was advised by an old practitioner to use fluid ex- 
tract of skullcap in a case in my own family, and the result was 
most gratif3-ing. I have since employed it in several cases de- 
pendent upon nervous conditions only, and must say that results 
obtained have always been most satisfactory. A lad, twelve 
years of age, who would urinate from three to six times every 
night during his sleep, and had done so for several years, re- 
ceived one drachm t. i. d. for two weeks, and was speedily and 
permanently cured. All the cases occurred in children." 

Dr. Winermark advises a trial, at least, of Scutellaria when 
other remedies have failed. He disclaims any credit for orig- 
inality in the use of the drug, as he says that it was recom- 
mended to him by another. 



CLASS-ROOM NOTES. 

To slight erosions on the nipples. Prof. Parvin applies tinct. 
benzoin. 

Prof. Bartholow says that the most effective treatment of 
cholera is bv chloral. The effectiveness of this remedy is in- 
creased b}' combination with morphine. 

To wash out the vagina during pregnancy, Prof. Parvin 
recommends the use of a solution of borate of soda, i dr. to pint. 

Prof. Da Costa placed a choreic boy, who was also decid- 
edy lana'mic, upon: 



Periscope and Abstract. 247 

R. Tinct. ferri chlor., 10 drops. 

Arsenici chlor., 1-40 gr. 

Syrupi simplicis, 

Aqua?, aa 2 dr. M. 

SiG. — Ter die. The arsenic to be increased. 

To a caput siiccedaneiim^ Prof. Parvin advises the applica- 
tion of a solution of muriate of ammonium. Do not open it to 
let out the blood, but should pus form make a free incision. 

In summer diarrhcea, the following has been found useful: 

R. Aqua? camphcrte, 3 oz. 

Tinct. lavand. comp., 1 oz, 

Tinct. opii., 1 to 2 dr. M. 

SiG. — Table spoonful every hour or two. 

When a child is very feeble, etc., at birth, Prof. Parvin adds 
whisky to the water in which it is bathed. 

A case of aggravated dyspepsia with constipation was, by 
Prof.. Da Costa, given: 

R. Tinct. capsici, 1 drop. 

Tinct. nucis vom., 8 drops. 

Tine. gent, comp., 1 dr. M. 

SiG — Ter die. With gr. 1-5 aloin at bedtime, and avoid a 

starchy diet. 

A young girl, aged 15 years, was shown to the class by 
Prof. Parvin, complaining of severe backache and constipation. 
She menstruated once every two weeks — was given quinine, gr. 
V daily, and arom. sulphuric acid, gtt. x twice daih'-; bran y^ oz. 
in water, at night, for bowels. 

In the early stage of a case of pneumonia. Prof. Da Costa 
gave : 

R. Tinct. verat. virid., 3 drops. 

Liquor, potass, citratis, 3 dr. 

Spirit, ieth. nitrosi, 2 dr. 

Syrup zingiberis, ad \ oz. M. 

SiG — .Every three hours. 

In chlorosis, the following has often been of avail: 

R. Ferri sulphat. exsic. 2 scruples. 

Quiniuie sulph., 1 scruple. 

Strychninre sulph., \ gr. 

Ft. pil. No. XX. 
SiG —One pil, three times a day — (Bartholow.) 

In a case of locomotor ataxia, where the patient had been 
pretty thoroughly saturated with silver. Prof. Da Costa, to tone 
up the system, gave: 



248 The Peoria Medical Monthly. 

R. Syrup, hypophosphit, 1 dr. 

Strychniuie, 1-60 gr. M. 

SiG. — Ter die. 

Prof. Bartholow savs that for haemoptysis "ipecacuhana is 
a remarkable physiological remedv."' In a case at the clinic it 
was given in combination, as follows: 

R. Ext. ipecacc. fluidi, 

Ext. ergot, fluid, aa 5 drops. M. 

SiG. — At a dose. 

In cases of leucorrhcea, associated with granular vaginitis, 
Prof. Parvin uses for the latter condition nitrate of silver, com- 
bined with a tampon saturated with i dr. each of alum and bis- 
muth. The tampon to remain twenty-four hours. For simple 
cases of leucorrhoea, he uses an injection of chlorate of potassium, 
I dr. to pint. 

The following combination, Prof. Bartholow's, for asthmatic 
attacks, has been found very useful: 

R. Ext. grindelise fluid., i oz. 

Ext. lobelicT fluid., 2 dr. 

Ext. belladon, fluid., 1 dr. 

Potassii iodidi, 3 dr. 

Glycerini, 3 oz. M. 

SiG. — Tablespoonful as required. 

Prof. Parvin placed a woman with uterine fibroid, upon the 
following : 

R. Ergotin., 1 gr. 

Ferri sulph. exsic, 1 gr. • M. 

Ft. pil. No. 1. 
SiG. — Ter die. Persistently used. 

For the accompanving hemorrhages a tampon saturated with 
tinct. iodine or Monsell's solution. 

A bov, xt: 18, a painter, was, the subject of lead poisoning. 
Had great pain at defecation, etc. Was given, by Prof. Da 
Costa: 

R. Ext. belladon. i gr. 

Rhei, 2 gr. M. 

Ft. pil. _ . _ 

SiG. — One moruin*:: and evening. 



Also; 



R. Pottassi iodidi, 10 gr. 

Ter die, until lines on gums disappear. 

— Col /cor (Did Clinic Record. 



Periscope and Abstract. 249 

ACUTE DYSENTERY. 
Prof. Da Costa placed a man with acute dysentery upon a 
diet of arrow-root, corn-starch and broth; an opium suppos., i 
gr., morning and night, to which was added rest and: 

R. Plumbi acetat., 2 gr. 

Ipecacuanha, i gr. 

Pulv. opii, 4 gr. M. 

SiG. — Give every two hours until blood disappears, then 

lengthen the intervals. 



CONSTIPATION. 

When there is atony or parah'sis of the muscular coat of 
the intestines, belladonna is an especiall}- valuable remedy. Five 
to ten drops of the tincture three times a day will often correct 
most obstinate constipation from this cause. The following pre- 
scription will be found serviceable where belladonna alone will 
not suffice: 

Ext. belladonna, 2 gr. 

Ext nucis vomica, 8 gr. 

Ext. aloes soc. aquos, 16 gr. 

]M. ft. pil. 16. Sig: One to four pills daily. 

For nervous constipation the following is recommended: 

Pulv. ferri sulphatis, li gr. 

Aloes socot, f gr. 

Ext. belladonna, i to 1-6 gr. 
One pill. One to four daily. 

Dr. Bartholow prescribes the following in many^cases of 
constipation with good effect: 

Tinct. nucis physostigmatis, 

Tinct. vomica, 

Tinct. belladonna, aa 2 dr. 

M. Sig: Thirty drops, in water, morning and evening. 

In habitual constipation, Dr. F. W. Pavy recommends the 
following pill: 

Pilluhe rhei comp., 2 to 3 gr. 

Pulveris capsici, 1 gr. 

To be taken with the food, and repeated daily, as occasion 
requires. 

Dr. Horace Dobell says the following formula is one of the 
most satisfactory he has ever tried : 

Podophyllin, , 2 gr. 

Essence of ginger, 2 dr. 

Alcohol, 2 oz. 

M. Sicr: A teaspoonful at bed time, in a wine-glassful of 
water, nightlv or every second or third night. 

' — Indiana J/ed. Jour. 



THE 

Peoria Medical Monthly. 



THOS. M. McILVAINE, A. M., M. D., 

Editor (i)id Publisher. 
204 S. Jefferson St., Peoria, III. 



***The Hflitor is not responsible for the statements or opinions of contributors. 

***Short original articles are invited from any reader, whether a subscriber or not. 

*:i:*If extra copies are desired by a contributor, the number must be specified when the 
article is sent to the Editor. 

*-;!*All exchanges, books for review, and communications must be addressed to the Editor 
and Publisher. 

***The publication day of this journal is on or about the 2.5th of each month. 



EDITORIAL. 

OUR LAST EXPLANATION. 

For the past three months the work of pubHshing this jour- 
nal has been the hardest of its whole six year's history. Delay 
has been constant and inevitable, do what we could to prevent it; 
and our position was such that we could not make a sufficient 
explanation to our readers of its cause. The delay this month 
has been greater than ever before, but we feel happy to say it is 
the last of our tribulations in that direction. Our old printer was 
financially embarrassed and ended up in August by an assign- 
ment, which tied up the work on the Monthly until the Tran- 
script Company could regain possession of the office. Then 
some scoundrel broke into the press room just when things were 
beginning to run smoothly again, and broke the presses and en- 
gine in such a way that a further delay was caused. Now, we 
hope, our trials are over and that next month (this month) we 
will be out on time. 



THE PROGRESS OF THE WAR. 

No severe engagement has taken place since our last report, 
but skirmishing all along the Une has been the order of the day. 



Editorial Department. 25E 

Circulars, pamphlets and letters are flying thick as leaves in Val- 
ambrosa, and charges and counter-charges, denials and re-denials 
iill up the correspondence departments in those journals most 
actively engaged. 

Instead of waiting until next Mav, the New I. M. Congress 
Committee hold another meetincr in New York to-dav, thus. 
" carrving the war into Africa " so to speak. 

Dr. Davis has delivered some scathing rebukes to the recal- 
citrants, in the 'Journal of the x\ssociation, and he has been an- 
swered bv the Record^ iSfezos and others. 

Some more appointees have withdrawn, the total number of 
withdrawals now being: in the neighborhood of one hundred and 
fifty: Still with the couple of thousand members of the Amer- 
ican Medical Association still remaining, it will not be hard to 
find enough to accept places in the Congress, to fill all vacancies- 



MEDICAL EXPERTS. 

The Chicago Tribune thus pa3's its compliments to that class 
of physicians existing only in large cities, known as medical ex- 
perts. It savs : " Reil's form of insanity is classed by one med- 
ical expert as ' magnalomania.' If it were not for medical ex- 
perts this world would be a dull place. Since the death of Ar- 
temus Ward's kangaroo they are, b}' all odds, the most 'amoosin* 
things in existence. They are so earnest too, with their theories, 
and their oroide classical nomenclature." 

We wonder what the writer of the above would say, were 
he to run across a full-fledged, ardent, aspiring gynecologist. 



A GRAA^E CHARGE CLEARED UP. 

Judge Rodgers quashed the capias writ issued against Dr. 
John V. Shoemaker, of Philadelphia, at the suit of Henry A, 
Merritt, of Trov, X. Y., because the aflidavit on which the writ 
was issued zuas on information and belief, and not tifon positive 
and tmdonbted knozvledge. In releasing Dr. Shoemaker's bail, 
the Court expressed his regrets at having granted the writ. Dr.. 
Shoemaker is a well-known physician of Philadelphia, and was. 



252 The Peoria Medical Monthly. 

charged by Merritt with having misstated the amount of money 
expended in taking his (Merritt's) sister with himself and wife 
on a European tour. The doctor maintained that he had done 
no such thing, but had rendered an account to Merritt for only 
so much money as had been spent. He claimed that Merritt did 
not state the facts positively, because they were untrue, and that 
the suit was brought for no other purpose than blackmail. — Chi- 
cago Times. 

We congratulate Dr. Shoemaker on being acquitted of the 
grave charge made against him, and hope he will keep out of all 
sorts of trouble in the future. 



MEDICAL ADVERTISING. 
Doctors who want to break loose from ethics and advertise, 
should remember that unless they carry it to extremes, there 
wiU alwavs be some who will make larger displays and thus 
get ahead of their less pushing competitors, and the modest 
advertisers will be just as bad off as the}' are now. "Dr." J. I. 
Lighthall is now in Peoria, with a brass band, singers, gymnasts, 
etc., and is said to be taking in over five hundred dollars daily. 
He has about twenty tents of various sizes, and a large audience 
tent capable of holding several thousand. He pulls teeth free, 
and since his stay here must have pulled a peck a da3\ He is 
certainlv a very speedy extractor. He calls himself the " dia- 
mond king," wearing $30,000 worth of jewels on his person. 
His watch chain of solid gold is as large as a trace chain; his 
watch is encrusted with jewels and is worth $2,500. We men- 
tion these things to show what advertising means by a medical 
man, and to what an extent others must carry it before they can 
hope to compete with '• diamond kings." We do not know by 
what right he practices, except that he pavs a hcense of one 
hundred dollars a month. 



A LAY EDITOR'S ETHICS. 

We take the following •' advice to a young doctor " from the 
columns of the Brooklyn EagJe^ and reprint it as a curiosit}'. It 
contains some advice that is good, but also displays the usual lay 
ignorance of professional ethics: 



I 



THE HIGHEST AWARD, 

GOLD MEDAL, 

Has been granted to 

MELLIN'S FOOD 

FOR INFANTS AND INVALIDS, 

At the World's Exposition, New Orleans. 

1885. 



Dolibar, Goodale & Co., 

40, 41, 42 & 43 Central Wharf, BOSTON, MASS. 



A Sample of MELLIN'S FOOD, Sufficient for trial, will be sent free 
to any Physician desiring it 



NON-ALCOHOLIC. NON-RESINOUS 

BLAND AND UNIRRITATING. 

FLUID HYDRASTIS. 

A definite and permanent solution of the Alkaloids of Golden Seal Eoot, 
viz: 

B E R B E R I N A— Of a bright yeliow color, the salts of which are known in com- 
merce as .Sulphate, Muriate and Phosphate Berberiua (Hydrastia.) 

Hydrastia, crystallizing in icliite prismatic forms and insoluble in water. 

Xanthopucclna, or the unknown third alkaloid, of a dark yellow color, but 
Which has never been carefully isolated, ahd is unknown in commerce. 

The use of Fluid Hydrastis is suggested in all affections of the mucous sor- 
faces ; correcting abnormal conditions characterized by profuse discharge of tenacious 
mucous, subcute inflammation, erosions and superficial ulceratiow. 



McDade^s Prescription 

FOR 

VENEREAL AND CUTANEOUS DISEASES. 



FORMULA. 

Fluid Ext. Smilax Sarsaparilla, 
Fluid Ext. Stillingia Sj'lvatica, 
Fluid Ext. Lappa Minor, 

Fluid Ext. Phytolacca Decandra, a a, two ounces. 
Tiuct. Xanthoxyllum Carolinianum, one ounce. 
Mix— Take a teaspoonful in water three times a day before meals, and gradually 
Increase to tablespoonful doses. 

CAUTION. 

"In making the Fluid Extracts there is great risk of getting a remedy less efficient 
than the original Indian decoction, because the manufacturer may use roots that have 
been kept too long and lost some of their active principles ; while the decoction used 
on the plantations was always made of Fresh Roots just gathered from the 
■woods. In making the Fluid Extracts we should, therefore, be careful to have them 
made from roots receutlj' gathered." 

REMARKS. 

The Wii. S. Merrell Chemical Co. of Cincinnati offer the formula of Dr. 
McDade, prepared in accordance with t'ae principles so strenuously held by them for 
more than thirty years, viz., that the volatile elements of many plants are dissipated 
by the drying process, thereby injurihg, if not wholly destroying, their medical proper- 
ties. 

PRICE, $12.00 per Dozen. $1.25 per Pint. 

Green Plant and other Fluid Extracts.— Merrell. 

These remedies are positive Medicinal ngenls:— positive, not because they!wi!i 
invariably cure disease, but because their sensitive properties are definiti:, unifonn\s.nA. 
certain. Send for our paper on the subject of "-Green Plant Fluid Extracts." 



Agents for Peoria and Central Illinois. 

SINGER & WHEELER, ] 
COLBURN, BIRKS & CO., ^p^ia 111 
SUTLIFF, SHULTZ & CO., | ^^^^^^^ ^^^* 
ROBT. A. KING. J 



Editorial Department. 253 

Do not be persuaded by foolish friends to plant 3'ourself in 
any new quarter of the city. All new colonies are fatal to any 
early enterprise, the first settlers only clear the way for those who 
follow, and are regularl}- ruined for the benefit of posterity. 
When you have taken a house and put your brass plate on the 
door, you cannot do better than go abroad for four or five years. 
At vour return vou will probably find that no one has inquired 
for you, which must be very consolatory to your feelings, inas- 
much as it will show you have lost nothing by your absence, and 
have yet given the world time to begin to ascertain there is such 
a person in existence as yourself. Having familiarized people 
with your name, it behooves you then to give it notoriety ; there- 
fore lose no time in getting into print. You cannot lay out a 
couple of hundred dollars to better advantage than publishing a 
pamphlet on any popular medical subject. A treatise on indi- 
gestion has gained many a physician a sumptuous dinner. Mott, 
Francis, Buck, furnish excellent examples of the sort of alchemy 
which transmits a grievous dyspepsia to a groaning table. " So 
many dishes," sa3^s Seneca, " so many disorders," but vice versa 
with the doctors, so many disorders, so many dishes. 

The great majority of mankind are fools — that large portion 
vou are to live by; therefore mystify 3'our patients. When you 
talk to them, let it be in King Camb3-ses' vein. The ears of the 
million are easilv captivated; when once their senses are con- 
founded, the3' have naturalh^ a reveration for anvthing the3' do 
not understand. In brief, in all vour dealings with men, remem- 
ber you have to do with folks who, according to the Latin prov- 
erb, " have all at some time been insane." Never give a direct 
answer to a patient's question, never commit 3'ourself b3- entering 
into explanation with the friends. To the sick man 3-ou cannot 
put too few question ; to the relatives 3'ou can never give too few 
replies. 

The great art of a ph3'sician is to gain the confidence of the 
patient, and for that purpose his first object should be to inspire 
him with hope. It is not a hesitating manner or a melanchol3^ 
mien which is calculated to raise the drooping spirits of the sick ; 
it is not a hangman's look or a mute's demeanor that is likeh* to 
lend the physiognom3' of the physician the character of a mes- 



254 The Peoria Medical Monthly. 

senger of glad tidings, who comes with healing on his wings and 
the gift of health in his right hand; it is not the timid eye, the 
irresolute tread, the frivolous tongue, the fearful voice, or the 
foolish simper of servile acquiescence with the opinions of the 
friends or the prejudices of the attendants of the sick, which are 
at all favorable to the production of that faith which can remove 
diseases which have been mountains to mere medicine. 

Never refuse a fee from any person who is able to give one, 
in order that you may never have occasion to take one from a 
man who is too poor to well afford one. It matters not how 
mercenary you may be accounted b}' the rich, so long as you are 
merciful to the poor. If 3'ou can not get fees without depriving 
them of bread, it were better you had never been a doctor. 
Your friends nor your familiars have any claim on your skill, 
whatever they may have on your affection. If they are entitled 
to your gratuitous attendance a large connection would be a great 
evil to a physician. Were you a merchant they \vould not ask 
your goods without an equivalent, and surely because you are a 
man of science they cannot expect the still more precious chat- 
tels of the mind without an}' compensation. 

To obtain practice be sure to enlist the service on your side 
of the pastors of all denominations in your neighborhood, and 
pay your court assiduously to the influential women, but above 
all, if in the country, to the one or two charitable ladies, -par ex- 
cellence, who are to be found in every town, devoting a life of 
single blessedness and all the leisure of neglected beauty and im- 
perishable celibacy to the service of religion and humanity. Be 
sure that buy golden opinions of these good women, for with all 
their active benevolence they have a large portion of their leisure 
to bestow on the privacy of their friends and neighbors, and 
heaven defend the reputation of that poor wretch who, at the 
terrible Areopagus of their tea table, is consigned to the tender 
mercies of their envenomed tongues. 

Avoid the society of your patients. Physicians should have 
no familiars; to be thoroughly respected, they must stand aloof 
from the gaze of society. A prophet has no power in his own 
country, neither has a physician in his own circle. Without skill 
it is impossible to become a flourishing physician, but without 



Editorial Department. 255 

good manners all the skill of the most eminent physicians will not 
avail you in a large capital. A good address is everything to a 
doctor. The public are incapable of judging of a medical man's 
real knowledge; the only way thev have of forming an opinion, 
therefore, is by analogy, by scrutinizing those superficial qual- 
ities and the outward and visible signs of them, which come im- 
mediately wathin the narrow sphere of their comprehension. If 
his manners be good, thev give his mind credit for the advan- 
tage. 

The last and greatest precept of all is: Never violate in 
thought, word or deed the sanctitv of the sick chamber! He is 
a villain who reveals the secrets of that prison house, where pure 
humanit}^ lies bare and helpless: he is a traitor to his profession 
who gossips about the infirmities he is called to relieve; he is un- 
worthy the name of a physician who, abusing the confidence 
which is reposed in his humanity and his honor, has no sooner 
turned from the bedside of the patient than the infirmities he has 
witnessed become the subject of a ribald jest. 



The Mississippi Vallev Medical Society will meet in Evans- 
ville, Ind., September 8th, 9th and loth. This is the second 
largest Medical Societv in the countrv and is always largely 
attended. It has no constitution, or bv-laws, and its sessions 
are given up entirely to legitimate business. 



The Illinois State Board of Health is now engaged in re- 
vising the "Official Register of Ph^'sicians and Midwives." 

Any notification of changes, omissions, or errors will be 
regarded as a favor, as the Board wishes to make the coming 
register as near correct as possible. Address, Secretary State 
Board Health, Springfield, 111. 



Dr. John Ten Brook of Paris, Edgar Co., 111., died at his 
home, August 8, 1885, aged 77 years. Dr. Ten Brook was one 
of the oldest practitioners in this State; he was a graduate of 
the Jefferson Medical College in 1838, and had practiced in Illi- 
nois for about 48 years. 



256 The Peoria Medical Monthly 

BOOK NOTICES. 



Elements of Modern Medicine — Including Principles of Pa- 
thology and Therapeutics with many useful memoranda 
and valuable tables for reference. Designed for the use of 
Students and Practitioners of Medicine. — By R. French 
Stone, M. D., Professor of Materia Medica, Therapeutics 
and Clinical Medicine in the Central College of Physicians 
and Surgeons, Indianapohs, Ind., etc., etc. i2mo; pp. 368, 
Leather, tucks. D. x\ppleton & Co., New York. 1885. 
As stated by the author in his preface, " The design has 
been to not only present m a regular and systematic order, the 
general principles of pathology and therapeutics and in the light 
of present knowledge to harmonize these principles with one 
another, but to simplify and to facilitate their appHcation to the 
investigation and management of individual cases." 

Apart from the small size of the type used, we have no fault 
to find with this work. It admirably fills the design of the 
author as a text-book for the use of students, and as a ready 
reference book for the use of practioners. The author is evi- 
dently a man not only of fine education, but also a practical man, 
and we venture to say a competent teacher and successful prac- 
tioner. A book written by a man of this kind is always worth 
reading and a place for frequent reference. This volume is of 
convenient size and shape to carry in the pocket, and we doubt 
not will have a handsome welcome. 

Poisons — Their Effects and Detection. A manual for the 
use of analytical chemists and experts. With an introductory 
essay on the Growth of Modern Toxicology. — By Alexan- 
der Blyth, M.R.C.S.F.C.S., etc. With tables and illustra- 
tions. Cloth, 8vo; pp. 334. Vol. II. Wm. Wood & Co., 
New York. 
The first volume of this standard work was noticed in the 

June issue of this journal. This volume completes the work. 

On Renal and Urinary Affections. Miscellaneous Af- 
fections OF the Kidneys and Urine, — By W. Howship 
Dickinson, M.D., (Cantab.), F.R.C.P., etc., etc. Cloth, 
8vo: pp. 343. Wm. Wood & Co., New York. 1SS5. 



Editorial Department. 257 

This work is the second of a series on Diseases of the Kid- 
neys by this distinguished cHnician and author; the lirst of which, 
a treaties on Albuminuria was printed in Woocfs Library of Stan- 
dard Medical Authors for 1 88 1. The position of Dr. Dickinson 
as an authority on renal diseases is such, that any work from his 
pen is at once accorded a high rank in medical literature. Treat- 
ing as it does of a variety of different diseases of the kidneys, 
this yolume is one of the most practical and generally useful that 
IVood^s Library has yet giyen us. 

A Treatise on Epidemic Cholera and Allied Diseases. — 
Bv A. B. Palmer, M.D., L.L.D., Professor of Pathology, 
Practice of Medicine and Clinical Medicine in the College of 
Medicine and Surgery in the University of Michigan. Au- 
thor of a work on the Science and Practice of Medicine, 
etc., etc. Cloth, i2mo: pp. 224. Register Publishing 
Honse, Ann Arbor, Mich. 1885. $1.00. 
This publication, so timely in view of the possible visitation 
of epidemic cholera in this country, consists of a volume of about 
200 pages, neatly and substantially gotten up, and bound in 
cloth. It contains a summar}' of the literature on the subject 
brought down to the present time, including the recent investi- 
gations of Koch and others; and in it the causes, methods of pre- 
vention and treatment are fully discussed, and definite directions 
given. 

The reputation of the writer as a practitioner, teacher, and 
writer, and his large experience in cholera during three seasons 
of its prevalence in Chicago, is a guarantee of the character of 
the work. 

The Technologv of Bacteria Investigation. Concise di- 
rection for the study of bacteria, their culture, staining, 
inoculation, mounting, etc., according to the methods em- 
ployed by the most eminent Microbists. — Bv Dr. C. S» 
DoLLEY. pp. 263; i2mo, Cloth. S. E. Cassino & Co., 41 
Arch St., Boston, Mass. Price $2.00. 

There is nothing as yet in English, or in any language, 
that gives the physician and investigator the methods employed 
by such men as Pasteur, Koch, Erlich, Weigertz, etc., and it if 
believed a book giving concise directions where to look for and 



258 The Feoria Medical Monthly. 

how to study the different forms, especial!}- those having a pa- 
thogenic significance, will be gladly welcomed, especially at this 
time when there is such widespread interest in the etiology of 
■certain infectious diseases. It is also hoped that the publication 
of this work will stimulate original work among American inves- 
tigators in this department, as heretofore b}- far the greater 
amount of the work has been done by European. The follow- 
ing is a summary of the work: 

General Introductory Remarks. 

Chapter I. Microscopical Preparations. — (i) Stud}- of liv- 
ing forms; (2) Study of fixed forms — ((?) without staining, (/;) 
by staining; (3) Methods of making preparations of the Bacilli 
of Anthrax, Glanders, Hog Cholera, Lepra, Septicaemia, Tuber- 
culosis, Typhoid Fever, the Micrococci of Gonorrhoea, Infectious 
Myelitis, Pneumonia, Rabies, etc., according to the methods of 
Weigertz, Kaatzer, Koch, Babes, Baumgarten, Erlich, Flugge, 
Rindfleish, Gibbes, Frankels, etc. 

Chapter II. Study of Bacteria by Culture. — (i) Culture 
vessels; (2) Culture media; (3) Introduction of media into cul- 
ture vessels; (4) Sowing microbes in culture media; (5) Carry- 
ing on the culture. 

Chapter III. Vaccination Method of Studying Bacteria.. — 
Bacillus Anthracis, Chicken Cholera, Bacillus of Tuberculosis. 

Chapter IV. Study of Bacteria by Biological Analysis. — 
Engelmann's method; Metschnikoff's method. 

Chapter V. Fornudce., etc. 

Second Report of the State Board of Health of the 
State of Tennessee, October 1880 to December 1884. 
Cloth, 8vo; pp. 600. A. B. Tavel, State Printer. 1885. 
This report contains many valuable papers on subjects re- 
lating to hygiene and sanitary matters. The gentlemen comprising 
the Board are active and energetic and take a lively interest in 
the sanitary affairs of their State. The Report is well gotten 
up and finely indexed. 

Transactions of the Louisiana State Medical Society — 
At its Seventh Annual Session held at New Orleans. 1885. 
8vo; paper, pp. 184. 



Editorial Deqartment. 259 

Contains many interesting papers. As usual in such cases 
the President's address is the longest paper in the volume. The 
article on Hemorrhagic Malarial Fever is worthy of especial note. 



OUR ADVERTISERS. 

The advertising department of a medical journal is by no means the 
least important. What would a newspaper be worth without advertise- 
ments ? A physician who keeps himself thoroughly posted, must read the 
announcements of medical houses in his journal. All notices made in 
the reading pages of this journal are made of our own accord, without 
pay, for the triangular benefit of our readers, our advertising patrons and 
our journal. Nearly all of our advertisers will forward samples of their 
goods to physicians if they mention the Peoria Medical Monthly in. 
the request. 

John Wyeth & Co. claim absolute accuracy of dose, ready and en- 
tire solubility and perfect preservation of the drug, for their Hypodermic 
Tablets. A full list will be found on page 15. We have tried them 
and know them to be perfectly reliable. 

H. Planten & Son, 224 William street. New York, established 
1836, the well-known manufacturers of capsules for medical use, are in- 
troducing to the medical profession, druggists and the public, several 
new kinds of their excellent Filled Cajmdea. Besides their so-called 
"black" capsules (com. cap. and oil of cub.), and other standard kinds, 
which in quality, size and price are unsurpassed by any other brand in 
the market, they now offer pure East India sandal wood oil, either in 
hard or soft capsules, and recently oil of ivintergreen, which, in rheuma- 
tism, is regarded as a specific by the medical profession. This firm was 
the first to introduce that so highly valuable article empty capsules. They 
have improved their manufacture in such a degree that their brand main- 
tains its old high place among the best. They ofler now the largest va- 
riety and are the cheapest in the market. 

The New York Pharmacal Association wish to call your attention 
to their advertisement on page 2, in which they claim to have the most 
important remedial agent ever presented to the profession for dyspepsia, 
vomiting in pregnancy, cholera infantum, constipation, etc. 

Nervous Prostration and Brain Troubles. — For some time 
past I have used Celerina in my practice. I used it first in a case of 
nervous prostration and found it a success when other remedies failed. 
Would recommend it in all nervous diseases or brain troubles. I find it 
soothing, lasting and permanent in its effects, and in many cases of ner- 
vous debility and loss of will jjower in certain directions, produced by- 
indiscretions, etc., I consider it an invaluable remedy. 

L. Andrews, M.D. 

I TRIED ''Peacock's Fucus Marina," in two cases of typho-malarial 
fever (or remittant bilious fever with typhoid complications ) tuith success^ 
and I also used it in one case of jaundice with the best results. 

P. McA DA J ; 



26o The Peoria Medical Monthly. 

I HEARTILY recommend Bromidia as one of the best hypnotics I 
ever used. I know whereof I speak when I sing the praises of " King" 
Bromidia. T. A. Gibson, M.D. 

Williamsburg, Miss. 

AV. A. WaPwNER & Co. have received the first premium at the 
World's Exposition, New Orleans, for great uniformity and solubility for 
their Sugar-Coated Pills. This is the 9th World's Fair Prize which 
attests to their excellence. 

Others will be mentioned in following numbers, also other articles of 
value, even if they are not advertisers. 



RECEIPTS. 



The date following each name, indicates where the amount 
credited extends the subscription: 

Illinois— Drs. L. S. Halsey (2.00), June, 1886; A. W.' H. Keen 
(2.00), May, 1886; P. C. Robinson (2.00), May, 1889; D. W. Magee 
(4.00), June, 1886; A. E. Gibbs (2.50), November, 1>85; W. H. Gith- 
ens (2.00), August, 1886; R. W. Bower (3.00), August, 1886; W. D. 
Karns (100), November, 1885; Jno. Gary (2.00), May, 1886; S. F. 
Sanders ( 2.00), September, 1885; R. L. Henry (1.00), November, 1885; 
R. Roskoten (300), May, 1886; H. N. Baldwin (1.50), July, 1885; 
C. E. Harnsberger (3.00), September, 1886; J. M. Ansley (1.00), De- 
cember, 1885; W. E. Guthrie (3.00), January, 1886; H. A. Raney 
(2 00), October, 1885; E. H. Keith (2.00), May, 1886; Wm. A. Bvrd 
(2.00), May, 1886; Robt. Boal (2.00), May, 1886; S. O. Loughridge 
(6.00), May, 1886; C M. Baker (2.00), Map, 188^; Jno. H. Ranch 
(2.00), November, 1885; G. L. Corcoran (2.00), January, 1886; J. J. 
Thometz (2.00), August, 1885; C. M. Miller (2.00), 31ay, 1886; J. S. 
Blankenship (2.00), May, 1886; J. N. Speed (2.00), May, 1886; W. N. 
Cline (2.00), May, 1886; N. Holton, (2.00), >f ay. 1886. 

Iowa— Drs. M. I. Powers (1.00), October, 1885; D. W. Jackson 
(2.50), May, 1886; R. Stephenson, Jr., (1.00), November, 1885; J. W. 
Campbell (3.00), January, 1885. 

Michigan— Dr. A. Garwood (2.00), June. 1886. 

Washington, D. C. — Library Surgeon General's Office (2.00), 
May, 1886. 

Dakota— Dr. A. P. Bryan (1.00), July, 1885. 
■ Wisconsin— Drs. A. Edwards (2.50), August, 1886; J. E. Marsh 
(2.50), January, 1886. 

Missouri — Dr. J. Seererv (1.00), August, 1885. 

Minnesota— Drs. A. P. Whitman (2^00), July, 1886; H. G. Mur- 
doch (2.00), May, 1886. 

Florida- Dr. L. R. Quackenbush (2.00), November, 1885. 

Kansas— Dr. D'. C. Tyler (2.00), February, 1886. 

Ohio— Dr. S. W. Mercer (1.00), November, 1885. 



The Peoria 
MEDICAL MONTHLY. 



Vol. VI. ; : SEPTEMBER : 1885 : : No. 5. 



ORIGINAL COMMUNICATIONS. 
THE CAUSE OF IMMUNITY IN DISEASE. 

BY DR. ROMAINE J. CURTISS, JOLIET, ILL. 

In the July number of the Monthly, I proposed the doc- 
trine of natural selection as the explanation of the fact of immu- 
nity in disease, and signified my intention of considering the 
other theories that have been advanced to explain the various 
phenomena which belong to contagion and immunity. 

" A Writer," I am pleased to see, feels an interest in this 
subject sufficient to give me a review in the August number. 
On reading his paper I am happy to agree with him on a few of 
his points, viz: " Scientific phrases have a lovely and captivating 
sound;" " An}^ physician of experience could give a very good 
guess as to what persons would be likely to be affected by dif- 
ferent kinds of weather;" " When certain diseases are rampant 
(what is rampant, anyhow?) we fear for the constitution of cer- 
tain persons;" " Given the color of the hair, eyes, skin, the chest, 
abdominal and head measurements, their place of birth, sex, age, 
residence and occupation, and a little of their personal history, 
and it is not hard to forecast their morbid future." 

I suppose the above " aphorisms " are not " quasi-scientific," 
but I can't see what relation they have to the immunity in dis- 
ease. It appears that the writer does not either, but a little fur- 
ther on he proposes his theory for all the phenomena of immu- 
nity, in these words; "The eternal fitness of things." 



262 The Peoria Medical Monthly. 

Now that the matter has beeij satisfactorily decided, it 
would appear to be useless to consider it further, but as this ex- 
planation of the " eternal fitness " must come up in conflict with 
other theories that have been proposed, I may as well bring up 
the other theories and compare them with the theory of natural 
selection, and with this later '• corruscation of brilliance " the 
theory of the " eternal fitness of things." I wonder if we can 
class phenomena as well as things under this head?) 

I must premise, however, that I am sorry to have brought 
up easy cases of variation and atavism, which are really " not 
Darwinian." The adjuster of " eternal fitness" in medical mat- 
ters thinks that the callous formed on the hand bv rowing a 
boat and its subsequent removal is not a variation and an atavism. 
Well, I am willing to admit that it belongs to " eternal fitness " 
(no use disputing small points), but I rather think that the 
whole process comes under the head of physiological variations 
and atavism also. The combat of the cells of the skin with the 
oar certainly produces a variation in the form, size, number and 
enlargement of the cells, the object being to enable the skin to 
endure friction. Now, when the cause of this variation has been 
removed, this variation necessaril}- changes — ^the skin resumes 
the form it had before. This change is plwsiological atavism, 
or else there is no such thincr as atavism. 

By the use of this special instance, I did not expect to illus- 
trate the whole phenomena of variation, atavism, and hereditary 
descent, or explain all there is in natural selection. I used the 
special instance for all it was worth and no more. It may be a 
better explanation to say that a callous forms on the hand by 
rowing a boat, and afterwards goes off again b}' the " eternal 
fitness of things," but though this explanation bears the stamp 
of science and devoutness, it is " hard " to understand. 

But our reviewer thinks natural selection can't explain the 
facts of immunity in disease, because it is too slow in action. 
Natural selection, he quotes, is slow, and " zvill S'00)i banish tJic 
belief of any sudden or great modification of structure.'''' This 
is all true, I suppose, except as natural selection acts upon belief, 
and it is for this reason that natural selection is capable of cxt 
plaining the immunity in disease. 



I 



Original Communications. 263 

Man\' centuries of time have elapsed since history gives us 
an account of disease. This history tells us about the great 
epide;nics which overran Europe in the middle ages. History 
tells us about their rise and fall, and that they declined to all 
appearance spontaneously. If it were not true that natural 
selection acts slowly, it could not explain the decline of the great 
epidemics, but I hold that it does explain their decline. It may 
be possible that if our scientific and devout reviewer had been 
in Europe during the middle ages, and had measured the people's 
" chests and abdomens," and noted the " color of their eyes and 
hair," that he could have prophesied, from these data, just when 
the epidemics would decline by "eternal fitness," but ps these 
data are not at hand now, I have the honor to suggest the slow- 
going law of natural selection as the explanation. 

But the real animus of our critic's remarks appears to be 
his assumed devoutness. He says, " No half-way developed 
animals are found in the earth alive." "Moses is said to have 
made mistakes," " but so far science is with him, and God saw 
everything he had made, and behold it was very good." From 
this remark I infer that the critic thinks natural selection is 
" quasi-science," and don't believe it anyhow. He reminds me 
of another alleged devout man who lived in the times of Coper- 
nicus, and who believed the world was round, not because 
" Moses made mistakes," but because " in the second comiitg of 
the Lord the people who lived on the other side couldn't see him 
come." It may be that one of the things the Lord saw and pro- 
nounced "good" was the general biological law of natural selec- 
tion, and He no doubt made the world round and called it 
"good." At any rate the people who are looking for the 
second coming do not appear to be disturbed by the spherical 
character of the earth. But our critic now turns over, and like 
a restless sleeper, lies on the other side awhile. He says that 
" it is not to be wondered at that continued exposure to destruc- 
tive agencies may result in such changes of tissues as to secure 
entire immunity. When exposure ceases it is not unreasonable 
to believe that they retm-n to their normal condition." Now I 
can put no other construction upon these propositions than the 
admission of the doctrine of natural selection. Of course the 



364 The Peoria Medical MoxNthly. 

language is ambiguous, and I don't know what is meant by 
" destructive agencies," but I suppose the writer chooses an am- 
biguous method to escape being "sonorous," or "quasi-scientific," 
or "giving a title to an essay," or a "dogbite," or some other 
original elegance of expression. 

But in addition to the doctrine of " eternal fitness," and that 
of natural selection, are one or two more which have been sug- 
gested to explain the immunity from disease. The first of these 
is based upon a peculiar property or physiology of bacteria, 
which is that the physiological waste of a given species may act 
as a poison to another given species, and also to the same spe- 
cies. An instance may be given by the well known fact that the 
yeast organism will live and prosper in a mixture of sugar and 
water, and consume it, and convert the material into alcohol — - 
the alcohol being the physiological waste product of the yeast 
organism. Now the yeast organism cannot live in alcohol, its 
own waste product, and many other organisms cannot either. In 
fact, there are no species of living organisms known which can 
live in their own waste products, except the citizens of Chicago, 
who seem to prosper by drinking their own sewage. The 
theory of immunity, based upon this fact is, that the organisms 
of disease leave their waste products in the tissues of the dis- 
eased person, and the result is that other colonies of the same 
disease organisms cannot exist in the same person, by reason of 
the presence of these waste products in the tissues. This is the- 
ory one. The theory rests of course upon the assumption that 
the waste products of the micro-organisms do stay in the tissues, 
but is not proven because these products ought to be found, if 
they are there, and they never have been found. 

Theory No. 2, is based upon the diet question. It assumes 
that different species of bacteria have an affinity for certain tis- 
sues as a diet. When the organisms of a given disease attack 
the body, they consume all the tissue to which they are " adapted 
in the eternal fitness of things," and consequently the person has 
an immunity from this disease until the tissue is repaired. 

This theory rests upon the assumption that certain tissues 
in disease are entirely consumed, or at least certain chemical 
constituents; but if this were true the microscope would cer- 



Original Communications. 265 

tainly be able to demonstrate the fact, which has not been done. 

Theory No. 3, is called the oxygen theory, and was pro- 
posed by Dr. Salmon. It assumes that the microbe gets into 
the body of man by accident, and not as the final result of natural 
selection in its development, or adaptation, or the " eternal fitness 
of things." (This fitness reminds me of the doctor who could 
cure anything by changing it to fits, then curing the fits.) But 
Salmon's theory assumes that the organisms of disease, after 
first getting into the body, are obliged to defend themselves, which 
they do by taking the oxygen away from the tissue cells, where- 
upon the cells become asphyxiated and fall an easy prey to the 
microbe. The theory, then, assumes that the cells acquire a re- 
sistance to the microbe from the experience gained by conflict, 
and that this experience enables them, the next time, to prevent 
the microbe from taking away their oxygen. 

Now, there are two or three conditions of things which in- 
terfere with this theory. In the first place, there is no uncom- 
bined oxygen in the tissues; all such oxygen exists in combina- 
tion. Salmon's theory, which assumes free oxygen in the tissues, 
can't exist where there is no free oxygen. Another fact in the 
way is the known action of the microbe in killing its prey, the 
cells, by poison, instead of by robbing them of oxygen. Besides 
this. Dr. Salmon, in order to show the relation of his theory to 
immunity, says that the cells acquire, by conflict with the mi- 
crobe, a successful resistance. Now, acquiring a successful re- 
sistance, in this manner, is just what is claimed for natural selec- 
tion. The cell acquires a variation by this conflict, but the vari- 
ation does not enable it to consume its own oxygen in spite of 
the microbe; it enables it to resist the poison of the microbe. 
Natural selection assumes that when this process has been re- 
peated often enough and long enough, in relation to an epidemic 
cause and the subjects of the epidemics or diseases, that the tis- 
sue cells will acquire a physical resistance to the action of the 
poison of the microbe, which shafl be a successful resistance. 
The people who have acquired in this way — by actual conflict 
with the microbe — a variation of cells and physical resistance to 
poison, by hereditary transmission of these powers, represent 
the people thus naturally selected by the law of natural selection, 



266 Tiiii Peoria Medical Monthly. 

as being the fittest to survive, at least so far as their rehitions go 
to this particular microbe. 

To conclude, I wish to say that, of course, I do not claim 
any originalitv in the application of the law of natural selection 
to the immunity from disease, no more than my critic would 
claim originality were he to cipher out the orbits of the moons 
of Mars by the law of gravitation. The matter was suggested 
to me as the possible solution of the question, because natural 
selection is as much a law of life as gravitation is in physics, and 
there is, therefore, no way of avoiding the explanation of immu- 
nity by this method. I will say further, that however short I 
may be in a knowledge of the law of natural selection, or of 
gravitation, or of the " eternal fitness of things," that this as- 
sumption can make no difference with the true relations of im- 
munity in disease and natural selection. I would like to see the 
subject discussed in a gentlemanly way, as I tried to discuss it 
without blackguarding anybod}^ and b\' men who are capable of 
thinking in a scientific manner, but can so divest themselves of 
theological dogmas that they are not afraid to look at something 
round for fear that the world after all ma}' happen to be a sphere, 
and the Lord may call for them when it is daylight for the 
heathen Chinee and a little dark in Illinois. 



PERISCOPE AND ABSTRACT. 

COUGH. 

In this da\' of ph\sical examination of the thorax some other 
matters have almost dropped out of sight. The old physician 
who recently declined the loan of a stethoscope by a young clin- 
ical assistant for the diagnosis of pneumonia, saying, " Thank 
^'ou, voung man; but I think I can detect pneumonia without a 
stethoscope!" could no doubt have taught that youth much that 
would be useful to him. A stethoscope is a capital instrument 
in the hands of a man who knows its use; but it has undoubt- 
edly drawn attention away from what may be termed rational 
consideration of the chest, and a judicial handling of what the 
patient has to tell, which often furnishes a clew to the treatment; 
a matter on which sometimes the stethoscope is silent. It is not 
that physical examination is not a most valuable means of ac- 
quiring pertain information; but that this other information is 



Periscope and Abstract. 267 

apt to be overlooked or underestimated; and thus a good pro- 
portion betwixt the two means of examination is lacking. 

A cough is a forced expiration to eject some offending ma- 
terial from the air-tubes, just as a sneeze clears the nares. But 
suppose the offending or irritant matter can not be ejected, what 
then is the value of the cough? Nothing whatever. There is, 
then, much useless cough, as well as useful cough. Other mat- 
ters than something in the air-tubes may set up a cough. Thus 
we find cough equally present when there is some phlegm in the 
air-tubes; when there is a mass of tubercle undergoing softening; 
and in the pulmonary congestion of a mitral lesion. A crumb in 
the larynx wull provoke violent cough; and so will other laryn- 
geal irritation. All know the brazen trumpet-like cough of 
aneurism of the aortic arch pressing upon the recurrent laryn- 
geal nerve, a cough closely simulated in character at times by a 
neurosal cough. This last was so marked in two girls that their 
cough told when they were on the hospital premises. It is need- 
less to say their departure was always expedited. Then, cough 
in the form of " hawking " is exceedingly common in pharyngeal 
disturbance. 

There is, too, cough unconnected with the air-passages and 
the respiratory organs. There is the well-known cough of preg- 
nanc}^ the " nine months' cough." There is ear-cough, said to 
be connected with the tympanic branch of the glosso pharyngeal 
nerves, which is set up by irritation in the ear. There is the 
cough of gastric irritation, common with alcohol indulgence. In 
one case, at least, known to me, diarrhoea always set up a cough. 
Cough of the " hemming " character, often misinterpreted as the 
short cough of early phthisis, is found commonly in girls at or 
after puberty, linked with ovarian or spinal irritation. It is clear, 
then, that cough has various causal associations. 

The importance of reflex cough need not be considered here; 
nor 3-et the means by which it may be relieved. In all reflex 
actions the bromides suggest themselves at once. If the exciting 
cause can be dealt with, then the resultant cough is relieved. 

It is rather the intention here to consider cough from its 
clinical and therapeutic point of view, and to see what indica- 
tions it furnishes us for treatment. For instance, in " heart 
cough," /. r., where the cough — a hard, dry cough — is set up by 
congestion of the pulmonic or lesser circulation by some dam or 
block at the mitral ostium, sedatives are more undesirable. 

Such cough is most commonly found in a young girl with 
mitral lesion. One such case I well remember when the resi- 
dent medical officer of the Leeds Public Dispensary. The girl, 
a child of twelve, had mitral regurgitation — ^an injury inflicted 
ypon her previous to her coming under my notice, Digitalis mA 



268 The Peoria Medical Monthly. 

iron improved the general condition, and with it the amount of 
cough; but still ihe child, a bright neurosal creature, coughed 
considerably. She ceased to attend, but some weeks later her 
mother came and made a frank confession to this effect : " Doc- 
tor, I thought the girl ought to have some cough medicine, and 
when I asked you for it, you always refused to give her any. 
One day I came when I knew you would be out, and got one of 
your assistants to grant me some cough stuff. It acted like a 
charm; but she soon fell off and lost her appetite, and could not 
get about; and now there is dropsv in her ankles. She is so 
bad, I want you to do what you can for her." Appropriate 
treatment soon restored the child to her ordinary condition; but 
her mother did not hanker after cough medicine after this expe- 
rience. This case illustrates vividlv the disastrous effects of 
allaying the cough when due to pulmonary congestion. For a 
little time it gave relief, but the after condition was worse than 
the first. So much for the indication afforded by cough under 
one set of circumstances, the case just mentioned by no means 
standing^ alone. 

c> 

The consideration of "useful" and "useless" cough may 
now engage our attention. It is a matter involving the gravest 
thought, and well deserves our best consideration. We will take 
cough in bronchial cases first. There is in the early stages of 
acute bronchitis much useless cough set up bv the dry mucous 
membrane, and the means for its relief have been set forth in a 
preceding article ("Bronchitis, Acute and Chronic" ). Then it 
was said there existed no particular objection to opium, which 
gives great relief. But in such case the sedative is combined 
with other agents of a relaxant character, as tartar emetic or 
aconite. As soon as free secretion comes the cough changes its 
character. It is no longer the drv, harsh, shaking cough of in- 
effectual effort, raising nothing, but becomes the less painful, 
trul}' expulsive cough of successful effort. Now, what we are 
required to do is to give stimulating expectorants, and so help 
and improve the character of the expulsive cough. There is 
usually at this point no indication for opium, and none is required 
unless it be a little at bedtime in certain cases. 

It is rather in chronic bronchitis with little expectoration 
and much bronchial irritation that the question of decision taxes 
our best mental energies. In some cases the rest at night is 
broken by irritant cough, and then the question arises of the 
leSser of two evils. If the opium arrest the secretion, and so 
render it tougher and more dithcult to get up; if the opium 
brings lethargy to the liver, impairing the appetite, and locking 
up the bowels, still it gives the patient rest. Consequently it 
may become necessary to administer it. But it should be given 



Periscope And ABSfRAcl** 269 

with benzoic acid in compound squill pill, and a little podophyllin 
or water}' extract of aloes to counteract its undesirable effects in 
the alimentary canal. And by such combination no doubt the 
maximum of good with the minimum of bad effect can be se- 
cured. Numbers of chronic bronchitics under my father's pro- 
fessional care took such a pill every night for two years without 
apparent injury, while it added greath' to their comfort. (T re- 
fer to my father's experience in these cases because I seryed un- 
der him and saw his practice, my own experience of general 
practice being short. ) But granting all this, the less opium in 
disease of the respiratory organs the better — as a broad rule. 
Sometimes some chloral, or bromide of ammonium with tincture 
of hyoscyamus, may seem indicated rather than opium, or eyen 
may be the best agent to employ in certain cases. But, in a gen- 
eral way, opium (in such pill combination as has just been sug- 
gested), with some alcohol at bedtime as a " night-cap," /'. c., 
whiskey or brandy and hot water, taken on getting into bed, is 
the best practice with chronic bronchitis. One great matter 
there is in such cases, never to be lost sight of b}' the patient, 
and that is to avoid passing from a warm sitting-room to a cold 
bedroom; the bedroom should also be warm. Another is to 
have the bed warmed by the old-fashioned warming-pan, or, 
perhaps better still, by a hot-water bottle, which can be pushed 
down to the foot of the bed (so as to keep the feet warm ) when 
the patient gets into bed. This matter of an equable tempera- 
ture is very important, and man}' bronchitics toast themselves 
well before going up stairs to a cold, unwarmed bedroom, where 
they cast off their day clothes, don a cold night-shirt or gown, 
as the case may be, then kneel down and sa}' their pra3'ers, and 
get into a cold bed. It is needless to say that no medicinal 
course can be successful in a case where this goes on. 

Important as the matter of cough and its indications for 
treatment are in chronic bronchitis, the matter of cough in 
chronic pulmonary phthisis is even still more important. There 
is the cough in the night breaking the sleep, and there is the 
cough in the day shaking the sufferer; both objectionable and 
undesirable, and requiring to be dealt with. The circumstances 
under which cough is developed in pulmonary phthisis vary. 
Sometimes mere apex consolidation is accompanied by cough. 
Where there is bronchial implication and localized bronchitis in 
the affected area this can readily be understood; but at times 
there is cough without the moist rales indicative of this condi- 
tion. We are compelled here to suppose some irritation of the 
pulmonary fibres of the vagus, which is transmitted to the respi- 
rator}' center, leading to a discharge producing the modified in- 
spiration and expiration familiar to us as " cough." Belladonna 



27<3 The Peoria Medical MontiilV- 

is said to exercise a decided influence over these fibres, and so is 
indicated in such condition. (By this property belladonna, or 
atropine, is a desirable addition to an opiate for a night-pill.) 

It has also been claimed for gelsemium sempervirens that it 
is useful in such cough by its action upon the nervous mechanism 
of the respiration. Bromide of ammonium suggests itself at 
once for the relief of such cough, from the known utilit}- of the 
bromides in all reflex trouble. 

One curious point there is about cough in its relations to 
static pulmonar}^ consolidation, afld that is this: Whenever a per- 
son possessed of a patch of consolidated lung has also the liver 
upset, then the irritation in the said patch with resultant cough is 
marked. No cough medicines nor antispasmodics do anv good; 
but agents which act upon the liver, as a blue-pill at bedtime (or 
other mercurial), and a dose of sulphate of soda next morning, 
produce a distinct and unmistakable effect in lessening the cough. 
Consequently, when a patient complains of troublesome cough 
and an area of consolidated lung is found, it is often well to in- 
spect the tongue and inquire into those subjecti^■e sensations ex- 
perienced when a person is bilious or " liverish." From its 
known effect upon the liver, opium not onh' gives no relief, but 
positively aggravates the condition. 

When a tubercular mass, or a portion of the consolidated 
area commences to soften — probably by the proliferating cells 
being so crowded on each other that they die; possibl}- by the 
appearance of bacifli on the scene — then we can readily under- 
stand the oncome of cough, and often severe cough. The dead 
mass is an irritant — like the thorn of Van Helmont — as a pro- 
cess of ulceration cuts it off from the surrounding lung-tissue; 
and during the time the process is going on there is distinct local 
irritation setting up the cough. There is, too, hectic fever, with 
nocturnal pyrexia and night-sweats. In this condition it may be- 
come necessary to add some opium or morphia to the mixture 
of quinine or phosphoric acid so much in vogue for its relief; and 
whether any sedative must be added or not; and if so, what 
quantity is a matter to be decided by the merits of each partic- 
ular case. That some morphia is unavoidable to procure sleep 
in such condition goes without question; but it must be guarded by 
the additions suggested in the article on " Pulmonar}- Phthisis." 
Such a condition is like a specific fever, or a storm at sea, in that 
it comes to an end sooner or later, and if the organism can be 
kept going, or the ship afloat till the end comes, all is well. Of 
course if there be but one softening patch the irritation set up is 
smaller than when there are several such morbid areas. In the 
latter case, opium in the day may be unavoidable; and its draw- 
backs must be met and got rid of, or neutralized, by such wit 



Periscope and ABSTkAcr. 271 

and skill as the medical attendant can command, eithef in him- 
self or in some consultant of more experience or deeper thought. 
Above all things, keep up the powers by such food as the pa- 
tient can take. The fever usually brings with it thirst. Then 
let the patient have cold beef-tea, with baked flour in it; malt 
extract, with effervescing water; milk, with a mineral water or 
whey; or milk diluted with water, and some MeUin's food added; 
and good home-made lemonade, with a fair amount of acid and 
sugar or malt extract in it. Rice-water, or barley-water, or 
tamarind water may be relished. Grapes and the juice of fruit 
are excellent. Alcohol may, too, be indicated. Sometimes it is 
neck or nothing. The patient must be heavily dosed with opium 
to allay the paroxysms of cough; aye, and there is something 
more than a cough, viz., the danger of hemorrhage from a rup- 
tured blood-vessel in the softening area, brought about by the 
violent effort of cough. The poor patient is like a soldier with 
the bullets flying over his head; if he escapes one, another hits 
him. The patient is passing through a period of acute perils; 
perhaps rather, he is like a canoe shooting rapids stuffed with 
rocks; much, ver}^ much depends upon the boatman's skill and 
experience; something upon luck — and the patient's luck is the 
luck of a good constitution! If the softening areas be numerous 
or extensive, then the prospects of escape is small, and the skill 
of the steerer will be gravely taxed. In spite of everything that 
skill and assiduous attention can do or accomplish, the case may 
go on from bad to worse unto the inevitable end. 

But, in my own experience of phthisis, cough has not been 
so very prominent a matter as to require treatment in the da}', 
except in a few instances. It is not common ^or the consump- 
tive to be shaken by racking cough requiring opium in the da3\ 
And on inquiring of an experienced sister at the hospital, who 
has watched the practice of many ph3^sicians, including the late 
Dr. Peacock, she informs me that my personal experience is in 
harmony with that of other physicians at Victoria Park Hospital. 
It is at night that cough is prevalent; and the use of opium, in 
combination with other agents, to procure a good night for the 
phthisical is a matter upon which there is general agreement. 

When there is one or more cavities present, the use of 
opium is not affected by the fact. Indeed, a cavity is a matter 
of little moment, either one way or the other, therapeutically. 
Of course, the patient is no better for having a cavit}-; but the 
question is. Is he any worse? Patients with cavities die, cer- 
tainly; and patients with cavities leave the hospital very greatly 
improved by their sta3% As to the question of cough and its 
treatment, a cavity counts for nothing; the cough certainl}- may 
be connected with its contents, or perhaps the condition of its 



272 The Peoria Medical Moxthlv, 

wall. But the fact of the patient being in the third stage of 
phthisis (following the classification of Pollock in his " Elements 
of Diagnosis in Phthisis") does not affect the treatment. 

Finally, in dealing with cough, the physician ma}- observe 
and reason upon the cause of the cough, what it accomplishes, 
and how it affects the patient, before proceeding to deal with it. 
Some cough is useless, because ineffective, and needs some stim- 
ulating expectorant to render it efhcacious — a very common af- 
fair; some cough is useless from every point of view, and so re- 
quires a sedative; and here the physician must decide in each 
case which is the lesser of two evils — the cough or the sedative. 
— "J. Milncr Fothcrgill in Med. Record. 



FRACTURE OF THE NECK OF THE THIGH BONE: 

The frequency of its occurrence, the gravity of its often 
arising complications, and the rarity of its satisfactory repair, 
gives never failing interest to the consideration of fracture of the 
neck of the thigh bone. 

Occasionally met with in middle life, possible even in child- 
hood, it is one of the common accidents of old age. For this 
there is good anatomical reason in the increased brittleness of 
the bone; dependent not, as was long held, upon an altered pro- 
portion of animal and inorganic matter, but upon senile rarefac- 
tion. As the active period of life passes away, the cortical com- 
pact layer of the neck becomes thinner, its trabeculge (that like 
pointed arches so marvelously support weight and transmit 
shock) more and ^ore disappear, and the interseptal spaces cor- 
respondingly increase. The neck settles down, and its angle 
with the shaft diminishes — more in women than in men, and 
hence the greater frequency of the accident in aged females. 
Very possibly the ligaments of the hip actually as well as rela- 
tively, increase in firmness, and the bone yields rather than its 
fibrous investments; fracture takes place, not dislocation. Mus- 
cular atrophy, by removing one of the protective forces, contrib- 
utes its share to putting the parts in condition to be injuriously 
acted upon. 

Where may the break occur? Anywhere between the head 
and the inter-trochanteric lines; the degree of obliquity of the 
feature depending in part upon the structure of the neck, but 
in great measure upon the direction of the breaking force, usu- 
all}- a blow upon the region of the great trochanter or the thigh 
just below. 

The literature of the profession is full of discussion, at times 
acrimonious, upon the intra and extra-capsular fractures; their 



Periscope and Abstract. 273 

relative frequency, their differential diagnosis, their appropriate 
methods of treatment, and their resulting repair. But practically 
all this is of little or no value. It is impossible in any given case 
to determine, except by -post-nwrtcm examinations, whether the 
fracture lies wholly in or partly without the capsule; for only 
upon inspection of the joint can it be known just where the cap- 
sule posteriorly blends with the S3'novial membrane. Anteriorly, 
it normally comes dow^n to the inter-trochanteric line, but upon 
the posterior surface it may stop well up toward the head, or 
approach quite closely the line joining the trochanters. In other 
words, all neck fractures are intra-capsular in front, but behind 
some are and some are not; and I know of no way in which, 
during life, the one class can be absolutely diagnosticated from 
the other. Just here lies the little or no value of all specimens 
of assumed bon}- union, which are unaccompanied with their 
capsular ligaments left in situ. The wise course, therefore, it 
seems to me, is to stop with the determination of the existence of 
a neck fracture; and to treat all cases as if complete repair by 
bone might naturally and properh' be expected, and in such way 
as to secure the desired result with least discomfort and risk to 
the patient. 

As we all know, the cardinal principles in the treatment of 
any fracture, are to place the fragments in apposition and to keep 
them there; and the careful, faithful atttention to these principles 
in the great majority of cases, results in satisfactory union, with- 
out regard to the age of the patient or to the bone broken. 
Why, then, is this neck fracture so generally recovered from 
with a fibrous union, shorter or longer, and at times followed by 
entire w^ant of repair? Because (it is commonly held) of the 
very limited blood supply to the upper fragment, the compara- 
tively small area of the surfaces of the break, and of the constant 
presence of S3movial fluid bathing the ends of the fragments. 
But if the amount of blood carried to the head and neck is suffi- 
cient for growth and maintenance in a state of health, it surely 
ought to be enough for repair; even if there is no increased afflux 
to the damaged part because of existing irritation and inflamma- 
tion, as there must of necessity be. 

In all other parts of the skeleton, the mere superficies of the 
fracture surface does not make for or against proper consolida- 
tion ; and besides, the area in the fracture under consideration is 
not ver}^ small. In fractures involving other joints, though svno- 
vial fluid in excess is present, still firm union takes place. Even 
if the alleged causes of failure are operative, they can be so only 
to a Hmited extent, and they must be regarded as very largely 
insufficient to produce the result which is generally effected. 
What then is it that, either alone or in connection with defective 



274 '^^^^' Peoria Medical Monthly. 

nutrition and excessive secretion, causes the ordinary imperfect 
repair of neck fracture? To what is due ligamentous union or 
non-union in fractures of other long bones? Chiefly, usually 
wholly, want of proper apposition of the fragment and failure to 
keep them quiet — one or both. Why is not the same thing true 
when it is the cervix-femoris that is broken? Let impaction 
occur at the time of the accident, and let it not be broken up b}^ 
injudicious manipulation or by inflammatory softening, and re- 
pair takes place readily enough, and the patient ultimately has 
a useful limb; more or less shortened, more or less everted, but 
nevertheless a good limb upon which to stand and with which to 
stand and with which to walk. Why? Not because more 
blood is carried to the parts, not because the synovial fluid is 
kept out from between the pieces, but because these latter are 
held in firm apposition. Experimentally pin the two parts to- 
gether, as Senn did, and complete repair will follow. In the 
unimpacted cases treated with a long splint, muscular action is 
constantl}- tilting or sHding the fragments; the weight of the 
body resting upon any ordinary bed is crowding the pelvis, and 
with it the upper fragment, down upon the thigh; and every 
time the patient is moved, or raised even, as in sliding under a 
bed-pan, displacement to a greater or less extent is made at the 
seat of injury. Is it any wonder that imperfect union is the 
result? 

At the present da}-, the weight and extension treatment or 
the immovable dressing is much more generally adopted than 
the time-honored long splint, which, as we have already seen, 
fails in great measure of securing such fixed apposition of the 
fragments as is a necessary prerequisite to proper repair. The 
weight and extension dressing, which answers so well in frac- 
tures of the shaft, when appHed to those of the neck proves de- 
fective in so far as it permits of considerable movement at the 
seat of injury, does not control the outward displacement of the 
upper end of the lower fragment, and fails in the very essential 
requisite of any suitable fracture dressing, that it shall altogether 
prevent or reduce to a minimum movement of the joints immedi- 
ately above and below the line of break. And, further, it does 
not and cannot keep the fragments in fixed relation to each other 
when movements of the trunk or limb are made; so that if 
changes of position of the body are effected, as they must and 
will be, more or less disturbance of the fragments must result. 

The immovable dressing, to fully satisfy the requirements of 
the case, must embrace not only the thigh, but the pelvis, or at 
least the half of it, in order that the hip joint may be fixed, and 
the action of the hip muscles restrained as far as possible. And 
just here lies the difficulty in the application of such dressings, 



Periscope and Abstract. 2^5 

and the imperfection of it as generally seen. Froni below the 
level of the great trochanter, the plaster of Paris bandage (and 
this is, of course, for many reasons, the best of the immovable 
dressings) can be put on; care being taken to properly cut it 
out and protect it on the inner side, so that no undue pressure 
shall be made upon the region of the genito-crural furrow, and 
that urine soiling shall not occur. But to carry it up to and over 
the iliac crest, and inward to the ischial tuberosity — in other 
words, to apply it over the whole gluteal region, and hold it 
there, requires an additional girdling of the upper part of the 
opposite half of the pelvis, or the carrying of the supporting 
dressing obliquely around the body, across the opposite lumbar 
region. Unless this is done, no matter hov/ closely applied at 
first, in a few hours, or, at most, days, the dressing will be found 
to have sprung off, and to be no longer exerting due pressure 
upon the hip muscles; as the result of which, the motion of the 
joint will be little or not at at all controlled, no more so than if 
the bandage had onlv been carried up over the trochanter inajor. 
Even if the immovable dressing has been properly applied and 
well maintained in position, there is always a chance that in con- 
sequence of wasting of the limb, sufficient loosening may take 
place to permit of some displacement of the fragments; to pre- 
vent which the weight and extension treatment may be very 
profitably combined with the fixed dressing. 

Applied earlv, the immovable dressing saves the patient 
much suffering, and permits with safety, so far as the fracture 
is concerned, of such changes of position as will not only greatly 
add to comfort, but materiallv lessen the chances of the devel- 
opment of that hypostatic pneumonia, which is so often the 
direct cause of death. 

The more experience I have had of this method of treat- 
ing neck fractures, the more convinced I have become that by 
careful application of it w^e can secure better results with less 
trouble than in any other way; and I feel confident that in a 
large proportion of cases recovery will take place with a limb 
of good functional value. 

Perhaps in the future it will be clearly shown that the rare 
occurrence of bonv union in the past has been simply because 
the fragments of the broken femoral neck have not been kept 
steadily in apposition, but have, by the permitted motion of the 
hip joint and unrestrained muscular action upon the shaft, been 
allowed to so separate and play upon each other as that only an 
imperfect ligamentous repair has been possible. — College and 
Clinical Record. 



276 The Peoria Medical Monthly. 

TETANUS. 

The course of tetanus is remarkable from the exactness 
with which it follows, while at the same time it exaggerates and 
perverts, the normal reflexes of the nervous system. Other 
well-known diseases exhibit the same peculiarity in a different 
degree. Among these we may note the many forms of convul- 
sion common to childhood, and the allied state of hysteria in the 
adult. In the former of these there is present, as a rule, a nor- 
mal spinal cord, which is incited to impulsive and disorderly 
action bv peripheral stimuli; in the latter, probably, along with 
such stimulation, an irritable cord, the cerebral will-control being 
in both cases ineffective. The patholog}' of tetanus in its turn, 
so far as that is known, exemplifies the further and extreme 
stages of the double affection. In the progressive inflammation 
travelling from the seat of injury upwards along the sensory 
nerves to their apparent origin in the spinal cord, we have sug- 
gested to us the plan and reason of its symptomatic action. The 
tendency of morbid nervous change to advance in the direction 
of the usual physiological impulses is also impressed in these 
lesion. Out of this progressive tendency arises the peculiar diffi- 
cult}- experienced in the treatment of tetanus. We have to com- 
bat a continual, not an intermittent stimulus. The intrinsic cause 
of mischief is almost from the first an inflammation of the torn 
or crushed nerve-terminations, which extends after its natural 
manner along the affected fibres, continuallv goaded by surface- 
irritation. Nor is evidence wanting which suggests that the 
central nerve-structures are apt to be involved, even at a very 
early period. 

An important experiment by Brown-Sequard showed that 
irritation of an afferent nerve, if severe enough, can produce les- 
sions in the spinal cord. An equal or less degree of irritation, 
due to superficial injury, especially if continuously active, might 
naturally be expected to lead to central congestion before the 
cord itself was reached by the progressive nerve-inflammation 
of tetanus. This may serve to explain those cases in which the 
disease is established within a few hours of the receipt of some 
peripheral shock. So far, the connection between tetanus and 
any septic agency cannot be regarded as a necessar\' one. Cases 
do undoubtedly follow the bites of wild animals, and are more 
common in hot and moist than in dry equable climates, and may 
therefore, seem to favor the theor}- of a bacterial origin. 
Such influence, however, as germs possess is evidently due rather 
to their general stimulant effect on inflammatory process, than 
to any special property. 

The rational treatment of tetanus necessaril}' follows the 
indications of its patholog}'. Rest, accordingly, must form its 



Periscope and Abstract. 277 

primarv object — -rest of the irritable nerve-centres in themselves, 
and in their peripheral relations. External warmth, silence, a 
darkened room, fluid nourishment administered in small quanti- 
ties — in a word, the studied exclusion of ever}^ cause of nervous 
shock, however trifling, are part of the long established routine 
of treatment in such cases. iVmong drugs, chloral in full doses, 
and, better still, the subcutaneous use of morphia, have gained a 
merited preference. It will be found that, where injections of 
morphia have to be kept up for a considerable time, the plan of 
combining it with a minute proportion of sulphate of atropia is 
of assistance in counteracting the nauseous effect of the former 
drug. M. Verneuil, in a recent communication made before the 
Society de Chirurgie of Paris, further reminds us of the fact that 
these measures should be persevered in for a definite period, not- 
withstanding temporary remissions of the disease; since, if this 
precaution be neglected, relapses readily occur. 

But, after all, medicine is rather an aid and a palliative than 
a principle in tetanus. So long as the original morbid change 
goes on unchecked, the action of the drugs, and of all merely 
general treatment, is met, and is liable to be thwarted, by the 
constant opposition of unchecked local stimulation. Until this 
is subsided, there can, of course, be but little hope of recovery. 
Relief of the central molecular changes must largely depend on 
timely control of the afferent stimuli. It should not be forgotten, 
moreover, that any surgical interference, in order to be effectual, 
must be early resorted to. The amputation of a crushed ex- 
tremity, the section of nerves, or the removal of their torn end- 
ings by a clean cut, will avail nothing if resorted to some days — ■ 
or even, it may be, hours — after the injury. By that time, the 
inflammatory action may be well established in the nerve-trunks. 
No time should, therefore, be lost in arresting the surface-irrita- 
tion by such operative measures as may be indicated. 

It may be well, before leaving this subject, to draw atten- 
tion to the great value of moist heat alone as a sedative of the 
irritable nerve terminations. Besides the various forms of fo- 
mentation, medicated or not, we would especially mention the 
warm water-bath. A limb, if kept immersed for days in warm 
water, periodically changed, even without the presence of anti- 
septic or sedative agents, can hardl}^ fail to lose much of this 
irritability; and the result, in absence of pain, in sleep thus 
(rained, and in creneral comfort, must exercise the best influence 
on the centres in the spinal cord which are the foci of the tetanic 
convulsions. On the other hand, local sedative and disinfectant 
remedies, if required in any case, can, of course, be as easily ad- 
ministered in this way as in any other. — British Medical Jour- 
iiaL 



278 The Peoria Medical Monthly. 

CHRONIC OTITIS MEDIA. 

The appalling number of cases of chronic non-suppurative 
otitis media renders it altogether the most important field for 
study in otolog}-. 

Its treatment in a rational manner began, of course, with 
catheterization of the Eustachian tube. 

For quite a number of 3'ears the catheter almost supplanted 
all other interference. 

To supplement the action of the forcible introduction of 
pure air, medicated air and vapor and the injection of various 
sorts of fluids (irritant, astringent, alterative,) was resorted to. 

Of late years more and more attention has been concentrated 
on naso-pharyngeal affections as the starting point and the con- 
tinuing cause of this trouble. 

And right here it would be important to know what effect, 
if any, the ordinary treatm.ent of pharyngeal troubles has in 
starting up the affection under consideration. 

We are all perfectly cognizant of the disastrous results fol- 
lowing treatment of nasal catarrh, and every one must be per- 
fectly aware of the care and study it requires to so treat the 
nasal and naso-pharyngeal space as to benefit the tube and mid- 
dle ear, and how much more care is required not to do positive 
harm to them. 

I have seen case after case of the most obstinate tubal and 
middle ear trouble (chronic) directly dependent upon nasal and 
naso-pharyngeal treatment. 

I have myself over and over again aggravated matters in- 
stead of improving them, and that, too, with all the care I could 
exercise. 

Now, if one whose whole attention is directed to the ear, 
and hence is in a condition to appreciate the slightest damage by 
or failure in the treatment, how much more is one liable to do 
harm who is taking little or no thought of these parts. 

We all know that the nasal douche has been virtually dis- 
carded by aurists, even also the once apparently innocent post- 
nares syringe (with which I have often blocked an Eustachian 
tube). There are cases even in which inflation by any method, 
especially with the catheter, not only does no good, but positive 
harm. In fact a careful study of this trouble over a long series 
of years has convinced me that it is a most complicated and del- 
icate chapter. 

If it is so complicated and delicate, and I fancy no one will 
dispute the statement, it has always been a mystery to me why 
some of the best men in the profession turn over the treatment 
not only to unskillful hands, but even to the patients themselves. 

I have met with a few cases in which the catheter had been 



Periscope and Abstract, 279 

put bv aurists into the hands of the patient, I need not sav with 
what rcsull. 

Both patient and physician must be taught that the Eusta- 
chian catheter, Hke the urethral, is an instrument as potent for 
evil as good. 

The profession is fast getting the idea that all ear cases 
should be catheterized. 

A ludicrous illustration of this statement came under my 
observation while preparing this paper. A very reputable phv- 
sician rather triumphantly informed me that he had been inflat- 
ing his ears for quite a while with a catheter, but he was still 
deaf, and wanted me to see what the trouble was. It was ear 
wax ! 

It is certainh" no unusual thing for the balloon to be put in- 
to the hands of patients and into the hands of parents. 

These cases require a vast amount of time, care and pa- 
tience, but those are not sufficient grounds for the slurring they 
receive. 

The percentage of these cases, even when of long 3'ears' 
standing, that are not more or less amenable to treatment, is ex- 
ceedinglv small. 

Unfortunateh' as yet our means of diagnosis are too imper- 
fect to inform us as to the leng-th of time treatment will be re- 
quired, and as to how much benefit will accrue. 

There is no special agreement even as to the means to be 
employed, nor as regards the manner of treatment, whether con- 
tinuous or interrupted. 

We constantly meet with the most discouraging expressions, 
both verbal and facial, from this class of patients. They are in 
the most discouraged state of mind, and extremelv hopeless of 
treatment doing anv good. 

The majority, perhaps, when thev hear that no verv favora- 
ble prognosis can be made in regard to the relief of the annoying 
tinnitus are ready to abandon treatment. 

I am fully persuaded that if all middle ear troubles could be 
ushered in with tinnitus it would be a most fortunate thing for 
this class of patients, as we would then see them early. 

Of course // is not the tinnitus that is so discouraging, but 
the cerebral state due to the car trouble. 

Nothing is more common than to hear ear patients after in- 
flation remark: "Now mv head feels better."' If my experience 
has taught me an3-thing it is that the mental depression can be 
relieved so that the tinnitus is no longer disturbing, even when 
no improvement has taken place in the hearing. The great dif- 
ficulty in these cases is in tiding patients over the first few weeks 
or months. ■ 



28o The Peoria Medical Monthly. 

It is a great mistake to think that because the Eustachian 
tubes are closed only catheterization will open them. 

Over and over again I have found some applications of vas- 
eline and boric acid, or what is better (since we have such im- 
pure acid preparations of vaseline) the yellow oxide of mercury 
and vaseline (lO grs. to the oz.), used through the nostrils, open 
tubes where catheterizations had little or no effect. 

In this connection I would say that salves, for me, have al- 
most if not quite superseded all other applications for nasal and 
naso-pharvngeal troubles. 

My clinical studies will, I think, justify the following conclu- 
sions: 

1. Only experience of sufficient length of time (often lasting 
over months ) in each case can determine whether treatment 
shall be continuous (dail}') or interrupted, /. f., perhaps dailv for 
a few weeks, followed by an interruption of some weeks or 
months. 

2. Onl}^ experience in each case can inform us whether 
treatment is to be directed entirely to the middle ear or entirely 
to the naso-pharynx, or combined against both. 

3. Only experience in each case can inform us whether in- 
jections into the cervical tympani are called for. 

Under this head I would say that strict medication, either of 
the middle ear or naso-pharynx as routine treatment is unwise 
till simple inflation has failed, 

4. Mechanical dilatation of the tubes is rarely necessary or 
advisable. 

I would remark here that only in extremely dry states of the 
tube is dilatation followed by much success. 

5. Hearing tests are not reliable, and hence patients with 
great deafness, great loss of bone conduction, etc., should not be 
sent away till the "test by trial" has been thoroughly gone 
through with. 

6. Simple inflation faihng, the greatest attention should be 
given to the naso-pharynx, even though i is in an apparently 
fair condition. 

7- Syringing, douching and swabbing the naso-pharynx 
should be abandoned. — W. W. Sccly, M. D., in Lancet and 
Clinic. 



SURGICAL TREATMENT OF INFANTS. 

First of all, must the children's surgeon acquaint himself 
with the anatomy of the child. This is rarely done, as the ordi- 
nary adult dissections ^during a college course give little idea of 



Periscope and Abstract, 281 

the size and position of the individual elements as seen in the in- 
fant. In consequence of ignorance upon this practical point, 
many grievous failures have occurred. After unusually large 
opportunities for the study of both normal and abnormal tissues 
in the diminutive frame, I am still frequently surprised to note 
the exceeding smallness of different organs and canals. 

Another essential element in the surgeon is tact in the man- 
agement of the little ones, especially when dealing with those 
between the ages of two and ten. In hospital cases but little his- 
tory is attainable, and much depends upon quick perception. 
Naturally fearful of pain, the patient's mind must be diverted and 
engaged, or great difficulties in diagnosis will often occur from 
the fright and struggling. The operator not in sympathy with 
children can never secure their confidence. Much will often be 
gained by quiet observation. It is not a month since my opinion, 
which at the first few moments of the consultation had been 
favorable to tracheotomy, was changed by five minutes close 
watching, and the result proved the correctness of the procedure. 
To the person, however, who will carefully stud}^ individuality 
as well as disease, no departure of medicine offers so pleasant a 
return for his labors. My personal experience with children has 
perhaps made me more hopeful in regard to the power of such 
individuals to endure pain, shock and disease, than would be in- 
dicated by the expressions of other authors; but to me there is 
no domain of surgery so attractive and gratif3'ing as the treat- 
ment of children below the age of pubert^^ Their natural con- 
dition is that of hopefulness, and as soon as the depressing influ- 
ence of the shock, pain or fear is removed, the normal resiliency 
of mind and body asserts itself with such rapidity that the results 
are often surprising. 

Again, a child has onl}- inherited taints of constitution to 
contend against, his viscera are ordinarily in a healthy condition, 
an adult has not only hereditary, but all the acquired vices occa- 
sioned by misuse of any organ or set of organs, a circumstance 
which often turns the scale in the struggle between life and 
death. Take, for example, the single instance of the outraging 
of tissues by either the moderate or the excessive use of alcohol, 
and every surgeon will testify that even sHght wounds may, in 
such an individual, quickly develop a fatal attack of mania-a-potu. 

Tetanus is more frequent in infants than in adults, notwith- 
standing the tendency of the former to nerve excitability. 

In regard to anesthetics, m}^ experience is that great bene- 
fit is obtained by the use of ether when pain can thereby be pre- 
vented. In the first weeks of existence, I admit that a feeble vi- 
tality would contra-indicate its use, although I have successfully 
administered it to a three-days-old infant. After the first or sec- 



282 The Peoria Medical Monthly. 

end month, I see no reason why we should needlessly inflict pain 
upon an infant simply because we can control it by brute force. 
In the examination of fractures, great suffering is often inflicted 
by careless and frequent manipulation, and unless the diagnosis 
is easy and positive, unconsciousness should be produced. No 
case of bone injury should ever be passed by undiagnosed, when 
ether wall solve the question. 

In the opening of abscesses, the " primary quieting influ- 
ence " of ether is so readily obtained that it should be brought 
into use whenever practicable, as keenness of pain can thereby 
be avoided. 

All preparations should be made out of sight and hearing of 
the patient and instruments need ever be seen by him, except 
when a strong impression is intended to be made upon the mind 
of a masturbating boy, requiring circumcision. 

One w^ord in regard to the method of anassthetization. It is 
but natural that a child should be distrustful of any attempt to 
deprive him of consciousness, a fear which is greatlv increased 
by the injudicious and greath* to be condemned habit of many 
parents, who systematically threaten their offspring with the ex- 
pression, " the doctor will come and cut your head off." A few 
kind words will often quiet the agitation, and simple directions 
as to the method of breathing, will save many minutes of strug- 
gling resistance. With very young children, the first smell of 
ether may be masked by permitting them to see cologne poured 
upon the towel after which ether may be quieth" added and they 
will feel that it is a perfume that thev are breathing. This de- 
vise has frequenth" served me a good purpose. I always allow 
a good admixture of fresh air for the first moment, but when the 
child actually begins to cr}^ then quick action answers best. The 
towel should now be well saturated and held firmly over nose 
and mouth until two or three strong screams and inhalations will 
yield a full primary impression which can be gradually followed 
up to complete anaesthesia with safety. 

Should any symptom of ether narcosis occur, it is so easy to 
depress the head of a child or to perform artificial respiration by 
acting upon the ribs, that serious accidents are infrequent. Sub- 
sequent vomiting is very common but is not persistent and is 
easily quieted by a small hypodermic of morphia, a procedure 
which ordinarily brings quiet sleep to the patient. If the child 
is feeble, I always allow milk up to within two or three hours of 
the operation, and then administer wine or whisky in water im- 
mediately before giving the anaesthetic. Milk with lime water 
and whisky is usually retained wathin ten minutes after the first 
vomiting on rousing. In tedious excisions, not only should pre- 
liminary precautions be taken to secure against prostration by 



Periscope and Abstract. 283 

shock, but hot water bags should be ready for use, which with 
hypodermics of brandy, may succeed in tiding over a temporary 
depression which would otherwise end in death. When the loss 
of blood has been great, especially in acute surgery, important 
assistance may be gained by transfusion, either of blood or of a 
warm saline solution. 

Under the head of arrest of hemorrhage, I would strongly 
advocate the use of animal ligatures, since the pain often incident 
upon the removal of threads, greatly disturbs the needed qui- 
etude of wound and mind. 

Thorough asepis and antisepis are especially valuable, since 
we not only secure the admirable results that are attainable by 
their use, but are also enabled to disturb the child with far less 
frequency. I am now treating a girl with a railroiid crush of the 
leg which would thoroughl}- have justified amputation, yet which 
under corrosive sublimate dressings has not been touched but six 
times in as man}- weeks even though extensive sloughing has oc- 
curred. Save, upon one occasion, at the height of the process of 
tissue death, the applications have been taken away perfectly 
sweet; and the child has the promise of a reasonably good limb. 
In my ante-seftic days, I certainly was never able to carry a 
patient through such a process and keep the temperature as has 
been done in this case, below 99^ degrees all the time, and 
usually but slightly above 96 degrees. With frequent dressings, 
the irritation of the child is but slight, and if pain is also absent, 
contentment is the rule, under proper nursing. 

I cannot to strongly emphasize the importance of this latter 
condition. A kind, quiet, gentle nurse, is one of the most valua- 
ble assistants in the real progress of the case, especially during 
the first week following operation. Such care cannot be dele- 
gated to untrained and careless people, hence it is absolutely 
necessary that children should be in separate hospitals, or in sep- 
arate wards, under the best of care takers. Even in private 
practice, the mother is rarel}^ the best nurse for a child past two 
or three years of ag-e, and a skilled attendant answers best. In 
hospital practice, I have often been surprised to see how con- 
tented and patient the majority of children of even three years of 
age will become, if the mother maintains a judicious absence and 
the nurse is efficient and kind. 

Another point which I wish most emphatically to emphasize 
to-night is, the fact that congenial defects are most inexcusably 
and persistently neglected by even good practitioners. Either 
under the mistaken opinion that nothing can be done, or that a 
later period will be early enough. The consequence is that 
man}' unfortunates become helpless and hopeless cripples by their 
physician's advice, since passing out of his sight and mind, the 



284 The Peoria Medical Monthly. 

neglect engendered by his direction, " wait," is fostered by 
parents, ever ready to postpone a dreaded day. — 6V. Louis Med. 
and Surg. 'Journal. 



ALBUMINURIA— ITS CAUSES AND VARIETIES. 

"Senator," in the Berliner Medical WorJienschift, No. 16, 
April 20, 1885, enumerates the following conditions liable to de- 
termine the presence of albumen in appreciable amount in the 
urine : 

Disturbances of the renal circulation. High pressure, if the 
urine be concentrated, should produce albumen. This condition 
is actually found to obtain by muscular action, on account of per- 
spiration and loss of fluid by the lungs, and, though not so accu- 
rately, by elevation of temperature. 

Passive hyperemia acts in itself similarly to increased ar- 
terial tension, but the distended veins in the medulla of the kid- 
neys press together the urinary tubes, leading to obstruction of 
the passage of urine and oedema of the kidne3'S. The conse- 
quence is: 

1. That albumen transudes from the interstitial capillaries 
into the urinary tubes. 

2. That urine exerting pressure upon the glomeruli pro- 
duces a diminution of pressure from the glomeruli, and leads to 
a relative increase of excretion of albumen. To this cause of 
albuminuria is allied that caused by blocking of the urinary tract, 
manifested when the impediment is removed, or when the ob- 
struction is not complete. 

3. The condition of the filtering membrane, as in inflamma- 
tion, fatty degeneration, and amyloid change. Not only does 
albuminuria result from an increased permeabilit}', but the de- 
generated membranes and epithelium themselves appear in the 
urine as albumens, and this may explain the tact that in the urine 
albumens may have a different relation to each other from what 
exists in the blood. The substance of the epithehum appears to 
contain a body intimately allied with globulin. 

4. The composition of the blood may cause the appearance 
of albumen, e. g., from an excess of nutriment, from increased 
dissolution of albumen, or from excessive secretion of water else- 
w^here, etc. It is held by Rosenbach, that the composition of 
the blood is constantly regulated by the action of the kidneys, 
and that inassimilable albumen is excreted by the kidneys. Al- 
buminuria not caused by inflammation, this author designates as 
"regulatory." His idea, though important, is not free from ob- 
jections. 



Periscope and Abstract. 285 

Finally, as Stokvis and Lehman have pointed out, the ex- 
cretion of albumen can act injuriously upon the kidneys. 

5. Mention has already been made of the influence of tem- 
perature in connection with changes of pressure. 

The author further remarks that the forms of albuminuria 
ma}^ be clinically divided into two classes, pathological and phys- 
iological, although no exact line of demarcation distinguishes 
them. Among physiological albuminurias may be mentioned 
that of the new-born, which is probably due to the suddenly 
increased pressure in the glomeruli, taken in connection with the 
probably increased destruction of the blood corpuscles. 

Albuminuria can exist in a healthy man for years without 
any signs of ill-health, and then cease. 

Fuebringer, too, has found this condition in children, in 
whom chronic nephritis is very rare. 

The author, in this connection, alludes to the albuminuria 
due to mental perturbation, and to that caused by cold baths. 

Patholoo'ical albunlinuria includes the followincf: 

1. That present in non-febrile diseases, in which the compo- 
sition of the blood is specially concerned, and in which the kid- 
neys do not participate to any extent; in anemia, leukemia, and 
pseudo-leukemia; in scurvy, in icterus and in certain cases of 
diabetes. Nothing is found in the urine indicative of renal disease. 

2. Albuminuria in non-febrile nervous diseases, in epileptic 
seizures, delirium tremens, cerebral apoplexy, neurasthenia, mi- 
graine, Basedow's disease, etc., and allowing for other existing 
causes, numerous cases exist where the albuminuria is traceable 
only to the nervous condition. 

3. Febrile albuminuria. In this condition there is a com- 
bination of favoring causes, such as high temperature, febrile 
changes in the circulation and in the composition of the blood, 
with consequent disturbance of the nutrition of the kidne3's, and, 
lastly, concentration of urine. 

4. Albuminuria of passive hyperemia. 

5. That due to blocking of the urine. 

6. The albuminuria of pregnancy due to various causes, 
disturbance of the lesser circulation, passive hyperemia due to 
abdominal pressure on the vessels, and constriction of the ureters. 

7. That due to diffuse inflammation and degeneration of the 
kidne3^s (acute nephritis, subacute annd chronic and amyloid de- 
generation). 

9. That depending on circumscribed affections of the kid- 
neys, such as infarcts, abscesses and tumors. 

In conclusion, the author insists on the necessity of con- 
stantly remembering that the treatment of each individual case 
of albuminuria varies with the exciting cause. — Medical N'cws. 



286 Thf Peoria Medical Monthly. 

PERITONITIS OF LOWER ABDOMEN— PERITY- 
PHLITIS. 

The general experience of pathological authorities shows 
that in a very considerable portion of fatal cases of inflamma- 
tory lesions in the ilio-C£ecal region the -processus vermiformis is 
in some wav or other the somxe of the inflammation. In the 
minority there is inflammation of the cellular tissue lying chiefl}- 
behind the cjecum and ascending colon; and in such cases the 
peritoneum luay escape implication, the abscess opening directly 
into the caecum. And as in the case of the uterine organs the 
names perimetritis and parametntis have been employed; the 
former, however, embracing by far the greater number of cases 
and being accordingly much the more familiar term in works on 
the subject. There is, moreover, a certain number of cases in 
which, though the inflammatory processes extend to the neigh- 
borhood of the caicum, they do not originate there; as where a 
pelvic abscess (parametritis ) burrows upward along the sheath 
of the psoas and iliacus muscles, or where a spinal or perinephric 
abscess burrows downward along the same sheath, and may end 
in forming a communication with the bowel, or by opening in 
the groin. In these cases the peritoneum usually remains ex- 
empt. 

Now, in the cases which recover (and these are the large 
majority) it is often not possible to make an exact diagnosis of 
the seat of the primary lesion, and therefore it is vain to attempt 
to classify them as above ; but in many or most of them the local 
peritonitis, extending from the right iliac fossa upward and in- 
ward, is the most prominent fact, and the name perityphlitis is 
applied without a too curious inquiry into the unknown origin of 
the lesion. The evidences of the inflammation are the pain, su- 
perficial or deep; tenderness on pressure, increased resistance, 
swelling, and dullness on percussion in the right iliac fossa; fever, 
often with repeated shiverings, and usually of a remittent type, 
which may go on, in protracted casjes, into a kind of hectic; the 
bowels being more often than not constipated, but occasionally 
with intervals of diarrhcea. Vomiting is by no means a constant 
feature of such cases, but is sometime pretty obstinate. Indeed, 
I have known the vomiting and constipation together such as to 
raise serious questions as to the existence of a mechanical ob- 
struction or invagination of the bowel; but usually it is not so. 
In well-marked cases, the dense semi-solid feeling of impaction 
extends quite down to the pelvis; in others, towards the middle 
line, and sometimes even above the umbilicus; and, in the female 
sex, it ma}- be only after careful examination of the pelvic organs 
that such cases can be distinguished from peritonitis of pelvic 



Periscope; and Abstract. 287 

origin. Occasionally, and especially when it is expedient to 
make such examination, owing to the patient being unmarried, 
or to the rapid recovery, it remains a doubtful question to the 
last. I have seen several such cases in female children who all 
made good recoveries; and although these cases passed for peri- 
typhlitis, I am by no means sure of the pathology of them even 
now. 

The most important clinical fact, however, to keep in view 
in dealing with such cases, is that a large proportion of them do, 
in fact, recover more or less completely, and after a longer or 
shorter period of careful management. This favorable prognosis 
is not commonl}" set forth, at all events so as to have impressed 
my own mind, in the various monographs on typhlitis and peri- 
t3^phlitis; perhaps owing to the fatal cases, and those submitted 
to -post-mortem examination, being chiefly accumulated in med- 
ical literature, and thus becoming unduly prominent. In one 
very admirable memoir, however, I find the view now presented 
fully more strongly asserted than I should have been disposed to 
put it, even apart from the evidence in the cases above noticed. 
"I believe," writes the late Dr. Hilton Fagge, "that even when 
acute peritonitis is set up by ulceration of the ca^cal appendix, 
the disease, if properly treated, is infinitely less dangerous than 
is supposed. I have never myself seen a case of this kind ter- 
minate in death, when its nature was correctly diagnosed, and 
when no purgatives nor enemata were allowed to be given. Nor 
of late years have any fatal cases occurred in the hospital (Guy's), 
except a few cases in which death occurred very shortly after 
admission. I have, therefore, been accustomed to give a favor-\ 
able, though guarded, prognosis in cases of typhlitis, even when 
symptoms of diffused peritonitis are present. It may, of course, 
be said that the very fact that one can make an exact diagnosis 
proves that the disease is not running on to a fatal termination 
within the first few hours, and that the signs of the general in- 
flammation do not preponderate very greatly over those of the 
local mischief; and I am ready to admit that there may be cases 
of sloughing of the appendix which are necessarily fatal. But, 
as I have shown, the differences in cases of typhlitis appear to be 
differences of degree, and not all of kind; and I believe I am 
justified in saying that when this disease is skilfully treated it 
scarcely ever terminates otherwise than in the recovery of the 
patient." 

Dr. Fagge further argues that there is no good reason to 
suppose (as has been supposed) that such cases, when they end 
in recovery, "differ essentially from cases of perforation of the 
appendix," which he regards as "really alwa3-s the starting-point 
of the inflammation." He alludes to three cases in which it 



288 The Peoria Medical Monthly. 

was pathologically determined that perforation was the cause of 
an attack which had virtually ended in recovery, when either a 
new attack of perityphlitis, or an intercurrent disease, attacked 
and carried off the patient. The most important of these cases 
is the following: "A patient suffering from chronic pleurisy was 
attacked with pain in the right iliac fossa, and the other symp- 
toms which I have just mentioned; a firm tumor, dull on per- 
cussion, could be felt in the right iliac fossa. Under careful 
management, the abdominal disease subsided, but pneumothorax 
occurred, and of this he died a few da3's afterward. The caecum 
was closely adherent, a small collection of purulent matter sur- 
rounded the vermiform appendix. This was perforated at its 
extremity, and outside it lay a small mass of hardened faeces." 

I have already conceded that it is often impossible, clinically 
(in cases which end in recovery), to be sure of the exact seat 
and nature of the original lesion ; and to this extent I am disposed 
to think that the weighty and striking sentences above quoted, 
from a great master of clinical and pathological investigation 
recently removed from us, may require some qualification. But 
the words of a man like Hilton Fagge must be taken as impl}-- 
ing not only strong conviction, but conviction founded on an 
amount of closely observed fact, which is perhaps not fully 
brought out in the details of the memoir itself. There are many 
circumstances tending to the belief that peritonitis even from per- 
foration of the small intestine is not so absolutely desperate a 
case as it has been frequently represented; and we have already 
seen that peritonitis of considerable severity and diffusion, arising 
from pelvic causes, admits of resolution, in many instances, with 
a completeness and rapidity that it is not easy, pathologically, to 
explain. The vermiform appendix is placed so as to offer the 
most favorable conditions possible for the isolation and limita- 
tion of the results of an ulcerated lesion, or even of a perforation ; 
but it is not necessary to suppose that in most, or all, of these 
cases actual perforation occurs, if. we only accept the idea that 
an ulcerative or other lesion tending to perforation is usually 
forestalled, as it were, by reparative processes which may often 
tend to prevent the threatened fatal rupture. In such processes, 
adhesive peritonitis, I believe, plays a principle part, and it is 
only a question of degree whether the extension and the charac- 
ter of the peritonitis are such as accurately to fulfill this, its con- 
servative work in the organism, or such as to become more or 
less of a disease and a danger per sc. At all events, there seems 
no escape from the conclusion that in some cases, at least (such 
as the one above quoted), even perforation of the vermiform ap- 
pendix may be followed, or accompanied, by what nearly am junts 



Periscope and Abstract. 289 

to a complete recoNery, through adhesion of it to the surround- 
ing parts. 

Dr. Fagge further points out that "t3'phlitis often recurs 
again and again at intervals of a few weeks. It is also exceed- 
ingly apt to relapse during convalescence if the patient is allowed 
to commit an^- indiscretion.'" This statement I can fully confirm, 
and the importance of it, from a practical point of view, in con- 
nection with the preceding observations, need not be more par- 
ticularly pointed out. The treatment of all such cases should be 
conducted on the same principles [mutatis iimtandis^ as in peri- 
tonitis of pelvic origin. Rest of the parts, absolute, if possible, 
is the main indication of treatment, and this, in the case of the 
Ciecum or vermiform appendix, implies, of course, abstinence 
from the use of purgatives, -and not unfrequently, also, the ad- 
ministration of opium, and the limitation of the diet. Enemata, 
if employed at all, should be only such as to empty the rectum; 
but, on the principle that a lower bowel loaded with faeces is 
more open to strain than one cleared out by warm water in mod- 
erate quantity, I am not sure that I am prepared to accept with- 
out some qualification Dr. Fagge's conclusion that enemata, as 
well as purgatives, are to be entirely proscribed as a first condi- 
tion of safety. It is perhaps necessary, however, to protest 
against Eichhorst's special recommendation of large cold water 
enemata three or four times a day in what may chance to be re- 
garded as t3'phlitis stercoralis. I cannot say that I have had 
such experience as would induce me to pronounce this an entirely 
distinct form of disease; and if, on the other hand, the constipa- 
tion, which often attends a case of inflammatory swelling in the 
iliac fossa, is not to be taken as the cause, but as the result, of 
the inflammation, usually, if not always, associated with ulcera- 
tion of the vermiform appendix, a treatment founded on mere 
emptying the lower bowel, mechanically or otherwise, cannot be 
expected to be successful. A liquid diet, at first exclusiveh' em- 
ployed, and afterward only a very gradual introduction of the 
most completely digestible solid foods, will be rightly held to be 
imperative, owing to the same \*t\-\ ob\'ious and paramount neces- 
sity of securing rest, as far as possible, to the whole intestinal 
tract, and especially to the caecum. In cases where vomiting is 
obstinate and long-continued, I should not be restrained from 
clearing the rectiim of its contents so far as to allow of nourish- 
ment and stimulants being given per anum; and morphia might 
in such case be used in considerable doses hypodermically. The 
patient should be rigidly kept in bed, and absolutely in the re- 
cumbent posture, until the tenderness and swelHng are nearly if 
not quite gone; and, holding in view the risk of relapse, it is 
hardly possible to insist too much upon great care in this respect. 



290 



The Feoria Medical Monthly 



The only local treatment I am disposed to recommend is the use 
of fomentations (medicated or not) ; poultices (if not too heavy) : 
sometimes, if there is much distension, or if the fever is very 
hii^h, the local application of cold for short periods by iced cloths; 
and, in more chronic cases the painting of iodine tincture, or lin- 
iment. — Med. Times and Gazette. 



ULCERATION OF THE BOWELS IN YOUNG 

INFANTS. 

It cannot, I think, be questioned that a speedier and more 
accurate information as regards the effect of remedies may often 
be trained from the study of chronic than of acute disease, inas- 
much as the same symptoms are apt to recur again and again, 
and the same remedies can be put to oft-repeated tests. The 
following case, which I have ventured to report, has given me 
an amount of information it might otherwise have taken years to 
obtain, and possibly it may prove of service to others. Accord- 
ing to the mother's statement the child in question had been 
given up by more than one physician, and I must say myself it 
was one of the worst cases I have ever seen recover. The little 
one was two years and eight monchs old, a perfect skeleton and 
quite unable to sit up. She had a sallow waxy appearance, 
without a particle of color about her face except a slight hectic 
flush on her cheeks. Was sick whenever she took food, which 
consisted entirely of milk and lime-water. Bowels moved about 
every four hours and the smell was perfectly unbearable. The 
stools consisted almost entirely of slime and pus, streaked wath 
blood, and adhering to the bottom of the chamber vessel even 
when it was held upside down. The stomach was slightly dis- 
tended and tender. The previous history was as follows: She 
was always rather sick from birth, but was worse after she was 
one year old. Had an attack of diarrhoea at eight months and 
urine was discolored (so the nurse says) with blood. She has 
always been troubled with diarrhoea on and off since. The 
stools were at first very large in quantity and semi-solid but not 
slimy. When the diarrhoea w^as at its worst, the actions occur- 
red about every two hours. The stomach w^as always more or 
less tender and distended. At twelve months old she had pains 
in the joints, and one knee had to be put up in a sphnt; both 
legs were much swollen. The father had had syphilis before 
his marriage, but was said to be perfectly well when this took 
place. The child was nursed for about four months, but occa- 
sionally had a bottle of Swiss milk. The indications for treat- 



Periscope and Abstract. 291 

ment appeared to me to give a light and easily digestible food, 
moreover one which after digestion would leave as little waste 
material as possible, to soothe the irritation of the bowels, and 
to improve the condition of the blood. I ordered two tablespoon- 
fiils of whev, and one tablespoonful of cream to be taken at each 
feeding, and in the course of twenty-four hours I found she man- 
aged to dispose of 3^ a pint of barley-water, ^ a pint of whey, 
y^ of a pint of cream, together with, later on, i y^ ounces of 
milk. She also took in twenty-four hours the white of four eggs 
beaten up in water, four teaspoonfuls of Brand's liquid essence 
of beef, and two ounces of linely-minced raw meat. I ordered 
the body to be thoroughly oiled night and morning, the loins and 
stomach to be kept warm with a tiannel bandage, and the feet to 
be well wrapped up. In order to alter the character and fre- 
quencv of the secretions, I gave three times dailv a mixture con- 
sisting of the following: one minim solution of potash; eight 
minims castor oil; ^ of a minim tincture opium; twenty minims 
s^'rup ginger, and y^ a drachm mucilage. Then when the pus 
and slime began to pass away and the bowels appeared simply 
relaxed, I gave two grains bicarbonate soda; three grains sub- 
carbonate bismuth; y^ a minim tincture opium; live minims 
tincture catechu; two minims tincture rhubarb; live minims 
coiT^pound tincture cardamoms with a little syrup and mucilage 
every four hours. Next, in order to improve the condition of 
the blood, as soon as the secretions began to improve, I ordered 
ten minims of the concentrated svrup of the lactophosphate of 
lime and iron to be given in water three times daily. The child 
was ordered from the start to get plenty of fresh air provided it 
was dry, and the rooms in which the child lived and slept were 
requested to be kept quite dry, and at the same time thoroughly 
clean and ventilated. In the course of about i^ years the child 
under this treatment made a good recovery, and was able to run 
about by herself and eat the same as any other child. The vom- 
iting ceased almost entirely from the time that the milk was 
given up. Whenever the secretions became purulent and slimy 
the castor-oil and laudanum mixture was resorted to, and the 
carminative and astringent one when the bowels were simply a 
little relaxed. The castor-oil and laudanum was successful in 
altering the character of the secretions, not simply once or twice, 
but on several occasions, and I have applied it since in other 
cases with uniform success. As regards the lactophosphates, I 
cannot speak too highly of them in aiding the subsequent recov- 
ery. As Dr. Dusart states, they act as general excitants of all 
the nutritive functions, insure digestion, bring back or increase 
the appetite, and generally improve the vital energies. — Prac- 
titioner, 



202 The Peoria Medical Monthly 



NASAL ASTHMA— ITS CAUSES AND TREATMENT. 

Dr. G. Hunter Mackenzie thus writes in the Brit. Med. 
yoitr.. Ma}' i6, 18S5: The casual relationship between nasal dis- 
ease and asthma was first pointed out by Voltolini in 1872 (re- 
ferred to by Morell Mackenzie, IMiDiiiaJ of the Discuses of t/ie 
Throat and JVose., Vol. ii., p. 360), and since that time numerous 
cases have been recorded which have established the accuracy of 
this observation. In all these instances, with one exception re- 
corded by myself {^Ediiiburi^-h Medical 'Journal, Februar}^, 1883), 
polypi, or marked swellings of the nasal mucous membrane, have 
been the varieties of disease present. This has given rise to the 
theory held by some, that the asthma is owing to mechanical ob- 
struction to the passage of air; and additional conlirmation of 
this view is supposed to be afforded by the disease disappearing 
on the removal of the obstructing mass. 

Against this theory two arguments can be advanced: the 
frequency of polypus or tumefaction of the nasal mucous mem- 
brane without asthma, and the presence of nasal asthma without 
tlie recurrence of either. The tirst is a matter of every-day ex- 
perience, and the second has received illustration by the case 
above referred to, in which violent paroxysms of asthma were 
associated with a condition of chronic (atrophic) inflammation of 
the nasal mvicous membrane, and ceased on the application of 
nasal remedies ; and by the following case that has recently come 
under my notice : 

A boy, aged thirteen, was brought to me on January 23d, 
1885, on account of a copious watery discharge from the nose, 
and asthma. He had suffered from these for about ten 3'ears, 
with slight periods of remission. The asthmatic attacks were 
often \cry severe, and generally occurred about 4 or 5 ^- ""*• 
The condition of his nose necessitated the use of from twenty to 
thirty handkerchiefs daily. Anterior and posterior rhinoscopy 
showed chronic catarrh of the nasal mucous membrane, with a 
slight amount of muco-purulent secretion. There was no poly- 
pus or thickening of the membrane. Though not robust, he 
presented no indications of disease elsewhere. (This patient has, 
apparently, quite recovered under the after-mentioned treatment.) 

What is the explanation of such cases? I believe the asthma 
U) l)e owing, not to any mechanical obstruction of the nasal pas- 
sages, but to a condition of abnormal irritabilit}- of the nasal mu- 
cous membrane, due to or aggravated by chronic inflammation. 
Polypi may, or may not co-exist; when present, they doubtless 
assist in maintaining the augmented irritability of the mucous 
lininiT. The hi<di detrree of normal sensitiveness of the mucous 



\ 



Periscope and Abstract. 293 

membrane of the nose is well known; and when this membrane 
has been the subject of long-continued inflammation, its irrita- 
bility appears to become highly augmented, and more easily ex- 
cited. Reflex acts are then readily induced, of which sneezing, 
cough, and asthma are the principal indications. 

The peripheral irritation may be caused by dust or pollen, 
and hence the attacks are usually worse in midsummer and 
autumn; by cold, therefore, their frequency in the early morning 
hours; or by the irritation of a polypus. Dr. John Alackcnzie 
has recently stated ( Transactions of the Medical and Chinirgical 
Faculty of JSIarylaud^ i^'^4) that asthmatic attacks in cases of 
nasal polypus only occur when the growth is, b}' force of grav- 
ity, brought against the posterior part of the nostril, correspond- 
ing with the most excitable spot in the sensiti\'e area. On the 
other hand. Hack, quoted by Morell Mackenzie {Manual of Dis- 
eases of the Throat and J\ose^ \"ol. ii., p. 361 ), considers that re- 
flex phenomena may be produced by irritation of any part of the 
lining membrane of the nose. 

Associated with the asthma are usuall}- excessive sneezing 
and profuse discharge of mucus from the nose, occasionally 
cough. There is more or less impairment of the general health, 
with languor and depression of spirits. 

The treatment of these cases must obviously, in the first 
place, be directed to the removal of the exciting cause. The pa- 
tient ought to be directed to reside in an atmosphere as free as 
possible from dust and other atmospheric impurities. Above all, 
active medication should be directed to the nose; and, after a 
fair trial of various remedies, I have found none so efficacious as 
belladonna, applied in the form of buginaria (nasal bougies). 
From one-twelfth to one-sixth of a grain of the extract ought to 
be incorporated in each bougie, one of these being introduced 
into each nostril night and morning, and allowed to thoroughly 
dissolve there. I have found their employment most beneficial, 
alike in regard to the sneezing, the secretion and the asthma. 
Their use is usuall}' followed by a burning sensation in the nose, 
but this is never severe, and soon disappears. I have also ex- 
perimented with the sulphate of atropia in the same way, but 
have found it less efficacious, and probabl}" more irritating than 
the extract. Previously to the introduction of the bougie, the 
nasal mucous membrane may be cleaned by the anterior nasal 
spray. The use of the bougies may be gradually made less fre- 
quent, according to the amount of success achieved. 

The cases which I have hitherto watched, have rather be- 
longed to the atrophic than the hypertrophic form of rhinitis, but 
where vascular engorgement is present, it seems probable that 



294 The Peoria Medic ae Monti ilv. 

the use of cocaine bougies would be beneficial. According to 
Bosworth [l)itcr)i(itionaIes CertraJhlatt fur Laryngologie und 
Rhinilooic^ No. 8), this drug has a remarkable effect in dimin- 
ishing the vascularity of the lining membrane of the nose. In 
acute nasal catarrh, its local application has only a temporary 
effect. 

The treatment ma}- be combined with the administration of 
tonics, and such other general remedies as may be deemed suit- 
able b}' the phwsician. B}- themselves, these are, however, sin- 
gularly inetiicacious. I venture, therefore, to commend to the 
profession the use of nasal bougies, containing belladonna, as an 
effectual method of treating the troublesome and obstinate com- 
plaints dependent upon chronic nasal catarrh and irritability, of 
which asthma is alike the most important and most intractable. 



WHITE OF EGG IN OBSTINATE DIARRHCEA. 

From the AUl;;. Med. CoiL-Zci'L, we learn that Celli has 
recently called attention to the curative properties of the albumen 
of hen's eacs in severe diarrha^al affections. In a discussion be- 
fore a medical society at Rome, he advocated its use, and related 
two cases of chronic enteritis and diarrhcva, which having re- 
sisted all treatment, speedih' made complete recoveries under the 
use of egg-albumen. The same diet is strongly recommended 
in the diarrha-a accompan3'ing febrile cachexia, and in that of 
phthisis. In two cases of diarrhoea dependent upon tertiary 
S3'philis, it was found of no avail. On post mortem examination 
diffuse am^'loid degeneration of the arterioles of the villi was 
found in these cases. The mode of administration is as follows: 
The white of eight or ten eggs are beaten up and made into an 
emulsion with a pint of water. This is to be taken in divided 
quantities during the da^^ More ma}" be gi^'en if desired. The 
insipid taste can be improved with lemon, anise or sugar. In 
case of colic, a few drops of tincture of opium may be added. 



ICE TO THE SPINE IN OBSTINATE VOMITING. 

Dr. Wm. L. Davis, in the Mississippi Valley Med. Mo., 
says: I was called to a patient, a't. forty-seven, the mother of 
nine children, suffering from a severe t3-phoid fever with intract- 
able vomiting, which had persisted for several da^-s. All of the 
ordinary means failed to control the condition of the stomach, 
and even pellets of ice were instantl}' rejected. High tempera- 
ture characterized the fever, and every effort was made for its 
reduction, believing that it had much to do with the production 



Periscope and Abstract. 295 

of the nausea and vomiting, but the latter prevented the medica- 
tion indicated for this purpose. 

Menstruation had been normal for some time, except the 
epoch just preceding the attack of fever, which, although the 
flow made its appearance, was but limited in quantitv. From 
the age of the parent and the number of children she had borne, 
I was inclined to the belief that the climacteric was a factor in 
the gastric derangement. Thinking, therefore, that the vomit- 
ing might depend upon reflex disturbance of uterine origin, or 
ill-defined spinal derangement, I applied ice in considerable quan- 
tity to the lowest part of the spine. The vomiting ceased in- 
stantly, and a profuse perspiration followed. The use of the ice 
was persisted in only as the indications appeared to demand it. 
Taking the hint from this, however, cool sponging was instituted 
with marked benefit, so that the use of the extreme cold to the 
spine was only of occasional necessity. With the exception of 
anod^'ne injections to produce rest at night, little other treatment 
was ordered. The subsequent progress of the case was satisfac- 
tor}', and the ultimate recovery complete in about the average 
time. 

The history of the case since her getting up has not con- 
firmed my conclusions in regard to the menopause. 



CLASS-ROOM NOTES. 

In wounds upon the face. Prof. Gross covered the sutures 
with a solution of iodoform ten parts, collodion ninet\' parts. 

Prof. Gross says: When we find a hea\ily coated, furred 
tongue, give 3 grs. calomel, followed b}' 2 dr. each, of Rochelle 
and Epsom salts. 

In gastralgia, Prof. Bartholow has often obtained good re- 
sults from — 

R. Atropinie sulph., 1 gr. 

Zinci sulph., 5 dr. 

Aqiue destil., 1 oz. M. 

SiG. — Three to five drops twice or thrice daily. 

The lead water and laudanum solution of Prof. Gross is as 
follows: 

R. Plumbi acetatis, 2 scruples. 

Tinct. opii, i oz. 

AquK?, 1 oz. M. 

SiG. — Lotion. 



296 The Peoria Medical Monthly. 

A young man who had for several years practiced mastur- 
bation, applied at the clinic for relief, as he was sufferini^ from a 
morbid sensibility of the urethra, with constant, sticky discharge 
from that canal. He was given, by Prof. Gross — 

R. Potass, broniid, 1 dr. 

Sodii bicarb., 15 gr. 

Inf. digitalis, i oz. 

Atropinie sulpli., 1-60 gr. M. 
SiG. — At bedtime. 

In case of cerebral hyperaMTiIa consequent upon a blow. 
Prof. DaCosta prescribed the following acti\e purgative: — 

R. Ext. eolocynth, 1 gr. 

Capsici, I gr. 

Ext. gentiaiiiv, 2 gr. M. 

SiG. — Ter die, in pill. 
At night, sodium bromide, 25 gr. 

A man, 61, years old, suffering from mitral stenosis with hy- 
pertrophy, and in whom atheromatous degeneration of the blood 
vessels was present, was given, by Prof. DaCosta, iluid ext. of 
convallaria, 8 drops ter die, to make heart beat more regularly: 
Fowler's solution for the atheroma. 

A bo}', 4 3'ears old, had recurring spasms. Two years pre- 
viously he fell, striking on his temple, causing instant paralysis 
on opposite side. Was gi\en b\- Prof. DaCosta — 

R. Potfiss. iodidi 3 gr. 

Potass, bromid., 5 gr. 

Elix. aurantii, ad 1 (\i\ M. 

SiG. — Ter (lie. 

To prepare ids ligatures for use. Prof. Gross uses jMcCuen's 
method: Take i oz. of chromic acid (crystals) to 5 oz. of water. 
Of this solution take i oz. and to it add 5 oz. of ghxerin. In 
this latter steep the animal ligatures for ten days, then remove 
and thoroughly dry them. Now, for preservation, keep them 
in a , ?, „ solution of carbolic acid. 



1 u u 



For a case of infantile parah'sis of two or three week's du- 
ration, in a girl a't. 4, in which the paralysis involved the right 
upper extremity and the left lower extremity, Prof. Bartholow 
brought about a good result by massage, also the administration 
of lactophosphate of calcium with ol. morrluue. Strychnia was 
injected into the muscles. 

Dr. Sajous, at the hospital, treats post-nasal catarrh as fol- 
lows: First a purgative, as sulphate of magnesia, 2 scruple, 
then use as a " snuff " ter die — 



J 



Periscope and Abstract. 297 

R. Bismuth subcarb., 

Pulv. acaciie, aa i dr. 

Zinci sulph., 10 gr. 

Morph. sulph., 2 gr. M. 

At the hospital, Dr. L. Webster Fox prescribed for a case 
of acute conjunctivitis: — 

R. Acid borici, 12 gr. 

Aqiue camphox'fe, 

Aqute destil., aa 2 oz. M. 

fSiG. — Eye lotion. 

Should this fail, use something stronger, as zinc, chloride, 
2 gr. to I oz. In the third stage, where we are confronted with 
granular lids, use the caustic copper, in sticks. 

Dr. Fox also spoke of jequirit}- in troublesome granular 
lids, to wit: Bruise i oz. of the beans to a pint of water. Take 
a little of this solution and apply to the eye, and in a week we 
obtain a smooth surface. 

To diminish the sensibility of the mucous membrane of nose, 
Dr. Sajous uses — 

R. Acid, tannic , 40 gr. 

Glycerini, 1 oz. M. 

SiG. — Ap|)ly with a cotton-wrapped probe. 

A solution of zinc chloride, 2 gr. to i oz., is also useful, or 
5 gr. to I oz. of the zinc sulpho-carbolate. 

To get rid of effusion when the aboye is of no ayail, let the 
patient sit covered with a sheet, and place a lamp within to steam 
him; or use — 

R. Bismuth, subcarb., 

Pulv. talc, aa 1 dr. 

Alumnts, * dr. 

Morph. sulph., 1 gr. 

Pulv. acacire, 1 dr. M. 

SiG. — To be used as snuff, several times a day. 

The following treatment, by Dr. Sojous, was recommended 
for chronic coryza:— 

R. Sodii salicyl, 2 dr. 

Sodii bibor., 3 dr. 

Glycerini, * oz. 

Aquje, ad 6 oz. M. 

SiG. — Of the above take 2 dr. and put into 1 pint warm water 

(100 deg. F.j. 



298 The Pkoria Medical Monthly, 

Of this latter solution, " snuff " into nostrils as much as cart 
be taken up in the hollow of one's hand, ter die. 

Prof. Bartholow ad\ised, in a case of catarrh of the nares, 
of specitic origin — 

R. Sodii iodidi. 10 gr. 

Syrupi picis, 2 dr. M. 

Sio.— Ter die. 

Also — 

R. Pil. ferri iodidKU. R. P.) 
Sk;. — One daily. 

In the management of pregnancy, Prof. Parvin spoke as 
follows: Let the patient eat but little in the latter mohths, though 
she may eat a little frequently during the day. A large meal 
causes much inconvenience, due to the already enlarged abdo- 
men. A bandage properh' applied around the abdomen is use- 
ful and comfortable. She should sleep eight hours, and take an 
occasional bath in tepid water. If leucorrhcea be present, let her 
use an injection of salt water, and bathe the external genitalia 
with tepid water. 

Care of the breasts. — Use oily matters, and no alcohol. In 
the morning the nipples ma^• be painted with equal parts of tinct. 
arnica and water, but in the evening should be covered with 
cocoa butter. 

High-heeled shoes should be dispensed with during preg- 
nancy. — Coll. and Clin. Record. 



NOTES OF TREATMENT. 

1. Dyspepsia. — Cau<.ci of Functional Indiocs.tion. i. Eat- 
ing too rapidly. 2. Drinking too much water at meal time. 
3. Improper food. 4. Want of exercise. 5. Too much tea and 
coffee. 6. Too much tobacco. 

Treatment. — Under-done meats and but little bread. No 
sweets. Pepsin sacch., gr. v, at each meal. The mineral acids 
before meals, as muriatic, nitro-muriatic, or phosphoric. Certain 
bitters, as nux vomica and strychnine combined with gentian or 
calomba. An alkali a few hours after meals when there is great 
acidity, but should not be used too frequentlv. 

2. Dilatation OF the Stomach. — Treatment : Dr}-, solid 
food; under-done meats; no milk. Carbolic acid to alla^- fer- 



Periscope and Abstract. 299 

mentation. Wash out stomach occasionally. Strychnia, hypo- 
dermically or by mouth. 

3. Chronic Gastritis. — Treatment: Cause to be removed. 
A scant}' supply of food. Pepsin at each meal (gr. v). Milk, 
with a little meat, maybe taken as food. Oxide of silver, or. y,^ 
a dose, will be found of value. Bismuth is useful. Avoid tonics, 
but use the mineral waters to keep portal svstem drained. 

4. Gastric Pain (Gastralgia). — Treatment : Diet of lit- 
tle importance. Stimulus at meals in small amounts. Morphia 
relieves at once, but use it carefull}-. i. Bismuth, with a little 
opium. 2. Nitro-muriatic acid, gtt. ij-iij, diluted, or — 

R. Morph. sulph., 1-32 gr. 

Acid carboiici, gtt. j. 

A(j nienth. pip. ad 1 dr. M. 

SiG — Ter die. 

4. Fowler's solution, beginnino- with gtt. j, and increase to gtt. v, 
ter die. 

4. H.^MATURiA. — Treat the cause as well as the s^-mptoms, 
though the treatment of both is generally the same. i. Gallic 
acid, in doses of gr. x-xx, repeated every hour or two. 2. Sul- 
phuric acid, alone or with gallic acid, unless contraindicated b\' 
scarlet fever, etc. 3. Fluid extract of ergot, gtt. xx, increased 
to I dr. All three of the above are reliable remedies. 

6. M]:i)iCAL Treatment of Diabetes Meelitus. — Do 
not use bromide of potassium; it is valueless. Quinine is of no 
use. Opium is of value, and is one of the best agents, but care 
should be taken in its use. Codeia, 5<("/^ ter die, is much used 
in France. Trousseau's plan, with strychnia, is very useful. 
The salicylate of sodium, gr. x-xv ter die, in compound spirits of 
lavender and water, is Prof. DaCosta's favorite. Ergot is useful, 
but less so than the others. The alkaline plan, which is quite 
popular in Europe, is of value. Aloes or aloin should be used 
for constipation that ma}^ arise. 

7. Diabetes Insipidus. — Uled/'eal Treatment : i. A course 
of iron, for its tonic effects. 2. Str}'chnia is very useful. 3. 
Ergot gives the best results; absolute cures follow its use; ^-i 
dr. of the fluid extract should be given ter die. — Cot/, and Ct/'n. 
Reeord. 



The Med/'eal Chroniele., of Baltimore, will be merged into 
the Medical Times., of Philadelphia. Dr. Rhoe, of the C/iro>iicte, 
will be on the editorial staff of the Tinics. 



THE 

Peoria Medical Monthly. 



THOS. M. McILVAINE, A. M., M. D., 

Editor and Piihlis/ier. 
204 S. Jefferson St., Peoria, III. 



*:t:*The Eilitor is not responsible for the statements or opinions of contributors. 

***Short original articles are invited from any reader, whether a subscriber or not. 

***If extra copies are desired by a contributor, the nmnber must be .specified when the 
article is sent to the Editor. 

***A11 exchanges, l>ooks for review, and communications must be addressed to the Editor 
and Publisher. 

***The publication day of this journal is^on or about the '25th of each month. 



EDITORIAL. 

RULES FOR THE INTERNATIONAL CONGRESS. 

At the special meeting of the revised committee on the or- 
ganization of the Congress, held in New York September 3d, 
the following rules were adopted: 

1. The Congress shall consist of members of the regular 
profession of medicine, who shall have inscribed their names on 
the register and shall have taken out their tickets of admission; 
and of such other scientitic men as the Executive Committee of 
the Congress may see fit to admit. 

2. The dues for members of the Congress shall be ten dol- 
lars each for members residing in the United Stotes. 

There shall be no dues for members residing in foreign 
countries. 

Each member of the Congress shall be entitled to receive 
a cop3' of the "Transactions" for t888. 

3. The Congress shall be di\'ided as follows, into seventeen 
Sections : 

I. General Medicine, 
II. General Surgery. 

III. Military and Naval Surgery. 

IV. Obstetrics. 



Editorial Deqartment. 301 

V. Gynecology. 

VI. Therapeutics and Materia Medica. 

VII. Anatomy. 

VIII. Physiology. 

IX. Pathology. 

X. Diseases of Children. 

XI. Opthalmology. 

XII. Otology and Laryngology. 

XIII. Dermatology and Syphilis. 

XIV. Public and International Hygiene. 

XV. Collective Investigation, Nomenclature, Vital Statis- 
tics, and Climatology. 

XVI. Psychological Medicine and diseases of the Nervous 
System. 

XVII. Dental and Oral Surgery. 

4. The General Meetings of the Congress shall be for the 
transaction of business and for addresses and communications of 
general scientific interest. 

5. Questions and topics that have been agreed upon for 
discussion in the sections shall be introduced by members pre- 
viously designated b}- the titular officers of each Section. Mem- 
bers who shall have been appointed to open discussions shall 
present in advance statements of the conclusions which they have 
formed as a basis for the debate. 

6. Brief abstracts of papers to be read in the Sections shall 
be sent to the Secretaries of the proper sections on or before 
April 30, 1887. These abstracts shall be treated as conhdential 
communications, and shall not be published before the meeting 
of the Congress. 

Papers relating to topics not included in the lists of subjects 
proposed by the Officers of the Sections may be accepted after 
April 30, 18S7; and any member wishing to introduce a topic 
not on the regular lists of subjects for discussion shall give no- 
tice of the same to the Secretary-General, at least twenty-one 
days before the opening of the Congress, and such notices shall 
be promptly transmitted by the Secretary-General to the Pres- 
idents of the proper Sections. The titular officers of each Sec- 
tion shall decide as to the acceptance of such proposed commu- 
nications and the time for their presentation. 



302 The Peoria Medical Monthly. 

7. All formal addresses, scientific conimunicalion and pa- 
pers presented, and scientific discussions held at the General 
Meeting's of the Congress, shall be promptly given in writing to 
the Secretary-General; and all papers presented and discussions 
held at the meetings of the Sections shall be promptly givep in 
writing to the Secretaries of the proper Sections. 

No communication shall be received which has already been 
published, or read before a societ}'. 

The Executive Committees, after the final adjournment of 
the Congress, shall direct tlie editing and the publicaticjn of its 
"Transactions," and shall have full power to publish the papers 
presented and the [discussions held thereon, either in full, in 
part, or in abstract, as in the judgment of the Conuuittee may 
be deemed best. 

8. The official languages of the Congress shall be English, 
French and German. 

In the meetings of the Sections, no member shall be allowed 
to speak for more than ten minutes, with the exceptions of the 
readers of papers and those who introduce subjects for discus- 
sion, who may each occupv twenty minutes. 

9. The rules and programmes sliall be published in English, 
French and German. 

Each paper and address shall be jirinted in the "Transac- 
tions" in the language in which it is to be delix'ered. 
All discussions shall be printed in English. 

10. The President of the Congress, the Secretarv-General, 
the Treasurer, the Chairman of Finance Committee, and the 
Presidents of the Sections, shall together constitute an Executive 
Committee of the Congress, which Committee shall direct the 
business of the Congress, shall authorize all expenditures for the 
immediate purposes of the Congress, shall super\-ise and audit 
the accounts of the Treasurer, and shall lill all vacancies in the 
offices of the Congress and of the Sections. This Committee 
shall have power to add to its membership, but the total lumiber 
of members shall not exceed thirty. A number equal to one- 
third of tlie members of tlie Committee shall constitute a quorum 
for the transaction of business. 

11. The Officers of the Congress shall be a President, Vice- 
Presidents, a Secretary-General, four Associate Secretaries, one 



Editorial Department. 303 

of whom shall be the French Secretary, and one of whom shall 
be the German Secretary, a Treasurer, and the Chairman of the 
Finance Committee. 

12. The officers of each section shall be a President, Vice- 
Presidents, Secretaries, and a council. 

13. The officers of the Congress and the officers of the Sec- 
tions shall be nominated to the Congress at the opening of its 
first session. 

14. The Executive Committee shall, at some convenient 
time before the meeting of the Congress, prepare a list of foreign 
Vice-Presidents of the Conoress and foreign Vice-Presidents of 
the Sections, to be nominated to the Congress at the opening of 
its first session. 

15. There shall be a standing Committee on Finance, com- 
posed of one representative from each State and Territory, the 
District of Columbia, the Medical Department of the Army, the 
Medical Department of the Navy, and the Marine Hospital Ser- 
vice. 

The Chairman of the Finance Committee shall report to the 
Executive Committee of the Congress. 

Each member of the Finance Committee shall appoint a 
local Finance Committee for his State, Territorv, District, or 
Government Department, consisting of one or more members 
from each Government Department or Congressional District. 

Each local Finance Committee shall report through its 
Chairman to the Chairman of the Finance Committee of the 
Congress. 



STATE BOARD OF HEALTI^ STATISTICS. 

The necrological report of the Secretary of the State Board 
of Health of Illinois, for the four years ending January ist, 1885, 
shows the following points of interest. 

During that period the death of 230 physicians has been 
reported. 

Notwithstanding the severe demands such a life makes upon 
the physical man, two of the number lived four-score years and 
more; twenty-seven were over seventy; and 112, or about 50 



304 The Peoria Medical Monthly. 

per cent, were tifty years old. The average age was fifty-one 
years, the oldest being eight-two, and the youngest twenty-four. 
As to the causes of death, it may be noticed: Affections of 
the respiratory system stands first with sixty to its credit, and 
twenty-four of these from pneumonia alone. Diseases of the di- 
gestive organs claim twenty-five. The circulatory and nervous 
systems each twenty, though of course many causes, as certain 
heart diseases, and even stomachic complaints often might be said 
to be primarily nervous rather than otherwise. Accidental causes 
record ten. So also ten from overdoses of medicines (almost 
universally these were soporifics). Of the remaining causes, 
perhaps the most notable is that six are suicides. . C. 



CHIEF OF MARINE HOSPITAL SERVICE. 

For some time past there have been rumors of a change of 
the Supervising Surgeon General of the Marine Hospital Ser- 
vice, and Drs. Mathews, of Louisville, and Walling, of Indianap- 
olis, have been mentioned in connection with the position. 

A late dispatch from Washington City, however, states 
that Vice-President Hendricks has informed the President that 
in his opinion a change is neither wise nor expedient, and that he 
has withdrawn the name of Dr. Mathews whom he had pre- 
viously urged for the place. It is said he will also oppose the 
appointment of Dr. Walling on the same grounds. The resig- 
nation of Surgeon General Hamilton has not yet been accepted, 
and the impression is, that he will be retained. 

We hope this report is true, and that no change for political 
reasons \x\\\ be made in the rervice. Dr. Hamilton has fiHed the 
office with honor to himself and credit to the service, and should 
undoubtedly^ be retained. 



A WONDERFUL MAN. 
Dr. N. S. Davis, of Chicago, is certainly one of the most 
extraordinary characters of contemporary medical history. 
Apart from his acknowledged abilities as a practitioner and 
teacher of medicine, his personal force and industry is almost un- 
rivalled. With an extensive practice (said by many to be the 



Editorial Depart]mext. 



305 



largest in the Northwest), and at an age when many would 
think of retiring full of honor and years, he is still the head of 
the American Medical Association, the Illinois State Society, the 
Chicago Medical College, the founder and editor of the 'Journal 
of the A)]ierican Medical Association, and now has been appointed 
to the onerous duties of Secretary General of the next Interna- 
tional Congress. Whatever criticisms may be made of his offi- 
cial utterances, no one can deny the wonderful energy of this 
wonderful man, and his name will long remain one of the noted 
names of American medicine. 



OUR BUSINESS. 



Readers are earnestly requested to send us short articles on 
any medical subject, reports of cases or therapeutic notes. We 
hope quite a number will comply with our request at once, that 
the October No. ma}- be out on time with many original articles. 
We know of some on whom we can safely depend, and would 
like to know of more who will help us out "in a pinch" for 
matter. Many thanks to those who have remitted; there are 
yet several hundred dilinquents, whom we would like to thank 
if they will onlv give us the opportunitv. 



NOTES AND COMMENTS. 

Dr. Fehling, of Stuttgart, the inventor of the well known 
test for sugar in urine, died on July ist, in his seventy-third year. 

The honor of nobilitv has been conferred on the eminent 
surgeon, Dr. Richard Volkmann, Prof, of Surgery in the Uni- 
\ersity of Halle. 

A correspondent of tlie Monthlv Magazine of Pharmacy, 
writing from Messina, says: "A bottle of bromine left in a closed 
room all night with the stopper out destro3-s all infection and 
insect life. I have cleared places which were infected with 
vermin many times. It is far more effectual than the vapor 
of burning sulphur. 

Dr. Ralph Richardson writes to the British Medical 
Journal that anv one mav be cured of stammering by simply 



3o6 The Peoria Medicae Monthly. 

making an audible note in expiration before each word. Stam- 
merers can sing as easily as other persons. Jack Broster, of 
Chester, who made a large fortune b^' curing stammering, simply 
made his pupils sa^■ Jicr before each word beginning with a con- 
sonant. 

A countryman with a jumping toothache entered a drug 
store and inquired for something to give him relief. 

"We have various remedies for that trouble," the druggist 
replied. " We can give 30U an3thing 3'ou like, sir." 

"Well," replied the suffering countrNinan, "I guess you kin 
give me a small bottle of Boston faith cure; I hear it's knocking 
the spots off evervthin. — GaillarcVs Afcdinil younial. 

Dr. Oliver Wendell Holmes says that a doctor's patients 
must put their tongues out, and a doctor's wife must keep her 
tongue in. 

Doctor {tofaticni) : "Well, how do you feel to-day?" 
Patient ( /;/ (/oy)uy): "Oh, doctor, do something for me. I 
suffer terribl}-. I have the pains of li — 1." 

Doctor [ill surprise): "What! Already?" 

In the Congo Free State are 4,500,000 people and only half 
a dozen doctors: at least so accounts state. 

Dr. Partington, after readinjj of tlie wholesale withdrawals 
from the International Medical Congress as at present governed, 
was heard to remark sententiouslv, tliat he feared the Congress 
was likelv to be merely a sexual one. — Bostoji Medical tnui 
Sitr^'iciji yonrinil. 

A druggist of Iloboken, Mr. Am Ende, \\ell known in this 
city as a conscientious and enterprising man, put up ten grains 
of morphine in powders, instead of quinine as prescribed. The 
powders were taken by two young ladies of Hoboken, and both 
died from morphine poisoning. Thereupon Mr. Am End took a 
poisonous dose of atropine but recovered. The incident bears 
its own moral: That the most careful can sometimes make the 
most serious mistakes. There is room for the broadcast charit}' 
for Mr. Am Ende, as there is for the sincerest sympathy for the 
afflicted {.wnWy .—J fal ira / Record. 



Editorial Department. 307 

We learn from the Laiircf that Dr. Keith, the well known 
ovariotomist, has just returned from a short visit to America, 
whither he had been summoned to give his opinion upon a seri- 
ous case. This is said to be the first instance, since the Declara- 
tion of Independence, of America having summoned medical aid 
from the old country'. — Caiuida Lancet. 

The consultation was held in Boston and Dr. K.'s fee is said 
to have been $10,000. He ag-reed both in diagnosis and treat- 
ment with the attending ph^'sician. 

Dr. P. O. Hooper, of Arkansas, President of the board of 
trustees of the State Lunatic Asylum, has been elected superin- 
tendent of that institution, vice Dr. C. C. Forbes, who has re- 
signed on account of ill health. The appointment is a most ex- 
cellent one. 

Dr. Thomas Waugh, a ph^-sician of Chicago, 111., was fatally 
shot on September T2th, while returning from a late visit to a 
patient. The assailant is said to have been a jealous husband. 

It is certain that Bismarck's pln'sician, though a charlatan, 
is no fool. It is related that when first presented the prince was 
sick, and peevishly declined to answer questions. "As 3^ou like," 
said the doctor, " then send for a veterinary surgeon, as such 
practitioners treat their patients without asking them any ques- 
tions. — -iMcdical Record. 

In 1880 there were in the United States 64,137 lawyers, or 
one to ever}' 7S2 people; 64,698 clerg3'men, or one to ever}' 775- 
85, 671 doctors, or one to 585. Of these 214,506 professional 
brain-workers, there were 75 female lawyers, 165 female clerg}-, 
and 2,432 female doctors. 

In 17845 the Pliilosoph/'cal Transactions recorded the case 
of a woman who had been tapped for o^■arian disease eight}' 
times, thirteen hogsheads and more being drawn from her during 
a period of twenty-eight years. So writes Dr. Waters in the 
Medical Times. 

Physicians are accustomed to say that cocaine is a local 
anresthetic. They are entirelv mistaken. Any chemist will tell 
you that cocaine is methyl benzomethoxyethyltetrahydropyridin- 
ecarboxylate. Remember that the next time you have occasion 

/ 



3o8 The Peoria Medical Monthly. 

to mention the article in your medical society, but practice on 
the name a little before you wrestle with it in public. — Detroit 
Lancet. 

Dr. C. A, Kingsbury, in Anicr. your. Dental Science, says 
that probably no professional man, surgeon, physician or dentist, 
ever received the patronage of so many crowned heads, princes, 
nobles, and persons of distinction and great wealth, as the Amer- 
ican dentist, Dr. Thos. W. Evans, of Paris. His fees have been 
fabulous, and the emoluments of his practice haAe been so large 
that his present wealth is estimated by millions. 

"Behold! old things have passed away and all things have 
become new " in the treatment of menstrual suppression. Ring- 
er's " En<xlish Bin-Oxide " has effected the transformation. 
Price, $i.oo. Clarke & Co., importers, 819 Arch St., Phila- 
delphia, Pa. 



BOOK NOTICES. 



Index Catalogue of the Library of the Sur(;eon's Offce, 
U. S. A. Cloth, 4to. Vols. I- VI. A. to In. Government 
Printing Office, Washington, D. C. 
This stupendous work will ever remain a monument to its 

projectors, and to the progressive genius of American Medicine. 

A Practical Treatise of the Disease of Children. By Al- 
fred VoGEL, M. D., Professor of Clinical Medicine in the 
University or Dorpat, Russia. Translated and edited by 
H. Raphael, M. D., etc., New York. Third American 
from the Eighth German edition; with plates. Cloth, Svo; 
pp. 640. D. Appleton and Compan^•, i, 3 and 5 Bond St., 
New York. 1885. 

The numerous editions througii which this work has passed 
in a few years, and the number of languages into which it has 
been translated adduces sufficient evidence as to its popularity 
and merit. It can safeh' be declared to be one of the standard 
works upon Paediatrics, and will continue to be such for many 
years to come. 

We can give no better idea of the scope of the work than 
by giving the titles of the various chapters. 



•' 



Editorial Department. 



309 



Beginning with a chapter on Anatomo-Pathological observa- 
tion upon the Infantile Organism, it is followed by General Rules 
for the Examination of Children, and on the Nursing and Care of 
Infants. We have chapters on — Diseases originating directly as 
the result of Delivery. Diseases of the Apparatus of Digestion. 
Diseases of the organs of Circulation, Respiration, Nervous Sys- 
tem, Bladder, and Genital Organs. Eruptive Diseases. Mias- 
matic Biseases. Local Diseases of the Skin. And finally. Gen- 
eral diseases of the Secretions. 

The style is that of an experienced teacher, plain and sim- 
ple, never pedantic. The translator has done his work well, and 
the publishers have contributed no little share to the beauty of 
the volume. 

Practical Therapeutics — A compendium of selected formula? 
and practical hints on treatment systematically arranged, 
interleaved and copiously indexed. By Edward J. Ber- 
MiXGHAM, A.M. M.D., etc., etc. Cloth, beveled boards, 8vo; 
pp. 420. J. R. Bermingham, 12S5 and 1287 Broadwa}-, 
New York. 1885. 

As a general rule we do not look with much favor upon 
compilations of this kind, since they apt to cause the young prac- 
titioner to fall into the habit of "writing his prescriptions from a 
book," and generally, too, the formula are of very unequal 
merit. But in this instance we are forced to give an unqualified 
approval. After a close examination we have not been able to 
find a single formula that did not commend itself to our mind. 
The blank leaves afford sufficient space for the preservation of 
prescriptions or hints on treatment from journals, and the work 
can be made, if rightlv used, of incalculable value to its owner. 
The press work, type, and binding leave nothing to be desired, 
and we predict for the work an extensive sale. 

A Treatise on Nervous Diseasf:s, Their Symptoms and 
Treatment. — A Text-Book for Students and Practitioners. 
By Samuel D. Webber, M.D., Clinical Instructor in Ner- 
vous Diseases. Harvard Medical School, etc. Cloth, 8vo; 
pp. 415. D. Appleton and Company, New York. 1885. 
As stated in the preface, this book is not written for special- 
ists, but for the use of students and general practitioners, and for 



3IO The Peoria Medicae MontheV. 

that reason alone it will prove of general value. It is divided 
into Diseases of the Brain, of the Spinal Cord, and of the Per- 
ipheral and Sympathetic Nerves, with a chapter on unclassitied 
diseases, as Vertigo Chorea, Hysteria, Epilepsy, Tetanus, Syph- 
ilis, etc. 

The author's style is concise and elegant, and his views are, 
so far as we are competent to judge, fully up to the times. 

The Use oe the Microscope in Clinical and Pathological 
ExAMiMATioNs, Bv Dr. Carl Friedl.^nder Berlin. 
Translated, with permission of the author, Bv Henry C. 
CoE, M. D., Pathologist to the Woman's Hospital, New 
York. Second edition, i2mo cloth, pp. 190. D. Appleton 
& Co., 1885. 

A few vears ago the methods of the use of the microscope 
w^ere exceedingiv simple, hut with the ad\"ances of the past few 
years, and especiallv in the held of vegetable parasites, the 
worker with this useful instrument must be exceedingly well 
posted to make his work of substantial value. This work is in- 
tended as a guide to the beginner, as well as a helper to the 
expert. 



RECEIPTS. 

The date following each name indicates where the amount 
credited extends the subscription: 

Illinois— Drs. W. N. Cline, (2.00), May, 1886; N. Holton, (2.00), 
May, 1880; D. T. Stewart (2.00), Feb. 1886; C. W. Durst (2.00), July, 
1886; L. E. Keeley (2. 00), May, 1886; Ch. H. Carter (2.00), May, 1886; 
J. H. Wallace (2.00 j, May, 1886; N. S. Tucker (2.00), August, 1886; 
S.B.Bennett (1.00), December, 1885; Julius Gunther (2.50) January, 
1886; J. H. Tyler (2.00), May, 1886; J. H. Timkins (2.00), May, 1886; 
J. W. Hensley (3. 00) May, 1886; J. P. Walker (^3.00), May, 1886; R. 
R. Worthington (5.00), March, 1886. 

Texas— Dr. J. F. Linden (1.00), September, 1886. 

Tennessee— Dr. W. A. H. Coop (3.00), February, 1886. 

Kansas— Drs. D. C. Tyler (2.00), February, 1886; A. Puderbaugh 
(2.00), November, 1885; J. A. Mitchell (3.00), May, 1886; Jay H. 
Payne (3.00), September ]885. 

Ohio— Dr. S. W. Mercer (1.00), October, 1885. 

Iowa— Drs. Geo. McCulloch (3.00), March, 1886; J. B. Galer, 
(2.00), May, 1886. 



The Peoria 
MEDICAL MONTHLY. 



Vol. VI. : : OCTOBER : 1885 : : No. 6. 



ORIGINAL COMMUNICATIONS. 
OVARIOTOMY— DEATH. 

BY O. B. WILL, M. D, PEORLV, ILL. 

Mrs. K. a German woman, from near Orchard Mines, this 
county, of a vivacious disposition, twenty-nine years of age, and 
the mother of three children, was admitted to Cottage Hospital 
Aug. II, with the following history: Six months ago she came 
in labor with the third child. So far as she was able to deter- 
mine, the period of gestation had not been accompanied by any 
unusual feelings or premonitions except, perhaps, toward the 
latter part, the impression that she was carrying twins! Nothing 
abnormal had been detected previous to conception. A midwife 
attended her during the iirst stage of labor, but as the latter de- 
veloped a tediousness and difficulty apparently out of proportion 
to the necessities of the normal condition, she prudenth' advised 
sending for a physician, and Dr. A. R. Warren, of Pekin, was 
summoned. He discovered the presence of a tumor about the 
size of a child's head at full term, and with considerable difficulty 
succeeded in extracting a living child. A ver}- considerable 
hemorrhage followed, which was linally, however, gotten under 
control, and the patient slowlv, though surel3^ regained a mod- 
erate degree of health. She resumed her domestic duties, but 
continued to feel rather weak. The tumor, which was located 
mostly in the left side of the abdomen, was from the date of labor 
continually prominent, and as time advanced grew with increas- 



312 The Peoria Medical Monthly. 

ing rapidity, tilling the abnormal cavity and creating great dis- 
tress by its size and weight, to say nothing of the accompanying 
chilliness, feyerishness and increasing emaciation and debility. 

Upon admission to the hospital she was found to be terribly 
weak and emaciated. The lower extremities presented the 
spectacle of the bones covered apparently by nothing but the in- 
te»>"ument. The veins were very much enlarged, as were also 
the veins of the abdominal parietes. The temperature of the 
body was almost continuously 102, and the pulse rate 120. The 
appetite was moderately good, the renal secretion about normal, 
and the bowels somewhat loose. An inspection of the abdomen, 
aside from the condition of the veins above alluded to, revealed 
the e:^stence of a tumor of large size, projecting out prominently 
to the front, and distinctly presenting a double lobulated appear- 
ance which was still more marked upon palpation. The smaller 
lobe occupied the left iliac region, and the larger one the right 
center and more prominent portion of the abdominal cavity. For 
a short distance the sulcus between the lobes was somewhat 
sharpel}' detined, but soon a firm and broad union was apparent. 
There was almost no mobility, but a semi-fluctuating condition 
was present. An introduction of the hypodermic syringe needle 
revealed the presence in the larger lobe ofji clear, albuminous 
liquid — perhaps slighth' cloud\'. The introduction of the finger 
into the vagina disclosed a very dense, bard and utterly immov- 
able mass in the hollow of the sacrum and posterior to the uterus 
and bearing" a little more to the left than ri<rht. The cervix 
uteri was found high up behind the pubes and pressed closely 
against the latter. The introduction of the sound revealed a 
uterus of normal, or rather less than normal depth, and the in- 
troduction of the catheter located the bladder against the parietes 
of the abdomen, and pressed out like a fan, so to speak, between 
the latter and the anterior surface of the tumor. 

In view of the fact that the woman was rapidh' approaching 
the grave any way, and at her earnest solicitation, it was deter- 
mined to attempt the removal of the mass by abdominal section. 

August 17th the patient was etherized and placed upon the 
table. With the assistance of Drs. Mcllvaine, Miller and Stout, 
and in the presence of a number of physicians of this city, I pro- 



Original Co:mmunications. 313 

ceeded to the operation. The usual incision was made, extend- 
ing from a point midwav between umbihcus and pubes, to near 
the latter. The abdominal wall was found to be scarcely one- 
quarter of an inch in thickness and adherent in front to the sur- 
face of the tumor. The latter was cut into somewhat unexpect- 
edly in consequence of its adhesion to the abdominal wall, the 
excessive tenuity ot the latter and the paper-like thinness of the 
parieties of the tumor itself. The wall of the growth was yery 
yascular, its internal surface being- well supplied with enlarged 
arteries and veins which bled very profusely upon severance, but 
defied any attempt to ligate on account of extreme friability of 
their own structure as well as the surrounding tissue. The in- 
cision was speedily enlarged upwardly, both in the wall of the 
abdomen and that of the tumor, and the contents of the larger 
section of the latter removed with the hand. They were found 
to consist of a jelly-like, or thick, semi-transparent material mixed 
with both venous and arterial blood, and enclosed in separate 
compartments, of varying size, easily broken into. After empty- 
ing the tumor as much and quickly as possible, the abdominal 
incision was still further enlarged near the umbilicus, and an at- 
tempt made to break the adhesions and turn the remainder of the 
tumor out. The adhesion to the wall in front was found to be 
neither very extensive nor very firm, and was soon broken up; 
but that to the omentum was very considerable and very firm. 
The only way to separate the surfaces was to tie the connecting 
tissues with fine silk and cut them through with the scissors, and 
it was accordinijlv done With some difficulty the tumor was 
then turned out, the smaller section, or lobe, being hard and re- 
sisting and completely involving the right ovary and broad liga- 
ment- The uterine extremity of the broad ligament and its con- 
tents was comparatively free and formed a very inviting pedicle. 
It was transfixed by a stout handled needle, carrying a good-sized 
silk ligature, and the latter tied in the manner desio-nated as the 
" Staffordshire knot." Upon the severance of the pedicle by the 
scissors no oozing of importance was discovered in that locality, 
and what there was from the other surfaces was soon suppressed 
by the application of sponges wrung from very hot water. The 
abdominal cavit}^ was finally well sponged out, the intestines re- 



314 The Peoria Medical Monthly. 

tained as nearly as possible /;/ situ by a large flat sponge laid 
over them and inside of the abdominal walls, and the wound 
closed by interrupted silk sutures in the usual manner. A large 
pad of cotton held on by a broad bandage and covering a car- 
bolized oil dressing completed the operation, and the patient was 
placed in bed and surrounded by bottles containing hot water. 
She was so much exhausted that the idea prevailed she would 
never get off the table alive; and indeed she was several times 
supposed to be dying. She rallied, however, under the use of 
injections of brandy, and some hours after being placed in bed 
reaction seemed to be pretty well established, and she rested in 
tolerable comfort except for the vomiting which continued to 
follow the administration of the ether in the first place. This 
was the trying symptom throughout. The patient was warm, 
cheerful, and had a desire for food but was unable to retain it for 
more than a few minutes. The urinary secretion was approxi- 
mately normal in quantity and quality, the bowels moved with 
as much freedom as could be expected, in response to repeated 
injections, and only a moderate degree of t3'mpanitis developed. 
The temperature never rose above 102 during the progress of 
the case, and but little pain was complained of, excepting in the 
back, which, on account of the extreme emaciation, was very 
sore, even approaching to abrasion. In spite of the use of nearly 
every means to be thought of, the vomiting continued at intervals 
of from ten minutes to an hour. The agent which proved of 
greatest value and gave most relief was iced champagne in doses 
of one-half to one teaspoonful every fifteen minutes. The pa- 
tient continued to reject all nourishment, gradually grew weaker 
and died of exhaustion on the iifth day. 

An examination of the tumor after its removal revealed the 
fact that it was primarily of a dermoid character. The smaller 
lobe, which was located in the sacral concavity, and was felt as 
an extremely hard body posteriorly to the uterus, was found to 
be a dense, fibrous sack, with parieties nearlv or quite an inch 
in thickness, enclosing several tufts of blonde hair several inches 
in length, and surrounded by a cheesy matter. To the upper 
and right side of this smaller lobe was attached the larger one, 
consisting of a thin membranous sack divided into various com- 



Original Communications. 315 

partments, adherent to the sides of which, as well as to the inside 
of the sack proper, was the peculiar thick, jelly-like substance 
formerly referred to, and the most of which was removed by the 
hand previous to turning out the tumor. 

Thus, briefly, I present this case to the consideration of the 
profession. The essential points in connection with it have, I 
think, all been given, and nothing would be gained by a resort 
to minor details. The two features to which I would ask the 
attention of the thoughtful reader are, first, the strong probability, 
as developed in the history and progress of the case, that an 
earlier operation would have proven successful, and, second, the 
uncontrollable vomiting and its influence in compelling a fatal 
issue. 



a case of placenta pr.^ivia and its 
sequel.e:. 

BY WM. A. JAMES, M. D., HARRISONVILLE, ILL. 

Mrs. E., age 32, of very slender build and inclined to be 
delicate, had a slight uterine hemorrhage on Mav 7th, 18S5, 
which she supposed was due to lifting a stove boiler full of water. 
The hemorrhage was repeated twice or three times up to June 
1 2th, but was controlled each time by rest in bed and Se^uibb's 
fl. ext. ergot. 

I was called to see her on the 12th of June. There was a 
pretty free hemorrhage from the uterus, and on making an ex- 
amination, I found the os dilated to the size of a silver quarter, 
soft and patulous. The head was presenting as it should, but 
the placenta was attached to the left posterior wall of the uterus 
and within half an inch of the os. I could insert my finger under 
the edge where it had been torn loose. There was some mala- 
rial fever also, the temperature ranging from normal to 100, and 
the pulse never under 100. I prescribed cinchonidia sulph. in 
3-grain doses every three hours, and 15 drops of ergot three 
times a da}^ and confined her to her bed. 

Saw her three or four times between the 12th and 26th. 
There was an occasional hemorrhage when she would move too 
much in bed. 



3i6 The Peoria Medic ai. Monthly. 

I was called again to see my patient on June 26th, at 9 A. 
M. Found the os dilated to the size of a half dollar, with pretty 
strong uterine pains and some hemorrhage, I watched the case 
about two hours when the pains became less and seemed as 
though they would cease intirely. I decided, as labor had com- 
menced, and my patient growing weaker dav bv day, to hasten 
the delivery. I ga\e 10 drops of ergot every lifteen minutes to 
increase the pains and control the hemorrhage. She had a 
severe chill at 12 M., which arrested the pains for a time. It 
was of short duration, lasting onh' a half hour, when the pains 
returned and I made the doses of ergot farther apart. At 1 130 
P. ]M. the temperature was 100 and the pulse no. At 2 she 
was delivered of a very small female child, about the eight month 
and weighing 2}:l pounds. The loss of so much blood and the 
weakened condition of the patient probabh' caused the lack of 
developement of the foetus. It lived until 10 P. M., June 27th. 

After waiting a half to three-quarters of an hour and using 
external manipulation to deliver the placenta, I made an exam- 
ination and found I had an adherent placenta to deal with. This 
being the fourth pregnancy and more or less adhesions each 
time, I decided to delay no longer. It was so hrmly attached to 
the uterine walls that it required twenty minutes or a half hour 
to deliver it. I got a tirm contraction of the uterus after the 
placenta was removed, which checked all hemorrhage, but she 
began immediately to sink, which was caused by the loss of so 
much blood and shock in delivering the placenta. She would 
complain every few minutes of " feeling so badly." When asked 
where 'she felt ' so badly, she could not tell only she " felt so 
badly." She continued to grow weaker with sighing respira- 
tion and profuse, cold perspiration, so much so that it would 
dampen a large towel in wiping the face twice. I gave her 5 
drops of ergot and a half teaspoonful of brandy every half hour 
and 2}4 grains cinchon. sulph. every 3 hours. 

At 6 P. M. the pulse was 160: at 6:30 I was not able to 
count it; at ^7 it was a little stronger and continued to gain a 
little strength during the night. At 2:30 A. ]\[., June 27th, Dr, 
Wetmore, of Waterloo, arrived in consultation. lie added bro- 
mide of ammonium, as she was not restinij well and tr. diijitalis 
to steady the heart's action, but thought the case hopeless. 



Original Comimuxications 317 

June 27th, 7 A. M. — Pulse 140 and less perspiration, also 
resting better. 4 P. M — Pulse 120 and a little feverish, with a 
great deal of thirst. Made the doses of ergot farther apart: 
other treatment the same as before except less of the brandy. 

June 28th, 9 A. M. — Pulse 115, temperature 102; patient 
had a high fever during the night with great restlessness and 
delirium. The skin was a little moist, tongue dry and heavily 
coated. Made the cinchonidia i grain and added i grain of 
Dover's powder every three hours: other treatment the same. 
9 P. M. — Pulse 107, temperature 101.5: skin moist and tongue 
also; slept most of the day: had the vagina syringed out with 
a half gallon of warm water and carbolic acid twice a day: each 
time after using the syringe had the external genitals well coated 
with carbolized oil; contmued the injections twice a day for a 
time, then once a day for the hrst two weeks, when the lochial 
discharge gradually ceased. At no time was the odor more 
offensive than I have seen in a natural labor during such warm 
weather. 

June 29th, 10 A. M. — Pulse 104, temperature 100.5: rested 
well during the night. 5 P. M. — Pulse loS, temperature 100.3; 
continued the same treatment. 

June 30th, 10 A. M. — Pulse 115, temperature 99.5. All 
symptoms good. 

July ist, 10 A. M. — Pulse no, temperature 99: rested well 
during the night; bowels moved three times from small dose of 
sulph. magnesia; passed plentv of urine and all other symptoms 
first rate. 

July 2d, II A. M. — Pulse 115, temperature 101.5. My at- 
tention was called to two large bed sores on the back, involving 
the upper portion of the nates and nearly uniting in the center 
over the sacrum. They were probably two inches in diameter 
with a half inch of sound tissue between them. There were two 
pieces of dead tissue an inch and a half in diameter lying in each 
sore. I could not tell how deeply they extended. I ordered 
carbolized oil (i to 20) to be used freelv and to keep off the 
back by lying first on one side then on the other. 

July 3d, 10 A. M. — All symptoms the same as the day pre- 
vious, except the back. She still persists in lying on it. Had a 
ring prepared to protect the back, but she would not use it. 



3i8 The Peoria Medical Monthly. 

July 4th, 10 A. M. — Pulse 64, temp, normal. 

July 6th, 10 A. M. — Pulse no, temp. 99. The bed sores 
not improving. 

July 8th, 10 A. M. — Pulse 108, temp. 100. The sores con- 
tinue to slough, the two now uniting and the dead tissue in the 
centre beginning to separate. I ordered powdered burnt alum to 
be dusted on once a day and continue the carbolized oil. 

July 10. — The same as on the 8th. Continuing the same 
treatment. 

July nth. — Troubled some with dysentery. Prescribed 
opium, bisnuith subnit. and prepared chalk. 

July 1 2th. — The dysenteric symptoms improving. The back 
is no better. The dead tissue separating and coming out. Still 
persists in lying on the back. 

July 13th, 10 A. M. — Pulse 125, temp. 101.5. Dysentery a 
great deal worse, having had ten or twelve stools in the past 
twenty-four hours; two were passed involuntarily in bed. The 
tormina and tenesmus annoving her very much. Prescribed ^ 
gr. morph. sulph., 10 gr. bismuth subnit. and 5 gr. prepared chalk 
in addition to 5 gr. each of cinchonidia sulph. and Dover's pwd. 
every three hours. 

July 14th. — Continued the same treatment. Bowels no bet- 
ter. Some symptoms of pelvic cellulitis. The sore on back con- 
tinues to sloui^h and ('•row larirer. 

July 15th, 10 A. M. — Pulse 120, temp. 102. Prescribed the 
following for the dysentery with the cinchonidia and the Dover; 
dropping the morphia. 

R. Bismuth subnit. 

Creta pra'p. aa. 160 grains. 

Ingluvin (Warner's) 1 drachm. 

Ext. rub. rad. fl., 2 ounce. 

Tr. opii camph. qs. ad. 2 ounces. M. 

Sici. — Shake well and give a teasiroonful every three hours. 

July i6th, 10 A.M. — Pulse 120, temp. 102. D^'sentery bet- 
ter, but some phlegmasia dolens of the right leg. I bandaged it 
and gave 73^ gr. doses of iodide potass., three times a day. 
Using iodoform freely in the sore on the back, with the carbo- 
lized oil. The sore was now six inches by three and one-half, 
running transversely across the back and exposing the spinous 



Original CoMMUNiCATtoNS, 319 

processes of the sacrum, also destroying a large portion of the 
gluteus maximus muscle on each side. It had become so painful 
that she could not lie on it any longer. 

July 17th, 10 A. M. — Pulse no, temp. 100.4. Bowels are 
a great deal better and all other symptoms improving. 

July iSth, 10 A. M, — Pulse 118, temp. loo.i. Still improv- 
ing. 

July 19th, 10 A. M. — Pulse 120, temp. loi. 

July 20th, 10 A. M. — Pulse 120, temp. 100.4. T'he bowels 
are inclined to be a little costive. 

July 2 1st, 10 A. M. — Pulse 120, temp. 100.8. Back heal- 
ing nicel}'. 

July 2 2d. — Pulse 120, temp. 100. 

July 23d. — Pulse 120, temp. 99.6. 

Jul}' 24th. — Pulse 120, temp. 100.2. 

July 25th. — Pulse 120, temp. 100. 

July 26th. — Pulse 120, temp. 99. 

July 27th. — Pulse 125, temp. 99.8. 

July 28th. — Pulse 125, temp. 99.5. 

July 29th. — Pulse 125, temp. 99.5. There was some de- 
lirium and muttering in the sleep during the night. Did not rest 
well. 

July 30th. — Pulse 130, temp. 101.4. Patient continues to 
grow worse, getting more stupid and hard to rouse up, but still 
not sleeping. Continued the cinchon. sulph. with i gr. of Dover 
every three hours and added tr. digitalis and tr. lobelia aa. 5 
drops every two hours. 

July 31st.— Pulse 204, temp. 99.8. Other symptoms a little 
better. 

Aug. ist. — Pulse 92, temp. 98.8. Still delirious and restless. 
Continued the same treatment with an abundance of nourishment, 
which I had rriven from the beirinninfj of the case. 

Aug. 2d. — Pulse 96, temp. 99. More delirious and rest- 
less. 

Aug. 3d. — Pulse no, temp. 100. Sinking, can hardly 
swallow. 

Aug. 4th. — Pulse 130. Getting still weaker. 

Aug. 5th, 9 A. M. — Dying. Pulse a mere thread. Died at 



^10 THK t^EOUlA MkDIcAL MoNTHLV. 

4 P. M. from pvajinia, the pus being absorbed from a pelvic ab- 
scess which opened through the vagina after death, discharging 
more than a pint of very offensive pus. There was no com- 
plaint of any pain or soreness to indicate that the abscess was 
forming, except in the last few days, w'hen she complained once 
or twice in her delirium of it hurting her in two places. 

What caused the pelvic abscess ? Was it the product of. 
the pelvic cellulitis or was it metastasis from the bed sore ? Dr. 
Wetmore is inclined to the latter view and the circumstances bear 
out his conclusions. First there was a very small amount of 
pelvic cellulitis and if it had been from that, there should have 
been more pain and tenderness longer continued, and the temper- 
ature should have run higher than it did. Second, the bed sore 
was discharging pus pretty freely within a few days of the first 
pvccmic symptoms. Now, the ulcer could not have ceased pro- 
ducing pus so suddenly, so it must have been taken up by the 
blood and deposited in the pelvic region. 



QUINIA BY INUNCTION. 

BY WM. W. MOORE, M. D. WARREN, MO. 

About one 3-ear ago I was called to see two children, one 
five and the other seven years of age, both suffering with mala- 
rial fever of a remittent type. I prescribed calomel and podo- 
phyllin in small doses every three hours until free catharsis was 
induced, alternating with liberal doses of quinia. The little fixe- 
vear-old bov took his medicine without any grumbling, but the 
combined force of her parents, supplemented by the nurse's and 
mv own efforts, failed to make the little seven-year-old girl 
swallow the medicine. Finding m3'self completely balked, I was 
non-plussed as to how I should proceed as it was plain that we 
could not force her to swallow, and the parents were unwilling 
that such a ten-ible struggle should be gone through with at the 
repetition of each dose. While thinking about the advisability 
of a blister sprinkled with quinia the thought obtruded, itself, 
"Why not try inunction?" No sooner thought than done. 

Calling for some lard I incorporated a large quantity of 
quina with it, at least three or four times as much as I should 



Original Communications. ^2t 

have given her in twenty-four hours, with directions to rub one- 
eighth of the mass thorough!}' every three hours over the abdo- 
men and inner surface of the thighs. I should have stated that 
the symptoms in the little girl were of far greater severity^ than 
those of her brother. I left promising to be there at the same 
hour the next dav. 

Judge of my surprise, when upon my return I found the pa- 
tient without fever and getting along nicely. I prescribed the 
same treatment for the next twent3'-four hours. I found her 
little brother with fever vet although the remission was well 
marked. I went back on the third da}' and found the little girl 
convalescing rapidly, while the little boy, who continued ta take 
his medicine per ofa/n, ran on until the fifth da}' before his fever 
" broke." I have had occasion twice since then to resort to the 
same method, each time with like result, although not quite so 
promptly. 

My success in those cases has led me to infer that inunction 
would be a good plan to resort to in some of those cases that 
manifestly need quinia, but, from an irritable or weak stomach 
it cannot be borne. There are many, many cases in every man's 
practice in which I opine, used in this manner, it could be made 
to fultill the indications for its use. 



BILIARY CALCULI. 

BY F, B. BATCHEI.DER, M. D. LYONS, IOWA. 

An interesting case of biliary calculi recentlv came under 
my observation, which mav be of interest to some of your 
readers. 

On April 2ist, 18S5, I was called to see Mrs. L., a German 
ladv, aged* 43 years, mother 'of ten children, the youngest 14 
months old, from~whom I obtained the following history: She 
had alwavs been healthy, excepting that on several occasions, 
about 'an hour after^eating,''she}had experienced a sharp pain in 
the region of the stomach, which was quickly relieved by taking 
a liquid prepared for her by her physician. At her last confine- 
ment she had ^been^ attended by a midwife. First and second 
stages of labor were normal. The midwife removed the placenta 



322 The Peoria Medical Monthly. 

by traction on the cord without waiting to give nature a chance 
to finish her work. The patient assisted by making strong ex- 
pulsive efforts. As the placenta was removed the patient felt a 
sharp i")ain in the right hypochondriac region radiating upwards 
into the slioulder and cervical region. 

Notwithstanding that this pain continued, she left her bed 
as soon as usual for her, probably about the third or fourth da}-. 
From her confinement till I saw her she had never been free 
from the pain, although she had persevered in attending to her 
household duties. She had consulted three or four physicians 
but had received no benefit. At the time of my first visit her 
condition was about as follows: Temperature, loi degrees F. ; 
pulse, 60; tongue covered with a thick, yellow fur, mouth sore, 
gums swollen with constant dribbling of sali\a, breath verv offen- 
sive to the smell, bowels constipated, stools clay colored, urine 
scanty and almost blood red, profuse night sweats and the most 
extensive jaundice I have ever seen, liver somewhat enlarged and 
extremelv tender, and a larije hard tumor over the remon of the 
gall bladder, stomach so irritable that nothing would remain on 
it- — not even water — thirst excessive, no appetite, intense head- 
ache. My diagnosis, of course, was jaundice from obstruction 
of the bile duct, though what caused the obstruction I was un- 
able to say. I immediately put her upon the following: 

Hyd. chl. niit.. 1 grain. 

Sodae hi carb., 25 grains. 

Podophyllum, 1 grain. 

M. et div. in chart No. 12. 
SiG — One every three hours during the day. 
Gave her a Seidlitz powder every other day. She improved 
steadily so as to be able to sit up in a few days, take some nour- 
ishment, headache disappeared, also soreness over the liver, I 
w^ill here state that I applied mustard plasters over the liver for 
counter irritation. The jaundice remained and the clay colored 
stools. I ordered tepid baths every alternate day in w^hich sodium 
bicarbonate was dissolved. After about three weeks of this 
treatment, and when I began to be discouraged about ever re- 
lieving the jaundice and had begun to suspect some malignant 
trouble in the stomach or intestines involving the bile duct, she 
told me she had had a jxissage from the bowels of natural color. 



Original Communications. 323 

I told her that was good news and I thought her trouble was 
about over. The next day I was hurridlv summoned to her bed 
side, the messenger stating that he thought she was dying. 
When I arrived I found her writhino- in terrible ajronv and 
vehemently stating that she could not hold out anv longer, she 
was dying and wished me to give her something that she might 
pass away easily. I immediately recognized the svmptoms of 
gall stones, and the cause of the jaundice now being clear, I gave 
her a Iwpodermic injection of morphia and atropia and when she 
became quiet, left her, telling the familv that she would probably 
be all right in a few hours. On calling the next dav found her 
feeling quite comfortable, and what was mv surprise on her pro- 
ducing a paper in which was carefulh' wrapped a gall stone 
about the size of a pea. From its shape I felt sure there had 
been others with it which had either escaped detection or re- 
mained in the gall bladder. Subsequent events demonstrated 
the correctness of this view as she has had three other attacks of 
pain and has passed in all 98 gall stones, passing in one day as 
high as 33 of these concretions. The weight of the entire collec- 
tion is 280 grains. She has now apparantly recovered her for- 
mer good health and the jaundice has entirely disappeared. 
These concretions are formed in layers and are easily cut with a 
knife. My theory in regard to the case is that the calculi had 
been forming for ^-ears till the gall bladder was nearly tilled up, 
and when the woman bore down to assist in the expulsion of the 
placenta the pressure of the muscles of the abdomen drove one 
of the calculi into the bile duct thus occluding that passage and 
producing the jaundice. 



RHUS TOXICODENDRON. 

i3Y SILAS HUBBARD, M. D., HUDSON, ILL. 

In the Aufrust number of the Monthly is an original article 
on the above subject. I have found bv experience that the rem- 
edies therein mentioned are good for the curing of the poisoning. 
The remedices are of a parasiticide nature. I lind that parasiti- 
cides are the best remedies for the rhus poisonings. Besides the 
remedies mentioned in the aforesaid article I have applied fre- 



324 TnK Peoria Mkdic.m. Montmi.v. 

quently a strong infusion of stramonium leaves with good effect. 
I have also frequently had the patient bathe the parts affected a 
lonii" time with verv warm water with <i^ood effect. And now as 
I have spoken of parasiticides I would sav that I am inclined to 
believe that the poisoning from the rhus comes from a specific 
parasite that infests the rhus, and that making a tincture, or de- 
coction of the rhus would kill the parasites and thus render it in- 
noxious, whatever other properties it possesses. I make the 
foregoing suggestions in hopes that microscopists will examine 
the fresh leaves of the rhus from the ist of Julv till the ist of 
September (that being the time thev seem the most virulent), 
and report the result of their examincition. 



TO REMOA'E GELATIXOID POLYPUS FROM THE 
NOSE— COUGH— DIABETES. 

BY R. I>. MOORE, M. I)., SPRIX(i VAI.EEV, MINX. 

Proceed the same as for plugging posterior nares for hem- 
orrhage, onlv have a strong cord, and a large, coarse cotton 
plug. Pull the plug clear through until it and the polypus come 
out of the anterior nares. 

In cough mixtures add glycerine and syr. rhei, arom, and 
your patient will bless vou. 

In diabetes use equal parts of ergot and the best fl. ext. 
hammelis, in teaspoonful doses for an adult, three or four times 
a day. 

SOCIETY TRANSACTIONS. 

CHICAGO MEDICAL SOCIETY. 

Stated meeting, September 21, 18S5. The President, C. T. 
Parkes, M. D., in the chair. 

" Special versus General Study in Medicine " was the title of 
a veiy interesting essav by Dr. Charles F. Sinclair. The fol- 
lowing is an abstract: During the seventeenth and eighteenth 
centuries there existed several schools of medicine founded upon 
medical investigations stimulated by the discovery of the circula- 
tion of the blood by Harvey. These schools were founded upon 
theories. One school exjilained the processt's of life as due to 



Society Transactioxs. 325 

fiiechanical laws; still another, as due to molecular movements; 
and finallv, schools were founded who respectively promulgated 
the doctrines that life was due to an ether or a spirit existing in 
the oTosser material of the bod\-. Thus we see that medical 
thought and investigation began to divide. This subdivision in 
thought led to separate investigations, and specialism was the 
result. This tendencv, which is becoming more marked each 
da}', mav be called, perhaps, the distinguishing characteristic of 
recent medical study. The more clearh* delined and generall}- 
recognized specialties to-day are surger}-, diseases of the eye, 
diseases of the ear, diseases of women, diseases of children, dis- 
eases of the skin, diseases of the nervous system, diseases of the 
genito-urinarv tract, including syphilis, diseases of the throat, 
heart and lungs, obstetrics and forensic medicine. The rapidit}^ 
with which the tendency of special study is being developed is 
seen in the fact that five years ago one of our oldest medical 
schools gave special notice of onlv two of the special subdivisions 
I have mentioned. However, within three years this school has 
added a fourth vear for the study of the branches mentioned. 
But it is objected that the student of a specialty should become 
practically conversant with the details of so-called general medi- 
cine. But it is a disastrous step for the young practitioner to trv 
to cultivate a special practice' from a general, if the old adage, 
" Once a general practitioner, always a general practitioner," is 
true. On the other hand, the specialist gains a footing more 
readily by contining himself to liis specialt}-. It is further ob- 
jected that the specialist is apt to forget that there are other im- 
portant organs in the bodv beside the one to which he has given 
his attention. But this objection is puerile, when it is seen that 
the successful specialist must of necessity study the relations the 
different organs of the bodv hold to each other, and remember 
that anv departure from the normal in one organ may be the re- 
sult of disease in a more remote organ. The medical profession 
should look with favor upon this subdivision of medical work, 
because we see such vast accumulations of material in all the va- 
rious departments of medicine that iew would care to undertake 
or have the abilitv, to even peruse our medical literature, much 
less master all the knowledge collected. In this day of rapid in- 



326 The Peorta Medicai. Monthly. 

terchange of thought none can be found who can keep abreast of 
all the discoveries in the various departments of medicine. Another 
reason for the existence of the specialist is the fact that very few 
men can secure the expensive instruments necessary to be used 
in the treatment of the various diseases, nor are there many phy- 
sicians who could skillfully use them were they so fortunate as 
to possess them. Many cases cannot be successfully treated 
without these instruments. In our city, specialties should receive 
further development, because as the}- are clearly defined and 
faithfully adhered to in practice, proportionately does the city 
rank as a medical center. 

Dr. F. M. Weller opened the discussion by asking wh}^ the 
subdivision of the practice of medicine into the special treatment 
of diseases of the various organs should not be carried further 
into specialties for various specific diseases ? Let us have phy- 
sicians whose respective specialties shall be catarrh, ague, dip- 
'theria, etc. 

Dr. W. F. Coleman said that while he agreed with the au- 
thor in the main points in his paper, he thought it should rest 
with each individual whether he shall confine hmiself to special 
practice or emphasize it in general practice. It is advantageous 
to specialists that they should confine themselves to their chosen 
fields. But we should not judge of the benefits to be derived 
from specialties b}' the individual success of each practitioner, 
but by the extent each practitioner enriched our literature by the 
record of his investigations. It is thus that the eve and ear 
speciahst, the speciahst in throat and lung diseases, the laryngol- 
ogist and others have done most to advance medicine. 

" The Treatment of Syphilis " was the title of a paper read 
bv Dr. L. T. Potter. He said that the treatment of syphilis must 
be threefold — hygienic, tonic and specific. By the latter is meant 
the administration of mercurial and iodine preparations. The 
profession seems to be greatly divided in opinion in regard to the 
methods of using these remedies and tlie length of time they 
should be employed. In scanning the literature on this subject 
the reporter was surprised to find that those high in authority 
differed as to these points. The reporter ad\anced two propo- 
sitions: first, that neither the iodine preparations alone, nor mer- 



Society Transactions. 327 

cur\' alone, can always be relied upon as effective in the treat- 
ment of syphilis, but that both are necessary to eradicate the dis- 
ease: second, that the duration of treatment must be at least two 
years, faithfully carried out, no matter how mild at attack. In 
support of his first proposition the reporter quoted Bartholow, 
Ringer, Jonathan Hutchinson, Keyes, Bumstead and Taylor as 
saying that mercury should be given in the primary and second- 
ary stages of syphilis, and iodide of potassium in the tertiary stage. 
The\' all agree that both must be used to effect what is called a 
cure. In support of his second proposition, he quotes VanBuren 
and Keyes, Fournier, Bumstead and Taylor, as insisting upon 
the treatment extendino- over a course of two years or more. 
Diday savs the minimum time for treatment is twenty-two 
months. The two-year course of treatment does not mean the 
continual administration of mercury or iodine, but at intervals the 
remedy may be discontinued for a short time, if it seems to have 
a debilitating effect on the patient. In the light of such unanim- 
ity of opinion of eminent authorities upon this question of dura- 
tion of treatment, it is surprising that intelligent physicians will 
positively assure their patients that they are cured of syphilis at 
the expiration of a course of treatment lasting from four to six 
months II A physician who does so is certainly criminally neg- 
Hgent, and is a misanthrope of the worst type. Then it becomes 
all to impress upon patients the importance of carrying on the 
treatment for at least two 3'ears. 

Dr. E. L. Holmes commenced the discussion by saying he 
considered the paper very valuable, because the author lays so 
much stress upon the importance of thorough and long-continued 
treatment. One of the most important lessons he had ever re- 
ceived was to treat syphilis according to the plan the gentleman 
has advocated. Many years ago he had been taught this lesson 
by sad experience. It had been his lot to see many patients suf- 
fering from specific diseases of the eye long after the\' had been 
discharged by their physicians as cured. He could not under- 
stand how any physician can believe it possible to cure syphilis 
without carrying out the treatment a long time. In many years' 
practice in this city he cannot remember of having seen but three 
primary syphilitic lesions, and these all occurred on some por- 



32S TiiK Pi-:()RiA Medical i>I').\'riii,v. 

tion of the eye. He saw one man \\ho had on the upper eveHd 
a sore whicli resembled and was treated as a burn, until its course 
decided it to be a chancre. The man would not tell how he ob- 
tained it, but it readily disappeared under specific treatment. A 
great many diseases of the eye occur thus, and the physician is 
unable to lind out how thev arise. Many years ago it was 
taught that iodide of potash, if given in large doses, would effect 
a sure and speedy cure, l^ut Dr. Holmes thought the treatment 
by large doses of iodide dangerous, as it ameliorates the s\mp- 
toms so quickly as to cause the plnsician and patient to abandon 
the remedy too soon. In this countr\- we do not ha\e so good 
an opportunity to study syphilis as the Europeans. In Vienna 
and Prague, where the people liye and do not pass from the ob- 
ser\'ation of physicians, their statistics are more \aluable and re- 
liable than ours can be. He thought it best to giye the patient 
all the mercury he can bear in the primary and secondary stages. 
Rub it in the skin and giye it internally. Follow this up eighteen 
months or two years, and then giye iodide of potassium later. 
Every three or four months give a course of treatment for years 
after. You will ha^■e no trouble impressing upon intelligent peo- 
ple the importance of long-continued treatment. 

Dr. R. Tilley said he wished to refer to one point not 
touched in the paper, and that is, patients treated for syphilis are 
often told b}' their physicians of the importance of long-continued 
treatment, but they will not heed these warnings, and do not re- 
turn. This fact will excuse the physician many times, as it is 
not in his power to carry out the treatment when he wishes: and 
thus physicians should often be relie\"ed of the blame of not hav- 
ing treated their patients long enough. He did not think an}- in- 
telligent physician would advocate treatment under two years, 
and he believed Keyes, in his last edition, extended the time of 
treatment to four ^-ears. Dr. Tilley was of the opinion that we 
cannot do without mercury, and yet some .a high places teach 
this doctrine. Those \vho try to treat s^'philis without mercur\- 
are certainly responsible for later developments. 

Dr. J. Zeisler thought the present treatment of s\-]-)hilis is 
not scientific, and that there had been little advance in this direc- 
tion in the last century. Cases are known in which, after seven 



SociETv Traxsactioxs. 329 

years' treatment, symptoms of the disease returned. Take the 
case of Prof. Zeissl, who died last year. He was infected while 
opening a bubo seyeral years ago. He certainh" knew how to 
treat himself, and yet he died of cerebral syphilis. This does 
not look as though the treatment of syphilis is 3'et founded on a 
scientific basis. » If the discoyery of the bacillus of syphilis proyes 
to be correct, it ma}- proye the means of enabling us to treat 
syphilis scientifically. 

Dr. G. C. Paoli said he is by nature a cosmopolitan, and al- 
ways selects the best from the writings of all nations. A great 
many books haye been written on this subject, among which Ri- 
cord's stands first. Ricord was a man of great talent, experi- 
ence and powers of obseryation. He had unexcelled opportu- 
nities for study in the Paris Hospital when he was the chief 
physician. In regard to treatment, all agree that mercury must 
be administered for a long time. There are syphilitic cases in 
which mercury is contraindicated, namel}', phthisical patients and 
in albuminuria, unless we belieye syphilis is the cause of the al- 
buminuria. 

Dr. R. Tilley referred to one point introduced by Dr. Zt^is- 
ler, who referred to Prof. Zeissl as haying died of cerebral syph- 
ilis, claiming that no one would doubt Prof. Zeissl's abilit}- to 
cure syphilis. But the question is not whether Prof. Zeissl knew 
how to treat syphilis, but how did he treat himself ? Cooper, in 
his book on syphilis, if he (Dr. Tilley) were not greatly mis- 
taken, cites Prof. Zeissl as a type of those who used mercury 
sparingly. If that is so, and Zeissl used it only sparingly on 
himself, then the death of Zeissl from cerebral syphilis is a yery 
important lesson, and bears materiall}' on the subject under dis- 
cussion. 

Dr. J. Zeisler said he knew that in the case of Prof. Zeissl 
mercurial inunctions were made, but to what extent he was un- 
able to say. 

Dr. L. T. Potter closed the discussion by expressing him- 
self as gratified at the amount of discussion which had been 
aroused; howeyer, he was surprised at the statement that 'there 
had been little or no adyancement in the treatment of syphilis. 
In this day of elegant pharmaceutical preparations and easy ad- 



330 The Peoria Medical Monthly. 

ministration of mercurials and iodides, he thought there liad been 
a great advancement, for pharmacy and chemistry have stepped 
in and given us preparations we did not use many years ago. 
Mercury sliould not be given when it is producing a debihtating 
effect. 

The President, Dr. C. T, Parkes, presented to the societv a 
specimen, with the following remarks: " I hardly know whether 
^-()u will call this a pathological specimen or not. But you see a 
mass which was removed from a uterus, and proves to be a 
sponge. A short time ago T was called to see a lad}^ who had 
been treated bv a physician who introduced a sponge tent into 
the cervix uteri, and instructed the lady to allow it to remain two 
or three days, and then pull it out. She attempted to do so, but 
the string broke and the sponge was not obtained. After three 
weeks of suffering, with a discharge per vaginam, I was called 
to see her. By digital examination I could not find any evidence 
of the sponge, tlie external os being closed so as to merely admit 
a probe. But I could not find any sponge by probing, so I in- 
troduced an Ellinger dilator, and soon seized the sponge with a 
forceps and brought it out. The symptoms present passed rap- 
idly away, and the patient is now well. The point to be learned 
is, that when a physician introduces a sponge tent, he himself 
should remove it. 

The society then adjourned. 



CHICAGO MEDICAL SOCIETY. 

Stated meeting, October 5, 1885, the President, C. T. 
Parkes, M. D., in the chair. 

hitubation of the Larynx, with a Report of Five Cases, was 
the title of a paper read bv Dr. F. E. Waxham. The paper was 
supplemental to one read before the society on April 20th, in 
which the operation was minutely described. Dr. Waxham ex- 
hibited a larynx with the tube in situ. He described the jnanner 
of performing the operation, as follows, by the nurse holding the 
child in her lap, with the hands at the side, an assistant firmly 
holding ti, - head backward. llie mouth is held open by a gag 
placed on the left side between the teeth. The tube, armed with 



So(^"iKTY Transactions. 331 

a silk bridle, well waxed, is now secured to the introducing in- 
strument. The right hand manipulates the instrument, while the 
index tinger of the left hand guides safel}' and quickl}^ the tube 
over the epiglottis into the larynx, when the introducing instru- 
ment is removed and the tip of the finger presses the tube well 
down into the larynx. We make sure the tube is in proper posi- 
tion by the easier breathing, the tube remaining stationary, and 
by coughing on the patient attempting to swallow water. The 
bridle of silk is apt to produce violent coughing, and is generally 
removed. The latest improvements in the tubes consist in an 
enlargement of the head of the tube with a backward curve, pre- 
venting the tube from slipping into the trachea and allowing the 
epiglottis to fall during the act of deglutition. There is also an 
enlargement in the center of the tube, allowing it to be more 
easilv extracted. Dr. Waxham reported in detail five cases of 
croup treated bv intubation. One case recovered, one died six 
days after intubation from pneumonia; the result of unfavorable 
surroundings. The other cases were not such that recovery 
could be definitely expected. Dr. Waxham then presented the 
history of the five cases in detail, after which Dr. H. T. Byford 
opened the discussion bv saying he had the pleasure of seeing 
the case reported in which there was a complete recovery. In 
the contrast between this operation and tracheotomy there are 
man}' points in favor of intubation, and there are not many cases 
in which tracheotomv is indicated that intubation is not, one of its 
chief advantages being its simplicity. The first case of trache- 
otomy he had ever performed was a success and gave him a 
great deal of encouras^ement, but the next was such a terrible 
case, and a failure, that he was discouraged. He had assisted at 
several tracheotomies, but the dilhculties of the operation, the 
trouble of overcoming the prejudice of the parents against the 
operation, and the difficulties and bad results fofiowing, had 
caused him to abandon the operation as of little use except in 
<:ood cases. But when he saw this case, with all the absence of 
numerous attendants and paraphernalia in the after-treatment, 
and the comfort and freedom of the patient, he was greatlv as- 
tonished. The simplicity and safety of the operation and the 
comfort afterwards; the fact that the consent of the parents can 



33- The Peoria Medical Monthly. 

be easily and early obtained, that failure to relieve will not brini;- 
discredit upon the physician, and that the tube opens in the 
throat instead of the external air, leaves no doubt in his mind 
that intubation, whenever it can be successfully accomplished, 
will supersede tracheotomv in pri\ate practice. 

Dr. W. E. Casselberry said he was in constant attendance on 
one of the cases which terminated unfavorabh", but the effect 
from the operation was such as to convince him of its utilitv in 
many cases. In this case the former phvsicians in attendance 
had thought the patient had recovered from diphtheria, but the 
membrane later iuNaded the trachea. The vounir child was /// 
cxfrciiiis jiiortis and it was decided tracheotomy would be of lio 
avail, and it was not thought intubation would be much better, 
but in order to give the child a chance it was done. The child 
lived twentv-four hours, and its last hours were comparatively 
comfortable. In this case there was considerable ditlicultv in the 
introduction of the tube, and it was a lesson to him that practice 
in introducing the tube on the cadaxer might obviate manv ditH- 
culties in introducing it on the living subject. In the case of this 
young child the tube attached to the instrument for introducing 
it made too short an angle to be easily introduced. The idea 
suggested itself to have a joint in the introducing instrument so 
as to be able to easily pass the curve of the pharvnx. The tube 
caused no- cough or dithculty in swallowing, and was easilv with- 
drawn. A German physician latelv states that in iii cases of 
tracheotomy under his control, 61, recovered, and an x\merican 
physician notes 20 cases, of which 9 recovered. It seems from 
these statistics that tracheotomy is not to be discarded, buf we 
nevertheless will hnd a large held for intubation of the larxnx. 
Intubation will be preferable in young children not apt to recover 
from tracheotomy, in diphtheritic cases, and in cases when the 
friends object to tracheotomv. 

Dr. R. G. Bogue said: I have happened to have something 
to do with tracheotomy. While there are a great manv incon- 
veniences attending the operation and the care of the patients, 
subsequently, there certainly has been a good deal to commend 
in its performance in many cases. The number of recox'eries 
after tracheotomy are not few. The gentleman preeeding me 



Society Transactioxs. 333 

referred to statistics showing" a larger percentage of recoveries 
than I had happened to know. But those who have operated a 
goodlv number of times have good reason, from its success, to 
resort to it in many cases. Intubation is a simple operation com- 
pared with tracheotomv, and will recommend itself in many ways, 
and if it proves to be of equal success in saving life, it should be 
used in preference to tracheotomy, ^lanv reasons arise whv it 
should be used. It is not a formidable operation: parents" con- 
sent to it can be easil}- obtained, and the relief obtained by in- 
tubation seems as great as in tracheotomy. After each trache- 
otomv there is a period of rest and quiet and apparent promise of 
success, for a period of twent^'-four to thirtv-six hours, then an 
extension of the disease into the deeper air passages, or some 
complication destroys the life of the patient. The benefit of in- 
tubation with onh" this alleviation is apparent. It is to be hoped 
after a more extended trial it will prove to be of as much, if not 
more, service that tracheotom\', and it will commend itself to the 
profession. 

Dr. G. C. Paoli said Diffenbach, of Berlin, was the tirst to 
use intubation in diphtheria and croup, and a Parisian physician 
tried it at the time, each without the knowledge of the other's ex- 
periments. Diffenbach used an india-rubber tube, but he as well 
as the Parisian physician abandoned intubation. This is a dif- 
ferent method, it is true, but it can never be recommended un- 
til we have statistics from those having great experience, in hos- 
pitals especially, to prove it preferable to tracheotomy. 

Dr. D. W. Graham commended the report as being an ef- 
fort in the rig-ht direction. It shows that intubation has some 
merit, as a means of treating obstruction of the larynx, and that 
it is destined to become at least a partial substitute for tracheot- 
omy in diphtheritic croup. From a theoretical standpoint it 
would seem that there would be some liability of these tubes 
causing oedema of the larynx, if retained in place any length of 
time, on account of the mechanical pressure on the veins of the 
mucous membrane. Future observation will show whether the\' 
are entireh' harmless. However, there does not appear to have 
been any trouble in this respect in the cases reported. 

If this method should become established and recognized, as 



334 Thk Peoria INIedical Monthey. 

it now promises, it would and ought to be counted as a new pro- 
cedure, notwithstanding what Dr. Paoli has said about the efforts 
of the older surgeons to put the same idea into practice, for 
whatever has been attempted heretofore in this direction has 
proved fruitless. 

Dr. Waxham, in closing the discussion, in answer to various 
questions, said the longest time the tube was worn continuously 
was six days. Dr. O'Dwyer reports two cases, terminating fa- 
vorably, in which the tubes had been worn ten davs. He never 
found any cedema of the larynx caused by the wearing of the 
tube. In very young children it is necessary to remove and 
cleanse the tube. Older children, if not exhausted by disease, 
will expectorate freely. The previous attempts at intubation in 
France were not successful, but they were not according to the 
methods now employed. Trousseau discouraged intubation, and 
thus French physicians were influenced against it. The tubes 
must be thin, but their weight is unimportant. He had never 
found it necessary to use cocaine in introducing the tube, as this 
operation is generally easily and quickly done. 



PERISCOPE AND ABSTRACT. 
SALICYLIC ACID IN RHEUMATISM. 

Dr. P. W. Latham, the Dowming Professor of Medicine at 
Cambridge, in an article entitled " Wh}' does Salicylic Acid Cure 
Rheumatism," lays down seven rules for its successful adminis- 
tration : 

' I^irsf, The true salicylic acid obtained from the vegetable 

kingdom must Alone be employed. If you have to give large 
doses, avoid giving the artificial product obtained from carbolic 
acid, however much it may have been dialysed and purified. An 
impure acid will very quickly produce symptoms closely resemb- 
ling delirium tremens. 

Sccoii'J/v, Give the acid without an^' alkaline base. A very 
good form is to mix lOO grains with 15 of acacia powder and a 
little mucilage. Allow the mass to stand and iiarden, and then 
di\-ide into 30 pills. 

Thlrdlx^ Place the patient fully under the influence of the 
drug — that is, let him have sufficient to produce cerebral dis- 
turbance — /. c, buzzing in the ears or headache, or slight deaf- 
ness; with the developement of these symptoms the temperature 



Periscope and Abstract. 335 

and the pain in the joints will begin to decline. To an adult he 
generallv administers three doses of 20 grains (six pills), at in- 
tervals of an hour, and if the head remains unaffected, a fourth 
dose at the end of another hour: and then repeat the 20 grains 
everv four hours until the physiological effect of the remedy 
shows itself. In the majority of cases, from 80 to 100 grains are 
enough. In severe cases 140 to 150 may be required. After- 
wards about So grains a day are sufficient, and as the tempera- 
ture declines, smaller quantities will develop their physiological 
effects, 60 or even 50 grains being then sufficient to produce 
cerebral disturbance. It would appear that as long as the rheu- 
matic poison is circulating in the system, the physiological effect 
— that is, the effect it produces in the healthy organism — does 
not show itself: acting as an antidote, the- greater the amount of 
poison, the larger must be the dose of the remedy; but as soon 
as the formation of the niafen'es uwrbi is stopped, then the excess 
of the remedy acts as it would in the healthy organism, and its 
peculiar physiological effects are developed. It is a very strik- 
ing illustration of the difference between the therapeutical effect 
of a remedy, and its physiological action. 

Fourthly. Give the patient from 40 to 80 grains daily for 
ten days, after all pain and pyrexia have passed away. 

Fifthly, Let the patient's diet consist entireh" of milk and 
farinaceous food for at least a week after the evening tempera- 
ture has been normal. On the other hand, if the patient has 
meat and soup, you mav look forward with fair probability to a 
relapse. 

Sixthly, Take care to maintain a daily and complete action 
of the bowels. Calomel is the best purgative, from 2 to 5 grains 
at night, followed in the morning, if necessar}', with a saline 
draught. This is the most important adjuvant to the action of 
salic3'lic acid. 

Seventhly, Let the patient be enveloped in a light blanket, 
and with no more bedclothes than are sufficient to keep him from 
feeling cold. The object of the treatment now is to cool the 
patient, not, as in former times, to sweat the poison out of him, 
and the cooler he is kept the sooner will the temperature be 
lowered. 

Dr. Latham has not yet concluded his observations, but so 
far he considers that though lactic acid has much to do with the 
symptoms, it is the excessive formation of glvcocine and of uric 
acid in the tissues that developes the s^-mptoms of rheumatic 
fever, and salicylic acid cures the disease by combining with the 
antecedents of these bodies, and prevents their formation. When 
salicylic acid is administered internally it passes off by the urine 



336 The Peoria Mrdicai. MontiilV, 

as salicyluric acid — -that is, it has combined in its passage throuc^h 
the system either with glycocine or its antecedent, for on treat- 
ing salicyluric acid with fuming hydrochloric acid, it is resolved 
into salicylic acid and glycocine. Consequently, in the system, 
by seizing either upon glycocine or its antecedent, salicylic acid 
takes away an essential constituent of uric acid, and so prevents 
the formation of this body. — Lancet. 



DIAPHORETIC TREATMENT OF NEPHRITIS. 

N. Hess, having made a number of obserxations on the 
treatment of nephritic patients b}' wet packs, hot baths supple- 
mented by wrapping in blankets, and hot-air baths, draws the 
followinir conclusions: 

1. The .least rise of temperature occurs with packs, tlie 
greatest with hot baths. 

2. While the temperature is found to sink still further 
twenty minutes after the pack, it remains at the same height for 
an hour after both the other methods of treatment. 

3. After water baths the temperature regains its original 
lieight more slowly than after air baths. 

4. During the pack the pulse becomes slower; during the 
water and air baths, on the contrary, it is quickened for an hour 
afterwards. 

5. Under the influence of the pack respiration is moderately 
quickened; during botli water and air baths it is still more quick- 
ened, but subsequently returns to its normal rate more rajiidh' 
than after the pack. 

6. The most powerful sudorific effects are produced b^' hot 
baths, the least powerful \)\ packing. 

7. Though the baths are more stimuhiting, packing soothes 
the action of the nerx'ous s\'steni, brings tlic patients on better, 
and produces a subjectixe feeling of impi-oxement afterwards. — 
LcDiccl. 



THE BEES AND APOLLO— A MEDICO-PHARMA- 
CEUTICAL FABLE. 

Once upon a time the busx' bees were gathering honey from 
a flowery Held on famed Hymettus. Suddenly one bee was 
heard to buzz much more loudly than the rest of his companions, 
who, upon listening, heard that he had found a new process for 
extracting a superior honey of remarkable medical properties. 
He had also, at the same time, invented a \erv ingenious way by 
which he could with conqiarative ease make his buzz sound four 



Periscope and Abstract. 337 

times as loud as that of the ordinary bee. By means of these in- 
ventions lie soon disposed of large quantities of honey at a high 
price. But one day Apollo, who was experienced in the matter 
of honey and its medical properties, came that way seeking some 
good sample for the use of his friend, Diana, who was a little ill. 
He looked at the new preparation, which was put up in soft cap- 
sules and called " honeyine," and at another kind which was put 
-up in chocolate tablets and called " honeyidea." He also listened 
to the new buzz. " I think," he said finally, " that the buzz is 
much more wonderful and effective than the honey: I will take 
it to Diana, who is fond of buzzing." 

Some days latter ^sop, on hearing this story, remarked 
that the moral which he should add was, that the art of advertis- 
ing a new medical preparation is of more importance than the 
art of making it. — Bustoii Med. a)id Sitrg: Journal. 



SHOCK AND ITS TREATMENT. 

In a critical study of shock intended to elucidate its pathol- 
ogical relations, Groninger, of Berlin, detines shock as an ex- 
haustion of the medulla oblongata and the spinal cord produced 
by violent excitation. This definition is no doubt perfectly 
proper, though it strikes us as if the term " exhaustion " is not 
sufficiently clear for defining purposes. 

He recognizes the following varieties: 

1. The lowest grade of shock, which causes no appreciable 
effects. 

2. A middle grade, which weakens sensation. 

3. A high grade, whicli extinguishes qualitative sensation. 

4. A highest grade which eradicates both passing and per- 
manent sensations of every kind. 

His views of the treatment are noteworthv: 

Enero-etic counter-irritations of the skin are to be excluded 
as useless and even dang^erous. 

Abstraction of blood is contraindicated. 

Transfusion of blood can only be thought of in cases of 
great loss of blood. 

Opium and chloroform are of no value whatever in shock, 
while dio-italis is worthv of further studv. 

Alcoholic stimulants and subcutaneous excitation are useful. 
Horizontal posture, application of warmth, perfect rest, and sub- 
cutaneous injection of strychnine are the most recommendable 
factors of treatment. — Tlicrapculic Gazette. 



338 Thk Peoria Medicat. Monthly. 

THE ECLECTIC JOURNALS. 

There come two or three Eclectic journals to our office. 
We read them because we are searching in every direction for 
somethino- to interest and benefit our readers, and, peradventure, 
we mi:';ht catch a thought from an Eclectic journal; and vet, if, 
under like circumstances, we were to exercise the same liberal- 
ity in the ordinary relations of society, our conduct would be re- 
garded as incompatible with self-respect. It would not be ex- 
pected of a gentleman to receive visitors into his house who took 
occasion at every visit to ridicule his sentiments and to heap upon 
him offensive and opprobious epithets. But this is just what 
every Eclectic exchange does for us that we receive. Scitddcr's 
yoiinial, which is prominent among that class, is especially given 
to that sort of exercise toward what he styles l/ic Rcg'iilafors. In 
his August issue he devotes several pages to this gratifying 
amusement, bringing in this journal for a share of his courtesies. 
We often wonder what this class of journals would do if deprived 
of the privilege of abusing the Regulars; and yet it must be hard 
to keep it up, as the Regulars rareh- notice or respond to their 
assaults. Usually the most pugnacious animal will lose his fero- 
city when no opposition is offered to his attacks: but these fel- 
lows never tire, from which we infer that the matter of these as- 
saults is not only luxurious to the editors, but ever fresh and at- 
tractive to their readers. When they have nothing else to inter- 
est their subscribers the}' can always get up something in this 
line to fill up with, and feel safe in so doing. This is in keeping 
with the advice of an old political editor to his son, whom he was 
instructing in the business of journalism, when he said, " Well, 
son, when you get out of soap, and can find nothing to say, the 
best thing to do is to abuse the opposite party. — Soutlicni Jlcd. 
Record. 



COUNTER-IRRITATIOX IN THE BRONCHITIS OF 

CHILDREN. 

The value of counter-irritations in bronchitis and severe 
colds is very great, but it only seems necessary here to call at- 
tention to an old, but almost forgotten remedy, the oil of amber, 
as being especially valuable in the treatment of bronchitis of 
young children, associated as it so often is with marked nervous 
disturbance and a tendency .to collapse. The oil diluted with 
from one to three parts of sweet oil applied to the chest as a sort 
of stupe (upon saturated flannel) sometimes acts very happily in 
allaying nervousness as well as internal congestion. — IT. C. ]Vood 
in the Therapeutic Gazette. 



Periscope and Abstract. 339 

THE CURABILITY OF CONSUMPTION. 

In an article on pulmonary phthisis in the Medical Record^ 
of the 2id ult., Dr. J. Milner Fothergill, of London, makes the 
somewhat startling assertion, based on an experience of ten years 
in a chest-hospital, that the disease is far from being necessarily 
fatal. Under fairly favorable circumstances, he holds, a rally may 
be made in the large bulk of cases, which may lead to recovery. 
This is glad tidings, and a detail of the means through which 
this consummation mav be reached, will be eagerlv read. It is 
customary in acquainting the patient of the fact that he has con- 
sumption, to do so in a tone and manner calculated to shut out 
from him the faintest ray of hope. Treatment, moreover, is 
usually undertaken with a view to euthanasia, rather than with a 
hope to snatch the brand from the burning. If, therefore. Dr. 
Fothergill has put it in our power to tell the consumptive that 
the odds are in favor of his outliving his disease, he will prove 
to have been one of the greatest of the benefactors of this and 
succeeding ages. He does not propose anything particularly 
new in the way of treatment, nor does he vaunt any specitic. 
His common sense application of means alread}' familiar will, 
however, commend themselves to the attention of the profession. 

The line of attack advised in incipient cases is to improve 
the general condition, in which improvement the new growth 
have its share. To check the body expenditure and to increase 
the body income are our aims. All out-goings must be stopped. 
This is the first step. If a woman, attend to anv leucorrrhaa at 
once. Many a good line of attack has failed, many a woman 
sunk into her grave who might have been rescued, if onh' that 
out-going had been attended to. If the catamenial loss be heavy, 
put an arresting linger upon it by some ergot, sulphuric acid, and 
sulphate of magnesia, commencing with this two days before the 
appearance of the flux, and continuing it during the flow, re\'ert- 
ing to the usual treatment on its completion. Then, is there 
diarrhcea ? If so, attend to it. Milk and farinaceous matters are 
indicated [no meat-broths, no beef-tea — '"giving the patient a 
stone when he asks for bread'' — unless some farina be added). 
Then for medicine some astringent preparation of iron" may be 
given in the day, and a pill of sulphate of copper (gr. ^-^ ) 
with opium (gr. i-i^) at bed-time. If there be both diarrhoia 
and night-sweats this pill will often "kill two birds with one 
stone." 

If there be night-sweats, arrest them at once, or as soon as 
may be. Sweat is an excretion, and is highly charged with 
blood-salts. Consequenth', profuse sweats are most exhausting. 
Check them, and the appetite returns, and between the two the 



340 Thk Peoria Medical Monthly. 

patient does well. Prof. Sidney Rini(er, F.R.S., has laid the 
phthisical world under a deep debt of gratitude by pointing out 
the potency of belladonna in the matter of hydrosis. The best 
preparation is atropine, not only because it is tasteless, but be- 
cause we know exactl}' what we are doing when using it. But 
to secure its good effects it must lie pushed. Its effects upon 
the pupil is nothing. Indeed, in a \ery extensiye use of belladonna 
the pupil has rarely been affected. ( The effect upon the pupil 
is a bug-bear which ought to be buried). Dry throat and dim 
eye-sight are discomforts, but unless seyere they need not dis- 
turb the treatment. There is a wide gulf between these and any 
real danger. The yery lowest dose is -^ig of a grain. If this does 
not achieye the desired end, then g^-. If that is insutbcient, then 
Jg. If that fails — which it rarely does — one must begin to look 
seriously at the case. When this dose is reached, and yet the 
sw^eats continue. Dr. F, adopts the plan of an old New York 
quack, of which Lewis Sayre told him, yiz., to sponge the paper 
oyer with hot yinegar (^ pint) w-ith a teaspoonful of cayenne 
in it. This is not at all disagreeable, and is effectiye. If the 
combined measures fail, the patient's case is hopeless, but his 
physician's conscience is clear. 

Perhaps the patient's rest is broken by cough. Dr. F. 
recommends the following combination in such cases: Morphine, 
(gr. 3^), atropine (gr. g^,,, )with pil. galban co. or "pil, al. et 
myrrh.," as the case ma}^ require. This is a pill which has done 
him yeoman seryice in his warfare with phthisis. It has fOund 
its w^ay into the Brompton Hospital, and more recently into 
Squire's Companion to the Pharniacopivia.'''' It will, he thinks, 
find its way before long into eyery consumption hospital in the 
world. This action of carbonic acid upon the sweat-glands has 
led Dr. Lauder Brunton to adyocate strychnine (a potent stim- 
ulant to the respiratory centre) in the night-sweats of phthisis. 
No doubt it is useful. Dr. F.'s practice is to giye it in the da\'- 
medicine. His fayorite mixture at the hospital consists of liquor 
strychnine (4 minims), acid, phosph. dil. (15 minims), tincture 
capsici (4 minims), in infus gent. (3 dr.), tcr indie. This forms 
a capital tonic. Some quinine or sulphate of magnesia (or soda) 
may be added as required. 

One of the rules which ha\e formed themselyes in his mind 
is to giye acids when the tongue is clean or coated. When the 
tongue is bare, raw, or irritable, then alkalines are indicated as 
am. carb. ( g. 2 to 5), tinct. nuc. yom. (10 minims) inf. gent. 
( I ounce ) , ter i>i die. 

On such a line of treatment the patient usually improyes. 
The night-sweats cease, the appetite returns, the cachectic look 
departs, and the patient feels much better. The impro\ement is 



Periscope and Abstract. 341 

maintained, and soon iron and arsenic can be added to the strych- 
nine, and cod-liver oil to the dietary (but cod-liver oil is not the 
best form of fat, nor yet the most palatable, though it is the most 
diirestible. Some forms of fat in an emulsionized state are now 
on the market which possess many advantages over cod-liver 
oil). Iron is a good ha^matinic. 

Arsenic is an alterative and a tonic greatly believed in by 
many good observers in lung-consolidation. If the patient can 
be induced to take fat in any form the healthy tissues can be 
built up. Ver}" commonly the affected area is found to shrink, 
and air to pass into it. In a few months, in many cases, it is 
scarcely possible to detect any change in the lung. The threat- 
ened danger has passed away! 

All along in the treatment advocated the matter of improv- 
incj the condition has never been lost sioht of for a moment. If 
the patient can get awa}" to a dr}- soil and a bracing locality, all 
the better for him or her. 

Another common patient is the person who has chronic 
phthisis with cavities. Such patient is ahvays spare and badly 
nourished at the best; and when anv intercurrent ailment still 
further lowers the general condition the luner trouble is aijo-ra- 
vated. (And one matter has forced itself upon his attention, 
viz., that wherever there is old lung-consolidation any disturb- 
ance in the liver sets up irritation in this consolidated patch with 
resultant coup'h. And this couirh, which is intractable to ordin- 
ary cough-medicines, is relieved bv acting upon the liver.) The 
appetite has fallen off and the nutrition is impaired ; and then the 
special danger in phthisis is set up. Ver^- often the tongue is 
raw, or beefsteaky, or patch}". Here attention to the priuue 
vice (as our grandfathers phrased it), is imperative. The pa- 
tient must be sent to bed, to reduce the body expenditure to the 
minimum. The medicine must be bismuth, with alkalies; and 
the food, milk with malt extract, or a malt preparation with Mel- 
lin's food, in small quantities at a time, oft-repeated. No solid 
particle in the stomach to vex and irritate the sensitive (because 
ill-fed) mucous membrane. Even an alkali — like carbonate of 
magnesia — may be required to neutralize acidit}' and prevent too 
firm curdling of the milk; as much as will lay on a sixpence to 
the half-pint of milk is usually sufficient. Having got the assim- 
ilating processes into good working order, the tonic ma}- be 
given. "The mor^e haste the less speed" is especially true of the 
treatment of phthisis; and the desire to push on with tonics and 
good food sadly too often defeats its own end. Sometimes a 
masterly inactivit}- is the wisest practice. A clear head and a 
firm will are often required to curb the desire of the patient 
(and still more the patient's friends.) to be getting on. Back- 



342 The Peoria Medical Monthly. 

cast after back-cast teach a painful lesson to the medical man, 
and involve the patient in acute danger. If the pressure put on 
a young medical attendant is becoming more than he can bear, 
let him call in an older head to help. 

The chief thing" to avoid is morphia tinctures for the cough. 
An opiate to procure sleep may be essential and unavoidable; 
but sedatives in the day are dangerous. They give relief from 
the cough but too commonly they give permanent relief by 
death. Opium la\s its palsving hand upon the assimilative or- 
gans, and destrovs the appetite. Its e\-il effects seem most dis- 
tinctly felt by the liver. When an opiate is indicated at night it 
should be combined with ipecac to antagonize its effect upon the 
liver, and with aloes and mvrrh pill to correct its action upon the 
bowels. Opium strikes directly at the assimilation which is the 
cardinal matter in the treatment of phthisis. The patient most 
certain to die, the case least amenable to anv treatment, is that 
one whose wasting progresses steadilv, and where the lungs are 
only affected quite late on — indeed, a brief v/hile before the final 
change sets in. 

As to other means of allaving the cough than opiates, inha- 
lations of steam are often serviceable. Friar's balsam, iodine, 
carbolic acid, terepene, eucalvptus, all are good as additions to 
steam. Where there is a cavity with ragged walls smelling 
offensively, a respirator with cotton wool charged with carbolic 
acid is indicated. 

Then, as to the other means of feeding the patient, there are 
inunctions of oil, often of service, especiallv with voung subjects. 
Nutritious enemata have onlv latelv suggested themselves; but ■ 
in one case of a medical man steadilv wasting, an enema of 
cod-li\er oil (emulsionized b\' a drop of bile) and milk in equal 
quantities is being tried. Such enema night and morning, while 
in the recumbent posture, would be readilv retained. When the 
temperature mounts up, and especiallv when the skin is also 
moist (the usual state in hectic fever connected with phthisis). 
Dr. F.'s plan is to give quinine (gr. 2 to 5) with tincture of dig- 
italis ( 10 to 15 minims) and dilute phosphoric acid (15 minims,) 
thrice daily. The effect is very satisfactorv usually. Where 
a severe raking cough is present, shaking the poor sufferer ter- 
ribly, it mav be necessary to give opiates; but. in the author's 
experience, such cough is verv rarelv found with pulmonary 
phthisis. 

The treatment of h;emf)ptysis is quiet; no movement, no 
talking. When it arises from the bursting of an aneurismal sac 
in a ca\il\-. or from an ulcerating process eating into a blood- 
\essi-l and oju-ning a communication between the \essel and an 
open air-tube, syncope alone is likeh to arrest it. In congestion 



Periscope axd Abstract. 343 

of the ]:\n<j it is often an excellent form of local bleedin<r. Men 
of old bled for its relief; now free purgation with mineral salts is 
in vogue. For small recurrent h;i;moptyses the best treatment 
is to keep the bowels open. Ice, ergot, and dilute sulphuric acid 
may also be tried; probabh' they will do no harm. It is a bad 
plan to feed up a case of recurrent hemorrhage; it only tills the 
vessels rapidlv, to end in more bleeding. 

Finallv, the management of phthisis pulmonalis, whether 
the less grave or the more serious conditions, is a good test of 
the knowedge, skill and tact of the practitioner, who must, like 
a competent soldier, be able alike to plan a campaign or execute 
a sudden change of front in an emergency. That is, he must be 
able to lay down a persisting plan of treatment, and promptly 
change his plan to meet some intercurrent condition, as ha?mop- 
tvsis or acute ijastric disturbance. — J/cd. Aijc. 



PROLAPSE OF THE RECTUM. 

In the PoI\cIi}iic for June 16, 1885, appears an excellent 
clinical lecture by Prof. C. B. Nancrede, of Philadelphia, relat- 
ing to this subject, from which we make the following abstract: 
x\fter speaking of this condition of the bowel in 3'oung children, 
and some of the causes for its concurrence, he went on to relate 
the details of his general treatment in such cases. He called at- 
tention to the paramount importance of not allowing the child to 
strain at stool, nor even to sit anv length of time on such occa- 
sions. The motions should only be passed lying on the side, at 
the edge of the bed, or even standing, and, whichever position 
was employed, traction should be lirmlv made upon one buttock, 
so as to tighten the anal oritice. The credit of this valuable aid 
to treatment he o-ave to Dr. H. Macormac, of Ireland, who first 
showed its worth to the profession in 1843. The lecturer ad- 
vised the invariable use of plain enema of cold water before each 
rectal action, with a thorough bathing of the parts with cold 
water afterward. An unirritating astringent injection should be 
thrown up into the rectum, such as a decoction of white oak 
bark, or a solution of sulphate or sub-sulphate of iron. He went 
on further to speak of the various mechanical appliances which 
have been suggested to retain the prolapsed bowel in place, after 
returning it to the rectum. A pad of oakum or tow, or better 
than either, a piece of soft sponge, should be placed over the 
anus, and the buttocks iirmlv pressed together and retained in 
position bv a broad transverse strip of adhesive plaster. This 
pad, however, should be used only in those cases where the skin 
is not irritated; and when, despite the careful bathing of the 



344 



Thk Prokia Medical Monthly 



parts in alcohol, it docs become inflamed, some one of the many 
anal trusses must be resorted to, if the case is a very old or des- 
perate one, otherwise an operation for the radical cure of the 
affection should be performed. 

In answer to the question as to which cases had best be 
operated upon, he could only say, those in which palliative meas- 
ures are either inapplicable or inoperative. As to the method 
of operating, he called attention to the study of the pathology of 
the affection, for a proper understanding of the subject. When 
from anv cause the mucous coat of the rectum has slipped away 
from the muscular coat, on account of the elongation and laxness 
of the sub-mucous coal, this condition (prolapsus) is of course 
established. Now, naturalh' enough, an3'thing which will set up 
a certain degree of plastic inflammation in that sub-mucous coat 
will glue together, as it were, the mucous and sub-mucous coats, 
thus producing a cure — always provided the sphincter ani muscle 
is not in a condition of atony or fatty atrophy. ^ 

The lecturer then referred to the different means of produc- 
ing the necessar}- plastic inflammation, and clinicallv described 
the operation he preferred as the safest and most expeditious. 
After etherizing the patient and elevating the hips upon a pillow, 
he reduces the prolapsed part, and introduces a large-sized Sims' 
speculum. Then with the thermo-cauterv, at a dull red heat, he 
draws three or four lines, commencing about two inches within 
the anus, and bringing them down to the delicate muco-cutaneous 
margin. An opium suppositor}^ and a pad and bandage, com- 
plete the operation. The lines mentioned mav be drawn with a 
pointed glass rod dipped in nitric acid, or the actual cautery, or 
the galvano-cautery ma}' be employed, but in his opinion neither 
equalled the thermo-cauter}' for simplicity aud safet}-. 

He called attention to the importance of the after treatment. 
The patient must retain the recumbent position for at least a 
week, all stools being passed in the lateral position, or into a bed- 
pan; and even after leaving the bed the bowels had best be 
moved in one of these wavs for a week or even ten da}s longer, 
all symptoms of costiveness being relieved by enemata rather 
than purgatives. Care should be taken for months afterward to 
keep the buttocks as closely together as possible during an oper- 
ation of the bowels. 

Should the first operation fail to produce a radical cure, n 
second ma^■ be performed, and new lines can be drawn between 
the old ones, or a series of scattered points mav be touched with 
the cautery, great care being exercised, however, not to destroy 
too much tissue lest a stricture result. 



Periscope and Abstract. 345 

TREATMENT OF HARE-LIP. 

The Marxland Medical younial,]\x\\ 18, 1885, contains the 
conclusion of a vakiable article on " Suro-ical Treatment of In- 
fants," by Dr. De Forest Willard, of Philadelphia, from which 
we take the following on the hackneyed subject of hare-lip. 
Notwithstandinfj the fact that this affection has been so thorousfh- 
ly written about in past years, there is much that is practical and 
original in Dr. Willard's remarks upon the treatment. 

He thinks, and very truly, that the proper relief of the affec- 
tion is not only a matter of surgical skill, but of surgico-artistic 
skill, the region being of so much importance in a cosmetic point 
of view. After referring to the wide diversity of opinion ex- 
pressed b}' surgeons as to the best time of infantile life when the 
operation should be performed, he says his rule is to relieve the 
deformit}' within three or four days if it interferes with the proper 
nursing of the child, although practically it often happens that 
by the end of the operation the milk has left the mother's breast, 
unless natural means have been taken to keep up the flow. He 
prefers to wait, if possible, about three months, until a full, vig- 
orous activity of growth and cell section is at work, and before 
'dentition has commenced. Besides this reason, the child at that 
age cannot use its hands as freelv as at a later period, thus avoid- 
ing some risk of injury to the patient. 

When operating upon fractious children, he no longer uses 
pins, but uses small catgut sutures for the mucous surfaces, which 
if properly inserted and tied in three knots, will remain in 
position until union occurs. For the skin edges he uses carbol- 
ized interrupted silk sutures, his reason for stitching the two sur- 
faces separately being that there is less linear depression of the 
cicatrix, and less constriction of tissues is thereby exercised, than 
by pins and figure of eight, while if each set penetrate half w^ay 
through the lip anterio-posteriorily, the sphincter is thoroughly 
controlled. One of the stitches should pierce the coronary arter- 
ies. He prevents any pouching of the flaps or separation of the 
deeper parts by oozing, b}^ means of drainage by horse-hairs 
left in for a few hours. He is not satisfied to simply apply trans- 
verse strips of plaster over the wound, but prevents any strain 
upon its lips by placing another strip on either side, beginning 
on the neck in front of the sterno-mastoid muscle near the horn 
of the hyoid bone, thence running just above the angle of the 
mouth across the opposite malar bone to the front of the ear. If 
these are all placed in position while the cheeks are held well 
together, it will be found, on releasing the grasp, that the mini- 
mum of tension is exerted upon the stitches. An excellent plan 
also is to have the nurse reirulate muscular action of the face 



346 The ri<:oRi.\ Medical Monthly. 

durin(( the first few days after operation, by pressure upon the 
cheeks whenever the child cries or eats. 

As it is onl}' by securing union In' first intenti(^n that a nar- 
row cicatrix can be hoped for, Dr. Willard does not allow the 
child to suck, as is the practice of some surgeons, but much pre- 
fers spoon feeding as producing less disturbance of the parts, and 
for the same reason does not hesitate to use anodynes to control 
pain and hold the little one is as quiescent a state as possible, of 
course keeping the jiatient in as perfect a physicial condition as 
can be managed. 

lie does not use the simple inverted V-incision, but com- 
mencing the cut at the ajiex of the cleft, stops just before reach- 
ing the border of the lip, thus leaving a base of supply to nourish 
the fiap which remains on either side — in this avoiding the 
marginal depression so commonly seen where the first named 
method is adopted. The two flaps, when the parts are brought 
together, project downward and form a fleshy prominence, but 
if the stitching is nicely done, subsequent absorption will, in a 
year's time, give only a slight projection. Even should it remain 
too large, a simple scissors cut will remo\e any deformity, while 
the ugly notch sometimes left after the V-incision can never be 
corrected. — I'^/roi'iiia JMcdical J\Ioiif/il\'. 



PRURITUS PUDENDI, DUE TO VASCULAR TUMOR 
OF THE URETHRA. 

Mrs. W., tct. 42, Feb., 1S84. She was complaining of al- 
most intolerable itching and burning pain in the " fore-parts," 
and had been doing so for more than, two Ncars. The itching, 
which had originall}- been confined to the vulva, had gradually 
extended back to the anus, down the inside of the thighs, across 
the groins, and was beginning to affect the lower part of the ab- 
dominal wall. The itching was not constant, but used to come 
on at irregular intervals, in paroxysms lasting from a few min- 
utes to several hours. One of these parox^-sms was already in- 
duced by warmth in bed, by exertion, and by marital intercourse; 
and the attacks were always worse just before, during, and im- 
mediatel}' after menstruation, and in warm weather. During the 
paroxysms, the condition of the patient was almost unbearable. 
It was impossible to resist itching and rubbing the parts whilst 
the itching continued, but this only served to aggravate the dis- 
comfort, for when the itching ceased, a tingling, burning sensa- 
tion remained in the parts which had been most irritated by 
scratching. The patient said she had lost a great deal of flesh; 
was quite unable to sleep at night; suffered from great depres- 



Periscope and Abstract. 3_}.7 

sion of spirits and irritabilit}^ of temper; and latterl}/, so much 
nervous disturbance had been produced, as to give her friends 
grave cause for fearing that her mind would give way. Having 
elimirfated the usual causes of pruritus, I fancied I could detect 
an urinous odor about the patient, and, on being questioned, she 
acknowledged being troubled with frequent calls to micturate, 
scalding pain during the act, and dribbing away of urine if the 
first desire to empty the bladder were not immediately gratified. 
Upon examination, I discovered a small, sessile, vascular growth, 
about the size of a hazel-nut, surrounding the lower segment of 
the meatus urinarius, and extending along the floor of the ure- 
thra for a short distance. The little tumor was exceedingly 
sensitive to the touch, and bled freely on the slightest manipula- 
tion. There was considerable thickening of the whole urethra, 
which could be easily traced as a firm cord, tender on pressure, 
running beneath the symphisis pubis. The long standing con- 
gestion of the whole urethra, often concomitant with vascular 
caruncle of the urethra, had evidently been followed here, as 
elsewhere, by hypertrophy of the cellular tissue of the urethra. 
There was a free ichorous discharge from the excrescence, and 
there could be little doubt that this acrid matter, mingled with 
urine, was the cause of the pruritus. The labia were hypertro- 
phied, dark colored and rigid, evidently the objective conse- 
quences of frequent intense scratching and rubbing. They were 
considerably excoriated near their mucous surfaces, and more 
externally were covered with eczematous patches, which ex- 
tended half way up the fold of the groin on either side. The 
eczema did not appear until some time after the itching began 
to be complained of, and was evidently the result of scratching. 
Treatment. — The patient having been anaesthetized, the 
thighs were flexed and the knees separated as widel}' as possible. 
The labia being now separated, I dissected out that part of the 
excrescence which affected the urethral lips, cutting well beyond 
the base of the growth. I was then enabled to dilate the urethra 
sufficiently, with a pair of dressing forceps, to remove that por- 
tion of the growth which encroached on the urethral canal. The 
raw surfaces were then lightly touched with Paquelin\s cauterv, 
partly with the object of arresting the hemorrhage, which was 
rather copious, and partly with the object of obviating the return 
of the growth. The tissues of the posterior urethral wall were 
so vascular and hypertrophied that I deemed it necessary to de- 
stroy the deep tissues below, so as to cut off the supph' of blood 
to the surface of the urethra. This was done by passing the in- 
candescent needle deeply beneath and parallel with the urethra, 
but without interfering with its mucous membrane. A soft 
catheter was then passed into the bladder, and was left in for a 



348 Thf Feoria Medical Monthly. 

week. After this period it was passed at intervals, for a short 
time, to ob\iate undue contraction of the urethra. A Hniment of 
chloroform and almond oil (40 minims ad i ounce) was ordered 
to allav the sense of itchino" and burning. Tliis it did effecUiallv. 
After the removal of the catheter, there was incontinence of 
urine for a few days; but the power of retention graduallv re- 
turned, and was complete three weeks after operation. Shortlv 
after this time, too, the pruritus and eczema had completely dis- 
appeared. Six months afterwards there were no signs of return 
of the growth, and the itching had ne\er been complained of. 
I have seen three other cases of a similar nature: a girl of twelve, 
a young woman of eighteen, and an elderly lady. In each case 
a similar plan of treatment was adopted, and in each case the 
result was equally satisfactorv. — Aiistralasia)i Med. Gazette. 



CITRIC ACID IN THE EXTIRPATION OF MALIG- 
NANT TUMORS. 

C. M. Finn, M. D., of San Diego, Cal., writes as follows in 
the yoitnial of Aiueriecm JMedicaJ Assoe/atio)i : 

Prior to the revelations of the microscope morbid growths, 
with few exceptions, were looked upon as local manifestations of 
some blood dvscrasia. They were known to be environed by a 
zone of intiltration or degeneration, or ^•ar^■ing area, and the 
c[uestion of recurrence after an operation was supposed to depend 
largel}' upon the extent of the incisions. The desire, however, 
to preserve symmetry-, especially if about the face, and to hasten 
cicatrization, frequently induced the surgeon to circumscribe 
his operative procedures, relying subsequently upon antiseptic 
applications to sterilize flaps and adjacent tissues. Unfortunately, 
it was seldom possible to thus reach the extreme boundaries of 
the disease, hidden as they were to sight, and the niateries »iorJi/\ 
with lymphatics and blood-vessels as avenues (?), quickly in- 
vaded other tissues and viscera; or the increased supply of nu- 
trient material, in the absence of the central mass, soon precipi- 
tated a recurrence at the original site. This process was all the 
more rapid after attempted extirpation by pastes and caustic 
lotions. Consequently the impression prevailed that surgical in- 
terference merely postponed the fatal denouement. 

Cellular pathology, however, has modified some of these 
theories, while confirming others. It has taught us, I think, that 
tumors, excepting, perhaps, the essentially cancerous ones, are for 
the most part of local origin, whether homologous or heterolo- 
gous as to the- tissue from ^\■hich• they arise; that the drier ones 
are seldom recurrent, and that when metastasis and recurrence 



Periscope and Abstract, 349 

take place, it is through the medium of morbid juices, which in- 
vade connective and other loose tissues, and set up foci of disease 
in other portions of the economv. These later investigations, in 
my opinion, should encourage the surgeon to attempt at least the 
radical extirpation of all kinds of tumors, though custom and 
classification may have placed some of them among the noli mc 
tangxre class. 

While yet a student, some twent}' vears ago, it was my 
privilege to assist in the removal of a great many epitheliomatous 
and other abnormal growths, and the rapidity with which some 
of them recurred impressed me most forcibl\' at the time. In 
many instances plastic operations w^ere successfully undertaken 
to conceal deformit}' and promote cicatrization, but at a later 
period these onl^^ added fuel to the flames. In later years, hav-- 
ing adopted the non-systemic theroy, and recalling the well known 
antagonism of citric acid to diseased tissue, while comparativelv 
innocuous to healthy cells, I devised a method for the extirpation 
of doubtful and malignant tumors which I shall be glad to see 
thoroughly tested. It consists, as will be noted, in an attempt to 
segregate the degenerated zone before using, the scalpel. 

The notes of a few^ cases, of dates sufficientl}^ remote to 
justif}^ conclusion, will best illustrate the process: 

Col. H. T. C, aged 48, of undoubtedly cancerous antece- 
dent, his grandfather and father having succumbed to malignant 
disease of the face, had been appealing to thirty-third triturations 
for the removal of a suspicious tumor situated upon the left ala 
of the nose. Notwithstanding the altcnuations, the disease had 
rapidly extended down the side of the nose until a large segment 
of it rested upon the cheek. Its track, fully an inch in length, 
and more than six lines in width, resembled the cicatrix of lupus 
exedens. When first examined by the writer the tumor, now 
larger than a filbert, had a sessile attachment, an encrusted sum- 
mit, and, in addition to an indurated margin, was evidenth' ex- 
ceedingly vascular. The elderly gentlemen remembering the 
fate of his ancestors, whose lives had scarcely been prolonged by 
the frequent operations to which they had been subjected, was 
naturall}' yer}' despondent, and while decidedly opposed to the 
employment of caustics, he w^as correspondingly incredulous as 
to any permanent relief to be obtained from the knife. 

At the outset my armamentarium included an old hypoder- 
mic syringe and a saturated solution of citric acid. The needle 
was introduced deeplv into the base of the growth, and about 
half a drachm of the solution injected. The entire mass became 
blanched at first, following which a few drops of the acid, 
mingled with blood, escaped at the surface. Beyond an insig- 
nificant tingling, the suffering was so slight that he voluntarily 



350 TiiK Peoria Medicat. ^NIontiit^y. 

returned on the following day for a repetition of the operation. 
At intervals of two and five davs the process was repeated, until 
a lar<^e zone had lieen thoroughly saturated w ith the solution. 
The size of the tumor graduallv diminished until a nodule as 
large as a small pea alone remained. After a lapse of about 
three weeks this nucleus was raised upon a tenaculum and ex- 
cised. The haemorrhage, as had been anticipated, was quite 
profuse, but yielded readily to styptics and compression. During 
the entire period of manipulation, the local irritation seldom re- 
quired restraining lotions. More than six years have already 
passed without an}^ evidence of recurrence, and the colonel feels 
that he has made a narrow escape. 

A second case occurred in the person of a middle-aged mat- 
ron, who also ga\'e a history of a cancerous diathesis in her fam- 
ily. The tumor was situated between the eves, and was slowly 
encroaching upon each of them. Immediate excision could not 
have been undertaken without leaving a most unsightly deform- 
ity. Subcutaneous injections of a similar kind were therefore 
used, the needle point being directed at times toward the center 
of the mass, and, again, outwardl}-, in various directions. A 
diminution of the induration was soon perceptible to the touch at 
the periphery of the zone, and continued until an elliptical incis- 
ion, ha\-ing a horizontal diameter of not more than t\vel\-e lines, 
included the entire growth. Three years have now elapsed 
without a return of the disease. 

Still another illustration of the vagaries of the cancer and 
the possibilities of this treatment maN' not be out of place here. 
A lad}', of perhaps 40 years, stated that about two years pre- 
vious to our interview, and without any assignable cause, a hard 
lump made its appearance, a little to the right of and below the 
right breast. It had been twice operated upon in a distant citv, 
without remo\'ing the indurated or mamarv and axillary glands. 
After a brief interval of repose it had again come to the surface, 
and was now manifestinir increased ^'irulence. A funiroid mass, 
as large as the top of a tea-cup, occupied the original site, and 
was so painful that large doses of opiates only procured tempo- 
rary relief. It was evident that the system was so saturated 
with the cancerous juices as to preclude further surgical interfer- 
ence. An operation promising even a temporary respite would 
have involved excision of the breast and axillar^• glands and an 
area of integument at least five inches in diameter. As in the 
other cases, citric acid was injected into the tumor and adjacent 
tissues, with the results that pain was mitigated, hivmorrhage 
somewhat restrained, besides other evidences of improvement. 
It was, of course, impossible to stay the progress of the malady 
by any other course of treatment. 



Periscope and Abstract. 35 1 

MOUNTAIN FEVER. 

The fall of 1880 witnessed the neginning of the great rush 
of immigration to Dakota. In September of that year I located 
at Pierre, on the Missouri River, and the prospective terminus 
of the Northwestern Railway. The latter, being built at the 
rate of two miles a day, was employing several hundred laborers. 
Of the village itself, the population at this time did not exceed 
live hundred. When I arrived on the ground, September 5th, 
I was the onh' ph3'sician (though others soon followed), and I 
found myself confronted by a form of fever entirelv new to me. 
During the months of September and October I treated as my 
notes show, sevent3'-three cases of the fever, forty-eight of which 
were in the camps of the railway laborers, and the balance in the 
families of the village, ranchmen and teamsters on the Black 
Hills' freight lines. That my first cases should puzzle me I 
think you will readily see, when I inform 3^ou that thev were 
typhoid fever with the abdominal symptoms left out; and, brieflv, 
that is my definition of mountain fever. It is t3'phoid fever with 
the principal anatomical lesion of that disease lacking, viz., in- 
flammation of the glands of Pever. We have the t3-poid skin 
(except the characteristic eruption), tongue, temperature and 
pulse, the latter ranging from 100 to 120 or even higher; but as 
it increases in frequency its force declines. It is a pulse of debil- 
it}'. The same ataxic s^-mptoms, cases var^'ing in this particular 
just as they do in typhoid; some characterized by merelv a 
mental hebetude, others with low muttering, delirium, subsultus 
tendinum, carphologia, stupor, and in a few cases active delirium. 
Bronchial complications exist in about the same ratio as in typhoid, 
and due to the same cause — hvpostatic congestion. In most of 
the cases the skin remained drv throughout; exceptionalh* there 
were cases with free prespiration. Usuall}' the skin was dr}' and 
dusk}', the secretions diminished; urine lessened in quanlitv, 
with, of course, increased specific gravity, and in a few cases 
slightly albuminous, but not suflicientl}' so to constitute a pathol- 
ogical element in the disease. 

I desire to call attention to two important features of this dis- 
ease proving conclusivel}' to my mind that it is a new fever, at least 
so far as our medical literature is concerned, and first, the fact of 
the bowels not being implicated proves that it is not t^-phoid, 
which it so nearly resembles. In fact the belly remains flat 
throughout its whole course, and, from the fact that anorexia 
prevails, and forced feeding of the usual concentrated diet of the 
sick-room is all that the patients lake, the belly usually becomes 
retracted, in some cases really hugging the spinal column, owing 
to the emptiness of the intestines. There is no diarrha^-a, the 



35- Tfik Pkoria Medical Moxtht.v. 

bowels usually requiring a mild laxative; and the excreta is nor- 
mal in character. Again, it is a continued fever, running from 
t\vent3'-one days in mild cases to fifty-six in extreme ones. From 
an observation of nearly one hundred and fifty cases that I treated 
during my two and one-half years' residence in Dakota, and a 
few cases seen at this place last autumn, I should place the aver- 
age duration of the fever at about twenty-eight davs, that is, 
counting from the time the patient seeks medical advice, or takes 
to the bed, until convalescence is established. The convalescence 
is ver}^ tedious, moreso than in typhoid e\'en. In fact, it is usu- 
ally i-qany months before the subject regains his usual vigor. It 
is not remittent, except in the sense that all fevers are so. We 
have the morning fall and evening rise, the temperature ranging 
about loi to I02 degrees F., morning; 103 to 104 degrees F., 
evening; exceptionally it may reach 105 degrees F. I beheve I 
have never seen that figure exceeded, except in a fatal case men- 
tioned hereafter. It is positively not malarial, for the good and 
sufficient reason that quinine will not abort it nor shorten the 
attack. 

Of S3'mptomatology I have said much; of its pathologv I 
can add nothing. The intrinsic tendency is unquestionably to 
recover}-. The tendency to death is certainly b}^ slow asthenia, 
and the indications are to support the patient first, last and all 
the time. Alcoholic stimulants and ailmentation form the basis 
of treatment. That the disease sometimes proves fatal there is 
no doubt. 

Regarding causation I can say but little. It is an autumnal 
fever, though I have met with cases at all seasons. It usually 
begins late in August, though at ma}- come earlier, and it inva- 
riably ends with the beginning of winter. No age or race is ex- 
empt, but by far the largest number attacked are young men 
and laboring men. In regard to the probable causation. I can 
only advance one plausible theory, and I give it for what it is 
worth; and that is the great diurnal variation of temperature that 
occurs in elevated countries. During that memorable September, 
1880, the thermometer ranged in the nineties during mid-day, 
frequently reaching 100 degrees F. in the shade; and at night 
water exposed outside of the house would be found frozen in the 
morning. This, coupled with the fact that by far the larger 
number attacked were men who worked exposed to the direct 
rays of the sun, and slept in the same garments they wore dur- 
ing the day. 

Regarding the morbid anatomy of this disease, I am sure 
that here, as in all diseases characterized b}' long-continued high 
lemperatm-e, parenchymatous degenerations take place in the 
various organs- the liver, kidneys, spleen, the muscular struc- 



Periscope and Abstract. 353 

ture of the heart, etc. This opinion I had a chance to verify in 
the case of a young man of twentv-six whom I was called to 
treat in the second week of the fever. It this case the tempera- 
ture was very high, 106 degrees F. He was wildly delirious, 
requiring to be held in the bed, spitting out food and medicine; 
and died in thirtv-six hours after I was called in, and on the 
twelfth dav of the attack. With some difficult}- myself and Dr. 
Henrv Frisius succeeded in getting permission to examine the 
abdominal organs. Briefly, the autopsy revealed a healthy con- 
dition of the intestinal canal, but we found fatty degeneration, or 
what is usually denominated '-cloudy swelling" of the liver, 
spleen and kidneys. The liver and spleen were notably softened 
and pulpy. 

I am firmly of the opinion that " mountain fever " is not a 
myth in the brains of ignorant western practitioners, but a new 
and distinct pathological entity, and as such it should take its 
place in medical literature. — /ia//sas City Medical Record. 



TREATMENT OF PALMAR GANGLION. 

The Lancet^ June 27, 1885, lays down the following rules 
for treatment of palmar ganglion, as in accord with the best and 
most recent views of surgical authorities on the subject. The 
first point of importance is to attempt the cure of the cases as 
early as possible. No good can come of delay, which merely 
leads to greater distension of the cvst, and is especially to be 
deprecated as endangering the adjoining tendons, which become 
stretched, and even in some cases severed, by the pressure to 
which they are subjected. Second, the free evacuation of the 
cyst and the removal of all the " melon-seed bodies " it contains, 
whether these be free in its interior or adherent to its walls. For 
this purpose an incision about an inch and a half long, not a 
pimcture, should be made in the most prominent part of the 
swelling, above the annular ligament, avoiding, of course, the 
radial vessels and the tendons, which can be felt through the 
skin. Pressure should be made in the palm to force out the 
fluid and as many of the loose bodies as will thus escape. Then 
a sharp spoon should be introduced, and the whole cavity 
scraped, to detach any " bodies " which may be still fixed to the 
synovial membrane. The " spoon "' is much the best means of 
doing this. Some have trusted to injecting a fresh stream of 
fluid into the cyst, but this will not remove " bodies " which are 
still firmly adherent to the cyst-wall. 

Volkmann passes a large drainage-tube through the cyst, 
and draws it sharply to and fro, and trusts to that to detach an}' 



354 The Peoria Medical Monthly. 

adherent "bodies;" this is, however, an uncertain method, and 
if the cyst be old and large, with pouches extending from the 
main cavity, they escape the friction of the tube altogether. 
Having thus carefully removed all the contents of the cyst, 
whether solid or fluid, a solution of chloride of zinc, 40 grains to 
I ounce, should be applied to the whole interior of the sac, the 
purpose of this being so to modify the nutrition of its lining as to 
prevent any recurrence of the dropsy. A solution of iodine has 
been used for the same purpose, and some surgeons may be in- 
clined to use iodoform instead. The most important steps in the 
treatment are those to be taken to secure healing of the wound 
without suppuration, at any rate without septic suppuration. As 
a preparatory step the parts must be thoroughly cleansed before 
the incision is made, and the operation should be conducted under 
an antiseptic spray or irrigation, and some efficient antiseptic 
dressing should be finally applied. A drainage-tube should be 
introduced into the wound and passed down beneath the anterior 
annular ligament, and only removed when the discharge through 
it is reduced to a minimum. 

Dr. Weiss shows that if pressure be carefully applied over 
the palmar part of the cyst, all retention of fluid can be carefully 
obviated. The hand should be kept fixed on some kind of splint 
applied to the extensor aspect, until the wound inflicted is healed. 
As soon as that is accomplished, the fingers should be liberated 
and the patient be encouraged to move them. The results of 
this treatment are entirely different from those formerly met 
with. When tlie antiseptic precautions are careful!}- carried out, 
there is no danger whatever of blood-poisoning or of profuse 
local suppuration, and the final result is the restoration of a 
thoroughl}' useful hand. The tendons are not bound down by 
cicatricial bands, and after a time it may be impossible to find 
any trace of the previous mischief beyond a linear scar in the 
forearm. Weiss considers that the process of cure of the synov- 
ial cyst is analogous to that obtained in a hydrocele by injection, 
or in dropsy of a joint treated by injection of iodine. At present 
no case of a recurrence of the ganglion after a septic incision and 
drainage has been reported. 



In Russia it is proposed to adopt a code of medical ethics, 
some of whose features are the following: "A practitioner who 
gives his adherence to any system of medicine unrecognized by 
science must be considered as having forfeited his rights of pro- 
fessional fellowship. It is also forbidden to write, publish or dis- 
tribute pamphlets giving the symptoms and treatment of diseases. 
Nor can the doctor trive testimonials as to the value of remedies 
and nuneral waters, etc/' 



Periscope and Abstract. 355 

THE TREATMENT OF SCIATICA. 

The Bostoji Med. and Siiro-. your., in an editorial article, 
directs attention to Debove's new method of revulsion by congel- 
ation. To this end he has had recourse to chloride of methyl, 
which is readily obtainable in commerce, and with which one 
may produce a speedy refrigeration. Debove says: "I practice 
with this agent, using for the purpose a siphon bottle furnished 
with suitable stop-cock and beak, pulverizations along the diseased 
nerve, directing the spray especially upon the points doulcurcux. 
This spraving ought not to last longer than a few minutes. It 
is much less disagreeable than the actual cauter}^, and, wdiat is 
more important, it is followed bv instantaneous disappearance of 
the pain. Ordinarily one seance suffices to cause the pain to 
completely disappear; sometimes, nevertheless, a second seance 
is necessary; but always after the first seance the pains are con- 
siderably lessened. When 3'ou prolong the spraying a little too 
long, you produce vesication. 



VOMITING OF PREGNANCY. 

The latest remedy for the obstinate vomiting of pregnancy 
is the hydrochlorate of cocaine. Dr. Holtz {Algcni. Med. 
Wochenschr.) says that in a case where, ever3'thing having 
failed, he had determined to produce abortion, but at the last 
moment thought of cocaine. He gave the patient 10 drops of a 
3 per cent, solution, and had the satisfaction of finding the vom- 
iting under control. — A at. Dniggi'st. 



VENEREAL WARTS. 

Nusbaum treats venereal warts by washin<r them thrice 
daily in salt water and afterward sprinkling them with calomel. 
The mild chloride of mercury in contact with the chloride of 
sodium is converted into bichloride, which is the remedial agent 
in the treatment. 



ENURESIS NOCTURNA. 

Dr. Willim says (in the Med. Chinirg. Rundschau^ that in 
the nocturnal enuresis of childhood he has found no remedy to 
equal the tincture of the sesquichoride of iron in doses of from 5 
to 10 minims achiiinistered three times a day. 



THE 

Peoria Medical Monthly. 



THOS. M. McILVAINE, A. M., M. D., 

Editor and Publisher. 
204 S. Jefferson St., Peoria, III. 



***The Editor is not responsible for the statements or opinions of contributors. 

***Short original articles are invited from any reader, wliether a subscriber or not. 

***If extra copies are desired by a contributor, the number must be .specihed when the 
article is sent to the Editor. 

***A11 exchanges, books for review, and communications must be addressed to the Editor 
and Publisher. 

***The publication day of this journal is on or about the 25th of each month. 



EDITORIAL. 

A HORSE OF ANOTHER COLOR. 

The belligerant members of the American Medical Associa- 
tion claimed and exercised the right to revise, amend and alter 
the work of the original committee on the International Congress, 
and they did alter it with a vengence by virtually kicking the 
old committee out of office and starting over again. Now the 
new committee do not propose to have anyone criticize, revise, 
amend or alter their work, and consequently have resolved "That 
" the actions of this Executive Committee are final, not being 
" subject to revision, amendment or alteration, either by the Com- 
" mittee of Arrangements or the American Medical Association." 
We do not believe this resolution, however, unanimously adopted 
by the committee, will save them from a general overhauhng at 
the St. Louis meeting in May, 1886. 

This is a funnv world, my masters, and doctors are about 
as funny a set of inhabitants as it contains, especially when they 
get to fooling with ethics. 



A PLEASANT PARTING. 
The occasion of the removal of Dr. J. Perrin Johnson from 
this city to Sioux City, Iowa, was made the occasion of an ele- 
gant banquet tendered him by his fellow-members of the Medi- 



Editorial Department. 357 

cal Society at the National Hotel, October ist. The resolutions 
given below will show the esteem in which Dr. Johnson was 
held by his co-workers in this city, where he has been the lead- 
ing oculist and aurist for over twenty-five years. We feel ver}^ 
sorry that Dr. J. has left us, but we know that it was for his own 
benefit, as he owns a large stock farm about forty miles from 
his new home, to which he could not give the needed oversight 
at this distance. 

The professional as well as social abilities of Dr. J. will soon, 
no doubt, make him as great a favorite among the physicians of 
Sioux City and surrounding country, as he was in Peoria. 

The following are the resolutions which were unanimously 
adopted by the Societ}-: 

Whereas, The members of the Peoria City Medical Society 
have learned with profound regret of the intended removal of our 
able, highly respected and genial colleague. Dr. J. Perrin Johnson, 

Resolved^ That in the severance of the ties which have 
bound him so closely to Peoria for the last quarter of a century, 
we feel that it loses a public-spirited citizen, a man of advanced 
views and strong convictions, who in all the relations of life has 
well and faithfully performed all the vari6us obligations which 
his prominent position imposed; a man eminently truthful, honest 
and conscientious, warm in his attachments to friends, tolerant 
and mafjnanimous. 

Resolved, That in his removal our profession loses its most 
talented and accomplished member in the department to which 
he devoted his energies, the Medical Society one of our most 
valuable and esteemed colleagues, and one of its most active and 
esteemed members. 

Resolved, That a copy of these resolutions be furnished Dr. 
Johnson, and that they be published in the Peoria Medical 
Monthly. 

Dr. J. was also an active member of our State Medical Soci- 
ety, and we venture the opinion that the Iowa State Medical 
Society will soon acquire an active and popular member. 



METHODS OF PRACTICE. 

We herewith give several illustrations of methods of getting 
practice — the Turk has about as good a way as any and he has 



35^ The Peoria Medicaid Montiilv. 

no ethical scruples to bother his conscience. The homoeopath 
is also clear of such hindrances, and Dr. Smoothtongue works 
strictly under the code. 

I. 

" I see you haye a ne\y doctor at 3'our liouse." " Yes, my 
wife won't haye anyone else now, since Smoothtongue made his 
lirst prescription for her." " Why! did it do her so much i^ood? 
What was it?" " Well, you know, she had headache, or neu- 
ralgia, or something- of that kind, and went to him for a prescrip- 
tion; he looked at her, gaye her some stuff, but told her she 
would neyer get well until she had a new bonnet. That settled 
him as our family doctor for life." 

II. 

A homa?opath in a city not a thousand miles from here, at- 
tempts to work up business in the following manner: A new 
family moyed to town, he made their acquaintance slightly, 
noticed a married dauirhter was in an interestinfj- condition, 
counted up her time in his head, and waited until he thought her 
term had nearly expired, then made a friendly yisit. Told the 
mother and daughter that the city air was prolific; women al- 
ways got that way when the}' came to town (with significant 
glances at the daughter), told of how many cases he had at- 
tended in the past month and how many he was engaged for, 
and after telling them where his residence was, took his depart- 
ure, feeling sure of a call in a short time. But he oyerreached 
himself; the family had intended to employ him but his yisit so 
disgusted them, that when her time came they sent for a " regu- 
lar," and the homcEopath is still wondering why Mrs. has 

not been sick yet. {Tnic storv.) 

III. 

The other day in Galata a man fell in some sort of a tit on 
the street. A great crowd gathered, shutting out the air, but 
some superstition kept them all from lending any aid. The acci- 
dent happened within a few doors of a doctor's office, and the 
doctor stood on the steps, looking on in an interested way, but 
making no moyement toward going to llie sufferer's assistance, 
though urged strenuouslv to do so h\ tlie b\standers. He was 



Editoriat. Department. 359 

a Greek, and I had met him on one of the little coast steamers 
that ply on the Black Sea. He was little and dirty and black, 
and his specialty was "herbs." 

He smiled when he saw me, and made a place for me on 
the steps. " You do not seem anxious to take the case," I said, 
with a glance toward the corner. He shrugged his shoulders 
and smiled again. "What is the use?" he said simply, " the 
man has no money, and his friends make no gifts." " But do 
you take no cases until the fee is advanced?" I asked. He re- 
plied with the counter question, " In your country do men work 
for nothing?" In the meantime the man died and his friends 
carried him away. 

Now, this little Greek doctor was no more hard-hearted 
than others of his profession along the Mediterranean. The 
healing art in Turkey is done on a strictly cash basis, that is all. 
There is no sentimentality that makes a Turkish doctor get up 
in the night to go out and alleviate the sufferings of a sick pauper 
where he knows the patient to be such. It is cash down or no 
cure. This, of course, is only with the poorer class of patients. 
With responsible parties a diametrically opposite course is pur- 
sued. No fee is demanded from them, and it would be consid- 
ered very bad manners in a doctor to bring them in a bill. 
The payment comes from them to a physician in the form of a 
gift, as if his service had been wholly voluntar}- and the return a 
consideration of esteem. Still, it is commonly paid on the spot, 
and is, as a rule, full}' as much as the doctor would have dared 
to charge. 

The number of regular physicians in Constantinople is 
strictlv limited, and many of them are foreifrners. Every doctor 
has his own territor}', into which professional etiquette allows no 
other plwsician to intrude. Each one makes a daih' round 
through his territory, beating up patients in the coffee-houses 
and the streets; and woe to the well-to-do man found ailing on 
the route. He is taken in hand unceremoniously and subjected 
to an examination that seldom fails to end in some sort of treat- 
ment or other. Besides the regulars, there are an innumerable 
number of specialists and quacks who cut in on prices and peddle 
all sorts of nostrums. They recognize no limitation as to terri- 



3^0 The Peoria Medical Monthlv, 

toiy and take practice wherever they can find it. I have seen 
the same vender practicing and crying his wares in Stamboul, 
Galata and Scutari. 

All the common cases of blood-lettinn; and headache cro to 
the barbers, who also pull teeth, and all classes indiscriminately 
patronize the dervishes and shrines. It is only in cases of fever 
and colds and other standard troubles that the regular physician 
is called in at all. Perhaps after all it is as well that this is so, 
for the regular ph^'sician in Turkey is expected to exhibit a pre- 
ternatural sagacity that would certainly fail him if the ranofe over 
which it is exercised were wide. When he is called to see a sick 
person he is not allowed to diagnose the case as a western phy- 
sician w^ould deem necessary. He is supposed to know as soon 
as he sets eyes on a patient what the matter is with him, and 
anv hesitation would be deemed a confession of io-norance. 

A little Irish doctor told me with wrath in his breath of a 
case W'hich he had attended, where from looking at the patient, 
he seemed to have a fever and be suffering great pain. The 
usual remedies failing to give relief, a closer examination showed 
that the sick man was chary of moving his left leg. This, being 
uncovered, proved to be broken and mangled and horribly 
swollen. The doctor's indignant question, why they had not 
told him this at first, elicited the contemptuous answer that they 
had supposed he knew his business, and thought of course he 
had been treating the patient for the trouble from the first. And 
before he could throw up the case and gracefulh' retire, they 
discharged him for incompetenc}'. — Constantinople Letter. 



RECEIPTS. 



Illinois— Drs. F. C. Gav (2.00), December, 1885; Thos. Temple 
(2.00), May, 1886; H. Kruse (2.00), May, 1886; W. A. Mansfield, (2.00), 
May, 1886; J. J. Reaburn (2. 00), November, 1885; G. M. Blackburn 
(2.00), September, ]885; Thos. D.Washburn (1.00), January, 1886; 
Henry W. Hewett (2.00), Mav, 1886; E. Schwartz (1.00), October, 1885; 
G. P, Ransom (2.00), March, 1886; E. E. Reynolds (1.00), October 1885. 

Iowa— Drs. J. P. Johnson (3. 00), May, 1886; J. Richardson (1.00), 
October, 1885. 

Nebraska— Dr. S. W. Dodge (2.00), May, 1886. 

Wisconsin— Dr. C. H. Frost (2.00), January, 1886. 

Kentucky — Dr. B. L. Herudon (2.00), January, 1886. 

Kansas— Dr. J. D. Bryan (2.00), December, 1885. 



The Peoria 
MEDICAL MONTHLY. 



Vol. VI. : : NOVE^IBER : i88s : : No. 



ORIGINAL COMMUNICATIONS. 

RESULT OF SYSTEMATIC TREATMENT IN NASO- 
PHARYNGEAL CATARRH AND CHRONIC 
SUPPURxVTION OF THE MIDDLE EAR. 

BY X. R. GORDON, M. D., SPRINGFIELD, ILL. 

The opinion that naso-phan-ngeal catarrh is incurable is 
proven erroneous by the light of experience and in\estigation. 
My observation in the treatment of catarrh justifies the following- 
statement: that naso-pharyngeal catarrh is more amenable to 
treatment than nnv other chronic disease. 

Catarrh is a very prevalent disease: bv some it is regarded 
as a necessary evil or an inalienable legac\". This is incorrect: 
it is the result of abnormal action in the tissues and stands in the 
relation of cause to effect. Numerous patent nostrums are on 
the market for the cure of catarrh, and ph^-sicians often for the 
want of a better remedy advise the use of salt and water, cubebs, 
chlorate potash, golden seal, all of which though thev ma^■ give 
temporary relief, only result in harm in most ever\- case. 

The nasal organs were not designed for douches or recep- 
tacles for snuffs or irritating powders. We will report a few 
cases from our note-book treated bv the warm spray method 
that the reader ma^- judge of the results. It must be remem- 
bered, the following cases had all been treated by the usual or- 
thodox method, as recommended in standard works. 



362 The Peoria Medical Monthly. 

CcfSi' I. A bright looking girl, 11 years of age: affected 
with naso-pharvngeal catarrh for tive years; the secretions would 
harden in the nasal chambers and require considerable effort to 
expel them: her breath was so offensive that other members of 
the family refused to occupy the same bed with her. She com- 
plained of pain between the eves and in the frontal region: her 
health was being rapidh' impaired bv the disease. She was an 
adept in the use of the douche. She was treated during x\ugust, 
September and October of '83. and a few times during the winter 
and following spring, when she was dismissed. She improved 
in flesh from the first, and is now free from all the troublesome 
symptoms of catarrh. 

Case 2. A single ladv of 20 years: had catarrh for live 
or six years: has used man^' of the patent nostrums: had been 
failing in health during the last year, and her friends feared she 
would have consumption. I treated her by the warm spray 
method during September, October and November of '83, and 
again in the following spring, for three weeks. She rapidly im- 
proved in health and gained ten pounds in weight during the first 
term of treatment. I a'ave her a tonic, althouirh she had taken 
a tonic before coming to me with no effect, and therefore it is 
proper to conclude the local treatment was the right thing. She 
remains well ,to-day. 

Case J. A boy of seventeen: catarrh for three years. 
Morning-s while makincr effort to clear out throat he would often 
vomit: the secretion was very tenacious: he took cold very easy, 
and, indeed, was rarely ever free from fresh cold: complained of 
fullness in the head and general feeling of malaise. He was 
treated for two months, again in following spring, and at present 
writing, eighteen months from last treatment, feels perfectly welL 

Case ^. A married lady, twenty-nine years of age, always 
had good health until the last six months; was treated by her 
family physician for laryngitis and incipient phthisis. She was 
much alarmed about her condition, fearing consumption. She 
complained of burning sensation in larynx and a slight cough, with 
loss of appetite: unable to sleep more than four hours during" 
night. Upon examination of pharyngeal space I discovered that 
she had catarrh. She was treated for six weeks, during which 
time she rapidh' improved, gaining seven poimds in weight. She 



Original Communications. ^,6 



O^v) 



remains well at present date, fourteen months after treatment, and 
is able to attend to her duties in the school-room. 

Case J. A widow lady, age 36, with great effort came to 
my office. She was confined to bed and room for four weeks pre- 
vious with violent cough, fever, pain in lar^'nx and loss of appetite : 
was reduced in flesh and strength : was told by her physician she 
had consumption, and the inference was, must die. She was 
treated more or less for three or four months, giving her warm 
sprav inhalations in connection with treatment of naso-pharyngeal 
space and general tonic remedies. She is now well and supports 
her familv bv her own industrv. 

Cases four and five are triven to illustrate the fact that catarrh 
often produces svmptoms simulating incipient phthisis; that phys- 
icians mav be misled into an erroneous diagnosis and treat them 
as consumption: that the warm sprav method gave them relief 
from the first treatment and positivelv cured them, as the patients 
are well and heartv to-da\', with no indication of tuberculosus. 

Chronic suppuration of the middle ear is usually dependent 
upon inflammation of the naso-pharyngeal space. 

Case 6. A single ladv of 24, very frail in general appear- 
ance ; discharge from right ear for six vears : had catarrh for the 
same length of time, if not longer. Large quantities of semi- 
transparent mucus is discharged from post-nasal cavities; her 
health is poor, feels despondent, and thinks but little can be done 
for her. The discharge from ear is muco-purulent and rather 
copious. The naso-pharvngeal space was treated daily for two 
months, after which time she was obliged to return home. She 
was given a home treatment, which she uses at times. Ear treated 
by Politzer's method and boric acid. She informs me fifteen 
months from date of last treatment, has no discharge from ear, 
and her throat gi\-es but verv slight trouble, general health im- 
proved and her weight improved twelve pounds. 

Case 7. Is 26 vears of age; has discharge from left ear for 
fifteen vears; the hearing in affected ear entirely destroyed; had 
catarrh for a long time. Gave same treatment as case number 
six but continued it six months; last treatment was given one year 
ago and no discharge from ear since. 



364 The Peoria Medicai. Monthly. 

ENLARGED TONSILS. 

BY J. S. GEICEEY, M. 1)., CANTON", n,L. 

Of all the chronic affections of childhood and earh- youth, 
this is perhaps the most common: and while in itself, when not 
existing in a great degree, does not give rise to any great amount 
of inconvenience, it at the same time renders the person affected 
peculiarly liable to certain throat troubles, and constitutes a grave 
complication in several of the diseases of childhood, such as scar- 
latina, diphtheria, etc. 

Enlargement of these glands mav be due to one of several 
causes, the most frequent of which is an antecedent inflammation 
(quinsy) followed by chronic intiammatory hypertrophy of the 
glandular elements, or a diathetic condition of the individual, in 
which there is a proneness to enlargement in the glands of the bod}' 
the tonsils merely keeping pace with its fellows in other loca- 
tions. This may be illustrated in those healthv. robust persons 
^vho ha^'e enlargement of the tonsils, but who exhibit no indica- 
tions of glandular enlargement elsewhere. These persons will 
tell you that they have an attack of "bad sore throat " almost 
every season, and that it usuall}' terminates in suppuration. In 
such cases the disease is pureh- local, and will, if left to itself, 
terminate in complete shrinkage of the glands through repeated 
attacks of suppuration and slough, bv the time the indi^'idual has 
reached middle life, leaving him, however, with a chronically in- 
flamed throat studded with enlarged follicles, and peculiarh' liable 
to acute attacks of inflammation at ever^• chano-e of the weather. 

If we examine the tliroal of one of these cases, we will see 
the tonsils jM'ojecting be\-ond the pillars of the fauces toward the 
median line. They are usually globular, of a duskv red hue, 
and scattered over their surface are numerous little ulcers in va- 
rious stages of cicatrization. The pillars of the fauces, soft pal- 
ate, and retro-phar^-ngeal wall, partake of the red hue of the ton- 
sils, and the latter is usuallv studded with enlarged follicles. The 
breath is generally offensi\e, owing, no doubt, to the decom- 
posing sebacious matter in the cr^•pts of the tonsils and folds of 
the palatal mucous membrane. 

Now in those cases of enlarged tonsils where there is a pre- 
disposition to glandular enlargement throughout the bod\-, careful 



Origixai. Communications. 365 

examination will reveal a different state of things. These patients 
are usually pale, anaemic, and the scrofulous tendency is well 
marked. There ma}-, or may not be a history of all antecedent 
quinsy, but if they are children the parents will tell us that they 
are frequently disturbed in the night by the child's loud breathing 
or snoring, and that sometimes there seems to be imminent 
danger of suffocation; they always sleep with their mouth open 
and generally breathe through the mouth when awake: in some 
there is a purulent discharge from the nose and the yoice has 
that peculiar tone due to usual obstruction, and in not a few of 
these cases we will find a considerable degree of deafness ex- 
isting, the .cause of which is obvious. Inspection will usually 
reveal two lobulated masses projecting into the pharynx, gener- 
ally pale, with portions almost pearly in color, and with numerous 
little crypts opening upon their surface. Many times the only 
evidence of inflammation about the throat is along the border of 
the soft palate and pillars of the fances, due merely to the 
displacement of these organs by the enlarged tonsils. 

In regard to the treatment of enlarcjed tonsils, there has 
been considerable difference of opinion, while some pin their 
faith entirely to local applications in the way of caustics, astrin- 
gents, etc., with constitutional treatment with tonics and altera- 
tives, others do not hesitate to express their utter lack of faith 
in these measures, and recommend excision as the only pro- 
ceedure that can give the patient assurance of relief. Now while 
I am rather inclined to the latter belief, still I think in the first 
mentioned class of cases of tonsilar hypertrophy, due to repeated 
attacks of quins^', and where all the surrounding structures are 
chronically inflamed, and where the tonsils are not so large as to 
constitute an impediment to restoration, much can be accom- 
plished by the use of drugs. I usually begin the treatment of 
such cases by brushing over the tonsils and neighboring struc- 
tures with a solution of nitrate of siher, twenty grains to the 
ounce, once or twice a week. Meanwhile the patient uses a 
gargle of the following mixture: 

R. |odis Borat ) ^^ 2 drachms. 

r 1. Hydrastis j 

Pinus Canadensis (white) ) ' 1 

r.^ ■ : aa i ounce. 

(jrlyceruie ) 

Aqua f[. s. ad 4 ounces. M. 

SiG. — Teaspoonful as a gargle three times a day. 



366 The Peoria Medical Monthly. 

If there is a catarrhal condition of the nasal passages, they 
are spra\ ed with the above mixture once a day. I also direct a 
vesicating mixture composed of croton oil, tinct. of iodine and 
comp. spts. itther, to be applied over the tonsils on the outside 
of the throat every few days. This treatment has answered ad- 
mirably in several cases for me. 

But when we come to treat true tonsilar hvpertrophv, we 
have to deal with an altogether different matter, for instead of 
two soft, fluffy, ulcerating glands, we have two hard modulated^ 
fibrous bodies protruding into the pharvnx, that will resist every 
effort toward their removal by the application of drugs. In these 
cases surgery alone can offer to the patient assurance of a radical 
removal of the difficultv. In my experience remedies directed 
toward the eradication of the constitutional vice that causes the 
glandular enlargement, has accomplished verv little, if anvthing. ' 
In one case, that of m\- own child, I ga\-e them a thorough trial, 
but the result was ;///. I was Hnally compelled to resort to oper- 
ation to prevent suffocation. I also think, that w^hen the tonsils 
are large enough to impede nasal respiration, the sooner they 
are removed the better — that is, after the child has reached the 
age of three years. I am aware that this is contrary to the ad- 
vice usually given in the books, but I cannot see the use of wait- 
ing until the child has passed the age of six, for there are very 
few children of anv age that will permit an operation without an 
anjtsthetic, and besides, the mechanical effect of the enlarged 
glands may produce serious changes in the organs of voice and 
respiration, to say nothing of the various other troubles that they 
may give rise to. 

Now, as to the best method of removal of enlarged tonsils. 
In my opinion the tonsilitome is nut the instrument to use. I 
have had no experience with anv but Fahnestock's, and that in 
my hands was a complete failure. I have tried it in several 
cases, but could onlv succeed in detaching a thin slice from the 
tonsil which did not materially reduce its size, neither have I 
been able to pull the gland through the ring with a tenaculum, 
as some claim can be done, the aperture being too small, but if 
it had been larger I don't think the instrument could be got into 
the throat. Of course there are some cases in which the tonsil- 



Original Communications. 367 

itome would do the work, but I prefer in all cases a simple probe 
pointed, curved bistoury, and a cross-action, vulsellum forceps. 
The bistoury should haye a stiff handle with a rather long shank 
and a cutting edge of not more than an inch and a quarter, but 
with rather more curve than usual. My mode of operating is 
this: The patient, if an adult, is seated facing a good light. 
After placing the tongue-depressor and giving to him to hold, 
the operator seizes the left tonsil with the forceps and makes 
slight traction toward the median line, then the bistoury is carried 
above and behind the tonsil, which is severed from its connection 
with the pharynx by a cut downward and slighly inward. After 
waiting a few minutes for the hemorrhage (which is usually very 
slight ) to subside, the right tonsil is seized in the same manner 
as before, but unless one is ambidexterous he will experience 
some little ditiicultv here, for the left hand holding the forceps is 
in the way of the hand holding the knife. But if the left arm be 
held high, with the elbow looking upward, it is out of the way 
of the knife, which is used under the curve formed by the arm. 
In children, I always use an anaesthetic. It saves time, and 
the child is not made sick by its struggles to resist. It always 
looked inhuman to me to see a doctor work with a screaming, 
struggling child, and finally frighten it into convulsions, as is not 
infrequently done. After the child is anaesthetized a pillow is 
placed under the shoulders, so that the head is in the same posi- 
tion as for tracheotomy. An assistant, standing at the patient's 
left, holds the tongue depressor, and the tonsils are removed as 
before described. As soon as the gland is out, the little patient 
is turned on the side. This allows the blood to run out of its 
mouth and prevents the same from entering the trachea. I usually 
remove but one tonsil at a time in children. While both might 
be removed at one operation, I think it increases the risk, and as 
the removal of one always relieves the urgency of the symptoms,. 
I think it best to allow an interval of two or three weeks to elapse 
between the two operations. Some writers advocate the removal 
.of only a part of the gland, expecting atrophy of the remainder: 
but why not remove all of it while we are about it? It certainly 
saves time, and I cannot think that it increases the danger to the 
patient, unless it would be through hemorrhage: but in all of my 
cases — some twelve or tifteen — I removed the glands completely. 



368 The Peoria Medical Monthly. 

llie bleeding being but vtvy trifling in eacb case. The after treat- 
ment of tonsilotomy is very simple. The majorit\- of cases will 
need nothing but a diet of bland and unirritating substances for a 
few days, although I usually throw a little iodoform over the 
stump of the tonsils by means of a powder blower. 



SOME THOUGHTS ABOUT PNEUMONIA. 

BY J. D. EBERT, -M. I)., DUNDEE. INI). 

I wish to briefly discuss in this paper the probable causes 
of pneumonia in a great many instances and the treatment, 
which to mv mind appears to be logicalh- adapted to each stage 
when coming up, especiallv as a complication with anv of the 
malarial troubles. The subject of pneumonia, however, in all of 
its details, phvsiological and pathological, is a broad subject. 
So much that in the brief space allotted in this paper, I will only 
be able to call up the points of special interest and dispose of 
them verv brieflv. Especially at this season of the vear pneu- 
monia is endemoteric. Anv one of the three varieties or forms 
of malarial fe\'ers, are subject to a complication of a dangerous 
pneumonia, ushering its insidious svmptoms in at each recurrence 
of the cold stage. This condition is pneumonitis, coming as a 
complication with a malarial form of fever, necessarilv has for 
its prime factors two grand causes at least; and mav have many 
minor or incidental conditions, growing from and out of this 
\'ery condition of patient, as secondary causes and effects, and 
after the congestive stage is fully reached, marked by the unmis- 
takable rust}' expectoration. The case is no longer strictly a 
malarial condition, nor can it return to such a condition of things, 
until the metabolic force of the s\-stem is normalh- adjusted. 
The para bysmaic condition of the lungs resulting in the en- 
gorgement of lung tissue and air cells as well as mucus membrane 
all b}- consequent inflltration, of course suffers violence, both func- 
tional and structural. Pneumonia in all of its conditions when as a 
■complication has for its pathological conditions: First, a vito 
chemical factor, viz.: A bacterial influence^exerting a very 
direct depressent effect on the great sxmpathetic nervous system, 
destroying the dvnamic force proper, culminating in the en- 



Original Communications 369 

gorgement of the softer tissues of the body: hence the lungs 
are very Hkely to be the seat of congestion; holding as the pul- 
monary organs do. a very intimate relationship phvsiologicallv 
to external causes, which in this changeable climate is almost an 
unavoidable condition to be considered, as a bad cold is invariabh' 
present. 

These two prominent causes combined with a stenthic con- 
dition of the blood, normal in quantity, but deteriorated in quality, 
produced both by the presence of bacteria, acting chemically, 
vitally, and mechanicall}-. The liver in its three-fold duties 
becomes embarrassed with the unnatural demand made upon it, 
that of dealing with those infinitel}' small, though countless entities, 
producing pathological changes in the blood. Acting both pri- 
marily, and reflexly, implicating the liver in fault in all of its 
functions. 

The \-ery strange behavior of bacteria in the human system 
are ^■ery much modified in their effects by pre-existing or 
chronic troubles. Perhaps as \'et. the special law that governs 
those little creatures is imperfectly understood by the pathologist 
of our da\'. 

When the blood-making process of the system is impaired 
by disease, as we have it in the continued form of fever, being 
announced by the failure of the appetite and power to digest 
food properly, we may very easily conclude that the blood- 
using process of the system is also impaired, and that the 
formative vessels are unable to use the already stored plastic 
material. Just how long the system can retain plastic material 
unused under its vital command ^vithout producing functional 
and subsequent structural disturbance I am unable to say: but I 
am w'ell assured in my own mind where the patient passes 
rapidly from apparent good health to disease, that the system is 
not only poisoned with bacteria but is also distressed with its 
own intended store of pabulum, which condition fa\ors local 
conjestion. and if strong and continued long enough on any 
organ, especially the lungs produces intiltration and effusion 
from the pulmonary arterioles, first of serum and finally blood cor- 
puscles. Pathologically this condition of the lungs, according to 
amount of lesion, and time which effusion is existing, presents 



370 The Peoria INIedical Monthly. 

two very iniporlanl resulting factors which becomes perturbatio 
in disease proper, and must be at all times considered in their 
proper sequence to properly treat the case in hand and be on 
the alert for future trouble. 

A lung tissue which has been intiltrated, and that too b\' 
impure blood, surcharged with bacteria and effete products suffi- 
cient to inaugurate a continued form of fe\'er, perhaps suggests 
another factor which has something to do in heightening the in- 
flammatory process, and in subsequent absorption probably plays 
a part in producing the morbund, or typhoid symptoms, which 
occasionally but quickly arises to still darken the cloud caused 
by the effused products from the lungs being absorbed back into 
the circulation in the process of repair. As destructiye metamor- 
phosis of waste albuminoids giyes urea proper this matter is de- 
serving of the closest attention to see that the emmunctories, 
<ispecially the kidneys, are in good working order, and if needed 
to assist a free catharsis should be produced, as urea in abnormal 
quantities in the blood disturbs the nerve centers and brain, pro- 
ducing, according to "^emperament, athymic or -contrariwise 
pervigilimnic state of affairs. 

In taking a brief resume of the foregoing thoughts on the 
complication of pneumonia, a few thoughts with reference to 
its treatment and its adaptation, would seem to be in order. 
When any of the three forms of malarial fever become at any 
time complicated with pneumonia, I at once leave off the special 
malarial remedies, such as tonics or any of the preparations of 
the bark, and open up a ne\\- line of warfare, as certainly sulph. 
of quinine or cinchonidia administered in the first or second 
stage of pneumonia works serious harm to the patient. Under 
the very pressing necessity to at once relie\-e the congestive 
trouble and cut off the third stage proper by timely and heroic 
treatment should be the first object, as the probable first cause, 
that of malaria, is a slow factor, consequently the digestive and 
assimilati\'e processes must luue the attention. Judging from 
effect to a cause, the liver in its second and third function is 
strongh- suspected to be at fault. Tiiat the tissue food is in posses- 
sion of abnormal constituents amounting perhaps to hypnosis, 
also sugar being found in the effused products of pneumonia, 
points to the glycogenic, or third function of the liver in fault. 



Original Communications. 371 

To strike hard and a sure lick is a oood motto right here, and I 
have found nothing- better than 

R. 

Hyd. cum creta, 10 grs. 

Powd. gum camphor, I2 grs. ^ 

Powd ipecac. Ih grs. 

Powd. ipecac et opii , 3 grs. 

Sulp. soda, 15 grs. 
M. Et. Divide into charts No. 12. 

Sig. One to be given every two hours to induce free ca- 
tharsis: if not, continue soda sulph., five grains every half hour 
hour, until the desired effect is produced. 

Also, as a nerve stimulant and promoter of absorption, give 

R. 

Ammonia, niuriat, 30 grs 

^- Powd. ipecac et. opii, 5 grs. 

Syrup simple, fl. 10 drchms, 

Sig. Dose a teaspoonful e^•ery two hours, alternating with 
the powders. 

Then, as a continued treatment until the thir<l stage is reached, 
when expectorants and tonics are indicated, give 

Hyd. cum creta, 12 grs. 

Powd. gum camphor, 3 grs. 

Powd. ipecac, 6 grs. 

Powd. ipecac et. opii,. 6 grs. 

y[. Et. Divide in chart Xo. 12. 

Sig. To be given ever\' three hours, alternated with the 
above mentioned syrup, sulphate soda in live grain doses, given 
when necessary to secure an action from the bowels twice or 
thrice daily. When the third stage is fully marked b}' moist, 
although light-coated tongue, pulse down to 85 or 90, temper- 
ature anvwhere between 97 and 100, with no delirium and ab- 
sence of the rusty sputa, but changed to a pus-like nature, I at 
once prescribe, 

Sulphate quinine, 16 grs. 

Potvci. ipecac et opii., 2 grs. 

Powd. ipecac, 2 grs. 

Camphor powd., 4 grs. 

Sulph. soda, 8 grs. 
M. Et. Divide in charts No. 8. 
Sig. One to be given e\ery three hours alternated with 



372 The Peoria Medical Monthly. 

Syr. scilla., 8 drs. 

Syr. stiliingia, 8 drs. 

Syr. senega, 4 drs. 

M. Sig. Dose two-thirds of a spoonful between powders. 

This paper ha\ing already become so ver}' lengthy, I close. 



THE FINANCIAL PROBLEM. 

BY ^V. S. STRODE, M. D., BERN ADOTTE, ILL. 

As this question is being considerably agitated and discussed 
by the various medical societies and journals throughout the coun- 
try, a description of the plan adopted bv some of the physicians 
of this county may be of interest to the readers of The Monthly : 

Each doctor prepares from his books a list of the " no pay "' 
patients, which he exchanges for like lists with the neighboring 
M. D's. 

When the " dead beats '" come out of their way for treatment, 
as they will generiUly do when pressed for settlement, we are able, 
by referring to our " black list," to know their standing aad treat 
them accordingly — as a rule demanding the cash or satisfactory 
security for treatment. We expect, bv adhering to this plan, to 
be able in time to do away with a large part of the "no pay"' 
practice, which now constitutes from one-third to one-half of all 
the business we do, and w^hich is a dead loss to us. This class of 
patients, as every physician knows, is the most exacting, requiring 
the greatest amount of medicine and attention of all the people 
with whom we have to deal (except the hysterical females). 

But there is another fact which is very patent to those who 
have tried it on these " ne'er do wells,"' and that is, when sick 
they will have treatment, even if the^• have to skirmish around 
and get something to fax for it. Some persons urge that this 
plan is hard on the poor. But this argument is sentimental non- 
sense, and it is such nonsense, coupled with the credit s^■stem, 
that encourages and perpetuates the great army of " tramps "' 
and " dead beats '" that our land is full of. 

Any man with health and strength can pa^• his honest debts 
if disposed to do so. But that law protects him if he chooses 
not to pay. 



Correspondence. 373 

When well he is independent of the doctor and when sick if 
one physician will not attend another will (so he argues). And 
hence it becomes necessary" that we do something to protect our- 
selves. 

It is to be hoped that this question will be agitated by our 
profession until a law is enacted bv our Legislature recognizing 
a physician's services as labor and making it possible for us to 
collect our fees. 



CORRESPONDENCE. 
PHYSICIANS THEIR OWN DISPENSERS. 

Editors Peoria J/cdical J/ont/i/x. 

Dear Sir: — Wh\- is it that so few medical men see tit to 
dispense their own medicines: Several years ago, if I mistake 
not. your journal editorially and through correspondence ad- 
vocated the plan and I ha\e since adopted it with the most 
{j'ratifvin"' results. 

In this da\' and aii'e of keen leiritimate and illegitimate 
competition it is necessary for the ordinary general practitioner 
to look to his own interest as sharply as possible, and in no way, 
in my estimation, can he do so with more pronounced effect than 
in judiciously dispensing his own medicines. It is true there 
may be some slight disadvantages connected with the plan, but 
certainh' the\' are vastly counter-balanced by the ad\antages 
arisino- therefrom. 

As for myself, I tind it just as convenient to drop out into a 
glass a sufficient quantity of concentrated tincture, or fluid ex- 
tract at the bed-side, as to write a prescription: and it is always 
intinitely more satisfactory to the patient, sometimes highly ad- 
vantageous to the urgency of the case, and is almost invariabh' 
placed emphatically to the credit of the doctor. And such 
opinion on the part of the patient is not unreasonable at all. 
Many a time and oft have seen bottle after bottle secured at the 
drug store arranged in the order of arrival on the table in the 
sick-room with their contents only partially gone, but each one 
representing a sum of money which in many instances would 
have been much more cheerfully used to liquidate the doctor's. 



374 The Peoria Medical Monthly. 

account, had he been shrewd enough to himself provide the 
necessary medicaments and thus add even a small percentage to 
the sum total of his collections. 

Frequent changes of prescriptions secured bv patients at the 
drug store make sad inroads upon a moderate purse, especially 
when sickness is long continued, and the phvsician is sure to be 
ultimate!}' the sufferer. In the main fancy, or so-called elegant 
preparations, together with bottles, corks and labels, are quite 
unnecessary and expensive luxuries. Glasses, cups and paper 
will usually answer an excellent purpose as receptacles, and no 
more need be prepared than will suffice for administration against 
the next regular ^•isit. 

Frequent changes of medicine, while that previously pre" 
scribed remains unused, is considered by the patient as evi- 
dence of indecision and professional ignorance, and too often 
leads to a sense of doubt and fear, detrimental alike to 
patient and medical attendant. These unpleasant features can 
w^ith certainty be avoided by dispensing one's own medicines at 
the bed-side, and in quantities sufficiently limited to admit of 
necessary change without exciting morbid apprehension on the 
part of the patient. Homoeopaths and other irregular practition- 
ers are quick to discern these factors in the make-up of human 
nature, and to fulh- profit by the knowledge thus acquired. 
These are facts which it is quite in place for scientific physicians 
to take into consideration for the benefit alike of themselves and 
their clientage. 

Again, it is almost always possible to secure the immediate 
payment of a moderate fee when the medicine is included, but 
often very difficult to secure it without. The average man recog- 
nizes the merchantable character of drugs at once, and feels that 
of necessity the\' must be paid for, but the pecuniary value of 
knowledire and skill is to him far less tan<rible and he fails to see 
that he is hx right just as responsible for a speedy settlement. 
As to this particular matter I know whereof I speak, for I have 
had an extensive experience which has taught me the wisdom of 
the course which I am now advocating. Hand the average man 
a written prescription and he will assume a distant, far-away look 
which bespeaks a mental computation of the druggist's charges, 



Correspondence. 375 

whilst the just claims of the ph\sician are not thought of: but 
hand him, on the contrary, a package of medicine, and his everv- 
day business instinct leads his hand directly to his pocket, and in 
nine cases out of ten the fee is forthcoming. As I said above, 
these are not fancies, but facts collected from evervdav experience. 
If we are to maintain our reputations as scientitic thinkers and 
workers, let us also adopt scientitic methods in securing our just 
pecuniary as well as professional deserts. Fancv fees and fabulous 
Jiouorariiinis are not the lot of most of us, and it behooves us to 
collect with scientitic exactness the just claims which we mav hold 
against individuals. The easiest and most iiiojfeiisive wavs to do 
this are the most scientitic and agreeable, and I sincerelv belie\e 
the above to be one of those wavs. 

But, there are other reasons why physicians should dispense 
their own medicines, among which mav be mentioned its influence 
for good upon the mind of the patient. Manv persons are mor- 
bidly sensitive on this point, and such is another potent factor in 
alienating the affections of manv from the regular practitioners. 
A distrust, no doubt in the main illv founded, exists in the minds 
of many as to the reliabilitv of ordinary apothecaries, and this 
distrust exhibits itself frequently by a heart^" acceptance of the 
services of him who dispenses his remedies at the bed side. This 
is a state of affairs emphasized in the experience of every medical 
man who chooses to think, and thousands ..f illustrations might 
be gathered daih'. 

Many more features of this question might be brought up, 
but for the present, at least, I forbear. I have no, peculiar ^•iews 
or opinions to foist upon a long-suffering profession, but wish 
simply to thus bring this subject again to the attention of those 
of our profession who mav care to profit bv it. 

x\s your paper is a practitioner s journal, an\-thing of interest 
to them will no doubt be acceptable, and for the purpose of nin- 
tual benefit I invite criticism and suggestions. 

I am, sir, very truly, A. E., M. D. 



MEDICAL PRETENSIONS. 

Editors Peoria Medical MontJiIx. 

Pretensions are not only intentions to deceive, but are in 
many instances ridiculous. x\ man who uses expressions of 



376 The Peoria MedicaIv Monthly. 

which he does not know the full meanini;-, niak-es himself riclieu- 
lous and tries to palm himself off as a hiy;her educated man than 
he really is. This is self depredation in the eyes of those who 
know better. 

If a man reads an article in a medical journal with pleasure 
and interest, and arrives in reading at an ungrammatical, ill 
understood latin or foreign expression, it spoils all the lustre of 
the author of the article. 

If the colleges, which are private institutions, which assume 
the right to judge the abilitv of their disciples to practice their 
chosen profession, know what preliminar>' knowledge is neces- 
sary, and do, notwithstanding, pass a fa\orable judgment on 
those wantinii" such knowled<jfe, and crown it with a final docu- 
ment written in a language the recei\'er does not understand, 
such an act falls under the head of pretentions and is decei\ing 
and ridiculous. 

It is an open question, in such a practical land, whether 
mathematics, phwsics and a little Latin, and e^•en Greek, consti- 
tute a needv preliminarv knowledge to the physician, as it is 
looked upon in Europe, where a profession means a vocation re- 
quiring the highest possible school-education. 

It is true a ph\sician ma\' treat a patient successfulh' with- 
out knowing how to spell er\-sipelas correcth'. but to call that 
man a member of the profession is a luimbug. 

The sciences used in i\nv professional stud\' are full oi latin 
expressions, bv reason of the presumption that latin is the gen- 
eral language understood b^■ the learned men of all the ci\ilized 
nations, and of the sense defining character of that, bv no means 
dead, language. On that account alone the knowledge of latin 
may be the necessar\- e\il for trulv professional men. There are 
occulists who ha\e not the slightest idea of a mathematical 
etjuation. 

America can show up most fa\orabh' with quite a number 
of medical men in comparison with the highest in Europe in 
skill, knowledge and education. I>ut still we are silenced manv 
a time h\ some f)verbearing Europeans. den\ing us equality as a 
profession. Though such men are somewhat ungentlemanlw we 
are forced to excuse them. 



Correspondence. 377 

America is thoroughly practical. A man may learn the 
topography of the ovaries without being able to write his name, 
and may by chance observe repeatedlv the operation of ovari- 
otomy, so that he may successfullv operate, though he may 
never have been anything else than a renowned horseshoer. 
Such a man the doctors ( ?) call a quack. 

l^ut where does the quack commence, or does he end at 
present at the college — door? 

A man may expose in frame the finest diploma in latin, and 
may have forgotten what he has, or has not learned, and has 
not studied since anno tabac. when he was made a doctor 
( misericordiie ) but he must be acknowledged a man of the 
s^■ringe because his diploma says so. 

( ? ) Dr. means learned man, able to impart his knowledge. 

If a man cannot compare favorably with other physicians, 
he must at least be not a general ignoramus, if he shall not stand 
below the dignity of the above mentioned horseshoer. 

For the so often mentioned care of the health and safety of 
the public, it would be desirable to have a State board of exam- 
iners whose duty it should be to examine all the ph3^sicians in the 
State, sa}- everv ten years, for the reason that even the best man 
may be so unfortunate as to have his mental faculties impaired 
incapacitating him for practice. This would look like a cruel 
proposal, if I would not be con\'inced of the charitable help of 
the profession for the unfortunate brother, if need bti. 

Farther, even if such an examination should prove a farce 
like the pharmaceutical examination in Iowa, it would deter many 
an incompetent man from appearing before the board. 

The aim of the practice of medicine may be lucre or bread 
and butter, but if it is not combned with love to study or the hu- 
mane desire to do some good, it is the most despicable business 
imaginable. E. Brendel, M.D. 

Cedar Rapids. Iowa. 



Naphthaline for Oed Uecers. ( Do^•odtchikoff in 
WirtcJi). Dust on thrice daily: wash the old dressing off before 
€ach new dressing; cover the ulcer with oiled silk.-— .SV. Louis 
J\Ied. and Siiri^'. your. 



37^ The Peoria Medical Monthly. 

SOCIETY TRANSACTIONS. 
CHICAGO MEDICAL SOCIETY. 

(Concluded from October Number,) 

Stated meeting, September 21, 1S85. The President, C. T. 
Parkes, M. D., in the chair. 

" Laparotomy in a Case of Gun-shot Wound of the Intestines " 
was the title of a paper read bv Dr. Augustus V. Park. He 
said: M. S., a butcher-boy, aged 16, of slight stature, formerly 
in poor but lately in good health, was shot on September is*-, 
1885, at 3:30 p. M, A pistol-ball, of caHbre 22, fired from a dis- 
tance of forty-five feet, entered the abdomen at a point midway 
between the symphysis pubis and umbilicus, two inches to the 
left of the median line. The patient was removed in a farmer's 
spring wagon from the place where he was shot to his home, a 
distance of seven miles. A dressing was applied, and at i p. m., 
the next day, he was taken to the Michael Reese Hospital. The 
patient arrived nearly exhausted; his temperature was 100 de- 
grees P., pulse 130, weak and intermitting. His respirations 
were 30, his abdomen tympanitic especially high on left side. 
There was no liver dullness, giving rise to a theory that the liver 
was crowded upward by extravasated blood. At 1 130 p. m. lapar- 
otomy was performed, the incision being made directly over the 
seat of the wound. We could not find any wound of the perito- 
neum, or where the ball passed through it. As the peritoneum 
was opened, decomposed blood rushed through the opening with 
great force. Blood and blood-clots which quickly formed were 
removed with sponges; the intestines were drawn out and exam- 
ined for wounds. The first wound found was an abrasion, the 
ball not having entered the intestine. There was but little hem- 
orrhage, and the wound was closed by the interrupted cat-gut 
suture. The second wound, half an inch in diarneter, opened di- 
rectly into the intestine. A small mesenteric artery was found 
divided and tied. All hemorrhage ceased. The wound was 
closed by interrupted sutvu'e; no further injury could be detected* 
The abdominal cavity was cleansed with one ( i ) per cent, solu- 
tion of carbolic acid; the intestines were washed, carefully ex- 
amined and returned. The abdominal incision was closed bv 



Society Transactions. 379 

two sets of sutures, the peritoneal surfaces were approximated 
and closed by continuous suture. 

At 5 :30 on the morning after the operation the patient died. 
Seven hours later an autopsy revealed commencing peritonitis, 
the small intestines being apparently agglutinated together. A 
few blood clots and a quantity of extravasated blood were found 
in the peritoneal cavity' on the left side. A contused wound of 
the rectum was found near the sigmoid flexure, the ball being 
deflected from this position into the musclar tissue below, where 
it was found imbedded. This case justifies the opinion of vari- 
ous eminent surgeons that we cannot tell the direction the bullet 
takes from the position of the wound of entrance, or exit. From 
the conditions existing in this case, he was of the opinion the 
case would have terminated favorablv had he been able to per- 
form, with antiseptic precautions, laparotomy immediately after 
the injury. 

Dr. F. E. Waxham said Dr. Park was entitled to a great 
deal of credit for presenting to the Society his paper and the 
specimen, because it is the report of a case which terminated un- 
favorabl}^ He thought the chances of the patient would have 
been better if he had been allowed more quiet. His frequent re- 
movals must have loosened the blood clots and increased the 
hemorrhage and prolonged the shock. If he had recovered he 
would have thought it almost miraculous, for it is one of the 
maxims of abdominal surgery to have complete and perfect 
quietude for the patient. 

Dr. R, Tilley said the studv of gun-shot wounds of the 
abdomen is interesting to every member of the profession, no 
matter in what particular direction his favorite studies may lead. 
Any one of us may find ourselves confronted with the responsi- 
bility associated with such cases when delay in action ma}' be 
culpable. Relative to the case before us, he should not only not 
consider a recovery miraculous, but deem the conditions asso- 
ciated with it more favorable than, on the average, can be ex- 
pected. One of the conclusions formulated by our President 
before the American Medical Association in Washington in 18S4 
is, in opening the abdomen to look for gun-shot wounds, the 
incision should be in the median line, regardless of the bullet 



jSo The Peoria Medical Monthly. 

wound. Tliis procedure certainlv facilitates efficient inspection, 
but in the present case it was ignored. He regretted that the 
cause of failure of the operation has not been thrown into 
^;tronger relief, and he felt like asking our President, Dr. C. T. 
Parkes, to formulate the lessons he would draw from the failure 
of this operation. Of course, the case will go on record as one 
of operation after gun-shot wound of the abdomen associated 
with failure, and will tend to develop hesitation in the mind of 
the general practitioner about a class of cases which, in his 
opinion, called for urgent, prompt operating. 

Dr. Bogue said there were a few lessons to be learned from 
tliis case. One is the adxantage which would follow an earlv 
operation, before the blood, or fluid in the abdominal cavity, 
decomposes. An operation should be made before the irritation 
from this source is severe. Another lesson is the necessit}' of a 
thorough exploration of the abdominal cavity for the purpose of 
discovering and removing anv foreign substance which mav be 
in it. It is necessary to control hemorrhage, bv opening the 
abdomen and having free access to every part of it. 

Dr. J. H. Etheridge said that it will be noticed the pulse- 
rate was high after the operation, which lasted two hours. The 
question arises, if we cannot account for death on the opinion 
that it was due to the action of the ether on the cardiac nervous 
system. Was there acute poisoning from ether r Or was death 
caused by septicaemia? He wished to thank Dr. Park for the 
report of this case, because it is from the reporting of the unsuc- 
cessful cases we obtain the most beneflt. He did not believe it 
w'ould deter any one from doing abdominal surgerv, as it had 
already taken such a rank that the report of one unsuccessful 
case would not intimidate any surgeon, but enable him to steer 
clear of difficulties others mav ha\e encountered. 

The President said: Your chairman feels somewhat diffi- 
dent about making anv remarks, because his experience in con- 
nection with gun-shot wounds of the abdomen was solelv in 
connection wtth the results of experiment upon the lower ani- 
mals. 

There is one fact demonstrated b\- this case, and it stands 
out in all the cases, of which I know, operated upon in man, 



Society Transactions. 381 

which corroborates the results of the experiments made by my- 
self, and that is, the necessity of free incision through the median 
line of the abdomen, without anv reference to the course of the 
bullet, as the best way to get at the injury so as to determine its 
extent, and to apply the means of repair as well as to secure a 
clean abdomen. Another item mentioned in the case is the one 
that blood flowed freely from the bullet wound while the 
patient was in the erect pbsition and ceased when he was recum- 
bent. As the bullet passed through parts of little vascularity, 
this item points to the wounding of some large vessels internally 
(as was found), and becomes a point of value in the question of 
perforation. This question of perforation is no easy one to settle 
positively, even in the best of hands. I am inclined to agree 
with Dr. Waxham in the opinion that it was not the best plan to 
remove the patient from his home before operating, notwith- 
stending his bad surroundings. We must take into considera- 
ation the fact that his patient was accustomed to his surround- 
ings, and far less likely to be harmfully affected by them than 
by the danger incidental to the jolting movements of removal. 

Some of the accidents of the case I am sure would have been 
a\oided bv obeying the rule of open incision in the median line. 
Post mortem showed considerable old blood in the cavity: this 
would have been found and removed. The paper states no ex- 
travasation of bowel contents \^■as noticed: the non-existence of 
such condition has doubt thrown upon it by the condition found in 
post mortem. The wound in the rectum would ha^•e been dis- 
covered, and the action of the bowel displayed shows an un- 
touched perforation of its walls: probably the wound of entrance 
of the bullet. The exit wound is sewed up. 

The manner of closing the external incision, as well as the 
bowel wounds, should be such as to sazr time in the operation, 
by usincr the continuous cat-o-ut suture for small bowel wounds 
and single through and through suture of the abdominal incision. 
It is pure waste of time to unite the latter in layers. 

It is a matter of some pride and great pleasure to me to 
know that the principles enunciated b}- me as the results of ex- 
periments on the lower animals ( especially as they are ridiculed 
by some 1 have so recently been put to a severe but successful 



3S2 The Peoria Medical Monthly. 

application upon the human body. Dr. Bull, of New York, had 
a successful case of nine perforations, and Dr. J. B- Hamilton, of 
Washington. D. C, also a successful case with eleven perforations. 

In Dr. Hamilton's case, the onlv bad happening arose from 
the formation of a blood tumor — probably, as Dr. Hamilton says, 
forming from a grazed surface, the bleeding from which could 
not be contracted. This was subsequently opened through the 
rectum and the patient recovered. But it is interesting to notice 
that the patient was in greater danger of his life from this mass 
of blood than from the wounds in the intestine after they had 
been closed. It shows also how necessary it is to prevent 
bleeding by securing, if possible, all bleeding points. 

After the pathological specimen was examined the Society 
adjourned. 



PERISCOPE AND ABSTRACT. 

CARDIAC DISEASE IX ADOLESCEX'CE, CONGEN- 
ITAL MALFORMATION OF THE HEART, 
AND AN.EMIC MURMURS. 

In a clinical lecture on the above subject by Dr. John yi. 
Keating, of Philadelphia, and reported by William A. Edwards, 
M.D., for the Medical and Surgical Reporter^ the following 
practical points are brought out: 

After describing at length the peculiarities of the fwtal heart 
and its circulation', he savs: Let us now consider this little pa- 
tient, babv G., aged six weeks, female. This patient presents 
you a form of congenital cardiac malformation that you will 
probably meet more frequently and recognize more readih' than 
any other. /. c.^ patulous foramen ovale, occasionally cyanosis^ 
popularh' known as " blue disease." 

Soon after birth the foarmen ovale should be closed by its 
valve probably contracting adhesions with the edge of the aper- 
ture, and by the equalization of pressure in the auricles. Should 
it remain permanenth' patulous, the condition which is so well 
illustrated before ^■ou. will arise. A small aperture may exist 
between the auricles without occasioning any admixture of blood, 
and consequently presenting no clinical history. If you will ex- 
amine an adult heart carefully, you may note above the fossa 
ovale a muscular projection, with its concavity looking posteri- 
orly and inferiorly. This has been designated the valve of 



Periscope and Abstract. 383 

Vieussens. It is continuous below with the Eustachian valve. The 
appearance of these two crossing arches is not unlike a pair of 
scissors, and in some cases will enable you to introduce the han- 
dle of a small scalpel from the right to the left, but when the 
auricles undergo systole the aperture is closed, and, as above 
stated, there will be no admixture of blood. 

Patulous foramen ovale appears to be more frequentlv seen 
in females, and our case helps to bear out the rule. 

This malformation may produce no disturbance until the 
auricular insufficiencv has had the same effect that vou know a 
continued mitral insufficiency will have, the heart then suffering 
from a systole and deepening the cvanosis, and bringing the 
oedematous svmptoms prominentlv forward. A case is recorded 
in the medical journals of a man reaching 66 years with a patu- 
lous foramen. 

Everv case that vou meet will not present vou such a clear 
and easiblv readable clinical picture as the one that you now have 
the opportunitv of witnessing. In certain cases the diagnosis can 
onlv be suspected. 

A clinical observer tells us that in a case of his, " A little 
girl suffering from palpitation of the heart, in whom the begin- 
ning of a svstole was indicated h\ cedema and venus stasis, a 
soft, deep-blowing svstolic murmur was present to the right of 
the sternum, in the second intercostal space, due probably to a 
persistence of the foramen ovale."" 

Another condition worth v of vour studv, of which unfor- 
tunatelv I have no case to illustrate, is a -persistent patulous duc- 
tus arteriosus. As I stated at the commencement of my lecture, 
the canal is not obliterated immediately after birth. * * * 

I would consider the persistence of the ductus arteriosus 
thirtv davs after birth as constituting a congenital malformation, 
but remember that a patulous duct is not inconsistent with the 
maintenance of life. * * * 

The svmptoms of patulous ductus arteriosus are more respi- 
ratorv than directlv cardiac, and do not show themselves in early 
infancv, Generallv about the second, third or fourth year they 
commence to attract attention, beiiig more noticeable after exer- 
tion. This grows progressivelv worse, the patients on the 
merest exertion being seized with suffocation, the skin becoming 
deeply engorged. Remember, if vou please, however, that cy- 
anosis is not constant, but occurs paroxysmally. appearing and 
disappearing, as he exerts himself or is in repose. Duroziez 
records a case in which cvanosis was almost the last scene of the' 
hnal svmptoms. 

The diagnosis of these cases is. of course, not easy: ill- 
detined blowinp- murmurs are trenerallv heard, but thev are diffi- 



3S4 The Peoria Medical Monthly. 

cult to locate and interpret correctly. In some cases recorded 
by reliable obseryers, no blo\yin<:^ murmur was present at all. 

The course and prognosis in these cases is much the same 
as organic heart disease. ]More particularly in regurgitations of 
the auriculo-yentricular oritices, the mitral or tricuspid yalyes. 

After describing some rare pathological conditions the lec- 
turer proceeds: 

Anivnn'c viurniurs haye yarious synonyms: inoriranic. func- 
tional, anaemic, accidental, are some of the headings under which 
Aou will find them described in the yarious text-books. It is not 
an uncommon thing at all to find a systolic murmur in a heart 
Ayhich is absolutely deyoid of anatomical or yah-ular lesion, hence 
\ye term these murmurs inorganic, in contradistinction to those 
^yhich result from organic change. These ha?mic murmurs haye 
certain \yell-defined characteristics that it will be well for us to 
consider. 

This little girl, conyalescent from scarlatina, presents us a 
functional murmur in its purity. As I place my ear to her pra:"- 
cordia, a soft, feeble, gently-blowing or softly-aspirated svstolic 
murmur is heard. These murmurs are always systolic, and are 
neyer harsh, sawing, or rasping. The systolic heart-sound that 
accompanies these murmurs is generally clear and ringing in 
character: it has lost its low, booming sound, so characteristic of 
the normal first sound. 

^'ou may often notice these murmurs in chlorotic girls, who 
will then generally also present you a Aenous hum or murmur in 
the neck. 

Not infrequently you may meet an ha:*mic murmur, during 
the course of acute pneumonia, puerperal fener, yariola, scarla- 
tina, pernicious anaemia, which disease is now becoming recog- 
nized in the yery young, as Kjelberg records a case in a child 
aged fiye. who died one and a half months after the inception of 
the disease. 

It is particularly in anaemic conditions that these murmurs 
may be recognized: the anaemia may be acute, as from sudden 
loss of blood by hemorrhage of a recently confined woman, or 
chronic anaemia due to long-standing disease, leukaemia, chlor- 
osis, marasmus, malarial cachexia. 

In cases where these murmurs are present, the heart struc- 
ture has undergone change, due to a fatt\' metamorphosis of its 
muscles. This seems to apply particularh' to the papillary mus- 
cles, and probably has some relation to tiie explanation of the 
physics of these murmurs. 

I do not anticipate for you much trouble in the recognition 
of these murmurs: the general condition of the patient will assist 
A'ou materially in the diagnosis, together with the character of 



Periscope and Abstract. 385 

the murmur, which is soft and cooing, is always systolic in time, 
is generally heard best over base of heart, and as a rule the first 
cardiac sound is high-pitched and ringing. Some observers state 
that these murmurs are intensified by the pressure of the steth- 
oscope. Of the truth of this statement I have never been able to 
satisfv myself. The course of the murmur will also aid in the 
diagnosis. If vour treatment is successful the murmur will dis- 
appear as the patient grows better, and when the patient is finally 
restored to good general health, the most acute anscultor will 
fail to hear any bruit. 

The question of treatment in these cases is always an im- 
portant one, depending of course upon the cause of the anaemia, 
as it is solely bv treating the hjtmic dyscrasia that your thera- 
peutics will meet with any measure of success.. 

Iron, of course, is the first drug that will occur to your 
mind, but let me sound a note of warning here. If you are en- 
deavoring to remove the cardiac symptoms in a case of progress- 
ive pernicious anaemia, vou will be surprised at the inutility of 
iron, but will be gratified with the action of arsenic in increasing- 
doses. In the ordinarv forms of anaemia, iron, the bitter tonics, 
liberal diet, good hvgiene, change of scene and mode of living, 
will generallv be sufficient to restore the patient to perfect health. 



EXTRAORDINARY CASE OF PREGXANXA'. 

The following interesting case is from the report of the trans- 
action of the Obst. Society of New York in the Journal of Ob- 
stetrics for November: 

Dr. Schoonover 1 present bv inxitation ) showed the specimen 
and read the following historv: The patient was 36 years of age, 
had been married four vears, and was pregnant for the second 
time. She was first seen by Dr. Schoonovers in January, when 
she complained of pain in the back and abdomen, accom- 
panied by a slight loss of blood. From her history it was in- 
ferred that she was in the sixth month of pregnacy. A digital 
examination showed that the uterus was situated high up in the 
pelvis, the cervix being firm to the touch and the os non-patulous. 
The contour of the abdomen was similar to that of a normally 
pregnant woman. The patient ascribed her symptoms to a fall 
on the ice. which had occurred a few days before, and feared a 
miscarriage. Morphine was prescribed for the relief of the pain 
and rest in bed was advised. She was visited the next day, and 
was found engaged in performing her housework, although there 
was still some hemorrhage. Two months later the doctor was 



386 The Peoria MkdiCxVl Monthly. 

called in and found the patient Nomitin^*-. There was marked 
tenderne'^s over the abdomen, but no pain. The nausea was 
checked by hve-grain doses of oxalate of cerium, and the woman 
was not seen again until four days later, when her attendant was 
summoned in haste, and thou<rht that she was in the first staefe of 
labor. On examination, howe\er, the os was found to be closed, 
the cer\ix was not softened, and the uterus had not chancfed its 
position. No contractions were felt. Inferring that labor had 
not yet commenced, Dr. Schoonover administered morphine and 
waited. The patient was now seen daily and was repeatedly ex- 
amined. The OS remaining closed, it was dilated on April 14th, 
when the doctor introduced his finger with great difiiculty on ac- 
count of the elevation of the uterus, and felt what appeared to be 
a placenta pre\'ia. Two fingers were pushed through the os in- 
ternum and an attempt was made to detach the supposed placenta, 
but neither hemorrhage nor uterine contractions followed this 
manipulation. The patient remained in nearly the same condition 
for three days, when she began to show signs of failing. She 
was anesthetized, and Dr. Schoonover introduced his hand into 
the vagina and explored the cavity of the uterus, finding it en- 
larged to five or six times its normal size, but perfecth' empty. 
It was now clear that the fetus was in the abdominal cavity. Dr. 
Hanks was called in consultation, and it was decided to stimulate 
the woman (who was failing rapidly), with a view to removing 
her to the Woman's Hospital for operation. This was on Sat- 
urday. Her condition improved so much during the day that it 
was resolved to wait until Monda\' before transferring her to the 
hospital. On Sunday she began to fail again, and although she 
took and retained a considerable amount of nourishment, she died 
on Monday morning. The abdomen was opened at once and the 
child was delivered. The post mortem examination showed that 
there had been extensive peritonitis, the sac being surrounded by 
adhesions. It was so firmly adherent to the parietal peritoneum 
that it could not be separated. No evidences of a rupture could 
be found. The placenta was attached to the right ovary and 
Fallopian tube, the latter extending over it. The child was well 
developed, weighed about eight pounds, and had evidently been 
dead for upwards of a week. 



ANTIQUARIES. 



In an address before the Medical Society of Virginia, Dr. S. 
K. Jackson, said: " Evidenth' many facts which we now value 
were known to the ancients, ha\ing been discovered before the 
world was ripe for them. The comma bacillus is described in 



Periscope and Abstract. 3*^7 

an old work published before the close of the last centur}'. Milk 
diet — our favorite at present in kidney affections — was the chief 
reliance of the ancients. Transfusion of blood had gone out of 
date in the days of Erasmus Darwin. The doctrine of germs 
has been traced to Harvey. Dean Swift tells of a microscopist 
who discovered worms in the flesh of animals. Hahnemann 
knew of the existence of the itch insect, for he thought it was 
the sole cause of all diseases. Some one has unearthed a pass- 
ag-e from M. Terentius Maso, who lived t\^'0 thousand vears ago, 
which accounts for malarial fe\-ers very much as we now do, and 
attributes them to the same cause. It is more than probable 
that but for the destruction of Babylon, and the burning of the 
Alexandrian library, we could iind proof that the nations had 
made as great advances in the sciences as their monuments 
show them to have made in the arts." 



TREATMENT OF TYPHOID FEVER. 

Dr. Arthur ^^ Meigs, in a chemical lecture at the Penn 
'H.ospita.\{ /Reporter ) has the following to say in regard to the treat- 
ment of typhoid fever : " The treatment must be what v;e call 
expectant. Whiskey, if necessary, to counteract a tendency to 
weakness and exhaustion, eight, ten, or even twelve ounces daily, 
according to the urgency of the case, though it is rarely neces- 
sary to exceed eight ounces; it is as much as the stomach will 
comfortably tolerate. If there is any malarial complication give 
quinine, sixteen grains daily, in four doses of four grains each. 
Following the treatment just laid down by the late Prof. George 
B. Wood, give turpentine and dilute muriatic acid, ten drops of 
the oil of the former and live drops of the latter several times 
daily." The specific treatment, that is to say, that based on the 
germ theory and germicidal action of drugs, represented by the 
use of tincture of iodine and carbolic acid, he has no faith in. 
The diet must be hquid — consisting of beef tea and milk, and as 
much water as the patient wishes. The attacks will last from 
three to six or eight weeks, and Dr. Meigs says that those who 
advocate the specific treatment do not claim that it will shorten 
the duration of the disease. 



AN UNUSUAL CASE OF FRACTURE OF THE 
FOREARM. 

On the 4th of September, E. M., a young man a;t. 17 years, 
tried for the first and last time to make a car coupling. The 



3S8 The Peoria Medical Monthly. 

" buUnoses *■ caught the right arm just alcove the wrist-joint, 
while the " deadwoods '' secured a good hold just below the 
elbow. I saw him about two hours after the accident. lie had 
not yet fully reco\ered from the shock. The hand and arm 
were cold, having been for an hour or so wrapped in a towel 
wet with ice water. Much swelling already existed, which 
greatly interfered with a proper examination, but I perse\'ered 
in spite of the obstacle. I found excessi\e mobility and crepitus 
just abo\e the wrist-joint. Both bones ^^ere fractured at this 
point and somewhat comminuted, but just how much commin- 
uted I was unable to determine. The flesh covering the bones 
was severely contused. At the junction of the middle and upper 
thirds of the radius and ulna the tiesh was also severelv con- 
tused, but the bones at this point were apparenth' uninjured. 
There was no injury to the arm whatever abo\e. The pulsa- 
tion of the radial arter^' was \'erv distinct, but no pulsation of 
the ulnar artery could be felt. I placed the forearm in splints, 
and warned by the rapiditv of the swelling, applied the band- 
ages much more loosely than I usualh' do in such cases. Took 
a look at the arm three hours later, found m\- dressing already 
too tight, the arm swelling as rapidlv as — I was about to say — a 
moistened sponge-tent. Reapplied the dressing, allowing room 
for any continued swelling which might occur. This was late 
at night. The follov/ing morning the arm presented a most un- 
usual appearance. In point of size, it certainly would ri\al the 
arm of the fat woman at the circus. The swelling had extended 
upward nearly to the shoulder. I abandoned the splints, and 
placed the arm upon a pillow. Suw patient again at noon. 
Found now that the swelling included the shoulder. The swel- 
ling of the forearm had not increased any, probabh- because the 
skin could not stretch any more. The following day Dr. Hurl- 
but saw the case with me, and coincided with my view that the 
conservative plan of treatment ought to be continued, and in all 
probability a useful arm would result. Cloths wet with tincture 
of arnica and whisk^• had been constanth- applied since placing 
the arm upon the pillow. In a couple of days more, large blis- 
ters, some containing possibh' half a drachm of blood\- serum, 
formed over the forearm. 

On the inner side, large sloughs were forming, the outer 
side being coiiipktclx co\ered with these blisters. The swelHng 
now extended upon the trunk, reaching nearly to the sternum. 
The blisters were punctured, and large quantities of serum 
escaped, but there was no diminution of the swelling. Five or 
six days later I felt that a crisis in the case had been reached, 
and now, what should I do? \ great portion of the inner aspect 
of the forearm was black, while the remaining portions of the 



Periscope and Abstract. 3S9 

entire forearm presented one continuous raw sore from the 
bursting of these blisters. 

Morphia had been given to control the pain thus far, and 
the whiskey and arnica cloths had been exchanged for dressings 
of carbolized cosmoline. I had the voung man also on quinia in 
good-sized doses and tinctura ferri mur. The pulse was strong 
and 120, while the temperature was 102 to 103. The sensation 
of the fingers was good. The denuded surface of a portion of 
the outer part of the forearm had a pinkish hue, but there were 
spots which looked dark — almost black. The color of the hand, 
which was also swollen to the utmost capacity of the skin, was 
not very promising. The color of the skin above the elbow was 
none too good. Was this gangrene? Should I amputate? If 
so, where? At what point will the line of demarcation probably 
form? The case had much the appearance of a compound frac- 
tured leg which I saw many years ago. This leg was under the 
charge of a justly eminent surgeon, who said: "While those 
islands of healthv skin remain, I still have hopes of saving the 
limb."' But the gangrenous tide would not recede, the islands 
were soon submerged, and live or six days later, death, with his 
relentless scvthe, severed the last lingering hopes of the surgeon 
and the earthly hopes of the patient. However, there was noth- 
ing for me to do but wait. Two or three days later, I discov- 
ered on the inner and anterior aspect of the arm, above the 
elbow, a spot which seemed very tender and somewhat soft to 
the touch. Applied flaxseed poultice, and the following day 
plunged in the lancet. About three ounces of bloody pus 
escaped. Next day there was much less swelling of all the parts 
above this point. The tide had linally begun to ebb. The 
sloughs soon began to separate, and great quantities of bloody 
pus escaped. From this time on the case continued to improve. 

The whole forearm seemed a mine of pus. I promptly 
opened the abscesses as rapidly as they formed. In about seven 
weeks I found that union of the fractured bones had taken place. 
The size of the wrist was enormous, owing to the great amount 
of callus thrown out. The shoulder and elbow were all right, 
wrist joint stiff, fingers benumbed and nearly motionless. Prona- 
tion and supination were also lost. The abscesses were still dis- 
charging large quantities of pus. Massage was soon begun, and 
also passive motion. At the end of six*months the discharge of 
pus had finally ceased. The proper motions of the wrist joint 
had been restored, as had also pronation and supination. The 
arm seemed quite straight, the callus had been absorbed until 
the wrist was no larger than it should be. The lingers and 
thumb could all be bent, but not voluntarily. The thumb and 



390 The Peoria Medical Monthly. 

tirst two fingers seemed to be partially paralyzed: the others 
were all ri<;ht. Massaw was continued. 

Now, at the end of a 3-ear, the arm is weaker than the 
other, and there is some little atroph^' of the muscles of the 
forearm. The motions of the thumb and tirst two lingers are 
still somewhat impaired, but the trouble seems to be at the ex- 
tremities only. The grip with the whole hand is good. He has 
been working for two or three months. 

What made this great swelling? Wh}- was there so much 
pus discharged? I think that a blood-yessel was ruptured, and 
as there is no pulsation of the ulnar artery now, I think here lies 
the secret. — Walter 11, Pctrrch, M. D., in Medical and Surgical 
/Reporter. 



THE OPERATIVE TREATMENT OF ACUTE INTES- 
TINAL OBSTURCTION. 

Read in the Section of Surgery at the meeting of tlie Britisli ^Medical Association in Cardiff, by 
J. Greig Smith, MA., F.R.S.E. 

In regard to the general principles which ought to guide us 
in the operatiye treatment of intestinal obstruction, I am in full 
and hearty accord with Mr. Treyes. I think the time has come 
when laparatom^- for this malady may no longer have to strug- 
gle against the ban of being considered as a forlorn hope, but 
may be elevated to the dignity of a plan of treatment. Medicinal 
treatment too often is aimed, not at the disease but at the diag- 
nosis; forgetting that, while drugs are obscuring our vision, the 
disease is killing our patient. We must not forget that a patient 
with acute intestinal obstruction is as <xi"avely ill as if he were 
bleeding from a large artery, and that, though the disease is not 
so palpable, and perhaps not so rapidly fatal, it is one requiring 
an attention just as close and continuous, and a treatment even 
more decided and skilful. 

On these broad principles, so well put before us by Mr. 
Treves, I have nothing new to sa^■. I desire to occup}' the time 
at my disposal by specially considering two points in the opera- 
tive proceeding on which I am at variance with Mr. Treves, as 
well as with other sur^i-eons." 

The tirst point refers to the usual method of finding the 
cause of obstruction; the second to the treatment of the bowel 
after the obstructing cause has been removed. I may state them 
as propositions. 

I. The best guide to the seat of obstruction is not manual ex- 
ploration, but visual examination, assisted, if necessary, by ex- 
trusion of the bowel. 



Periscope and Abstract. 391 

II. No cause of operation for intestinal obstruction is prop- 
erly concluded until overdistended bowels are relieved of their 
contents. 

I. You are all familiar with the rules laid down for our 
guidance in seeking for the site of intestinal obstruction. We 
are to explore the common sites — the caecum, the promontory of 
the sacrum, or the umbilicus, we are to seek for collapsed bowely 
and follow it up until we come to dilated bowel. And this we 
are to do with the hand inserted in the abdominal cavity through 
the opening we have made. 

Let us suppose that the caecum is distended ; we expect that 
the obstruction is in the colon below it, and we are told to follow 
up the colon until we meet with it. The incision is in the middle 
line, below the umbilicus. The abdomen is distended, its walls 
are tense, and the transverse colon is probably pushed high up 
imder the ribs. Through this opening, therefore, we must insert 
the hand, push it over the distended coils, perhaps as far as the 
elbow, and isolate and diagnose the condition of the colon through 
its course. Easy as this looks upon paper, I would consider it 
in practice as one of the most difficult undertakings in surgery. 
If those of you who have not tried it in practice will try it sev- 
eral times in the ^ost inortcni room, I think you will agree with 
me. 

Looking for the constriction by exploring in other ways is 
only a little less difficult. If the hand, on insertion, were not met 
and surrounded by a bewildering labyrinth of dilated bowel that 
will stick to the skin, and will not give up following it; if the or- 
dinary sites of obstruction were open to vision or to touch ; if the 
intestinal walls were only a little more definitely palpable, and a 
good deal less dilated, then exploration would easil}' and surely 
lead us to the obstructing cause. But the conditions are all 
against the exploring hand, and I am in favor of another method. 

The abdomen being opened, the presenting bowel is keenly 
observed. The most dilated portion of the bowel rises nearest 
the surface, and the chances are strongly in favor of its being 
near the abdominal opening. Move the coils upwards and down- 
wards, to the right and to the left, and fix upon the most dilated 
or the most congested portion. Use this portion as a guide, run- 
ning the forefinger along its mesentery; it will probably guide 
us to the seat of constriction. If this most dilated piece of the 
gut be with difficult}- detained inside the cavity, let it escape; it 
wants further treatment; and if we have not already discovered 
the obstructing cause, its escape and the manner in which it 
comes out will help us to find the cause. At the site of obstruc- 
tion, and near it, the bowel is fixed, and this portion will not 
readily be extruded at this end of the loop, for, as we do so, in- 



392 The Peoria Medical Monthly. 

<:reasing congestion and distension will tell us that we come nearer 
iind nearer to the obstruction, until, in a comparatively short time, 
we are certain to reach it. 

I may say at once that, even if we can diagnose obstruc- 
tions in the colon through the ordinary laparotomy incision, we 
cannot treat them by this incision. Obstruction in the colon is 
nearly always diagnosed as such before operation, and is treated 
by colotomy, lumbar or genital. As far as I know, median lap- 
arotom}- has, in the large majority of cases, had to be supple- 
mented either by a transverse or a lumbar incision where remo- 
val of a growth or relief of an obstruction in the colon has been 
attempted by the operation. It is, therefore, something only a 
little less than a surgical catastrophe if we perform median lapar- 
otomy for obstruction in the colon. This somewhat diminishes 
the value of our discovery of a dilated caecum in such cases. 

I would, therefore, substitute the finger for the hand, and 
supplement both by the sight: I would in the first instance at 
least, ignore the c<ecum; I would permit the bowel to extrude if 
It were much extended; I would even encourage it to do so, if I 
liad not at once discovered the seat of obstruction, and its extru- 
sion were any help to me in this discovery; and I would go 
through all this before I inserted my hand to grope for the cause. 

I cannot understand the universal condemnation of extrusion 
of the gut in these cases. Surely it is a remnant of the pre- 
abdominal era of surgery, when exposure of the peritoneum was 
considered as a calamity, and extrusion of the bowel as almost 
certain death. We handle the bowel freely enough in other 
abdominal cases. We strip it from adhesions, tear it and 
stitch it up: cleanse it of inflammatory and extravasated material, 
and handle it in every conceivable way without harm. Why 
should the simple escape of it from the abdominal ca\ity alarm 
us so in intestinal obstruction? If we protect it properly with 
flat carbolized sponges it will come to no harm: if we decide to 
return it intact, we can do so readily enough after emptying it 
by compression between the hands, and so forcing its contents 
into the general abdominal cavity. But, in most cases, I think 
we ought to empty it before returning it: and this brings me to 
the next proposition. 

II. No operation for intestinal obstruction is completed that 
leaves the abdominal cavity full of overdistended bowels. In 
every case where intestinal distension is a feature of obstruction, 
I believe that the intestines ought to be relieved of their contents; 
or, if this cannot be done with sufiicient ease or rapidity, that an 
artificial anus ought to be made, and closed after the dangerous 
. symptoms have passed. 



Periscope and Abstract. 395 

When we have found and removed the primary cause o£ 
obstruction, we are apt to believe that we have done as much 
as our art tells us we can do for the cure of the patient. I 
believe this is very far from being the case. Large quantities 
of fluid lying in intestines paralvzed from overdistension and in- 
flammation may be a cause of obstruction, as efficient and as dan- 
gerous as strangulation by a band. The condition is, in fact,, 
similar to or almost identical with that found in the class of ob- 
struction known as physiological, and is, as being complicated 
with laparotomv, even more dangerous. 

Some aid to our understanding of the physics of this condi- 
tion ma}' be got from simple experiments in the post mortem 
room. If, before the abdomen is fullv opened, it be sought ta 
fill the intestines with fluid through an opening in the duodenum^ 
it will be found that a very considerable amount of pressure is 
required to do so; that in most cases the abdomen will be fully 
distended before the fluid has passed half-wav down ileum: and 
that, if the abdomen be fully opened, and the intestines permitted 
to extrude, many ruptures of their peritoneal covering will have 
taken place before the fluid escapes from the anus. If, now, the 
mesentery be cut through at its root, and the bowels laid on the 
table, open at both ends and free to empty themselves, onh' a little 
fluid will escape, and the mass of fluid will remain imprisoned- 
The cause of this is easily seen to be the acute flexures of the bow- 
els, brought about partly bv their being confined inside a close 
cavity, and partly by their attachment to the mesentery. These 
acute flexures of the intestinal tube upon itself, forcing in the 
mesenteric side as a sort of valve, cause an obstruction to the 
lumen, which, repeated over three or four bends, is practically in- 
superable by the force at command. And these forces are of the. 
feeblest. An overdistended bowel, like an overdistended blad- 
der, IS already half paralyzed; and if to this be superadded the 
parah'sis arising from inflammation, we can appreciate the weak- 
ness of the force which has overcome the by no means inconsid- 
erable obstacle. The small amount of good that follows tapping; 
a distended bowel with a fine trocar is thus explained; the gut is- 
emptied down to the first or second flexure, and that is all. We 
may reasonably conclude, therefore, that the presence of an ex- 
cess of intestinal contents is in itself a cause of obstruction. 

Various approved modes of treatment lend support to this- 
view. I would refer to the high value which for centuries was 
placed upon emetics in the treatment of this complaint, by the 
most skilled practitioners. Quite recently Kussmaul, by an 
emesis which is purely mechanical, and not medicinal, has re- 
vived this treatment with a gratifying measure of success. By 
repeated applications of the stomach-pump, he empties the loade L 



394 The Peoria Medical Monthly. 

intestines of their gas and fluids, always to the relief of the symp- 
toms, and not unfrequentlv to the cure of the disease. Vomiting 
always relieves the patient, and, if this theory be right, ought to 
be encouraged. It is one of the evils of opium that it diminishes 
the contractility of the intestinal fibre, prevents vomiting, and 
permits this deleterious accumulation of fluid and gas in the in- 
testines. If opium is less dangerous than croton-oil, I am bv no 
means certain that sulphate of zinc is not less harmful than either. 

In support of mv thesis, I would place most weight on the 
acknowledged value and increasing reputation of Nelaton's op- 
eration of enterotom}', as it might be called. It is a fact of ex- 
traordinary significance, that mere drainage of the intestinal con- 
tents in any and every form of intestinal obstruction should be 
frequenttv successful in saving life, and even in curing disease. 
For almost every form of obstruction, enterotomy is applicable; 
and in nearl}- ever}^ form it has had success. The obstruction 
may not have been relieved, the strangulation may not have been 
reduced; all that is done is to give the intestinal contents free 
exit at an}' point that mav be convenient; and this alone may 
save the patient's life. Kussmaul's treatment goes to show that 
discharge of intestinal contents bv the upper extremity of the 
bowel is beneficial. Nelaton's operation has with much greater 
frequency shown that discharge through a low opening is ben- 
eficial. If to these practical facts we add the theoretical consid- 
erations I have advanced, it seems to me that a strong case is 
made out in favor of relief of o\'erdistended bowels. If this can 
be satisfactorily done bv incision and immediate suturing, all the 
better, if not, I think it is our dutv to establish for a short time 
an artificial anus. 

Upon the details of the operation itself, the time at my dis- 
posal does not permit me to speak. Though, as operator or as 
chief assistant, I have been concerned in onlv nine cases of lap- 
arotomy for acute intestinal obstruction, I htue seen enough to 
make me certain that the operation is one of the most delicate 
and difficult in the whole range of surgerv; that it demands a 
combination of dexterit\' in manipulation, of sensitiveness in touch, 
of rapidity and decision in thought and action, such as accurate 
knowledge and practical culture alone can give. In the future, 
an increasino- number of these cases will \)e handed over to us 
by physicians; it behooves us, as surgeons, bv every means in 
our power to prove ourseh'es worth\- of the trust.-»-/>^;'///>7/ J/cd- 
ical yournal. 



The Peoria Medical Monthly, a practitioner's journal. 
"Two dollars a vear, in ad\ance. 



Periscope and x\BSTR.AC'r. 395 

THE INFLUENCE OF DRUGS ON MILK. 

In a medico-lefral case MM. Brouardel and Pouchet were 
asked whether an infant of two months could have been poisoned 
fatally through its mother's milk, the mother having been for 
some time under treatment with arsenic, and on several occa- 
sions having shown svmptoms of arsenical poisoning. 

To settle the point, M. Brouardel made a number of experi- 
mients bv giving Fowler's solution to nursing women, the result 
-of which showed that arsenic can readily be found in the milk 
•even "when taken in small doses, but that no toxic symptoms are 
likelv to be produced in the child, unless the mother be taking a 
toxic dose, 

Fehlimg has latelv experimented upon the subject of the 
elimintation of drugs bv the milk, and found that salicvlate of 
soda, iodide of potash and iodoform can all be traced to the urine 
•of the nursling, the latter drug when taken in verv small quanti- 
ties and even when applied externallv. Hence he advises against 
its use as a dressing for wounds in nursing women. He has also 
found corrosive sublimate in the urine of children whose nurses 
had the drug applied externallv, but the quantity passing to the 
.child was so small, that he thinks it unnecessary to use the same 
precautions with corrosive sublimate as with iodoform. 

The narcotic substances are without effect upon the nurs- 
ling. The largest doses of opium or chloral administered to the 
nurse do not bring about any especial symptoms in the child. 

Atropine was tried on animals and no dilation of the pupil 
'Or other manifestations occur in the suckling, excepting when 
the maximum therapeutic dose has been exceeded. 

Fehling therefore comes to the conclusion that while but 
few drugs administered to the mother prove deleterious to the 
infant, a strong exception, however, should be made of those 
substances that are eliminated with difficulty and accumulate in 
the organism. 

Nevertheless it is certain that manv substances "when in- 
gested produce decided effects upon the milk. " Milk sickness," 
or "the trembles,"' occurs in persons using the milk of cows 
which have fed on certain pasturage, and the odor of copaiba or 
asparagus can be detected in the child's urine when these sub- 
stances have been taken bv the nurse: moreover, artichokes, 
absinthe and other substances will make the milk bitter. — ^A ort/i- 
ivesteni Lancet. 



THE BROMIDES IN INFANTILE THERAPEUTICS. 

Especial reference is made to the use of the bromide of 
otassium, the other suits being less frequently used. Accord- 



39^ The Peoria Medical Monthly. 

ing to the age of the patient, it should be given as follows : To 
a child under one year of age, about three grains daih', in two 
portions: to a child under two years of age, about six grains, in 
two portions: in either case being given as a powder or svrup, 
and always well diluted with a suitable liquid. To children over 
two \ears of age, it should be given in 15, 30, and 45 grain 
doses, until it produces its physiological effect. In some cases 
the dose should be a fixed one, in others, the quantity should be 
gradually increased during five or ten days, then diniinished un- 
til it is given up altogether. In epilepsy, the doses should be 
gradually increased until the limit of tolerance is reached, the 
treatment being kept up for a long time, and very graduallv dis- 
continued. The iodide and bromide of potassium combined are 
frequently indicated in the treatment of epileptiform attacks^ 
symptomatic of cerebral lesions. Simon advises onlv the bro- 
mide in the cases of cephalalgia and irritable heart, which occur 
so often during the period of rapid growth in youth. It must 
always be remembered in giving the bromides for a long period, 
or in very large doses, that there is danger of exciting an irrita- 
tion of the gastric mucous membrane, and perhaps of producing 
an intense gastralgia. — Arc//, of Pediatrics. 



THE RELATIONS BETWEEN PHYSICIANS AND 
THEIR PATIENTS. 

Nothing has worked more harm, both to phvsicians and 
their patients, than the latter's crude ideas of disease and their 
consequent treatment of the former. 

The practice of medicine is very old; it long antedates any 
true knowledge of disease: but ills did not call less loudly for re- 
lief because they were not understood, and these calls were not 
made in vain. This practice, prior to the knowledge of disease, 
however, was not always without reason and method: in those 
days they had two ways of proceeding: (i) b}' specifics, and at 
a much later date (2) by symptomatic treatment. In the begin- 
ning, all recognized diseases had their names and specifics, later 
the more observant began to notice ills that could not be included 
in the list of diseases known, and having no specifics for them 
commenced to treat them symptoraatically ; success gradually 
made them sceptical of their former specifics until none of the 
original remained, and since men can be said to have reallv ac- 
quired some knowledge of disease, ver\- few have been added in 
their places. 

It naturally follows that the laity not being possessed of this 
knowledge, their idea of treatment is the use of specifics: and 



Periscope and Abstract. 397 

they think it strange that all these centuries of study and expe- 
rience have resulted in the rejection of the former host of specifics 
and the replacing of them by scarce a corporal's guard in number. 

To them, disease is a something entirely distinct from the 
body which ought to be neutralized or driven out immediately, 
should the physician understand his business. They are unwill- 
ing to believe that organs which have gradually become diseased 
can at best only gradually recover, and that with the self-limited 
diseases which have no antidote, the doctor who ably seconds na- 
ture in its struggle deserves far more credit and recompense than 
if he had possessed a specific. As an example, the treatment of 
malarial fever, before the introduction of quinine, required much 
more skill and attention than at present. 

That this craving for specifics among the laity is taken ad- 
vantage of by unscrupulous men, may be seen by taking up any 
daily newspaper and glancing through its columns. These men 
are sharp enough to propound questions to the would-be sick, 
that soon convince them thev are on the verge of dissolution and 
can only be saved by taking the medicine in question. 

We have, also, travelling quacks who always promise cures, 
in fact guarantee them, but always exact part payment in advance: 
it is true they hardly ever get the second payment when they have 
any real disease to handle, but they make the first payment large 
enough to pay them. For a working rule, we would sa}' that a 
man's honesty or ability is in the inverse ratio of the number of 
specifics he vaunts. 

There is no doubt that the pathies, which flourish in this 
country, have some good in them. It is not that the baths of the 
h3'dropaths do not benefit some troubles. The fault we find is 
that the}^ are recommended for the cure of all diseases. In fact, 
the cry of all pathies is cure, and it is as attractive to the general 
public as the music of the pied piper was to the rats and child- 
ren of Hamelin town, and the results, we think, often as disastrous- 
to the victims. 

Though there are few diseases w^hich are susceptible of cure, 
there is an immense number the course of which the physician 
can check and ease, or even in certain cases completely arrest. 

In febrile, diseases, also, timeh* aid may enable an exhausted 
vitality to tide over the crisis, and thus a true physician may be 
said to be the companion who helps his patients fight their batdes. 
and not the magician who annihilates their enemy. They must 
regard him as one, human like themselves (even to the apprecia- 
tion of money), who has spent the best part of his life in laborious 
studies, in order to be able to shield them from the results of those 
inroads he is powerless to prevent. 

In choosing a physician they must remember that they are 



398 The Peoria Medical Monthly. 

choosino' one to whom their life may at an^■ time be entrusted and 
they must make the choice serioush', but when once made, mi- 
plicit confidence should be given, for no layman is the competent 
judge of the treatment of a case, and no physician can do full 
justice to his patient unless he feels he has his confidence. — Al:zcf 
Orleans Medical yoiiDial. 



ON DIETETIC ERRORS IN FEEDING INFANTS. 

In view of the absolute and relative increase in the number 
of children affected with rachitis, within the last ten years, the 
supposition is warrantable, savs the editor, that the various arti- 
ficial foods, with which the market is flooded, are deficient as a 
•substitute for mother's milk, or else that their mode of exhibition 
is at fault. Especially during the first four to six weeks of life 
should artificial foods be avoided, since the pancreas does not 
begin to secrete its diastatic ferment until after the first month. 
Hullmann, of Halle, has recently written an important paper, 
covering the subject of artificial foods, and his opinion is that the 
objection to them is due to the improper manner in which they 
are exhibited. The conclusions of his paper are: 

1. Mother's milk is the onlv perfect food for the infant. 

2. The infant ought not to be fed artificially during the first 
lour to six weeks. 

3. Cow's milk is the best substitute for mother's milk. 

4. The qualitv, quantity, and mode of ingestion of food 
stuffs ought to be equally considered. 

5. Diarrhoea in children must be regarded as a grave affec- 
iion. — Therapeutic Gazette. 



CREASOTE WATER AS A LOCAL ANAESTHETIC. 

The officinal aqua creasoti, or creasote water, is so important 
as a preparation for one special use that it is well to notice it in 
order to emphasize that special use. It is a simple i per cent, 
■solution of wood creasote in water, and, like similar solutions of 
carbolic acid and of cresol, it is a most effective local anjtsthetic, 
and topical dressing to burns and scalds. It is no better than the 
solutions of carbolic acid, or of coal-tar creasote, for this purpose, 
but it is quite as good, so that whichever is most accessible or 
most convenient ma}' be used. This creasote water, as made by 
the above formula — or diluted with an equal ^•olume of water, or 
with more water for delicate svirfaces in women and children — 
and applied by means of a single thickness of thin muslin, or worn- 



Periscope and Abstract. 399 

out cotton or linen, such as handker stuff, and the application re- 
newed from time to time, as the return of pain requires it — will 
relieve the pain of burns and scalds in five to ten minutes, and 
will retain the relief as long as the applications are properly re- 
newed, or until the painful stage is over. 

It is also very effective as a local anesthetic for general use 
in all painful conditions of the surface only, such as the pain of 
erysipelas. The benumbing effect of these phenols upon the skin 
is very promptly reached, and can be carried to almost any degree 
that is desirable by simple management of the strengths of the 
solutions and the mode of application. They are true anaesthetics 
to the skin, while the much-lauded cocaine is not. 

This statement has been published so often during the past 
twenty years, and the treatment has been so effective in so many 
hands, that it is wonderful to notice how the common practice is 
still to us the old and comparatively useless hot dressings, such as 
carron oil, white lead ground in oil, flour, liniments, etc., or the 
newer application of solution of corbonate of sodium. — jMedical 
jVczvs.. 



PROF. DA COSTA'S CLINIC. 

I. On September 28th, a bov, aged thirteen, presented 
himself for supposed ascites. Abdomen much swollen : came on 
suddenly; has had malarial fever: no swelling of feet: is consti- 
pated at times; tongue somewhat coated. On examination, 
spleen is found to be not markedlv enlarged; no fluctuation of 
abdomen, but on percussion, a markedly resonent note is heard. 

Diagnosis — Flatulency, due to atonv of the bowel. 

Treatment — Strvchnine, ^\y grain three times a day, and 
i\r grain aloin each night. On October 5th, the bov came back 
entirely recovered. 

II. Boy, aged twelve, complains of vomiting, pain in the 
head and vertigo, which he has had for several months. He 
describes the pain as jumping: it is in the temples and back of 
the head, and periodical: pupils large and react sluggishly: there 
has been no loss of flesh: no historv of a blow or injury to head; 
pulse rather rapid, not quite regular; tongue quite clean. Vom- 
iting takes place w'ithout regard to meals; urine normal: no evi- 
dence of anv hereditarv taint, teeth not notched: no ptosis: on 
opthalmoscopic examination, both optic nerves are found to be 
swollen, tt'dematous, and the arteries and veins enlarged and tor- 
tuous (choked disks). He suffers with convulsions; sight is 
failincr. 



400 The Peoria Medical Monthly. 



I 



Dii7g-)iosis — Intractional pressure from a tumor toward the 
base. Inherited s^vphiHs the most probable cause. 

Trcatmctit — Bichloride of mercurv, ^^ gi'^in ter die, slowly 
increased to ^^ grain. A bland, easily digested diet. 

III. Man. aged thirty-four: was well until a year ago last 
April, when he began to have pains in legs and thighs, with a 
tired feeling: soon began to lose power of locomotion, until last 
February it was almost entirely gone: no history of blow, acci- 
dent, or of syphilis: uses tobacco but no liquor; generally free 
from headache. Eyesight and hearing haye been poor since he- 
had scarlet fever: taste keen: tonpue clean, sliffhtlv fissured: 
pulse 96: no heart lesion, although an anaemic murmur is heard: 
never had rheumatism: muscles are much dwindled, and show 
fibrillar contraction on being struck on arms, chest and back. 
He was a hard laborer: grasp very feeble: tendon reflex good: 
cannot walk without assistance, and then the feet are not raised 
much from the ground: sensation unimpaired: electro-muscular 
contractility well preserved: can stand with feet close together: 
appetite and digestion good: bowels constipated: no attacks of 
giddiness: no spinal tenderness. 

Diagnosis — Progressive muscular atrophy. 

Prognosis — He will improve, but will not recover. 

Treatment — The best treatment is that which keeps in mind 
the muscles. Massage, friction, electricity, with y\, grain of 
strychnia ter die. — Col. and Clin. Reeord. 



PRECURSORS OF BRAIN DISEASE. 



The precedent of all grave cerebral disease is neuratrophia^ ' 
or defective nerve nutrition. Xeuratrophia may, in a sense, be_ 
considered as functional, to distinguish it from organic disease;. , 
/. r.. it may be so slig'htly orp'anic as to not necessarily excite- " 
alarm for such seriously destructive change as tends to a speedy 
and grave destruction of physiological function. 

The essential psychical symptoms of general fi nctional neu- 
ratrophia, which are precursory of brain break down, and which 
by long continuance, unrelieved by curative treatment, so often 
ultimate in destructive conditions, are now to engage our atten- 
tion. 

Impending brain failure is seldom manifest on the psychical 
side — indeed. I doubt if it ever is — without some mental chanfjes. 
The bold business man becomes timid and overcautious, or the 
discreet man becomes indiscreet and somewhat reckless in his 
business transactions without adequate appreciable cause. 

Timidity unnatural to the .individual, a shrinkinir from un- 



Periscope and Abstract. 401 

<dertakino-s which, in better states of brain tonicity, would have 
• been entered upon with reasonable confidence and courage, is a 
sign of more value than has been attributed to it. 

Unnatural timiditv, irresolution, and fear, should alwavs en- 
; ^age our attention, and the victims of them should ha\'e our ad- 
j vice long before anv particular organ of the svstem fails. This 
' is the most important fact for the general practitioner to consider. 
A recuperative therapy should be advised in rest, recreation, 
and change of mental occupation and environment. These mor- 
'■ bid fears, and the irresolution and timidity which underlie them, 
'are but the shadows (if unaverted ) cast before the gra\'er coming- 
events in the accepted svmptoms of insanity. Neuratrophia 
underlies almost all insanity. — C. H. Hitgiics, JI.D., in Kansas. 
City Med. Record. 



SALICYLIC ACID AND CASTOR OIL IX PSORIASIS. 

Dr. Fox, of New York, showed at a meeting of the New 
York Dermatological Society a girl eight vears old who had 
j)soriasis covering all the bodv. The patient's father and sister 
also had psoriasis. When she was admitted to the hospital, a 2 
per cent, solution of salicvlic acid in castor oil was applied to the 
right arm, a weak solution being used because of the great con- 
gestion of the skin. When the patient was shown the scaling 
was less, and manv of the patches had disappeared, although the 
disease ^vas spreading in other directions. To the left arm the 
mixture of oxide of zinc and balsam of Peru had been applied, 
.and there was even less congestion in this situation. In the sec- 
ond case, the lower extremities were chiefly affected. This pa- 
tient was peculiarlv susceptible to the action of ammoniated mer- 
"■Curial ointment, even in a very small quantity exciting severe der- 
matitis. Chrysarobin pigment had been sppHed to the right leg, 
and a 5 per cent, solution of salic3dic acid to the left leg, produc- 
ing a marked improvement in the condition of the eruption in the 
latter situation. — journal of Cutaneous and Venereal Diseases. 



CANCER OF THE UTERUS. 

The following is taken from a clinical lecture b}- William 
Goodell, M. D., published in the Medical Bulletin., August, 1885. 
The patient was thirty-nine 3'ears of age, had had five children, 
the youngest eleven years of age. 

There are three forms of cancer which may attack the 
uterus: scirrhus, epithelioma, and encephaloid, but there is no 



402 The Peoria Medical Monthly. 

doubt that thev merge one into the other. The practical ques- 
tion is not so much, is the tumor scirrhus, epitelioma, or enceph- 
aloid cancer, as it is a question whether or not the growth is ma- 
lignant. There is only one thing about this differentiation, and 
that is that epithelioma is more amenable to treatment than either 
of the other forms, In the vast majority of cases, when cancer 
attacks the uterus it takes the form of epithelioma. There are 
some cases which seem to begin as scirrhus, and ultimatel}' break 
down into the epithelial form. 

There are certain popular fallacies about cancer of the uterus. 
One is that it is always accompanied with pain. Carcinoma of 
the neck of the womb does not always produce more pain than 
most women experience at each period. It is only when the dis- 
ease advances tow^ard the internal os that pain is felt. When it 
ascends and invades the cavity of the womb the woman's suffer- 
ings are verv great. You see in our practice in the dispensary 
the same thing. We hook tenacula into the cervix and apply 
powerful caustics without eliciting any sign of pain. Under 
some circumstances, just as cartilage, which is normallv insensi- 
ble, mav become excessively tender, so the cervix of the womb 
will, under certain circumstances, become very sensitive, and the 
slightest touch will cause the patient to flinch: but, as a rule, in 
cancer limited to the neck of the womb there is no pain. There 
may be leucorrhoea, and that will certainly be if there is an open 
sore. This is a verv common delusion. Old phvsicians have 
said to me, "O no, doctor, it cannot be a cancer, there has been 
no pain.'' The idea of cancer is associated in their minds with 
lancinating pain, which cuts like a knife. When carcinoma in- 
vades external portions of the body which are well supplied with 
nerves, these pains are present. The sensitive portion of the 
w^omb begins at the internal os, and the lining membrane is very 
sensitive. 

Another fallacv is, that there is, in every instance, the can- 
cerous cachexia. This is a great mistake. ]VIy impression is 
that one-half of the cases which come to me do not present the 
cancerous cachexia. Instead of being lean, bony, and scrawny, 
with the leaden hue of the countenance, many of these cases 
present a buxom appearance, with rosy cheeks. It is my expe- 
rience that such cases are less amenable to treatment, and opera- 
tion is less liable to be followed by temporary benefit, than in 
those cases which present the appearance of the patient before 
us. In our patient, if the disease were limited to the cervix, I 
should expect that the operation would do a great deal of good. 

Again, cancer may exist without bleeding. Before ulcera- 
tion occurs it is not present, and e\-en in the vegetating form it 
ma}- be absent, although there is usually some discharge. This 



Periscope and Abstract. 403 

discharge need not be offensive, and this is another point which 
it is well to bear in mind. 

I wish now to give you a little history of this case. She 
comes from a distance, and was brought here by her husband ia 
great distress of mind. She had been told that she had a cancer, 
Mv own rule, to which exceptions are very rare, is never to tell 
a woman that she has a cancer. I speak of it as a bad ulcera- 
tion. Man}' of mv patients have known in their hearts that they 
have a cancer, and know that I know it, and yet the word "can- 

>cer" never passes our lips. Many women say to me, "Now, 
Doctor, if I have a cancer, do not tell me." I advise you to adopt 
the rule which I follow. I do not want you to lie about it, but 
never tell a woman that she has a cancer if you can get out of it. 
This woman came in a very painful state of mind. As a 
drowning man will grasp a straw, so she was willing to embrace 
anything that would do her good. She tells me that she has 
hve children and can not bear to think of leaving them. I said 
to her, " While I cannot cure you, I may be able to do something 
which will do you a great deal of good." She jumped at the 
idea, and I have not disillusionized her. She thinks that I am 

"^ going to do more than I can do. 

When I examined her, I found a great excavation. What I 
thought of doing was to scrape off the vegetations, and if I dared, 
cover the part with nitric acid, but a symptom has appeared 
which shows that the disease has attacked the bladder, and I can 
do nothing for her. Three days ago she began to pass blood 
from the bladder. The urine does not trickle into the vagina, 
because there is no opening as 3'et, but the disease has involved 
the bladder, and in the course of a few days the tissue will break 
down, and there will be produced a vesico-vaginal listula, through 

"<' which the urine will trickle into the vagina. 

There is still one other thing. That woman has not long to 
live. Her sufferings will, I think, be excruciating. She ought 
to have as much opium or morphia as will make her comforta- 
ble. Some would object to this, saying that she would get into 
the opium habit. She will not live loug enough to contract the 
habit. I say let us make the last end of her life as comfortable 
and peaceful as we can. Give her opium in an}- form or amount 
that she chooses to take it, exercising a little restriction in the 
beginning. — Med. yoiinial. 



GONORRHCEAL RHEUMATISM. 

The following is taken from a report of the discussion of the 
above subject before the Cincinnati Academy of Medicine in the 
Laiicei and Clinic for November: 



404 ' The Peoria Medical Monthly. 

Dr. Thrasher thought that the essayist and authorities quoted 
by him had adhered too closly to the doctrines of fost hoc, ergo 
propter hoc. So many individuals suffer from gonorrhosa that it 
is not wonderful that some of them should have rheumatism, or re- 
peated attacks of rheumatism coincident with the gonorrhoea. 
But the rheumatic attacks are so varying that the true rheumatism 
mav frequently be confounded with other arthritic affections. 
The several ino;enious methods of reasoning' as to the connection 
between gonorrhoea and rhevjmatism seem extremely fallacious. 
The most ingenious is probabh' the neuro-pathic theory, but it is 
difficult to see how irritation of the extremitv of a nerve should 
occasion a reflex pain in one certain joint and not in others. The 
same objection mav be raised as to the pyaemia theory. It is ex- 
ceedingly improbable that in migration the gonococcus should 
stop at one joint and not at others, or why it should not in its pas- 
sage lodge in the liver, lungs, brain or other parts of the body 
which it traverses. 

Nothincj is better known than that true rheumatism will re- 
peatedly attack the same joint. 

We might, indeed, rather account for the gonorrhoea as 
caused by the rheumatism, than vice versa. We know that gleet 
can be readily changed into a gonorrhoea again h\ an irritating 
condition of the urine. The acid condition of the urine in rheu- 
matism may come on before the febrile symptoms of the rheu- 
matic manifestations, and by thus causing a recurrence of the 
gonorrhoea, support the theory of the existence of a gonorrhoea! 
rheumatism. 

Among the number of examinations of the joint exudations 
in so-called cases of gonorrhoeal rheumatism, in but one was the 
gonococcus found. Even the best microscopists makes mistakes, 
and even admittting that the gonococcus is the cause of gonorrhoea, 
it w'ould have to be discovered in many more cases before it could 
be accepted as the cause of the accompanying rheumatism. 

In the case reported the rheumatism came on after the gon- 
orrhoea had been present for fourteen or fifteen days. The pa- 
tient's health by this time was certainly considerably impaired 
and it is in just such debilitated states of the system that rheumatic 
affections limited to one joint are most apt to come on. In this 
sense there mio-ht be some relation between jjonorrhcea and the 
ensuing rheumatism — not as a direct but only as a predisposing 
cause. s 

Dr. Ravogli did not admit that rheumatism could be caused 
by gonorrhoea. Until now it has not been established whether 
gonorrhoea was a specific affection or not, whether it was due to 
a virus or not. If we review the history of gonorrhoea we find 
that Swediaur injected his urethra with caustic ammonia. A 



Periscope and Abstract. 405 

urethritis, with all the symptoms of a gonorrhea, followed and 
lasted six to eight weeks. Handel reports the case of a young 
man who used as an injection a solution of caustic potassa. A 
urethritis with all the characteristics of an ordinary gonorrhoea 
resulted. On the i6th dav he had connection with a woman, 
who, in turn, was attacked with a typical case of vaginitis blenn- 
orrhagica. Ricord would not admit gonorrhoea to be specific 
until demonstrated that something existed in the chemical or physi- 
cal characteristics of the pus to substantiate the yiew. Roliet. 
who was exceedingly opposed to the doctrines of Ricord, in 
speaking of the specificity of blennorrhagia, says that it w ould be 
a great presumption on the part of a physician to state \\ hether an 
attack was specific or not. Many cases are reported of women 
haying a simple leiicorrhea who do not infect their husbands, yet 
if cohabiting with another man will infect him. This may be ex- 
plained by a kind of acclimatization. 

Elkunod, of Stockholm, demonstrated the gonococcus to be 
identical with a micrococcus occurring in stomatitis ulcerosa and 
some diseases of the stomach and intestines. If this be true, 
then certainly the so-called gonococcus cannot be considered the 
specific cause of gonorrhoea. Blennorrhagia is nothing but a lo- 
calized disease of the urethra or of another mucous membrane 
W'ith which the pus of blennorrhagia may come in contact. 

Prof. Gruben spoke of the contagiousness of the purulent se- 
cretion of the Eustachian tube, which may be carried from one 
side to the other. It seems that in the secretions of the mucous 
membranes there is something which has the propert\- of repro- 
ducing the same process in another mucous membrane. We 
know also that pus exposed to the air is capable of taking some 
irritating properties, as is shown in the purulent discharge from 
the ear causing an eczema of the ear and face. Thus we find 
about the genitalia of a woman with blennorrhagia an eczema. 
and hence it is not to be wondered at. that when this irritating- 
substance comes in contact with the male uretha an inflammation 
results. If the pus of blennorhagia possesses some specific prop- 
erty it would necessarily at any time produce an acute inflamma- 
tion, but when taken at the end of an attack when but few pus 
corpuscles remain, it will produce only a slight affection. Blenn- 
orrhagia. except in its severer forms, is rarely attended by fe\er. 
In his extensive hospital experience of venereal diseases, the 
speaker had never met with a case of rheumatism due to blenn- 
orrhagia. In but one case urethritis attended an attack of gon- 
orrhoea. It was located in the foot, and probabh- due to an in- 
jury or to the occupation of the man. He frequently attended 
this man for the same affection of the same part, and would con- 
sider the simultaneous appearance of gonorrhea and urethritis a 



406 The Peoria Medical Monthly. 

simple coincidence. The speaker remembered the case of a man 
who was conlined to his bed every five or six months with an 
attack of rheumatism, and at such times in consequence of the 
uric acid an irritation of the urethra resulted. We have arthritis 
occurring in scarlet fever and measles, which are essentially viru- 
lent diseases. 



PREPARATIONS OF GLYCERINE. 

The British Pharmacofocia contains five preparations of 
-glycerine, all of which are useful and convenient: some of them 
are used externall}^, some internallv, and some applicable in both 
ways. " Glycerine of carbolic acid," " glvcerine of tannic acid,'* 
and " glycerine of gallic acid,'' each contain one part of their re- 
spective acids in four and a half parts of glycerine. " Glycerine 
■of borax" contains a like proportion of borax. "Glvcerine of 
starch " contains one part of starch in eight and a half parts of 
glycerine. The United States Pharmacopceia also contains these 
preparations ( excepting the last one) ; but their proportions and 
formuke are somewhat different. We also have an officinal 
'• glycerine of tar." Our term " glyceritum," or " glycerate," is 
preferable to the English "glvcerine." 

Glycerine of carbolic acid, in doses ranging from five to ten 
minims, suitably diluted, is serviceable in scarlet fever, measles, 
and small-pox; and by lowering the pulse and inducing perspira- 
tion, it has a beneficial effect in fever. Many forms of diarrhoea, 
"vomiting and dyspepsia yield to it; and it often times promotes 
the expulsion of intestinal worms. It mav be used as a gargle, 
well diluted, in sore threat with foetid breath, and, mixed with an 
€qual bulk of water, is painted on the tonsils and fauces in diph- 
theria. One drachm in an ounce of water form an excellent lo- 
tion for eczema, lepra, carbuncles, syphilitic ulcers, etc. Undi- 
luted, it is emploved in small-pox, to prevent the " pitting," and 
is useful in ringworm, scabies, and other parasitic diseases. 

Glycerine of gallic acid ma}' be taken internally in ten to 
sixty minims, diluted, as a general astringent, in the night sweats 
of phthisis, in pvrosis, and in albuminuria. It is one of the best 
agents for the arrest of hemorrhage from the kidnevs, uterus, or 
bladder: and for all cases where the bleeding]: vessels have to 
be reached through the circulation. For external use, it is in- 
ferior to glycerine of tannic acid. 

Glycerine of tannic acid may be taken internally in doses of 

;ten to forty minims, for the same purposes as glycerine of gallic 

■acid, but it is generallv less efficient. Externally, it is more useful 

than gallic acid, and is a good paint for relaxed uvula, chronic 

■.tonsillitis, and many throat affections, and is beneficial in oza^na. 



Periscope and Abstract. 407 

chronic otorrhoea. ha}' fever, and coryza. It also makes an ad- 
mirable injection, well diluted, for gonorrhoea (male and female j 
urethritis, and gleet. 

Gh'cerine of borax, from half a drachm to two drachms, di- 
luted, is refrigerant and diuretic. It has an acid reaction. It 
causes contraction of the uterus, and, sometimes, abortion. Com- 
bined with ergot, it assists the expulsion of the placenta. It is 
useful as an emmenagogue. Half an ounce of glycerine of borax 
in four ounces of water act as an aphrodisiac, when used as an 
enema. Externally, it has many uses in skin diseases, notably in 
chloasma, or pityriasis versicolor, which it cures by dissolving 
the epidermis. It is used for chilblains, chapped hands, fissured 
tongue, aptha, and cracked nipples, applied as an undiluted paint, 
and is valuable in pruritus pudendi, and sometimes in diphtheria.* 

Gh'cerine of starch is employed externally for excoriations, 
etc., and is a useful article in the nurserv. — Med. World. 



POST-PARTUM HEMORRHAGE. 

Last vear I had the honor to present to this society a paper 
on Post-Partum Hemorrhage, which excited an earnest and pro- 
tracted debate — that I am fain to do some good — by bringing up 
to our professional vision with great distinctness two very import- 
ant points in obstetrical practice, viz. : that there are certain prin- 
ciples underlving the scientific management of post-partum hem- 
orrhage, and that he only is a competent and safe obstetrician who, 
in advance of meeting with a case of this hemorrhage, is thor- 
oughlv conversant with these principles, it being manifest that 
after the advent of the hemorrhage there is no time to hunt up 
the proper practice nor send for counsel. Whatever is necessary 
to save the patient must be done at once. A delay to do the right 
thing for even a few minutes may be fatal to the patient, and to 
do the wrong thing promptly or deliberately may be equally dis- 
astrous. 

It is these considerations that give me warrant to present the 
subject afresh at the first opportunity: and, furthermore, the di- 
verse views of the proper management of these cases proclaimed 
by the polemics last year seem to make it judicious to keep the 
subject agitated until our professional minds arrive at something 
approaching unanimity as to the best line of procedure, or other- 
wise establish the fact that several lines are equally feasable and 
reliable. 

My position last year was that the dogma, so earnestly pro- 

*Salycylic acid dissolves readily in water, by the addition of four times its quantity of gly- 
cerine of borax. 



4o8 ' The Peoria Medical Monthly. 

mulgated by the late Prof. Meigs in these cases, " Turn out that 
clot," was surely not a safe rule of action in all cases, and possibly 
applicable to onh' a small minority of them, and after the inter- 
change of sentiment and experience bv the members on that oc- 
casion I was conlirmed in that position. 

x\lthough it was not distinctly stated in my former essay, 
that it was neyer necessary to insert the hand into the uterus for 
the sole purpose of clearing it of the clots of hemmorrhage after 
childbirth, such an inference was a fair conclusion from the tenor 
of the article, and I felt justihed in the idea from the fact that in 
oyer forty 3'ears of general practice, with a full proportion of ob- 
stetrical engagements. I had neyer met with such a necessity. 
The one condition that would theoretically demand such an inter- 
terference is when the uterus is tilled with blood and the hemor- 
rhage continuing, and the attendant wholh- unable to secure con- 
traction of the womb b^' external manipulation or otherwise. 

Holding that the contraction of the womb is the legitimate 
and natural mode of arresting the hemorrhage, by bending and 
occluding the sinuses, n^\ thought was that if the contraction 
could not be commanded by other means, the hand should be in- 
serted and the clot tvu-ned out. But it appears that the uterus 
may refuse to contract, and still the best practice may be not to 
turn out the clot. 

In the Medical Xezcs- (Philadelphia) of October 18, 1884, 
there is an editorial reciting the points of my last year's paper in 
a spirit of commendation, and closing with the particulars of a 
case reported b^■ Lnmpe. in a recent number of the Archiv. fur 
Gvil(lk(>h>i>l'c. 

In Lumpe"s case. " after the delixery of the child, the uterus 
did not contract at all but remained relaxed like a leather bag, 
and its contour could not be felt through the abdominal walls. 
The placenta was detached but still there was no contraction of 
the uterus: A'et the bleeding was not excessive. More blood was 
discharged than usual, but gradually ceased, and I felt the cervix 
coagula. I beheve it \\ould have been most improper for me to 
have removed the blood coagula from the uterus and the vagina, 
for only the exceptional coagulability of the blood saved the 
woman from Hooding." 

With this additional testimony we must surely see that there 
cannot be an unwavering routine of acts to be gone through with 
in every case of post-partum hemorrhage, but that in this, as in 
all other disorders, it is indispensable that the scientific attendant 
first clearly comprehends the nature of the ditliculty he has to 
contend with, and then as fully understands the principles of the 
means of relief applicable to the case. 



Periscope and Abstract. 409 

To illustrate another point in practice in cases of post-partum 
hemorrhage, I submit the following: 

I was called at i o'clock p. m., August 21, 1884, to see J. G. 
M. in labor with her first child. She first felt pain at 4 a. m, 
of same dav and the labor progressed smoothly to 3 p, m., when 
first stage was completed, and I ruptured the membranes, giving 
€xit to a moderate quantity of liquor amnii. The second stage of 
labor was completed at 4:20 by the delivery of a vigorous boy, 
and the third stage at 4:50, the deliver}^ of the placenta being as- 
sisted somewhat by my fingers. The uterus contracted promptly 
under massage, but showing a slight disposition to relax, and the 
patient complaining of more than usual pain after normal first la- 
bors, I gave her ten minims of Squibb\s fluid extract of ergot and 
the tenth of a grain of morphia. In a few minutes all appeared 
to be quiet, and soon after I had left the lying-in chamber, and 
was adjusting mv cuffs in another room, when the nurse notified 
me that she thought the patient was bleeding too much, and on 
returning to the bedside I found the patient in great pain ; refer- 
red to the left iliac region in front and the sacrum in the rear, and 
that the fundus of the uterus had risen to the umbilicus. I im- 
mediately administered twenty minims of fluid extract ergot and 
a tenth grain of morphia, and resorted to massage of the uterus 
through the abdominal wall, which induced contraction without 
reducing its size or position. The patient was lying on her back, 
now complaining of still greater pain, and I had her turned to her 
left side, the position in which she was delivered of both child and 
secundines. The only effect of this turning over was to transfer 
the pain from the left to the right iliac region, it and the sacrum 
pain both now so intensified that the victim declared the suffering- 
much greater than at the second stage of her labor. This pain 
Avas located where I had not before known in a primipara, and it 
was of a severity 1 had not before witnessed in a primipara. It 
amounted to agony. And added to this the uterus was contract- 
ing powerfully under manipulation at regular short intervals but 
was not at all reduced in size. The pulse had become frequent 
and feeble, and the prolabia had lost some of their freshness, but 
no blood was passing the vulva. My diagnosis was that the womb 
was filled with blood, which the contractions, strong as they were, 
<:ould not remove. 

Here, then, was a case militating against the views I had held 
and the doctrine I had preached for many years, viz.: that a 
healthy womb after a normal labor did not have a mischievous 
<:lot in it that could not be expelled by its own contractile power, 
stimulated by external manipulation, rendering it always unneces- 
sary to insert the hand into the organ to turn out the clot, ac- 
cording to the orthodox rule in such cases made and provided. 



4IO The Peoria Medical Monthly. 

The case in hand clearly indicated to me the necessity of 
rendering manual assistance to rid the uterus of the offending clot, 
and I proceeded promptly to that seryice. Passing my fingers 
bet^yeen the labia, I found the ositum yaginee closed by a small 
body, seeming to tne touch like a ball of considerable dimensions 
coyered with a serous membrane. This puzzled me. In the at- 
tempt to obtain knowledge as to its character by a digital explo- 
ration of it, it was ruptured, and my fingers passed into its sub- 
stance, sohing the mystery by demonstrating it a clot of blood, 
of an extent that plugged up the entire vagina and reaching into 
the womb. Having determined these facts, it was the work of 
but a moment to break the vaginal coagulum, and, the contracting^ 
womb extruding its contents, the whole mass speedily driven 
through the vulva, and the uterus on the instant was reduced to its 
proper size and position, the pain and distress immediately disap- 
peared, everything promptl}' assumed a satisfactory condition, 
and all was well. The loss of blood had been considerable, but 
not enough to require further special attention at the moment, nor 
did it prevent an ordinary good recover\' of the patient. 

The outcome of this case declared the correctness of my diag" 
nosis so far as the ultimate facts are concerned, but my view^ 
were at fault in supposing the barrier to be the exit of the womb, 
clot to be at the uterine os instead of the ostium vagina?, where I 
found it, and the removal of which cleared away the whole diffi- 
culty, rendering it not only unnecessary to pass my hand into the 
womb, but making it obvious that it would have been bad prac- 
tice to have done so, leaving me at liberty still to declare that in 
over forty years' practice I have never met with a case of post- 
partum hemorrhage when, to save the life of the patient, it was 
necessary to pass the hand into the womb and turn out the clot. 

This paper is intended as a plea, as was the one on the sub- 
ject last year, for a clear comprehension of the nature of post- 
partum hemorrhage and of the principles which should govern in 
its management, to the end that the accoucheur, when suddenly 
brought face to face with the alarming difficulty, shall at once 
recognize the essential points in the particular case before him, 
see promptly what ought to be done and promptly do it, not fail- 
ing to turn out the clot if such procedure is best, but not feeling 
that he must pass his hand into every womb when there is a 
hemorrhage after childbirth because such violent proceeding is 
sometimes necessar}'. The scientific dogma in this, as in all other 
therapeutic procedures, should be that the simplest measure that 
is promptly efficient is the best. — y. F. Hihberd, M. D., in Forf 
Wayne journal of Medical Sciences. 



/ 



Periscope and Abstract. 41 l 

POISONING BY CHLOROFORM INTERNALLY 
ADMINISTERED. 

Since chloroform administered internally in the treatment 
of tape-worm has frequently been referred to in these columns, 
the following case of poisoning through the accidental adminis- 
tration of an overdose, reported in the ^A ezc Tork Medical Record 
for October 3, by Dr. J. M. Latta, of Millerton, Kansas, is de- 
serving of attention: 

The case was that of a boy, six years of age, suffering from 
tape-worm, for which he ordered a mixture of one part chloro- 
form in three parts simple syrup, of which one teaspoonful was 
to be given every hour until four doses had been taken. By 
mistake the parents gave the mixture in tablespoonful doses. 
Twenty minutes after he had taken the fourth dose of the mix- 
ture the boy said the medicine was " about to kill him:"" he reeled 
like a drunken person and vomited violently, throwing up mu- 
cus tinged with blood. The child was rational when first seen 
by Dr. Latta, and said that his stomach hurt him, but in a fe\v 
minutes he became unconscious. The pupils were normal, the 
breathing easy, and the pulse a little accelerated, but regular, and 
rather full and bounding. The face was covered with an evert 
red flush, arterial in tint. The temperature was not taken. It 
was impossible to arouse the boy by calling or shaking him. All 
the pillows were removed, the body was placed straight and all 
constricted portions of clothing loosened, and fresh air was freely 
admitted into the room. The pulse and respiration were care- 
full}- watched, but as they furnished no special indications for 
treatment, nothing more was done. The pulse became gradually 
less rapid, the flush disappeared from the face, and in an hour 
and a half the boy awoke and expressed himself as being all right. 
A saline was administered a few hours later and the bowels were 
moved, but there was no appearance of any tape-worm. — Thera- 
peutic Gazette. 



A CASE OF ATROPINE-POISONING SUCCESS- 
FULLY TREATED BY JABORANDI. 

Dr. Suzuki reports in the Transactions of the Sci / Azuai^ 
August, 18S5, the case of a woman aged nineteen, who drank a 
tablespoonful of -'miso shiru" ta kind of pea-soup") in which a 
certain quantity ( about half a grain 1 of sulphate of atropine was 
mixed by an insane person. Immediately after she felt a disa- 
greeable bitter taste, so that she tried to vomit by tickling the 
throat with her lingers, and succeeded in vomiting a small amount 



_j.i2 The Pkoria Medical Monthly. 

of the contents of her ston:iach. About half an hour after the 
event she complained of headache, giddiness, flushing of face, 
dryness of mouth, and weariness. When she came to Dr. Su- 
>:uki her pulse was frequent, the conjunctivie dilated, the mouth 
imd the nares were dry. He gave her immediately a solution of 
eight grains of tannic accid in one and a half ounces of water, 
and repeated again the same dose after live minute's interval: at 
the same time with it the ice-bag was applied to her head, but the 
symptoms continued to increase in severity and without the 
slightest effect being produced M' the measures taken. At 1 1 
o'clock A. M., paralysis of the tongue was noticed, articulation 
and deglutition became difficult, the extremities were cold, the 
pulse was weak and thready, and she was restless and delirious, 
presenting symptoms almost like insanit}'. A warm infusion of 
jaborandi, one grain of the leaves to four ounces of boiling water, 
was administered at once, and in about ten minutes after its ex- 
hibition the serious symptoms gradually subsided. After about 
im hour and a half the pupils began to contract, the tongue 
moistened slightly, and the articulation became distinct, but gen- 
t^ral debility, paralysis of the left arm, thirst, and fullness of the 
stomach persisted. At this time the patient said that she felt as 
if the intoxication had passed over, but she did not recollect what 
had occurred during the attack. The next morning she only 
complained of a slight headache and diminished appetite. No 
other svmptoms remained. — Therapeutic Gazette. 



MERCURIC BICHLORIDE IX ENTERIC FEVER. 

W. Greifenberger (Berliner /\//nise/ie }\'oe/ieiiseIirift, No. 
38 ) concludes that abortion of t\phoid fever with calomel is due 
to purgative action in tirst order: and that since repeated large 
<loses of calomel cause no further evacuation, the subsequent influ- 
ence of calomel is due to the disinfecting power of such portions 
of it as are converted into corrosive sublimate bv the aciditv of 
the gastric juice. As sublimate ma}- be given at any stage with- 
out danger to the intestines, he has used a solution of one grain of 
corrosive sublimate and an ounce of simple syrup or of pepper- 
imint and water, with sufficient water to make eight or ten ounces. 
Of this, one tablespoonful is given everv hour or two. or about 
Hialf of the ab()\'e mixture in twentv-four hours. Infusion of dig- 
italis, or morphine, may be added to the solution. The bowels 
jTiay be regulated h\ castor oil or .senna. While sublimate is 
i(i\en let the patients gargle frequently, and be fed with gruel 
iuid }olk of <^g\:J[,. The sublimate is usuallv given three or four 
days. ProslraLon was treated with tincture quinine and muri- 



Periscope and Abstract. 413 

atic acid,'' camphor, ether-camphor, etc. Dr. G.'s success was 
remarkable. The method is cheap, simple, and better than mer- 
curial inunction. — Med. Annals. 



A PLEASANT QUININE MIXTURE FOR CHILDREN. 

The Canada Lancet says that a most pleasant and palatable 
disguise for quinine may be extemporized as follow : 

R. Quiniie sulph., 12 grs. 

Acidi tannic, 20 grs. 

Tinct. opii camph., • \ oz. 
Tinct. cinchonje, \ oz. 

Spts. lavand co., 3 dr. 

Syrup simp., ad., 4 ozs. M. 

Shake well before using. The dose will be usually one tea- 
spoonful three times a day, but the amount of quinia desired to 
be administered should govern the size of the dose. It will make 
a beautifully creamy mixture, if the quinia and tannin are rub- 
bed together on a pill tile or a sheet of paper with a spatula until 
all lumps disappear, then put in a suitable bottle and first add the 
paregoric, shaking at once, then the cinchona and lavender, fol- 
lowed bv the svrup. 



OX-GALL IN TYPHOID FEVER. 

Dr. George Van Schaick [ .^tarferly Bulletin) regards the 
tympanites, high fever and mental disturbances as largely due 
to changes in the liver, which result in diminution of secretion of 
the bile. With this belief he tried ox-gall in enteric fever, the 
patients being fed on milk and fluid diet, which probably needs 
but little bile. 

His first case was seen on the sixth day of the attack, at 
which time the morning temperature was 103 1. and the evening 
io5|. On the next dav the eruption appeared, and the morning 
temperature was 103 i. At 3:30 p.m. he gave i dr. pure gall in 
gelatine capsule, and at 4 p. m. tifteen minims more. The result 
was an evening temperature of 104. After this he gave \)^ to 
3 drachms of bile daily, and nothing else. The patient did well 
in everv respect, her temperature never exceeding 103, except 
on one' day. when the butcher failed to get the bile, when it 
reached 105 ■^. But it was immediately reduced upon resump- 
tion of the drug. 

In the second case the highest temperature reached was 104 
on the eleventh dav. The bile was pushed in this case to i oz. 



414 The Peoria Medical Monthly. 

daily, but no special result was observable, and the dose was 
again reduced to i dr. three times a. day. 

In the third case antipyrine. quinine, cold affusion, etc., were 
used, but the tympanites, hebetude, weakened heart's action and 
a temperature of 105 1 soon showed the treatment useless, and 
bile was begun. The following day the evening temperature, 
was 103 ij. and the patient continued to an excellent recovery. 

Altogether the author was pleased with the results, though 
aware that three cases are not sufficient to establish the treat- 
ment over all others. — Med. Aiuiah. 



NIGHT-COUGH IN YOUNG CHILDREN. 

The author concludes a paper published in the McdicaT 
\civs.., February 28, 1885, as follows: It is a well-known fact 
that a drink given to the child w ill often cause a cessation of the 
paroxysm, the fluid simply pushing downward the exciting for- 
eign body. This clinical fact gives us the clew to tlie successful 
management of these troublesome cases. If the nasal passages 
are thoroughly cleansed before the child is put to bed. the night 
will probably be uninterrupted by this irritati\e cough. If the 
discharge accumulates in the nasal passages or upper pharvnx 
during the night and gives rise to a paroxysm, it is a simple 
procedure to cleanse the nasal chambers, and at once relieve the 
symptoms. Treatment can be most effectiveh' carried out by 
means of spray composed of an aquecnis solution of an alkali.. 
By its use these cases need no longer be harassing to either 
practitioner or patient. 



THE INFECTION OF SCARLET FEVER. 

It is reported by the Medical Committee appointed to inquire 
into the alleged recurrence of scarlet fe\er at an orphan as}lum, 
from a premature discharge of patients from the institution for 
infectious diseases at Liverpool, that a failure to cleanse the head 
thoroughly is b^' no means a rare cause of retained infection of 
the disease, the desquamation of the scalp being taken for 
" scurf.'' Another common source of tiie conta<jion was found 
to be the clothingr which the children had worn at the time of 
their admission to the institution, this bein<<; sent away with them 
after being, as it was thought, thoroughly disinfected.- -yT/c/rvA^//<^^ 
Med. 'Your. 



The Peoria Medical Monthly, a practitioner's journaL 
Tw o dollars a year, in advance. 



Therapeutic Notes. 
THERAPEUTIC NOTES. 



415 



HEADACHE DXTE TO REXAL POISONING. 

R. Hydg. bichlorid., 1 dr. 
Tine, ferri pevchlor. 
Glycerine, aa ^4. ^'^■ 

Aqufe purse, ad 12 ozs. 

M. A tablespoonful in an equal 
quantitj^ of water or one ounce ot in- 
fusion quassia, three times a day. This 
for headache where due to renal con- 
gestion, with anasarsa and ansmia, and 
in some forms of syphilitic headache 
when the cachectic state is marked. 

HEADACHE FKOM MALARIAL POISONING. 

R. Liquor towleri. 

Tinct. belladonna, aa 1 dr. 
Aqu* purge, ad IV2 oz. 

M. big. — A teaspoonful in a wine- 
glassful of water three times a day. 
In headache from malarial poisoning, 
when it recurs from time to time. 

The above formulte as well as the 
following, are from Dr. Day's mono- 
graph on " Headaches '" : 

HEADACHE OF CEREBRAL AN.EMIA. 

R. Ext. gentian. 
Ferri. sulph. 

Pulv. digitalis, aa 12 grs. 
Pulv. cinnamom, 6 grs. 
Mi.sce et divide in pil. No. 12. Take 
one three times a day. 

In the headache of cerebral ana-mia, 
where digitalis is required; where 
there is unsteadiness of the liearts ac- 
tion after food, and there is flatulence, 
the iron may be advantageous)}* omit- 
ted, and pulv. zingib. substituted for 
pulv. cinnamom. 

CHRONIC diarrho-:a. 
R. Acidi nitrici diluti, % dr. 
Liquoris opii sedativi 

(Battley), 1 dr. 

Tictur* gentianie, ^2 ^'^• 

Infusi gentiana^ 43.^ ozs. 

Aqua menthse piperita- 

fort., ad 8 ozs. 

One ounce to be taken three times a 
day. 

In chronic diarrhoea, of probable neu 
rotic origin in females of nervous tem- 
perament. Dr. J. Vase Solomon {Brit. 
Med ./o?/?'.) has found the above quite 
efticatious. 

MALIGNANT SCAJILET FEVER. 

R. Acid, salicylat, 2 dr. 

Tiiict. aconit. radicis, 12 drops. 



Inf. digitalis, 1% oz. 

Spts. ammon, arom., 3 dr. 

Syr. auranti. cort., H oz. 

Aquse, 1 oz. 

M Sig. — Teaspoonful for n child 
five years old every three hours. In 
malignant scarlet fever, with cold ex- 
emities and tongue and high temper- 
ature. — Dr. B. Brown, Alexandria, Va^ 

TREATMENT OF NEURASTHENIA. 

Dr. M. L. James, of Richmond, Va., 
recommends highly the following for- 
mulae in the condition of neurasthenia 
and its accompanying digestive 
troubles, together with a most careful 
attention to the diet : 
R. Quiniae phosphat, 32 grs. 

Strychnise phosphat, \i gr. 

Acid phosphorci, 40 min. 

Caftein. citrat., 32 grs. 

Aquae purae, fl. 14 drs. 

Glycerinse purae. 

Spts. vini recti ficat, aa f. 1 oz. 

Tinct. card, comp., f. 2 drs. 
Misce secundem artem. 
Sig. — One or two teaspoonsful im- 
mediately before or after breakfast and 
dinner. 

He referred I0 those extreme cases 
where the disorder of the stomach was 
such that the patient could not ingest 
the foods ordinarily in use, and for 
those cases he indicated the use of 
such fluid diet as Valentine's Beef 
Juice, or foods predigested by the use 
of pancreatine and pepsin; and in 
those cases attended by such aggrava- 
tion that the stomach would tolerate 
no food at all by articles similar to 
those, alimentation should be main- 
tained through the rectum. 

FOR RHEUMATISM. 

R. Guaiaci (vit ovi semel), 1 scruple. 

Aquae dest., 1 oz. 

Liq. amnion, acet., 2 drs. 

Syrupi, 1 dr. 

M. ' For one dose. 

—Dr. E. J. Clarke 

TO PRODUCE DIAPHORESIS IN FEVERS, 

R. Inf serpentaria:', 9 drs. 

Ammoni carb., o grs. 

Syrupi, 1 dr. 

:M. Sig.— To be taken twice daily. 

— Dr. Paris^ 



THE 

Peoria Medical Monthly. 



THOS. M. McILVAINE, A. M., M. D., 

Editor-in-Chief. 

O. B. WILL, M. D., 

Associate Editor. 

J. H. COULTER, A. B., M. D., 

Business Manager. 

204 S. Jefferson St., Peoria, III. 



***The Editor is not responsible for the statements or opinions of contributors. 

***Short original articles are invited from any reader, whether a subseriber or not. 

***If e.xtra copies are desired by a contributor, the number must be specified when the 
article is sent to the Editor. 

***A11 exchanges, books for review, and communications must be addressed to the Peoria 
Medical Monthly. 

*s;*The publication day of this journal is on or about the 2.5th of each month. 



EDITORIAL. 
ANNOUNCEMENT. 

As will be noticed elsewhere, the working force of The 
Monthly has been increased b}' the addition of Drs. Will and 
Coulter to the editorial staff, and w^e feel no hesitancy in saying 
that the well-known abilit}- and energy of these gentlemen will 
soon be felt in the conduct of our journal. It is our intention to 
push The Monthly still nearer to the standard that has in the 
past been aimed at. and we hope to make it a necessity to eveiy 
physician in our State, a.s well as a welcome and helpful visitor 
to a very large number of practitioners throughout our country. 
The Monthly has friends that are now numbered by thousands, 
and if each one of this larjie number will take a little interest in 
its further spread bv speaking a good word for it among his med- 
ical friends, its growth will be still more rapid. Will von not help 
us? 



MIND CURE. 



Apropos of the " Mind Cure," or " Faith Cure," craze which 
is now prevailing in this and other sections of the country, the 



Editorial Department. 417 

following letter, written by a lach' not far from here to a friend in 
this city, and published in a late number of The Saturday Even- 
ing Call, may not prove uninteresting to our readers: 

"My Dear Friend: I wrote to congratulate you upon 
your wonderful recover}^. I understand that it is, if an} thing, 
too complete. The ardor with which Mrs. — hurled herself 
upon 3'our case occasioned surprising results. I am told she sur- 
prised even herself. It is reported that your hearing has so 
greath' improved that you have been obliged to give up wearing 
your watch, the loud ticking of which disturbs you, even when it 
is reposing in your pocket. That you are now able to hear 
yourself think is well known. 

" While I congratulate you heartily, her failure in mv case 
leads me to deep self-abasement. I did not suppose I was a 
tougher subject than yourself, but so it seems. Well, neither 
Mrs. — , nor any of her followers, can wave me like a banner 
from the outer wall and sa}' 'mind cure did it:' because it didn't 
do it. From the first, Mrs. — eved me with suspicion. x\nd 
why should she? I mereh' sought for information, free, and that 
in the humblest manner, but I didn't get much. 

" When I asked her why, if the mind-power was infinite and 
could control everything, she could not overcome sleep, hunger, 
thirst and cold, and all the other wants of the bod}^ she said: 
' Shut your eyes now. I want to get in mv work,' or words to 
that effect. 

" So she shut hers at the rate of a dollar a minute, and I 
closed mine for nothing. When I pointed out to her how conve- 
nient and economical it would be to ifjnore the body altoijether 

C? */ c!> 

she did not seem impressed. I pointed out to her as gently as I 
could the advantages of this S3'Stem. No young man need be 
afraid to marry now. Salary is no object. All he has to do is to 
tell his bride : ' No, you are not hungry, nor cold, nor tired. No, 
3-ou don't want a new dress: \o\\ just imagine it!' and the thing 
is done. I also inquired, always in the same humble tone, if the 
force of her will could keep a ball thrown into the air from fall- 
ing; also, if, as she said herself, no one could get cold, nor feel 
tired or overdone under this system, it were possible to walk for 
years without fatigue. She claims no limit. \X this stage of 
affairs it seemed to occur to her that, in the words of the poet, I 
was getting ' too much sugar for a cent,' so she replied that at 
the lectures all these things would be explained — price $15.00. 

" But I did not have fifteen dollars' worth of curiosity con- 
cealed on my person, so I refrained from pursuing the subject. 
Like the bo^' who set one hundred epirs under a hen to see her 
* hump herself,' I asked her these questions, but she did not hump 



4i8 The Peoria Medical Monthly. 

herself to any great extent. Now I believe for some things Mrs. 
— is a great success. You know they say if you put a chicken's 
beak on the ground and draw a chalk line from its bill to anv 
given point, it will imagine itself tied and never try to move. 
Now Peoria contains a good many of these chickens. Thev have 
been thinking themselves fastened down for vears, and have not 
tried to move. Along comes Mrs. — and wipes out the chalk 
mark. Off goes the chickens (hens mostly). How many fath- 
ers have cause to bless her! But I would like to see her trv some 
one who was chained and fastened by actual acute disease. 

" This is what I think, and all I know concerning ' mind 
cure.' We are working it for all there is in it in our family at 
present. Gus is trying to persuade me that I don't want a seal 
skin sacque — I only imagine it. But, while the theory is all right, 
in this individual case the experiment fails. I do not believe all 
the ' healers ' in the country could convince me of that. 

" Father asked me w^hat I thou^dit of the ' mind cure.' Give 

•I • • • 

him this to read, and let him see for himself. 

" Yours sincerely, ^*^ " 



A WAIL FROM CHICAGO. 

Recently, a Dr. Waugh was assassinated bv one Sweet, who 
was actuated thereto by a criminal intimacy existing between the 
Doctor and Mrs. Sweet. The grand jury failed to find a true 
bill against Sweet and he was discharged. Now, the Western 
Medical Reporter makes this action of the grand jury the text of 
a w^ail because of the " one-sidedness of public opinion whenever 
and wherever a ph^-sician is involved." It is true the Reporter 
does not condone the offense, of which it admits Dr. Waugh was 
probably guilty, but it claims that probably Mrs. Sweet was the 
seducer, and that the poor Doctor was her game. From the 
Reporters statement, the lot of a Chicago ph\^sician must be a 
most unhappy one. It says: 

" There is hardly a ph3^sician in general practice, but can tes- 
tify that the profession of medicine is one which is attended by 
great temptations at the hands of persons who consider the doctor 
to be a man who is fair game, and whose best interests lie in the 
direction of discreet silence. Verih', between such persons on 
the one hand, and professional blackmailers, hysterical subjects 
and nymphomaniacs upon the other, not to speak of a touch of 
that human nature, which makes all men kin, the doctor is in a 



Editorial Department. 419 

worse predicament than was poor Odysseus, for he could hope 
to escape from both Sc3'lla and Charybdis in a reasonable time, 
w^hile your poor devil of a doctor is menaced by them throughout 
the whole of his professional career." 

If this be true, we give it as a solemn warning to all phys- 
icians who contemplate moving to Chicago, and offer our sin- 
cerest sympathies to those who are so unfortunate to be unable 
to leave such a crime-sodden city. 

The Reporter thinks the law should be interpreted, " Thou 
shalt not like anyone but doctors," and suggests this may be a 
satisfactory answer to '• What shall we do with our graduates?" 
Hereafter we shall emplov a body-guard whenever w^e visit a 
Chicago doctor's office. 



AN ATTACK ON DR. N. S. DAVIS. 

The loiva Medieal Reporter continues to attack Dr. N. S. Da- 
vis, of Chicago, in a very bitter manner. It accuses him of grave 
misdemeanors as Dean of the Chicago Medical College, and de- 
mands that he be retired, both from his deanship and as editor of 
the Journal of the American Medical Association. We have not 
vet seen anv defense from Dr. Davis, and we doubt whether he 
will make one. With all his faults, no one has yet dared to ac- 
cuse him of unethical conduct or disreputable practices, and it 
would take overwhelming evidence to convince us of his guilt in 
these directions. 

Dr. Davis is often dictatorial, approaching nearly to arro- 
gance, in his manner, but we have always believed that this was 
due to the powder of his convictions rather than to any disposition 
to be unfair or unjust. As to his being dishonest, the idea is 
ridiculous. 



SMALL-POX IN PEORIA. 

Reference has already been made to the prevalence of this 
disease in this city during the past few months. It is almost en- 
tirely confined to the lower portion of the city, and is not spread- 
ing very fast. The total number of cases to date is sixty-nine, 
with six deaths. Vaccination has been pretty generally prac- 



420 The Peoria Medical Monthly. 

ticed, and the health board chiim to have the scourge under com- 
plete control. 

As usual, we have some anti-\'accinationists who cannot re- 
frain from airing their opinions and names in the public press 
(mostly the German press), and thus foster the common, igno- 
rant hostility to this valuable procedure, but the general public is 
in favor of vaccination and uphold the health othcers in execut- 
ing their plans to control the disease. 



OFFICE THIEF. 

A young, rather heavy-set man, Avith large sandy mustache, 
engaged in selling second-hand medical books at ridiculously 
low prices, passed through Peoria a short time ago. x\t the 
same time several plnsicians missed various books, but after- 
wards found them in the hands of other physicians who had 
bought them from a man answering to the above description. 
The police were too lazy to make any attempt at his arrest, 
although ample notice was given. Look out for a second-hand 
man. 



GREAT OFFER. 

All new subscribers sending $2.00 before December 31st 
will receive the Monthly from November 1885 to Ma^• 1887. 
This is an offer worth considering. All readers will confer a 
great favor, if thev will call the attention of their medical friends 
to this offer. 



NOTICE TO SUBSCRIBERS. 

Owing to the changes made in the publishing department of 
the Monthly, it will be necessary for all delinquents to pay up 
bv December 31st. We wish to open a set of " clean '• books 
with the new \'ear. 



MARRIED. 

Dr. Charles F. Ross (Rush \Si ). of Saunemin, 111., was 
married November 5th to Miss Grace D. Mills. The •' boys of 



Editorial Department. 421 

'81 " will surely congratulate the doctor on his wise course. 
Shake, doctor, shake. 

Our jovial friend Dr. W. H. Conibear, of Morton, 111., was 
married October 29th to Miss Mary A. Bogardus. May his 
shadow never grow less, nor his laugh grow faint. We beg to 
offer our sincere congratulations. 



DEATHS IN THE PROFESSION. 

Dr. William B. Carpenter, a well known writer on physiol- 
ogv, died in London, Eng., Nov. 9th, aged 73 years. 

Dr. Fehling, Stuttgart, Germany, (inventor of the sugar 
test), July I St, aged 73. 

Dr. A. C. Fessenden, Eastport, Me., Oct. 2 2d, aged 66 years. 

Dr. Jas. H. Snodgrass, Pittsburgh, Pa., July — , aged 53 
years. 

Dr. Thad. M. Stevens, Indianapolis, Ind., Nov. 7th, aged 56 
years. 

Dr. A. T. Keyt, Cincinnati, Ohio, Nov. 9th. 

Dr. Jno. L. Atlee, Lancaster, Pa., Oct. ist, aged 85. 

Dr. Richard McSherry, Baltimore, Md., Oct. 7th, aged 68. 

Dr. Samuel G. Armor, Brooklyn, N. Y.. Oct. 27th. 

Dr. W. W. Goldsmith, Louisville, Ky., Nov. 2d, aged 64. 

Dr. Wm. K. Bowhng, , Tenn., Aug. 6th, aged 77. 

Dr. J. N. McChesney, New York, N. Y., Sept. — , aged 33. 

Dr. E. A. Hildneth, Wheeling, W. Va., Aug. 31st, aged 64. 

Dr. F. D. Cunningham, Richmond, Va., Sept. 9th. aged 49- 



QUESTIONS. 

Several applications for therapeutic information have reached 
us during the past month, with the request that we put them be- 
fore our readers, and that they be answered by several in the 
next issue. Let us have numerous replies. 

1. Dr. — , Wisconsin. — Asks for the best method for dis- 
guising the taste of quinine, especially for administration to chil- 
dren. 

2. Dr. M., //linois. —Says. I have a case of sweating — boy 
aged 9 years, fairly nourished, had a "bad cold" four years ago. 



422 The Peoria Medical Monthly. 

since then he sweats every night when in bed; if he would not 
go to bed, he would not sweat. He sweats only from neck to 
knees. Have tried acids, atropia, ergot, and a host of other 
remedies without any relief. / 'j:ant help. 

3. Dr. L., A7/;/5fl'5.— Have any of your readers had an}- ex- 
perience with antipyrin? I ask countrv doctors who have tried 
it. I am somewhat skeptical about hospital reports in the big 
journals, and put more dependence on reports from plain doctors 
like myself. Is antipyrin worth trying? 



NOTES AND COMMENTS. 

A Siberian priest in the village of Troitzky claims to have 
successfullv inoculated cows against the Siberian plague many 
years before Pasteur began his experiments in the same field. 

Cremation would appear to be gaining ground. The newest 
organization favoring it is called the New England society, at 
Boston, which has just been incorporated with a capital stock of 
$25,000. 

In speaking of premature menopause. Dr. T. G. Thomas 
said : " When called upon to express an opinion in the earlv part 
of a supposed pregnancy, you should always sa^^ that up to the 
end of the third month no one can decide the matter by even the 
most careful examination." 

Says the Medical and Surgical Reporter : A wealthy farmer 
of Whitewater, Indiana, traveled around with a cancer doctor one 
day for fun. The funniest thing about it all is the suit which one 
of the doctor's patient's executors are now bringing against the 
wealty farmer for looking at the doctor kill her. 

Dr. Thomas M. Hope died at Alton, where he had resided 
for over half a century. He was a surgeon in the war with Mex- 
ico, in which campaign he fought a duel with Dr. E. B. Price. 
He served one term as Mayor of his citv, and in i860 was the 
Breckinridge candidate for Governor of Illinois. 

By the way, the last kind of a cold (for men only ) is an 
" overcoat cold." This is the name given by the London Lancet 
to the cold a man takes from wearing a thin overcoat on a cool- 
ish kind of a day, when it seems, according to the Lancet., he 



Editorial Department. 423 

should simply have put on a thicker coat, waiting until cold 
weather to don a heavy overcoat. 

One of the small-pox curiosities at Montreal last week was a 
cat who had a well-developed attack of the disease. The sere- 
nader had been fondled by an afflicted child during its illness, and 
after the death of its little guardian, exhibited svmptoms of the 
disease. When the health officers went to disinfect the premises 
the cat was found to be covered with pustules. The afflicted 
grimalkin was promptly shot and cremated. 

The making of a doctor in the old country is a process in- 
volving 3'ears of study and severe examination. This has a dis- 
astrous effect on the intellectual faculties of such women as may 
seek to become full-fledged medicos. In the year 1881 there 
were but twentv-five women practicing medicine in England and 
bv the end of 1884, or three years later, eight of them were in 
various foolhouses, while three others died prematurely. 

Sir James Paget has been tracing the course in life of 1,000 
medical students, taken at random from an English institute. He 
found that twenty-three out of the 1,000 achieved distinguished 
success; sixtv-six had considerable success; 507 made a living; 
124 had a very limited success, not having made a fair practice 
within fifteen vears after graduation, and fifty-six failed utterly. 
Nearh' 10 per cent, (ninety-three) of the whole number left the 
profession after beginning either study or practice, eighty-seven 
died after entering practice, and forty-one died when students. 

Not onlv do calves furnish vaccine virus, but they create a 
demand for it as well. This may seem paradoxical, but tbis is 
the way of it. Human subjects who have been vaccinated sev- 
eral times upon an arm, or who may fear disfigurement b}^ the 
operation, are now vaccinated upon the calf of the leg. This 
method has also been found convenient in vaccinating babies 
and young children. Almost everyone grabs a bab}' by the arm 
in lifting it, to its decided inconvenience soon after innoculation. 
All this is avoided by vaccinating the patient on the calf. 

A daily paper amongst our exchanges contains the follow- 
ing: " It is a part of the small humor of the day to taunt the doc- 
tor with his want of skill, to hold him jesting-ly responsible for 



424 The Peoria Medicat. Monthly. 

man's failure to combat death itself; to charge him, indeed, in 
mockery of our human weakness, with being recreant to his 
kniiihthood and in leajjue with the hosts of death. But even this 
ofibe has a ohastlv echo; when we utter it we know that it has 
no truth. We know only too well that when the doctor shakes 
his head and turns away, and when his cheery tictions lose the 
glibness of their flow, that we ourselves haul down the flag in 
helpless surrender." 

A newspaper exchange contains the following very pertinent 
remark : " See here, girls, Dio Lewis, a medical gentleman, who 
writes a few lines of common sense and dead loads of balderdash, 
says that cutting the hair short at the back of the head induces 
baldness. If this be true what a crowd of smooth-pated girls w^e 
will have about this settlement in a year or two! The main thincr 
to find out now is w^hether, in making this statement, Dio Lewis 
wrote it with his common sense or his balderdash pen. Opinions 
on this subject will be equally divided among those who have 
shed their back hair and those who still retain it.'" 

There are some people who can handle the poison ivy with 
impunity; a great many suffer a good deal of pain and annoy- 
ance from its touch: and some there are who cannot go within 
fifty feet of it, if the wind should be blowing toward them, with- 
out their hands, faces, and sometimes their legs, swell up like puff 
balls, the whole surface being covered with horrid little itching, 
w'atery pustules. Singularly enough a church was recently 
dressed with poison ivy, among other things, and most of the per- 
sons present were badly poisoned. I know a New York editor 
who is sometimes totally incapacitated for business for two wrecks 
or three weeks at a time from this cause; and then it is interest- 
ing to notice how mad a very mild-tempered man can get. I 
have been poisoned myself, and was advised by an old lady in 
the country to use a tea made of the sweet fern (comp- 
tonia aspienifolia), and found it so smooth and curative 
that I always recommend it. The tea or decoction should be 
made strong. It is not to be drank, but rubbed on freely, and 
left to dry. It stains the parts a deep yellowy but is easily washed 
off. — E.xchanQ-e. 



Editorial Department. 425 

BOOK NOTICES. 
A Reference Hand Book of the Medical Sciences. Illus- 
trated by chromo-lithographs and line wood engravings. 
Edited By Albert H. Buck, M.D. Small quarto, pp. 808, 
Aac. toCat. Vol. I. New York. Wm. Wood & Co. 1885. 

This invaluable series will consist of eight volumes to be 
completed within the next two years. When finished it will fill 
a place in medical literature that no other work occupies. From 
its title we learn that its is " a complete and convenient work for 
reference for information upon topics belonging to the entire 
range of scientific and practical medicine, and consisting of a 
series of concise essays and brief paragraphs arranged in the 
alphabetical order of the topics of which they treat." The names 
of ninety contributors to the work are given and nearly all are 
citizens of our own country. This fact will make it essentially 
an American work, and will render it all the more accept- 
able to American physicians. It is not like Ziemssen's great 
work an encyclopedia of medicines only, but it is an encyclopedia 
of everything relating to medicine, including botany, chemistry, 
histology, toxicology, etc., etc., a whole library in itself, and ele- 
gantly printed. We predict an immense sale for the work, and 
advise all who can to buy it. The price is moderate, six, seven 
and eight dollars a volume, according to binding. 

A Formula Book. How to use Listerine. Lambert Pharma- 

cal Co., St. Louis, Mo. 

A neatly printed Httle book of 32 pages, full of formula?, 
with instructions how to use this popular antiseptic, both inter- 
nally and externalh'. Listerine has a wider range of usefulness 
than man}' suppose, which fact is attested by the writings of 
many eminent specialists in the country. Free on application to 
the publishers. 

Several books received will be duly noticed in the Decem- 
ber number, being crowded out of the present issue. 



RECEIPTS. 

The date following each name, indicates where the amount 
credited extends the subscription : 

Illinois.— Drs. E. E. Reynolds (1.00) November, 1885; A. Grim 
(2.00) January, 1886; Jno. Wright (2 00) June, 1886; A. R. Graham 
(2.00J January, 1886; F. G. Shipp (2 dO) January, 1886; H. Knappen- 
berger (2.00) February, 1886; S. C, Latham (2.00) April, 1886; W. H. 



4^6 The Peoria Medical Monthly. 

Veatch (2.00; January, 1886; C. T. Dripps ( 2,00) May, 1886; E. L. Fri- 
denberg (1.00) November, 1885; Geo. Bratton (2.50) May, 1886; A. R. 
Howard (2.00) February, 1886, W. R. Mizclle (2.00) Jue, 1886; R. F. 
Harris (4.20) November, 1885; John Becker (2.00) January, 1886; N. F. 
Felker (2.00) January, 18.-'6; W. O'Brien (1.00) November, 1886; J. 
Henry (2. 00) January, 1886; W. J. Thurman (1,00) November, 1885; 
R. C. Poos (4.50) May, 1887; A. F. Burnham (2.00) July, 1886; J. 
Wills (2.50) June, 1886; M; S. Marcy (2 00) June, 1386; A. L. Craig 
(2.00) May, 1886. 

Iowa.— Drs. B. F. Hyatt (1.00) December, 1885; D. W. Overholt 
(2.00) January, 1886, Shelton &Son (2.00) August, 8 6. 

Missouri. -Drs. S. F. Bonney (1.00) January, 1886; J. H. Bencher 
(2.00) June, 1886. 

Dakota.— Dr. E.M. Bentley (2.00) December, 1885. 

Indiana.— Dr. M. L. Humsten (2.00) February, 1886. 

Wisconsin.— Drs. W. H. Earles (100) December, 1885; Day (2.00) 
March, 1886; W. Monroe (3 00) May, 1886; O. N. Murdock (2.00) June, 
1886. 

Nebraska. — Dr. Geo. G. Case (2.00) January, 1886. 

Texas.— Dr. A. Garwood (5.00) August, 188- 

Kentucky.— Drs. Duncan & Douglas (2.00) May, 1886. 

Minnesota.— Drs F. H. Welcome (1.50) November, 1885; F. Ib- 
berson (2.00) June, 1886. 

Ohio.— Dr. D. S. Hartiuger (2.00) June, 1885. 

California.— Dr. W. V. Grimes (1.00) December, 1885. 



Messrs. Parke, Davis & Co., Detroit, Mich., propose to 
furnish physicians and students in medicine and pharmacy an 
elegant, efficient and most valuable aid to the practical study of 
vegetable materia medica. It consists of a collection of all crude 
drugs of vegetable origin recognized in the United States 
Pharmacopoeia, and many not so recognized that are in common 
use. The specimens number two hundred and eight3'-eight in 
all, and are contained in a substantial black-walnut case, which 
is twenty-three inches long, sixteen inches wide, and thirteen and 
one-half inches in depth. The manufacturers offer this splendid 
collection at the very moderate sum of ten dollars ; but to be able 
to put it forth without pecuniary loss, they must be secured in 
the sale of fifty sets. No doubt the guarant}^ will be made good 
at an early day, and the collection thereby placed permanently 
among the helps to the study of medicine and pharmacy. 



I have prescribed Fucus Marina (Peacock), and find that it 
will do all that is claimed for it. As a malarial antidote (and to 
prevent the return of ague after it has been checked with qui- 
nine), it surpasses any agent I have ever employed. I shall con- 
tinue to prescribe it whenever it is indicated. 

I. N. Graves, M. D., Dongola, 111. 



The Peoria 
MEDICAL MONTHLY. 



Vol. VL : : DECEMBER : i88; : : No. 8. 



ORIGINAL COMMUNICATIONS. 

FLEXION OF THE THIGH, WITH THE LEG IN THE 
STRAIGHT POSITION, FOR SCIATICiV. 

BY ALBERT B. STRONG, M. D., CHICAGO, ILL. 

I have frequently obtained valuable ideas from the short, 
pithy articles in The Monthly, and I owe something to it for 
value received, besides keeping up my subscription. 

There are many " wrinkles " in practice, and I offer you 
one, for the many received, that has served me w'ell. 

Case — A short time ago I was called to see a laborer suffer- 
ing acutely from a severe attack of sciatica of the right nerve. 
He was 55 years old, always enjoyed good health, with the ex- 
ception of some seven years ago, he had a similar attack that 
confined him to the house for eight weeks. In the mean time 
the limb had remained well. He never had rheumatism or 
specific disease. 

The present trouble began three weeks before I saw him. 
For the last week he had scarcely obtained any rest day or 
night. The pain was present all the time down the back of the 
thigh as far as the toes, and in the region of the groin.. 

It was paroxysmal, worse at night and so intense, particu- 
larly in the calf of the leg, that it felt, as he said, as though a 
dog had grasped the muscles and was tearing them from the 
bone. The great and adjoining toe was numb. He obtained 



428 The Peoria Medical Monthly. 

the greatest relief by sitting by the fire ahnost constantly, grasp- 
ing the knee with both hands and flexing the thigh strongly 
upon the abdomen. When the paroxysm would come on in the 
night he would throw off all covers and feel some better by 
lying perfectly naked in a cold room. At other times he would 
obtain some relief by standing up, grasping a table with both 
hands, getting half way down on his left knee, throwing his 
right lower extremity as far back as he could and putting all his 
weight on the toes of his right foot. 

Standing thus for a few moments, the paroxysm would dis- 
appear, and on going to bed would sleep for an hour or so. I 
requested him to lie down upon the lounge. He walked to it a 
few feet distant, with much difficulty, and hitched himself on to 
it, all the time holding the right extremity perfectly rigid. He 
lay on his back. I grasped the ankle with one hand, the knee 
with the other, and so keeping the leg perfectly straight, gradu- 
ally flexed the thigh to a right angle with the body. This 
caused him excruciating pain, referred chiefly to the point of 
exit of the nerye and to the calf. The limb was held in this 
position for about fiye minutes when the pain gradually disap- 
peared. On lowering the limb he instantly remarked that it felt 
much better; that he had not for three weeks been able to allow 
the leg to rest upon its calf as it was now doing. He was re- 
quested to get up and walk about. He began to do this in a 
stiff and awkward sort of a way, but findino- that the accustomed 
pain was gone, completed the remainder of the process in a sur- 
prising agile manner. He began to walk at first cautiously, then 
more boldly, till in a few minutes he walked nearly as well as 
eyer and entirely free from pain. 

The instant relief from his sufferings was a source of great 
surprise to him and satisfaction to me. I again went through 
the same manipulation; this time but little pain was produced. 

Ordered 12 capsules, each containing morphia sulph. J gr., 
quinia^ sulph. 3 gr., to be taken eyery four hours. Instructed 
him to bend the leg next morning should the pains return. 

Saw him again the third day. There had been no return 
of the paroxysm and he felt much better in eyery way; com- 
plained onl}' of numbness in the great and adjoining toe. Left 
off the morphine and continued the quinine for three days more 



Original Communications. 429 

« 

when I saw him for the last time. He had slept well from the 
first, walked with perfect freedom and free from all pain, onl}- 
complaining of numbness in the toes. 

That the sciatica nerve can be very materially stretched, was 
rendered quite apparent when I cut down upon the nerve in a 
cadaver, put my finger under it on the quadratus femoris and 
made the manipulation as described above. 

The finger in this position was almost painfully compressed. 

The ham-string muscles were also rendered very tense. 
"The tension of the nerve and muscles of the calf can be greatly 
increased by firmly flexing the foot on the leg while the lower 
limb is in the position as above described. It is well known that 
the thigh can be brought in contact with the abdomen: but with 
the leg extended the thigh, in the adult at least, cannot, as a 
rule, be flexed much beyond a right angle without doing vio- 
lence to the parts. 

I hope some of your readers will make this simple manipu- 
lation in similar case and report the result. 



THE HEART AND PULSE IX ORGANIC FUNCTION- 
AL DERANGEMENT AND DISEASE. 

BY JAMES S. WHITMIRE, M. D., METAMORA, ILL. 
(Read at a meeting of the X. C. Medical Association, at Metamora, 111., Tuesday, Dec. 1, 18^. 

Mr. President^ and Gentlemen of the Society : 

I have thought that a limited paper, written from observa- 
tion and an experience acquired in the course of a fortv years 
country practice, might be neither uninteresting nor uninstruc- 
tive to our membership, on the significant symptoms developed 
by the pulse, and occasioned bv the action of the heart, in or- 
ganic functional derangement and disease. 

In all ailments, whether occasioned from simple functional 
derangement of the physiological action of any of the organs of 
the animal economy, or from absolute disease, the heart — the 
great center of the circulatory system — is the first organ of the 
body to sympathize with the condition and sound the alarm to 
the general system, and notify it that all is not right within the 
organism. This notification is indicated either by the force and 



430 The Peoria Medical Monthly. 

# 

frequency of the heart's action, or by the feebleness or other 
character of the cardiac impulse given to the blood through the 
arterial system, and made manifest by the tension or relaxation 
of the elastic walls of the arteries. 

These manifestations denote the different characters of the 
pulse, represented by the different manifestations presented. 
The pulse may be divided into and designated by certain names^, 
which may be readily recognized by an accurate observer. 

There is, first, the natural pulse of childhood, of youth, of 
vigorous manhood, and finally, that of old age; second, the pulse 
in disease, or organic functional derangement, may be divided, 
primarily, into frequent, quick, full, tense, full and soft, and an 
intermitting, and also, an irregular pulse. These are the princi- 
ple characters and designations bv which the pulse is known; 
but it must be remembered that all these varieties of the pulse 
may, and do merge into one another, or partake, at the same time,, 
of one or more of these varieties of the pulse, according to the cir- 
cumstances under which thev are induced. To begin, then, I 
will state that a normal pulse is one that belongs to a healthy in- 
dividual at a given age; and the average rate may be stated, ac- 
cording to our best and most critical observers, to be, at birth, 
from 130 to 140 per minute, the circumstance of sex, at this time 
of life, not having any apparent influence on the pulse rate; 
from the 2d to the 5th 3'ear it runs from 100 to 120; from the 
6th to the 9th year, about 90; at puberty, 80; from manhood to- 
the beginning of decadence in life, 65 to 75, and in old age the 
pulse-rate will run from 55 to 65 per minute. In regard to this 
statement of the average rate, our most accurate observers do 
not all agree; but, in my opinion, these figures may be relied 
upon as being as nearly correct as will be found necessary for 
all practical purposes, though in many individuals, and especially 
in those who are peculiarly idiocyncratic, and in some tempera- 
ments, a great range of difference may be looked for and ex- 
pected; and under such circumstances, the range may be, in the 
adult, from 100 down to 40 without an}- apparent manifestations 
of disease. The fact is, that the vagaries of the heart's action^ 
under like circumstances, with different individuals is, some- 
times, utterlv unaccountable. In the adult sex seems to exercise 



Original Communications. 4.31 

some difference in the pulse-rate, 80 to 85 being the average for 
the female, and 60 to 70 for the male. Those persons, of either 
sex, of nervous temperament, may be expected to go above these 
figures, while those of a bilious, or phlegmatic temperament will 
range below. The pulse-rate is the greatest when the individual 
is standing, less frequent while in a sitting posture, and the low- 
est when the person is in a recumbent position, or in a tranquil 
sleep. Any exercise, whether mental or physical, that calls for 
a greater blood supply, will increase both the frequencv and 
force of the heart's action, such as violent exercise, immoderate 
passion, or great, good and unexpected news; while a mental cr 
physical shock, coming suddenly, without premonition, will 
lessen the frequencv and force of the contractions of the heart; 
and even death has been known to occur under these circum.- 
stances, from the failure of cardiac action; not because of any 
fatal organic lesion but whollv from mental shock caused from 
sudden horror, or other mental impression. 

I now speak of these circumstances as affecting cardiac 
action while all the organic functions are in a phvsiological con- 
dition; because there is no other method of eliciting the state of 
the general svstem, nor of local disease, excepting it be by means 
of comparison between the cardiac movements in health and 
disease. 

The vagaries of the movements of the heart, under different 
conditions, is trulv wonderful, and hence it requires acute dis- 
cernment, and local discrimination in the various phases of dis- 
ease, to ascertain from the cardiac sounds and impulse the actual 
condition of the vital forces that are keeping alive and in work- 
ing order, the functions of the economy. But, when we come 
to compare the different characters of the pulse, induced by the 
force or frequencv, or both, by the impulse given to the blood 
b}' the heart's action, we may see more clearly the indications 
for treatment during the progress of disease, organic or general. 

The frequent or rapid pulse has relation to the number of 
the pulsations or contractions of the heart per minute, without 
regard to its force or other qualities. 

A quick pulse has regard to the suddenness of the impulse 
given bv an irritated heart, and the comparative brevity of time 



432 The Peoria Medical Monthly. 

the impulse lasts upon the examining fingers, denoting the small 
quantity of blood passing through the artery at each impulse at 
a given time, and has no relation to the frequency of the contrac- 
tion of the yentricles. 

A full pulse has relation to and denotes the quantity of 
blood passing through the artery in a given time, and has rela- 
tion to its volume only. 

A tense or hard pulse denotes the force of the blood press- 
ure; and such a pulse may be full, tense and frequent, or small, 
hard and frequent, or it ma}' be full and tense, or small and 
tense, without being frequent, and be recognized, in either case, 
by the difficulty we experience of compressing the artery so as 
to prevent the blood from passing under the fingers during ex- 
amination. 

A full, round, soft pulse, indicates, if regular, a normal con- 
dition of both the heart and arteries, and a general healthy con- 
dition of all the organic functions of the economy. 

A small, soft or feeble pulse denotes either great prostration 
of the vital forces, and a consequent feeble systole of the heart, 
or it gives us due and timely notice of dilitation of the left ven- 
tricle, and a consequent inability to propel the blood through its 
channels with its accustomed force. Again, great prostration of 
the vital functions of the body and dihtation of the ventricles of 
the heart may co-exist, and each condition being, to some extent 
at least, dependent on the other, gives us ample reasons to show 
why the pulse should be soft, the tension nil, and the impulse 
feeble. 

An intermittent pulse is one where the impulse given to the 
blood by the contraction of the ventricles, does not extend to the 
extremities: or it may be an entire omission of the ventricles to 
contract, but this occurrence is very rare. The prime cause of 
an intermitting pulse, usually, being the feebleness of the systole 
of the heart, from whatever cause this condition may have been 
derived. 

An irregular pulse has no relation to an intermittent, and 
yet, both may be present at the same time and in the same in- 
dividual. Irregularity simply indicates the condition of the car- 
diac action, that it is slow for a few beats, and then frequent for 



Original Communications. 433 

an equal or greater number of beats; and this condition of the 
heart's action always indicates a low condition of vitality, or irri- 
tation of the nerve centers that preside over the cardiac move- 
ments, or, perhaps, both conditions may exist at the same time; 
but in either case there would be abundant cause for such irreg- 
ularity. 

There are several other varieties of pulse of which authors 
speak, but the distinctions that they make are drawn a little too 
fine for any practical purpose to the general practitioner, and 
consequently I shall relegate them to the expert or connoisseur in 
such matters, who have more time, taste and opportunity^ to in- 
vestigate the pathological conditions which give rise to the more 
intricate manifestations of the heart's action, and its effect upon 
the pulse, which induces its most intricate variations. 

There is one thing, however, in this connection, that I would 
impress upon the minds of the younger members of the profes- 
sion, and that is, when you perceive any abnormal action, or 
sounds of the heart, never leave your patient till you have made 
a thorough stethescopic investigation of its sounds, and have pic- 
tured to yourself, in your mind's eye, the relations existing be- 
tween such condition and any functional derangement or organic 
disease, or lesion, that you may have under investigation. The 
facts are that we are all too much inclined to be in a hurry, and 
disposed to jump at conclusions, when we have only made desul- 
tor}- or casual examinations, and leave to nature — the greatest 
physician of us all — the repairs that we should have assisted her 
in bringing to a successful termination. We should be more 
methodical and deliberate in our investigations and aim to do 
nothing until we have made an investigation of all points con- 
nected with the case, and can give a good and sufficient reason 
for what we propose to do, under the prevailing conditions con- 
nected with the case. In man}- of the pecufiarities of the pulse, 
the cause may be looked for in the heart itself, it being as sub- 
ject to disease and functional irregularities as any other organ of 
the body, and the derangement, or disease, of this great central 
organ, may be regarded as a greater cause for alarm than any 
other viscus contained in either of the great cavities. The great 
and important reason for this is, that every other organ and 



434 The Feoria Medical Monthly. 

tissue of the bocl\- must and does receive its nourishment from- 
the heart by oxidation through the blood, which is the common 
carrier of these vital agents. The condition of the heart, there- 
fore, whether diseased or in a healthy state, is one of the princi- 
ple factors in the production of whatever character of pulse we 
may meet; and yet, the condition of the great nerve centers, or 
at least, that portion of them that presides over the nutrition and 
motion of the heart, mav have such an influence over the pulsa- 
tions as to make it very diflicult to diagnose the cause of such 
irregularities. Then, again, the pulse mav be full and tense, or 
small and tense, when there is hvpertrophv of the left ventricle,. 
and yet there may be neither a plethoric nor a sthenic condition 
of the system. Indeed, I have known old men, who had hvper- 
trophy of the heart to have a tense pulse to within a few hours- 
of their death. 

There are other conditions, however, that are either local 
or general, independent of the pulse, that mav enable us to make 
a correct diagnosis in any case, but w^e would naturally, even 
then, turn otu- attention to the pulse to ascertain the general con- 
dition of the system and its vital possibilities. If the disease is- 
sthenic, we will find a frequent, round, full, tense pulse, and the 
temperature above normal; in this case, the indications would be 
evacuants, sedatives, refrigerants, etc. But there ma}' be a 
sthenic condition and vet a small, corded pulse, which would be 
most likely to occur in congestion of the lungs when the capillar- 
ies refuse to let the blood through, either from contraction or en- 
gorgement from relaxation, to the left side of the heart; the 
right auricle and vsntricle becoming oppressed from engorge- 
ment with blood from the general system, and on account of the 
constriction or engorgement of the pulminary capillaries, the 
heart labors in vain to supply the general want. In such case 
we would have a small, soft, frequent pulse, and a mistake in 
diagnosis, in this case, might be a fatal error; because, instead 
of giving stimulants, as the pulse would indicate, the lancet 
should be used to relieve the engorgement of the right heart,^ 
and saline cathartics to lessen the engorgement of the portal cir- 
culation, and at the same time lessen hepatic embarrassment from 
blood pressure, caueed bv the inability of the heart to get rid of 



Original Communications. 435 

its apoplectic condition, caused by the engorgement of the capil- 
laries of the lungs. Again, we ma}' have a feeble, small, soft 
pulse, that may be occasioned from dilitation of the left ventri- 
cle, which, on a casual examination, would induce us to adminis- 
ter alcoholic stimulants, and then leave our patient to the tender 
care of uncertainties, under the conviction that we were doing 
all that could be done in the case, while, if we had made a more 
critical examination, we would have learned that, in addition to 
what we had ordered, v/e should have given digitalis with great 
satisfaction to ourselves and obvious advantage to our patient; 
the reason for which is too obvious to us all for further comment. 
Then, again, there are cardiac valvular lesions that interfere with 
the normal impulse given to the blood bv the contraction of the 
ventricles, which should be taken into considerate investigation. 
When we find the pulse is not normal, which may be ascertained 
pretty accurately by the different sounds transmitted through the 
chest-walls, and through the current of blood in its transmission 
through the arteries, we should be on our guard lest we should 
be taken unawares. For instance: In case of inefficiency of the 
tricusped valves, we not onlv hear a peculiar regurgitant mur- 
mur, but we see a retrograde impulse given to the blood in the 
external jugular veins, that mav be not onh' seen, but it may be 
felt; also, in case of perforation or sloughing of the semi-luner 
valves from ulceration, or other cause, the second sound of the 
heart becomes indistinct, or imperceptible on account of the 
blood beino- thrown back into the ventricles bv the elasticitv of 
the arterial membranes. This condition would not only signify 
a feeble pulse, but a vibrating one, and an indistinct impulse from 
the systole of the heart. 

I throw out these suggestions, gentlemen — by no means 
complete or exhaustive — on this subject, not because there is 
anything new or novel in them, but to call the attention of the 
younger members of the profession to the importance of this 
subject, and if I should succeed in this, I will be amply repaid 
for the thought and care I have given this subject. 



Subscribe for the Peoria Medical InIonthly, a practition- 
er's journal; $2.00 per annum. 



436 The Peoria Medical Monthly. 

TAPE WORM. 

BY J. OETTIKER, M. D., PLATTEVILLE, WIS. 

Having had excellent success in the cure of the few cases of 
tape worm which has fallen to my lot to treat, I will giv^e my 
method of procedure, and would ask those who have trouble in 
expelling this parasite to give this method a trial. 

In the treatment of four cases, the entire worm was brought 
away in three, at the hrst attempt; the fourth required a second 
treatment. I proceed as follows: Have the patient prepare a 
double handfull of pumpkin seeds — here in the country this is no 
trouble. I prepare 4 ounces of decoction of fresh pomegranate 
root bark, by macerating 21/2 ounces of the bark in 8 ounces of 
water for 24 hours, then gradually simmer down to 4 ounces. I 
then direct the patient to eat a very light dinner; at supper take 
half the pumpkin seeds, at breakfast the other half; half an hour 
after I give one-third of the decoction of bark, giving the re- 
mainder in two doses at the same intervals, following this in 
about t^^■o hours b}^ a large dose of castor oil. In case the pa- 
tient is inclined to constipation, I see that the bowels are well 
opened before beginning treatment. 

This treatment brought away a worm from a party who 
had received treatment from several physicians during a space 
of two years. 

There is nothing new in the remedies but probably few use 
the pomegranate and pumpkin seeds together. 



CORRESPONDENCE. 
CASES FROM PRACTICE. 



Brenham, Kas,, Dec. iS, 8185. 
Editor Peoria Medical Monthly : 

Not being overburdened with patients at present, while 
" holding down a claim," I will give you the outline of a case I 
attended in Mason County, 111., during September and October, 
1878, asking for comments as to treatment. 

A lad of fourteen sustained the fracture of both clavicles at 
the outer third and of left acromion process. Being somewhat 



CORRESPONDEN'CE. 437 

nonplused at such a combination, was at a loss, nevertheless I 
applied a double Fox's dressing, and secured a good result, not- 
withstanding his extreme restlessness. 

I can find nothing in Gross, Holmes or Hamilton for the 
treatment of such fracture, and would ask if there is a better way 
than I adopted? 

Last June was called to see R. D , aged 40; found him 

suffering from a dislocation of the left femur at its upper 
extremity, upward and backward into the illiac fossa. The 
characteristic shape of the muscles over the hip was fully de- 
veloped: the knee rested on the opposite limb above the knee; 
toe inverted touching above the ankle; a great degree of short- 
ening existing. 

Dr. Xorris, who attended with me, anaesthetized him and 
I reduced it in [a couple of trials, by manipulation alone. By 
using a protection bandage, there was no further trouble, except- 
ing the day after when I found the bowels fearfullv distended, 
this entirely disappearing on the exhibition of a brisk cathartic. 

Moved him eight miles on the fifth dav, and at the end of 
the third week he was moving around on crutches. 

W. P. Walker, M. D. 



MISTAKE CORRECTED. 

Wilmington, O., Dec. 5, 1S85. 
Editor Peoria Medical Monthly : 

Allow me to call your attention to what I believe to be 
a very grave and dangerous tvpographical error which occurs in 
^•our last issue of the Monthly, on page 415 in the formula for 
headache, according to which vou propose to give 7^ grains of 
corrosive sublimate (or about that amount) in a da}-. I suppose 
the " gr." should be substituted for the "dr." in the formula. To 
one of experience it would need no warning from me, but it 
might fall into the hands of one inexperienced in the drug and 
result in fatal consequences. I am sir, 

Yours respectfully, 

'g. S. Hill. M.D. 



438 The Peoria Medical Monthly. 

QUININE FOR CHILDREN— SWEATING. 

Editor Peoria Medical Mont/ilv : 

In your journal for November Dr. -, Wisconsin, wants 

to know the "best method for disguising the taste of quinine, 
especiall3' for children." 

Let me say that the formula published in the same number 
of your journal, page 413, or a slight modification of it, I have 
found as good as an}-, but I have for a number of years been 
using, with a great degree of satisfaction for some adults as well 
as children, the preparation known as " sweet quinine," manu- 
factured by Stearns, Farr & Co., of New York. It has in my 
hands, and in those of other I know, proven very efficient, is 
almost absolutely tasteless, and is taken b}' any child as readilv 
as is Dover's powder. It must be given in about one-third 
larger doses than the ordinarv quinine sulphate. I think that 
if the Doctor will use it a few times he will never again go 
amongst his little patients without it. 

In the same number of the Monthly Dr. M., of Illinois, 
inquires for a remedy for his case of night-sweats. Mv impres- 
sion founded on some experience, is that if he will give the child 
a spoonful of tincture of valerian each night upon going to bed it 
will soon recover from the vexatious complaint. 

Your other correspondent's querv in regard to the use of 
antipyrin I, too, would like to see answered bv some one prac- 
tically familiar with its use, for I know nothing of it mvself. 

Respectfullv, 

Medico. 



EXCESSIVE SWEATING. 

Editor Peoria Medical Monthly : 

In the last number of the Monthly Dr. M., of Illinois, in- 
quires for suggestions as to the treatment of a case of night- 
sweating in a child. In order to tr\- and aid the Doctor I will 
say that I some time ago had a couple of similar cases, and, rea- 
soning from the analogy between them and cases of sweating 
occurring with women at the change of life, I administered bro- 
mide of potassum with the happiest of results. I ha\e found 



Correspondence. 439 

nothing equal to the bromide in such manifestations at the cH- 
macteric, where the patient was otherwise in apparent health, 
and in my limited experience some cases in children, seem to be 
due to a similar condition of the vaso-motor nervous system, a 
condition which seems to be controlled, and in time removed, 

ty the bromides. \'erv trulv, 

G. 



C.^CAL OBSTRUCTIONS. 

Editor Peoria Medical MontJdx : 

The JS'ezu Tork Medical ^Journal, November 7, 1885, gives 
an account of the sickness, treatment, and death of James Law- 
rence Little, M. D. I have recently had two cases similar in 
symptoms which I treated successfully, and because I treated 
them successfullv, ond because both patients had been unsuc- 
cessfullv treated bv phvsicians before I attended them, therefore 
I give a brief account of mv treatment, so that others may have 
success in relieving the same kind of complaints. The com- 
plaint was caused by a collection of hardened faeces in the cae- 
cum, oppressing the iho-ccccal valve so that the patients had not 
had a movement of the bowels for days, and I could even feel a 
lump or swelling in the region or the caecum, and the patients 
were much distressed. I immediately had them lay on their 
right side, and a large injection of soap suds given to them so 
that the fluid would gravitate to the ceecum and iho-ca^cal valve 
to soften the hardened faeces and had the patients retain it as 
long as possible and then get up and discharge it. At the same 
time I gently kneaded the bowels in the rigct iHac fossa. This 
mode of procedure I pursued once or twice per day for several 
daj'S. The proceeding had the immediate effect to bring away 
considerable of the hardened fa?ces. I also gave to the patients 
slippery elm tea for a number of days. The both recovered 
rapidly and perfectly. 

Silas Hubbard, M. D., 

Hudson, 111. 



440 The Peoria Medical Monthly. 

PECULIAR SKIN AFFECTION. 

Editor Peoria Medical Monthlx : 

A year ago various persons in this vicinity suffered from a 
peculiar eruption of the skin. It was principally contined to 
men, and was very difficult to control. It was evidently not the 
ordinary itching eruption, inasmuch as the bacilla could not be 
detected by a high-power microscope. I used for it, sulphur, 
carbolic acid, and balsam Peru with marked success. Again, 
during the past few weeks, I ha\e had several cases for treat- 
ment. It is evidenth' the same, though in the present instances 
more distinctly postular. I now observe that it is found only in 
those of a weak constitution. This pustular eruption seems to 
be identical with that arisino- from a bed-bus: bite. The first one 
I saw I looked for a bed-bug. At this the lady became indig- 
nant, and informed me, in terms certainly as forcible as elegant, 
that there were none such in the house. 

Before long, I had a patient in my own hovise. The bed- 
bug theory is now, of course, out of the question. And as I can 
in this instance make a very close examination, I must confess I 
am unable to ia'ne the cause. I am not willin<£ to shove it into 
the locust's shoes, for it is alread}' sufficiently punished. As a 
second treatment I use a luke-warm solution of bicarb., sodium 
and iodide of potassium, following a mild cathartic. 

C. A. Wilde, M. D. 
Buckskin, Ind., July i8th. 

P. S. — Since writing you the letter I have recognized the 
insect which undoubtedly caused the eruption. It is the chiggTa 
or harvest bug. It must be a relation of the bed-bug. 



EXCESSIVE SWEATING. 

Palmyra, III., Deb. 17, 1885. 
Editor Peoria Medical MontJdx : 

For Dr. M.'s case of sweating I would advise alcohol in fuU 
doses, until relieved; then follow with — 
R. Con. tr. avena Sativ. 
Colerina. 

Elix. Simp., aa 2 ounces. M. 

SiG. — Teaspoonful every six hours. 

If you suspect phthisis give tr. verat. virid. in two drop doses 
twice a day, being careful to watch results. C. 



Society Transactions. 441 

SOCIETY TRANSACTIONS. 

CHICAGO MEDICAL SOCIETY. 

Stated Meeting, November i6th, 1SS5. The President, C. 
T. Parkes, M. D., in the chair. 

" A Report Embodying Two Hundred Cases of Tonsilitis," 
\vas the title of a paper read by Dr. J. INI. G. Carter, of Wauke- 
gan, lUinois. 

After detailing the treatments which had been employed in 
the cases, the author advanced the theoiy that since the great 
majorit}- of the cases occurred during March, April and May, 
when northeast winds prevailed, carrying landward more 
moisture from Eake Michigan, these winds must be one of the 
casual factors in the production of tonsihtis. Also the test from 
ozone during these months showed a greater percentage of ozone 
in the atmosphere. Another fact was noticed, that a great many 
cases occured in rheumatic patients. The author was of the 
opinion that the epidemic of cases detailed was due to the damp 
northeast winds, containing an excess of ozone, and to unusually 
disturbed electrical conditions of the atmosphere. The author 
grouped the two hundred cases, without classifying them, into-, 
cases of simple, diphtheritic or scarlatinous tonsilitis. He men- 
tioned, however, the fact that cases of simple tonsilitis were often 
accompanied or followed by attacks of diphtheria or scarlet fever 
among other members of the familv. 

DISCUSSION. 

Dr. F. O. Stockton said: We have tonsilitis in nearly all the 
eruptive fevers, usually following, and occasionally preceding 
them. The author refers to cases having diphtheritic patches 
ot the tonsils; I think he has confounded these diphtheritic cases 
with what we specialists call follicular tonsilitis. It is not a 
diphtheritic condition at all, but resembles it verv greatlv, so 
that in a different diagnosis these cases are verv often confounded. 
In regard to the temperature going up to 104, it is mv experi- 
ence, and that of authorities such as Cohen, Bosworth and Rob- 
inson, that it ranges from 102 to 103, seldom more than 103, 
usually 102. In the treatment of tonsilitis I have never found a 
gargle effective. In diphtheria or acute tonsilitis 3-ou can give 



442 The Feoria Medical Monthly. 

chloride of potash, or any other drug, but where a man has a 
pain in the angle of his jaw and a throat so sore he cannot 
swallow, if you can get him to gargle you can do more than I 
can. Ice held in the mouth until it dissolves is good, also powder 
•or tincture of guaiac and tincture of aconite internally, but never 
give more than three doses of aconite in one dav. Occasionally, 
if 3-0U see a case is going on to suppuration, use hot applications 
externally and internally in the wav of steam, otherwise never 
use hot applications. My idea is that heat promotes congestion 
more than cold, and my experience is that where cases are 
treated, some with cold and others with hot applications, that the 
cold in connection with other treatment, o^uaiac and tincture of 
aconite, is most surcessful. We ought to settle this question of 
tonsilitis. What is acute tonsihtis, and is there such a thing as 
acute tonsilitis r To me it is a misnomer. The abscess seldom 
forms in the tonsil, it is behind it in the loose connective tissue; 
and in opening it we cut behind or above the tonsil. 

Dr. C. W. Earle said: I would like to ask Dr. Carter if 
there was any appearance of contagion in anv of the cases? 

Dr. J. M. G. Carter said: Frequentlv the disease will attack 
everybody in the famih', old and voung. and just as frequently 
but one or two in the familv have the disease. It sometimes ap- 
pears to be contagious. 

D. G. C. PaoH said: Tonsilitis is a verv common disease 
in Chicago, especially among children. It is certain that there 
are different degrees of tonsilitis: there are liirht cases in which 
very little medicine is required, and again there are strumous 
children who are \-ery susceptible to the changes of weather, and 
in inclement weather get wet and have tonsilitis. In some cases 
one tonsil is affected, in others both, or the pharvnx. There are 
grave cases that cannot be cured in one week, or two, cases that 
develop into hypertrophv of the tonsils. In regard to treatment: 
a light case does not require ice, and a person with malignant 
scarlatina with tonsils affected would take cold from the applica- 
tion of ice. We should discriminate, and in malignant cases 
where the tonsils are inflamed, should be careful about applving 
ice. In the use of aconite, with children, we should be very 
careful, as in fever it diminishes the circulation, and I would not 
recommend its general use unless you can see the patient two or 



Society Transactions. 443" 

three times a day and watch the effect of the aconite. A simple 
thing to nse is a little potash with tincture of iodine. In scarla- 
tina complicated with diphtheria it is better to use very little 
medicine. I have nothing against chlorate of potash, however I 
read a verv interesting paper bv a professor in New York, his 
name I do not now remember, who sa3-s that observation has 
shown that chlorate of potash has often produced nephritis, and 
I think crreat care should be taken in its use. 

Dr. R. Tillev said: One of the points brought forward by 
the author is the use of kerosene. I remember that Besnier, a 
professor of skin diseases in Paris, savs that kerosene is used 
extensivelv by the laitv, but he regards it as a dangerous remedy 
in the hands of people generally, and a very inefficient one: he 
was speaking, it is true, of the treatment of itch. I protest 
against the use of the terms ozone and electrical conditions of the 
atmosphere: we know practically nothing about either. 

Dr. J. M. G. Carter said that he was obhged to leave in 
order to catch the train for Waukegan, and expressed regret 
that he could not remain and reply to the criticisms upon his 
paper. 

Dr. W. E. Quine said: An interesting feature of the ex- 
perience embodied in the paper is the obvious failure of the 
writer to differentiate infectious from non-infectious tonsilitis. I 
presume it is a matter of familiar observation to all who have 
been engaged in the practice of medicine that many cases of fol- 
licular tonsilitis occur which baffle the judgment of the most 
experienced physician to determine with precision whether they 
are infectious or non-infectious. I have often seen in my prac- 
tice cases of this kind. Often one member of the family, prob- 
ably the first one attacked, exhibits plainly marked features of 
simple follicular tonsifitis, and those of the family who sicken 
afterwards exhibit the phenomena of diphtheria, or less fre- 
quently, scarlatina. The text-books do not give a reliable guide 
to diagnosis, and if any of my colleages know of means by which, 
cases of this kind can be differentiated with certainty we would 
like to know them. 

One gentleman has alluded to the opinion of an eminent pro- 
fessor in New York; I remember that Jacobi, who is perhaps the 
person referred to, in a recent article maintains very vigorously 



444 The Peoria Medical Monthly. 

that man}' cases of so-called tonsilitis are in reality immature cases 
of diphtheria, and he stoutly maintains that there are many cases 
of diphtheria never having patches in the throat, and where the 
patient walks on the street and communicates the disease frtely 
to those with whom he comes in contact. 

Dr. Sarah Hackett Stevenson said: Last February I was 
called to see a ladv who had frequently suffered from tonsilitis. 
She was " subject to quinsy."' I suggested that her child should 
not be kept in the same room with her as the case seemed more 
than ordinarily violent, and gave the usual treatment for quinsy: 
the disease went on to suppuration. I was called out of the city 
after one of the tonsils had discharged, and during my absence, 
about live days, her child was attacked with malignant scarlet 
fever, and died before my return. This is the first case in which 
I ever suspected that a benign form of tonsilitis might repro- 
duce a malignant form. Since then I have watched all cases, 
however simple thev may seem. 

Dr. C. T. Fenn said: I think we should all take an interest 
in this work, especiallv in the most practical suggestions of Dr. 
Earle. The fact is, that to regard these cases ail as malignant, 
is to be on the safe side. A case of simple tonsilitis has a ten- 
dencv to develop into diphtheria. I protest against the folly of 
attempting to distinguish between mild and simple cases of ton- 
silitis and diphtheria. In regard to treatment, I have no use for 
gargles or washes: I will not force open the mouth of a child 
and cause it to crv, but steadily and persistently, every fifteen 
minutes, I will give such medicines as the child will pass over 
the tonsils when swallowing. 

Dr. J. S. Knox said: I regret that the paper is so general, 
the author evidentlv grouping together a variety of cases of ton- 
sihtis of different classes. There is undoubtedly an inflamma- 
tion of the tonsils due to eruptive diseases, such as small-pox and 
scarlet fever, and there is a tonsilitis which is purely catarrhal, 
and another which is purelv due to diathesis and which is rheu- 
matic or svphilitic. The treatment differs accordingly. I think 
there is an error as to the value of chlorate of potash: better 
results will be obtained from the use of bicarbonate of potash, 
the value of the drug lying in the fact that it is a potash salt, 
and 1 think that the bicarbonate of soda ^^ ould be still more effi- 
cient. Where the hvposulphite of soda would do good, the sa- 
licylate would do more. 



Society Transactions. 445 

Dr. J. J. M. Angear said: It seems to me that if we remem- 
ber that there is such a thing as resistance, the absence of which 
is succeptibility, it will explain some, if not all of these difficul- 
ties. We can readily imagine a robust, healthy child with strong 
resistance to morbid influences, and especially that of diphtheria, 
on exposure, would have simple tonsilitis (abortive diphtheria); 
but suppose that his brother, with strong susceptibilitv, is ex- 
posed to the same morbid influences, he will develop a case of 
undoubted diphtheria. 

In diphtheria, we have an inflammation with fibrinous exu- 
dation which breaks down the mucous cells and forms the diph- 
theritic patch; this furnishes a nidus for the micro-organisms, 
which go on secreting or fermenting their peculiar virus, the ab- 
sorbtion of which contaminates the whole body, and now we 
have a constitutional disease. Will not this explain a large num- 
ber, if not all, of those cases where four or five children in a 
family are taken apparently with simple tonsilitis, and some one 
child that has not their resistance is attacked with undoubted 
diphtheria. In this house we have tonsilitis, and our neighbor 
severe diphtheria. Bv remembering these pathological facts, 
we shall see that it is, or it mav be, all the same morbid influ- 
ence here and 3'onder; here, recover}' in a few days; there, death 
in a few hours. 

Dr. F. O. Stockton said: In acute tonsilitis I think it will 
be found that ice is the proper treatment in the first stage, before 
suppuration has begun. It is verv seldom that pus is located in 
the tonsil, it is behind the tonsil. With regard to a differential 
diagnosis between diphtheria and tonsilitis, there is almost always 
in diphtheria a regular graded rise in the temperature: in acute 
tonsilitis, so-called, or follicular, the temperature is not regular, 
it rises at a jump, the attack comes on suddenl}-, begins with a 
chill immediateh" followed by fever; in diphtheria there is a grad- 
ual rise, going up one day, dropping the next. I think if we took 
a record of given cases of diphtheria and tonsilitis, we would find 
that a regular rise in temperature in diphtheria occurs as in the 
essential fevers. 



446 The Peoria ]\I?:dicai. Monthly. 

PERISCOPE AND ABSTRACT. 

COMPLETE INVERSION OF THE UTERUS FOL- 
LOWING PARTURITION. 

Henry E. Crampton, M. D., of New York, concludes a ver\" 
interesting and exhaustive paper on the above subject in the No- 
vember number of the American journal of Obstetrics, from 
which we take the following as of special, practical importance 
to every man or woman engaged in obstetric practice: 

In recent inversion we have constant hemorrhage, more or 
less profuse. Shock is rarely absent. Conjoined with these 
there is a peculiar anxious expression and manner. The patient 
cannot keep quiet, but tosses fretfully about the bed, and screams 
with pain during examination. Every movement shows how 
profoundly the whole nervous system sympathizes with the ter- 
rible dislocation. 

A vaginal examination makes the diagnosis certain. 

If, "by reason of strength," she rallies from this state and 
gets about, she suffers from frequent hemorrhage, more severe 
at the menstrual period and after weaning. There is progressive 
anaemia, with leucorrhcea, frequent and exhausting faintness. 
Life is rendered niiserable. 

Crosse relates a horrible instance of mistaken diagnosis which 
I will briefly summarize: 

The patient had borne eight children. The last two labors 
had been delayed by adherent placenta. In her ninth confine- 
ment, she was attended by a licentiate of Apothecaries' Com- 
pany who, finding some difliculty in taking away the after-birth, 
proceeded to remove it by force. " He soon broke the funis and 
subsequently removed portions of the placenta, and continuing 
his operations, causing most excruciating sufferings to the pa- 
tient, he, at length, and by great perseverence, removed a large 
mass which the woman present thought looked like a liver or an 
enormous after-birth. This he took awav in a vessel to his own 
house, situated near b\', and soon returned; but before he arrived 
the patient was dead. The next dav, he represented that he had 
removed a large tumor or pol3-pus, weighing three pounds. 

" Strong suspicions of malpractice having been entertained, a 
post-inortcni examination was made. Dr. Crosse himself assisting, 
when it was demonstrated that the entire uterus, with its ap- 
pendages, all the large intestines, except the lowest thirteen 
inches, nearlv all the great omentum, the caput coli and two or 
three feet of the ileum next above it, had been forcibly removed, 
per ^•aginum, in this most unparalleled case.'' The result of the 
inquest was a verdict of manslaughter. The doctor was subse- 
quently tried, but escaped conviction. 



Periscope and Abstract. 447 

Chronic inversion has been mistaken for poh'pus, but the 
error can be corrected by a verv simple procedure. Two fingers 
of one hand should be introduced into the rectum, while, at the 
same time, a sound is passed through the urethra. If these meet 
above the tumor, the uterine bod}' is absent, and inversion must 
have taken place. 

Hemorrhage is the most constant svmptom. It is often 
profuse and alarming, and frequently the sole cause of death. 
In four cases only is it set down as slight, but in one of these 
death took place in half an hour from collapse and shock. In 
one instance it was entirely absent: the patient recovered. Shock 
was always marked. This peculiar indefinable condition, which 
we all recognize but cannot locate, is the great danger in 
uterine inversion. This will not seem strange if we think for a 
moment of the serious dislocation of the most sensitive tissues of 
the human body which must ensue from this accident. The 
ovaries, the Fallopian tubes, and the uterine ligaments are dragged 
down into the pelvis, while the sensitive and bleeding endome- 
trium itself is exposed. Death ensues in about twenty per cent. 
of recent inversions, whatever the treatment. 

In concluding his article, Dr. Crampton then submits the 
following propositions: 

1. Inversion of the uterus is preceded by paresis of some 
portion of the uterine muscle (not necessarily of the placental 
site), caused either by too frequent child-bearing, tedious labor, 
previous miscarriages, traumatism ( blows upon the abdomen 
received during pregnancy or labor), emotional excitement (no- 
tably in primipara? ), or too rapid labor. It is a pure neurosis in 
its inception. Traction upon the cord may induce prolapsus; if 
severe, procidentia. It will never alone produce inversion, but 
may facilitate it, if paresis is present. 

2. It is more apt to occur in first than in subsequent deliv- 
eries. 

3. This liability in primiparai is due to the peculiar emo- 
tional excitement preceding and associated with a first labor re- 
flected upon the exhausted uterine muscles for the first time called 
into unusual action. ( Eight out of ten of all cases of puerperal 
eclampsia occur in primipara? for analogous reasons.) .Given a 
slight degree of depression of any portion of the uterine body, 
and the natural rigorous contractions of the uterus in a first labor 
become a source of increased danger. 

4. In a great majority of cases of recent inversion, tirm and 
persistent pressure (under anaesthesia j upon any portion of the 
inverted organ will serve to reposit it. 



448 The Peoria Medical Monthly. 

5. In chronic inversion gentle, graduated, and long-contin- 
ued pressure, either manual or instrumental, or both combined, 
has proved the most successful treatment. Forcible taxis is not 
devoid of danger. Extirpation is a last resort. 

6. Chronic inversion would be rarely found if every physi- 
cian adopted the invariable custom of making repeated and care- 
ful vajxinal examinations after ever labor. 

7. The prophvlactic treatment of uterine mversion is ob- 
viouslv the same as that required for the prevention of puerperal 
eclampsia. 



BILROTH'S VIEWS OX ANTISEPTCS. 

Bilroth writes the following on antiseptics: 

I. Iodoform is the safest and most effective of all manage- 
able antiseptics. 2. Moss, wood, turf, mould, and oakum are 
useful when there are discharges from the wound. 3. Corrosive 
sublimate in dilute solution is practically inert as an antiseptic to 
wounds, and renders the patient and surgeon alike Hable to mer- 
curial poisoning. 4. Carbolic acid, which is known to be dan- 
gerous in strong solutions, is, in very weak ones, as good for 
wound irrigation as clean water, but probably no better. — Ca)!- 
ada Lancet. 



THE ACTION OF DISINFECTANTS ON MICRO- 

ZOOIDS. 

In the Sanitarian for December we tind an abstract of a 
paper read before the medical officers of Health Society, March 
20, 1885, and clip therefrom the concluding paragraph, as fol- 
lows : 

Turning to the practical aspect of the question, the author 
summarized the general conclusion to be drawn from these re- 
searches. Disinfectants, when they are not destructive agents, 
act as poisons: thev poison the microzooid in a manner not essen- 
tiallv different from the lethal poisoning of a higher life form, and 
this is the reason whv such poisonous substances as corrosive 
sublimate, carbolic acid, and chlorine are most to be relied upon. 
It was evident that, to perfectlv disinfect, the element of lime 
must not be disregarded: to receive the specific excreta into a 
strong solution of sulphate of iron or of carbolic acid, and then 
within a few minutes cast the excreta into a drain, could only 
superticiallv disinfect, and such excreta might in man}- obvious 
w'ays again become dangerous. He considered that the best 
and most efficient way to disinfect a room after disease was: 



Periscope and Abstract. 449 

First, to make it as much as possible like an hermetrically sealed 
box, and in this box to evolve chlorine: three pounds of chloride 
of lime and three pounds of hydrochloric acid for every thousand 
cubic feet of space. The chloride of lime was to be divided into 
several distinct parts in deep vessels, and to be placed as high in 
the room as possible; the hydrochloric acid was to be mixed 
with the chloride of lime gradually, in the manner described by 
Fischer and Proskaner. The room was to be kept closed for 
twentv-four hours. Secondly, all things in the room capable of 
being submitted to a moist heat were taken away to a suitable 
apparatus. Thirdly, the floor was to be washed with a solution 
corrosive subHmate (i to 1,000). The principles of this pro- 
cess had been carried out in the parish of Mar^lebone for more 
than a year, and the author considered the method the best at 
present known. 



DISGUISING QUININE. 

The Canada Lancet says " one and a half grains of tannin 
will neutralize the bitterness without changing the action of ten 
grains of quinine," and adds : " The intense bitterness of the drug- 
renders it almost impossible to administer it to children in its 
natural state." 



THE EPIDEMIC ZYMOTIC DISEASES OF ANDFALS 

AND HOW THEY ARE COMMUNICATED 

TO MAN. 

In the Canada Lancet for December we find an annual ad- 
dress on the above subject, read before the Medico-Chirugical 
Society, Ottawa, by Dr. J. A. Grant, of London, which contains 
so much that is of interest aud value not to be found succinctly 
stated elsewhere that we live the sahent points thereof, as fol- 
lows : 

"The subject,' says the Doctor, 'is one of vast importance 
to our common country, irrespective of its scientific aspect, inas- 
much as it involves milhons in our live stock. Endermic and 
epidemic diseases are not alone confined to the human species." 
The analogy in manifestation is so close that they are designated 
by the same names. 

" The next cause of these diseases is supposed in the an- 
imal organization to act like a ferment, hence the term 'zymotic' 
According to the most recent inquiries the generation of ' organic 
germs ' originate in the individual, or by fermentation in the dis- 
eased excretions of organism, and thus transmitted through va- 
rious media from body to body, at sensible and insensible dis- 
tances.' 



450 The Pp:oria Medical Monthly. 

" Diseases in animals are of two classes, the exolic or ?/;/- 
coniiiio)!, and the iiidiornoiis or coniDion. Of the first class we 
have sniall-pox In sheep and birds, pleuro-pneumonia of cattle, 
rinderpest, malignant diseases of the generative organs of the 
horse kind, malignant cholera of animals, aphthous fever, known 
as foot and mouth disease. Of the second class, or indigenous 
diseases, belong glanders, rabies, contagious foot rot, tuberculo- 
sis, mahgnant asthma, hog cholera, or intestinal fever of swine, 
influenza, strangles, canine distemper, and horse pox, seen in the 
cow, goat, and pig. In each of these zvmotic influence is at work 
as in development of disease in our own species. Impurity of 
air, soil and water produce these diseases, in both milk and meat, 
thus influencing the human family and spreading the germs of a 
disease of a most serious character. 

" Rinderpest, or Russian cattle plague, is a most contagious 
disease amongst animals of the same species. It is characterized 
b}' a congested state of the mucous membrane of stomach and 
bowels, associated with a high temperature and extensive des- 
quamation of both skin and mucous membrane. 

" Foot and mouth disease is a contagious erupti^■e disease, 
confined chiefly to cloven-footed animals, but has been known to 
extend to man. It is ushered in bv a rise in temperature and gen- 
eral feeling of discomfort, and uithin a da}' or two followed bv 
large blisters on the mucous membrane of the mouth, tougue, 
fauces, udders, and the parts in and about the clefts of the hoofs. 
Milk from such diseased animals is often carried to individuals, 
who in fact most frequently come in for a share of the diseased 
influence. Soreness and otherwise unaccountable lameness in 
cattle is a most significant indication, when associated with an 
apthous state of tongue or fauces. Thorough disinfection is 
here necessar}', and ablution with carbolic acid lotion, with isola- 
tion for ten or fifteen days after disappearance of the disease, 

" Epizoo, or epizooty, known as influenza or horse epidemic, 
has extended at same time to man and beast. Absolute quaran- 
tine is the best remedy. 

'' Intestinal fever of szc'ine. misnamed Iioi^- cholera, is attended 
by congestion, exudation, blood extra\azation in the mucous 
membrane of stomach and bowels, by general heat, and redness 
of the surface, and bv the appearance on the skin of spots and 
blotches of a scarlet, purple or black color. It is said to be in- 
fectious. It needs further investigation. 

Pork as an article of diet makes the diseases of the hog play 
an important part in relation to public health. Of the parasites 
which infest the flesh the trichina and the exsticcrcns celhilosce 
give the most trouble to man. The former taking up its abode 
in the muscles, and the latter producing the tape-worm. Through 
cooking will, in either case, pre\-ent disastrous consequences. 



I 



Periscope and Abstract. 451 

" Glanders, or farcv, requires more than a passing notice 
from the fact of its fatality when communicated to man from the 
horse. Its chief specitic peculiarities are its inflammatory lesions 
of the nasal and respiratory mucous membranes, lymphatic ves- 
sels and glands, marked constitutional depression, and frequently 
accompanied with a pustular cutaneous eruption. Glanders in 
man is very rare. It is alwavs communicated bv direct inocula- 
tion of virus from the diseased animal. Average duration about 
sixteen da^'S. The wound through which the poison is admitted 
becomes inflamed, tense, painful, and usuallv has an erysipelatous 
circumferance. The ulcer enlarges, presents a chancroid as- 
pect, discharging sanious, offensive matter, and the lymphatic 
vessels around present a knotted, cord-like, irregularity, modu- 
lated condition, known in man as farc\ buds. According to Vir- 
chovv, resolution and absorption occasionally take place, but more 
frequentlv abscesses form and constitutional svmptoms indicating 
a low type. Within the first or second da}- of this disease ( and 
sometimes longer), scattering collections of red spots appear on 
the skin, small, and resembling flea bites: subsequently they be- 
come papular, and elevated above the skin like small shot, and 
assume a vellow color. The mucous membranes become af- 
fected, particularh- that of the nose, with inflammation and ulcer- 
ation. The debilitatino- character of this disease indicates a stim- 
ulating, soothing and supporting treatment. Inhalation of iodine 
and carbolic acid are strongly recommended, and thorough syr- 
inging of the nose with Condv's fluid (solution) carbolic acid 
lotion, or iodized water."' 

Dr. Grant then reverts to the fact of the production of tu- 
bercular disease bv feeding animals on tubercular matter, ac- 
cording to the experiments of Dr. Bell, of New York, and others, 
and the promotion of t^'phoid fever bv impure milk. He thinks 
that much good mav be accomphshed by interesting ph^-sicians 
more deeply in this matter. According to Dr. Bowditch there 
are more than "two hundred thousand human beings slaughtered 
annually in the United States by preventable diseases." 

" As to disease in animals, the members of our profession 
hold great power in their own hands." The facts render it rea- 
sonable that there should be some degree of inspection as to both 
milk and meat, by the proper sanitary authorities. 

The country practitioner, especially, has it in his power to 
contribute to science many a fact connected with the matters 
above referred to, and possibly in time deflne the exact cause of 
various diseases of zymotic character, originating in animals and 
communicated to man in various modifled forms. 



452 The Peoria Medical Monthly. 

TREATMENT OF DIPHTHERIA. 

On November 25, 1885, Professor Joseph E. Winters read 
before the Section of Obstetrics and Diseases of Women and 
Children a paper, very exhaustive in character, on the above 
subject. The same was published in the iMedical Record for 
December, and from his remarks on treatment we take the fol- 
lowing sensible observations: 

" The treatment of diphtheria is far from having reached 
that unity that might have been expected from the attention which 
has been devoted to its consideration. The number of remedies 
to which physicians are continually having recourse proves the 
efficiency of the greater number of them. Some remedies which 
have recently been highl}- recommended, if used as unsparingly 
as their advocates directed, would certainly be injurious, while 
others have been tried and found to be useless. If we study the 
death-rate of this disease, we must confess that, up to the pres- 
ent time we have not, on the whole, been verv successful with 
any mode of treatment. It is easy to be deceived in regard to 
the usefulness of a remedy employed against diphtheria, for some 
cases will do well with very little treatment, provided they re- 
ceive good care: on the other hand, where a case or a number 
of cases are not influenced, or at least not favorablv affected by 
the treatment, we are too prone to tell the parents that it is a 
case of unusual virulency, or one of malignancv, instead of ex- 
amining into our comprehension of the case, and our treatment 
of it, and admitting that the cause of failure to cure lay here. 
True, there are cases of diphtheria of great malignancv, but if 
we were to adopt a system of rational therapeutics to meet the 
indications of each individual case, based on well-considered 
physiological and pathological data, we would hear less about 
malignant diphtheria. 

" We are too apt to be wedded to particular methods of 
treatment, and believe in their excellence, without giving due 
regard to the indications of cure furnished by the epidemic char- 
acter of the disease, the constitution and diathesis of the patient, 
the character of the symptoms, the disordered functions of the 
important organs of secretion and excretion; the modes and paths 
of elimination of the virus of the disease: the disposition to cer- 
tain complications; the prevalence of other epidemic diseases 
which might modifv its course; and the season of the year. 
Each and all of these conditions should be our chief guides, as in 
every case much depends on the precision with which the exact 
nature of the case, and the state of the vital powers are ascer- 
tained. The mode of treatment in vogue has for its object (ac- 
cording to its exponents) to attack tlie poison or germ of the 
disease, as an entity, and destroy it, leaving out of \iew every 
other consideration. 



Periscope and Abstract. 453 

" Physicians in search for such a specific are distracted from 
a rational treatment. These experiments have doubtless killed 
more patients than germs."' 

" x\fter carefully considering the results of mercurial treat- 
ment thus far adduced, as well as other features in the manage- 
ment of the disease, the author continues: 

" From carefullv weighing these facts, I haye come to re- 
gard elimination of the poison as the first indication of cure in 
diphtheria. By this management we promote the expulsion of 
the morbific matter, and we are able to use, with decided benefit, 
drugs directed against the disease, such as iron, quinine, etc.; 
but the use of these drugs from the outset in cases of marked 
febrile disturbance, without preparatory treatment, seems to ag- 
gravate the symptoms and to less thoroughly control the disease. 
For the purpose of eliminating the poison so far as possible by 
the throat, intestines, skin, and kidneys, have recourse to mild 
purgation, simply sufficient to excite the activity of the glands of 
the intestinal tract, triturated calomel in small doses being the 
best for this; put poultices to the neck to excite the activity of 
the mucous glands of the throat; powdered ipecacuanha com- 
pound, as a sedative, diaphoretic, diuretic, or a hot foot-bath, ac- 
cording to indications. Of course this plan is not to be adopted 
indiscriminately, but our treatment must be modeled in accord- 
ance with the degree and acuteness of the inflammation, and an 
accurate estimate of the vital individuality of the patient." 



DOCTOR'S BILLS. 

The Medical Record of recent date sa}'s that the reason the 
doctor's bills are so often impaired is that he fails to make a sea- 
sonable effort to collect them. This is especially the case with 
clerks, mechanics and the small trades generally. The bills are 
left so until they become relatively large, and then it is impossi- 
ble, nearly, for the " pa}- as a'ou go "' class to liquidate them. 
Better collect as frequently as the party collects his wages, and 
thus retain both his esteem and his practice. Excellent advice, 
we think. 



ANOTHER INX^OMPATIBLE. 

Chloral hydrate, mixed with bromide of potassium in an 
alcoholic or hydro-alcoholic solution, in the presence of sugar or 
syrup will form, at first, a milky mixture, and, upon standing, 
separate into two layers. The supernatent layer will consist of 



454 The Peoria Medical Monthly. 

a light straw colored liquid containing chloral alcoholate. The 
dense liquid below will consist of the bromide of potassium of a 
light color. Prof. F. H. Markoe communicated this fact to the 
Massachusetts State Pharmaceutical x\ssociation at their last 
meeting stating that such a mixture was not a desirable one for 
the reason that the harsher action of the chloral alcoholate upon 
the system was objectionable and the comparative immiscibilitv 
of the two layers rendered the equal distribution of doses almost 
an impossibilit}'. Equally objectionable is the mixture of chloral 
hydrate with sodium bromide, sodium chloride and magnesium 
sulphate, in strong solutions in the presence of sugar and alcohol, 
but ammonium chloride, ammonium bromide, potassium nitrate 
and calcium bromide were entirely compatible with chloral made 
under similar circumstances. — Dnfg-oy\</s' yourual. 



COCAINE— NITRIC ACID. 

The mixture of cocaine with nitric acid gives a painless es- 
charotic for the removal of moles, deep seated freckles, etc. A 
formula for its preparation was recentlv published in the Xa- 
tional Druggist^ which we here give: 

R. Nitric acid (s. q. 1.340), tl 1 drachm. 

Cocaine, 6 grains. M. 

Keep in a small bottle with well fitting stopple for use. 

The mole or freckle should be surrounded with a rincj of 
wax to protect the adjacent skin. The end of a glass rod dipped 
in, and then cautiously applied to the surface of the mole or 
freckle, the process being repeated once or twice a day, and the 
unsightly spot has the vitality destroyed without pain, being then 
easih' and effectualh- removed. — Druggisis' younial. 



ANTI-FRECKLE LOTION. 

R. Hydrarg. bichlor, 12 grains. 

Acid hydrochlor, pur., 3 drachms. 
Fruct. amygd. amar., \h ounce. 

Glycerin, ] ounce. 

Tinct. benzoin, 2 drachms. 
Aqua flor. aurant., q. s. 

Dissolve the corrosive sublimate in three ounces of the or- 
ange flower water, add the hydpochloric acid, and set aside. 
Blanch the bitter almonds, and bruise them in a Wedgwood mor- 
tar, adding thereto the glycerin, and using the pestle vigorously; 



Periscope and Abstract. 455 

a smooth paste is thus obtained. Then add o-raduallv about nine 
ounces of the orange flower water, stirring constantly, continu- 
ing this operation until a fine, creamy emulsion is the result. 
Subject this to violent agitation — preferably with the aid of a 
mechanical egg-whisk- — and allow the tincture of benzoin to fall 
into it the while, drop b}' drop. Then add the mercurial solu- 
tion, filter, and make up the whole to the measure of twenty 
iluid-ounces with more orangre flower water. 

This preparation is recommended to us by an eminent der- 
matologist as being invariably efficacious in the treatment of 
€p/ic/is, and always greatly ameliorating loit/go, even if it does 
not entireh" decolorize the patches in the latter case. A general 
whitening of the skin is produced by this lotion, without any irri- 
tation. It is as well, however, not to apply it to any abraided 
surfaces. It has been found far superior in practice to a prepa- 
ration — which it sometimes resembles — sold at a high price in 
Paris, under the name of La if Aiitipheliijiic. — Phannaceiitical 
Hecord. 



HOW TO BUILD UP A MEDICAL SOCIETY. 

Our contemporary, the yonnial of the America)} Uledical 
Association^ in commenting upon an editorial which appeared in 
the issue of the Marylaud Medical journal oi October 31, under 
the above heading, has taken occasion to extend and supplement 
our remarks in an article which commends itself to all profes- 
sional readers. There can fee no denial of the fact that the man- 
ner in which man}^ medical societies are conducted is open to 
just criticism, and to correction. We have, previously, urged in 
our columns the importance of correcting some of the abuses 
which attach to the work done in our local medical societies, 
such, for example as the careless and indifferent way in which 
original papers are gotten up, cases reported and specimens ex- 
hibited, as also in the impromptu discussions which follow. It 
must occur to those who attend these society meetings that there 
is vast room for improvement in the methods of presenting work, 
and we think, with some effort on the part of each member, an 
improvement would follow if the reports of these societies were 
properly prepared and published. The facts that a speaker's re- 
marks will appear for or against him in print will have a double 
effect; it will encourage him to prepare well before he attempts 
to speak upon a given subject, or it will enjoin upon him the ne- 
cessity of keeping silent if he has nothing worth}' of remark. 
Both of these motives are worthy of encouragement. It is far 
better to kept silent than to talk irrele\-antly on any subject. On 



456 The Peoria Medical Monthly. 

the other hand, encouragement should be given to those debaters 
who come to a meeting prepared to instruct their associates in 
facts derived from experience or careful studv. Indeed, a society 
which stimulates original work, the development of an individual 
experience, or the cultivation of the intellectual faculties b\- dil- 
ligent study, is doing a valuable work for its membership, just as 
one which permits membership to run wild in careless statement 
and in voluble discussions is correspondinglv lowering the status 
of its work and usefulness. There must be a reason for the ex- 
istence of a society. The subject in view is not purely social or 
ethical. It seems to us the chief aim is to advance the individ- 
ual experience, skill and knowledge bv the association of ideas, 
exchange of views, and relation of the experiences of a number 
of individuals. By co-operation strength is imparted. But this 
co-operation cannot reach its full measure of strength unless each 
individual contributes a proportionate share. What one builds 
up another tears down unless each contributes to the general 
fund. Hence the societv which stimulates no power of strength 
is directly encouraging its elements of weakness. 

Our contemporarv offers the following", which we think 
worthy a place at the conclusion of our remarks: 

" One point more. Every phvsician should consider it his 
dut}' to belong to at least one medical societ}-: and his second 
duty is to attend the meeting. Verv manv phvsicians seem to 
regard membership in a medical societv as something accidental 
or incidental to professional life, rather than a dutv which each 
ones owes to himself and his profession. For example, of the 
fort}'-three or four hundred regular phvsicians in Illinois, there 
are not two thousand who are members of medical societies. 
This is certainly a verv bad showing for members of a 'learned 
profession.' But the same is true of almost everv state in the 
Union. For one county in Illinois, \\'ith twentv-four regular 
physicians, we learn that 'there is no medical societv in this 
county. The profession is divided." The ' divided profession* 
should remember that a societv is for the good of the whole, as 
well as for the benefit of individual members."' — Maryland Med. 
yoiinial. 



HAY FE\'ER. 



I have used, for two years, during the summer and fall 
months, the fluid extract and tincture of apoc\num for this 
strange disease. I have not supposed, for the last hve or six 
years, that there was any other wa}- to treat this disease except 
b}- partially destroying the mucous membrane of the nose. 



Periscope and Abstract. 457 

I have used apocynum on eleven cases of hay fever last year, 
and the past summer and fall, with a complete cure in five cases 
and ver}' great benefit in the other six. Two of the six were 
onh' partiall}' benefitted. I used on the last two named a four 
per cent, solution of muriate of cocaine, 25 drops to i ounce of 
vaseline. Place 20 grains of this mixture in each nostril at bed- 
time. This application, once every day, gave almost complete 
relief during the whole twent3^-four hours. 

The quantity of apocynum used w^as 30 drops of fluid ex- 
tract to 4 ounces of water; dose, i teaspoonful every three hours. 

I would like for some of your readers to use the above pre- 
paration, and report what success. — IV. H. Halbcrf, M. D., iit 
Georgia Ec. J\fed. your. 



ABSCESS OF THE LIVER. 

I do not propose to enter into an exhaustive discussion of the 
subject of this paper. Nor do I deem it at at all necessary, at 
this time, to deal too minutel}^ with a subject so generally under- 
stood by all physicians and surgeons as abscess of the liver. But 
in justification, somewhat, for the present detail I will say this, 
that the inexperienced upon this subject will find very little to 
console them by searching our standard authorities. The}- all 
state that this is a disease that prevails in Egvpt, in the East and 
West Indies; and one author states that it is occasionally seen in 
boatmen on the Mississippi river. 

That it does exist, and exists in sufficient abundance, all up 
and down our southern water-courses and other places where 
miasma abounds, is a truth that cannot be questioned, and urges 
every practitioner to ever be on the alert for hepatic abscesses in 
all cases of chronic disturbances of this organ. 

When we have a well-defined case of abscess of the liver 
pointing outwardly, we have a case easy of diagnosis, and easily 
treated; the prognosis of which, with proper treatment, I would 
always deemi favorable. But when the abscess is deeply seated, 
or pointing internally, the diagnosis is especiallv difficult, the op- 
erative treatment tedious and dangerous, and the percentage of 
deaths far greater. To distinguish these latter from encysted, 
or fatty tumors, from hydatids, and, in fact, to distinguish them 
at all, the aid of the exploring needle must frequently be called 
into requisition. An intelligent history of the case, howe^'er, 
will reveal enough, with the few physical symptoms that are de- 
veloped, to almost make certain our diagnosis. 

But just here w^e might ask: What use have we for the di- 
agnosis? When many of our standard authors say that we 



458 The Peoria Medicae Monthly. 

must not operate on the deep-seated abscesses at all: that the}- 
are sure to die: at the same time confessing that the fluid, left to 
itself, without an operation, will some day break internally, and 
by so doing- create a certain death. 

Begin, of France, recommends the following operation for 
deep-seated abscesses of the liver: Make an incision some two 
or three inches long upon the most prominent part of the swel- 
ling, and divide with great caution the layers of the abdominal 
wall, until the peritoneal linings are reached: raise this carefullv 
with the forceps, nick it and afterwards divide it. Upon reach- 
ing the surface of the tumor, the operation must be temporarily 
arrested, the wound filled with lint and dressed; the patient to 
remain three or four davs for adhesion to take place, after which 
we open into the abscess with reasonable hopes of success. Sev- 
eral years ago, the Medico-Surgical Society of Alexandria pub- 
lished the statisiics of 123 cases, of which only forty-two were 
operated upon, and eightv-one without an operation. Of the 
Avhole number seventy-nine died: in nine the results were not 
ascertained. It is of interest to note that of those not operated 
upon eight^• per cent, died, and of those who were operated upon 
only fifty per cent. died. It seems to me, with a limited ex- 
perience and knowledge of the disease, that the death-rate here 
cited in both classes of cases is higher than it would be in our 
countr}'. 

A clinical case of much interest has recently come under my 
observation, a recital of which ma}' be of interest to others. 

Case. — Saw D. M., colored male, about 30 3'ears of age, on 
March 2, 1885. He gave the following history: He had been a 
deck hand on a steamboat and a cotton picker up and down the 
Mississippi river for the past two years. Had been in bad health 
for six months: unable for two months to do anything. Was 
now complaining of gnawing pains in the right side, had fre- 
quent rigors, was somewhat dropsical, with enormous enlarge- 
ment of the liver: jaundiced appearance of the eye, etc., making, 
in my opinion, a well-defined case of hepatic abscess. To these 
symptoms were added a dry tongue, tympanites, a temperature 
of 102, and other symptoms of a slow and low grade of fever. 
A well-defined tumefaction presented itself in the center of the 
hepatic region. Being a long distance from home, I determined 
to try the virtue of my lancet, though I was entirely alone with 
my patient. Without unnecessary dela}- I ran my abscess lancet 
one inch through the adjacent walls, and to my surprise and dis- 
appointment failed to reach an abscess. With an exploring needle 
I found pus and a cavity one inch and a quarter deeper. I now 
rode a half mile to procure a nurse and assistant <^o carry out di- 
rections. On returning, I made a free incision, whereupon a 



Periscope and Abstract. 459 

stream of sero-purulent fluid began to spurt out with consider- 
able force. I pulled out an ordinary bucket, empty, from under 
the bed, and in twenty minutes it was fllled with this fluid, the 
latter half of which was thick pus. All told, there could not 
haye been less than eighteen pints of this fluid. I gaye him no 
anaesthetic except a small dose of morphia. Left an alteratiye to 
be administered, to be followed by quinine. 

On my arriyal next day I found my patient worse. Tem- 
perature 104.5, some delirium, and symptoms pointing to septic 
infection. The alteratiye medicine preyiously administered had 
acted well, but the aperture in the side had closed up; no drain- 
age had taken place for ten or twelye hours. On examination, I 
failed to find the peritoneal adhesions of the da}- before to the ab- 
dominal wall, and think that some effusion into the peritoneal 
cayity now took place. The adhesions doubtless were of recent 
date, and not firm enough to resist the pressure of fluid turned in 
that direction. I had previously bandaged the patient to aid 
drainage of the pus and to fayor adhesions in the cayity, when 
drained. His face was badly swollen, and eyery feature was one 
of anxiety and distress. After carefully probing the wound to 
the liyer, about three and one-half pints of pus were discharged. 
I saw him an hour later, when the swelling of the face had dis- 
appeared, as also did all his other unpleasant symptoms. I now 
left him, ordering tincture iron gtt. xy eyery four hours, alter- 
nating with turpentine emulsion — the latter for the feyer symp- 
toms, for its diurectic effect, and as a general diffusive stimulant. 
I left him this time confident that about twent^'-four or fort}'- 
eight hours, at the outside, was his probationary period for this 
life. 

I saw Mr. H. (on w^hose farm the patient lived), three days 
after my last visit, and was informed that the man was in fine 
spirits, had a good appetite, and was improving rapidh'. I sent 
syrup of hvpophosphites, to be taken in conjunction with the 
other treatment, and directed that the aperture be kept open, and 
a free drainage induced. He was left to nurses of his own race 
and color, who neglected this important part of the treatment. 
The wound closed, the drainage stopped, and the patient died 
two days afterwards. 

This is the fourth case of abscess of the liver that the writer 
has operated upon, and the only one of the four that died, though 
one of the other cases was a very delicate and nervous woman 
about 45 years of age, which had sanitary and dietetic surround- 
ings. The results of the operations in this case suggests the 
following conclusions : 

I. Always operate if a reasonable diagnosis is made out. 



460 The Peoria Medical Monthly. 

2. Anaesthetics are not necessary in every case for this op- 
eration. 

3. A free incision and a rational treatment warrant a more 
flattering prognosis, and a larger percentage of recoveries than 
our standard authorities lay down. — your. Amer. Med. Ass' 11. 



ELECTRICITY IN GYNAECOLOGY. 

Dr. Paul F. Munde read an exceedingly able and practical 
paper before the New York Academy of Medicine on the sub- 
ject '• Electricity as a Therapeutic Agent in Gynaecology." He 
enumerated the following cardinal points which are useful to 
remember in making applications in other diseases as well as in 
special tliseases of women : 

1. The galvanic current is far more generally useful than 
the faradic, which, as a rule, has a stimulating effect. The gal- 
vanic, on the other hand, acts as a sedative. 

2. A mild, steady galvanic current will answer every pur- 
pose, and is in every way preferable to a powerful, interrupted 
one. The faradic current, however, is useful in proportion to 
its strength. 

3. Whenever the constant current causes pain, it is doing- 
harm. 

4. Personally, he could never decide which pole, the nega- 
tive or the positive, should be placed within the body, provided 
care was taken that the current should not be too strong. The 
effect is apparently the same, whichever pole is used internally. 
There is, however, one prominent exception. In cases where 
there is circumscribed pain, the positive pole is the one to be 
placed near the painful point. In using the faradic current, it is 
of no consequence which pole is employed internally or externally. 

5. He had always found it safe to begin with a mild cur- 
rent and gradually increase it to the required strength. 

6. When internal electrolvzation is to be employed, it is 
always best to introduce the internal pole before closing the con- 
nection, on account of the sensitiveness of the external parts, 
Dr, Munde said he employed an electrode covered with leather 
for introduction into the vacjina, but that he had been recently 
informed by an electrologist that this in reality afforded no pro- 
tection to the parts. 

7. To be of any service, the treatment must be frequently 
repeated, for a considerable length of time. As a rule, it is 
useless to make applications less frequently than twice a week, 
and in many cases they should be made every other da}-, A 
course of treatment by localized gahanization should last from 
three to six months. 



Periscope and x\bstract. 461 

8. The results of faradization in chronic affections are less 
fa-vorable than those of galvanism. But, while relief from pain 
and an amelioration of the greneral condition are verv often 
obtained bv this means, a complete cure is not to be looked for 
in many of the affections which come under the gynecologist's 
notice. 

Among the pathological conditions referred to in which 
treatment by electricity is applicable, were deficient development 
of the uterus and ovaries, amenorrhoea, subinvolution and men- 
orrhagia, where there is deficient development faradization 
should be emploved in conjunction with the use of sponge tests 
and constitutional measures. For the treatment of chronic pelvic 
cellulitis, of obstructive and neuralgic dvsmenorrhoea, the galvanic 
current often benefits after all other forms of treatment have 
failed. — JY. W. Lancet. 



ACUTE ARTICULAR RHEUMATISM r— AX 
UNIQUE CASE. 

Dr. F. Hibbard presents the following in the November 
number of the Cincinnati Lancet and Clinic : 

I was hurriedlv summoned, a few days since, to see a child 
which the father said was paralvzed. 

An examination of the patient, a robust, hearty child of only 
five months age, revealed the lower extremities flexed and held 
in a stiffened position : the arms flexed with the fingers straight 
and dropping from the metacarpo phalangeal articulation. The 
historv brought out the fact that the child had played in a basin 
of water, splashing itself until wet and remaining sometime 
before the clothes were changed. On the day before, the mother 
stated that the child had been restless the after part of the night. 

I found, upon tickling the bottom of its feet and palm of 
hands, that it would immediatelv draw up its limb, but would 
crj'- out as with pain. Any movement of the limbs would pro- 
duce the most violent fit of crying. There was no sweUing of 
the joints, onlv a slight redness of the skin, most perceptible at 
the ankle joints. The temperature was 104. 

I hastily informed the family that it was not paralysis, cer- 
tainly not of the vocal organs. 

I advised hot applications to the joints and left an emulsion 
of gum acacia; and glycerine with five grains of salic\-lic acid to 
the teaspoonful. and directed a teaspoonful to be given every 
three hours, until better. As it was some distance in the country, 
I did not see the child until the next day: found it playing, and 



4^2 The Feoria Medical Monthly. 

b\' the day after the soreness had entirely disappeared, and the 
child remained well. 

It is needless to state, that it being mv first experience with 
such a case, I was nonplussed and only arrived at the diagnosis 
of acute articular rheumatism by careful exclusion. Smith states 
that acute rheumatism does occur in children. Bartholow 
teaches that it rareh', if ever, occurs before the age of seven. 

M}' conversation with old practitioners leads me to suppose 
it a very rare complication and to reporting the case thus fully. 



INFLUENCE OF MARRIAGE ON CHOLERA. 

A recent number of the younial dcs Assf/raurcs contains a 
short article on the mortality from cholera to which married and 
single men in Paris v,ere respectively subjected during the last 
visitation of that disease in the autumn of 18S4; and as the mat- 
ter is worthy of some attention, we append a free translation 
of it: 

" The statistical returns of the citv of Paris give an analysis 
of the deaths occasioned by the last cholera. We extract the 
following points for consideration which it may be interesting to 
notice. It is known that old men are especially hable to cholera, 
also persons who have been brought to a low state of health by 
grief, fatigue, privation, or excess: but, besides these, the civil 
condition of men exercises a considerable influence on their suc- 
ceptibility to the malady. The following figures will enable our 
readers to judge of this : 

Deaths of Males out of 100,000 Population in Paris 
FROM November 3 to 20, 1884. 

AGE. 

25-30 

30-35 

35-40 

40-45 152 

45-50 

50-55 16< 

55-60 

60-65 117 ■) 

65-70 89 - 46 

70-75 455 ) 

" This table shows clearly that at all periods of life single 
men presented about two or three times more deaths than mar- 
ried men. The social position of many bachelors, and especially 
their habits of Hving (for a great number of them would be 
obliged to live in unhealthy proximity to one another) may per- 



single. 
51 


MARRIED. 

18 


78 


21 


58 


40 


152 


44 


83 


47 


167 


37 


83 


57 



Periscope and Abstract. 463 

haps explain this surprising difference, which, indeed, deserves a 
deeper study than which it is possible to make from the facts 
supplied by the Bulletin dc Statistiqiie. Another fact which is 
no less remarkable is that cholera has attacked men and women 
most unequalh". From the 3d to the 20th November there were 
561 deaths of males (or 50 out of 100,000 | and only 379 deaths 
of females (or '}^}^ out of 100,000 |."' 

The foregoing statistics are not uninstructive, although they 
are put forth in a loose, inexact way that goes far to rob them of 
any value thev might have. The proportions of male and female 
deaths, referred to in the closing sentence of the extract, evi- 
dentlv relate in each case to 100,000 persons (males and females 
combined), although this is not so stated, and in the absence of 
remark it might v.-ell be thought that the male deaths were com- 
pared with 100,000 male inhabitants of the city, and the female 
deaths with an equal number of the female units of the popula- 
tion. On the main question of the respective susceptibility to 
cjiolera of married and single men, it is impossible to form any 
opinion until the relative numbers of married and single men in 
the total population are known. The death-rate prevailing 
among any special class of lives can only be determined by tak- 
ing the ratio of the observed deaths in that class to the total 
number of such persons who were exposed to the risk of death. 
Hence, if we accept the figures given by the official Bulletin as 
correct and unimpeachable, we are yet quite unable to compare 
the mortality from cholera among married with that among sin- 
gle men until we are informed how many married and single men 
respectivelv were in Paris at the time of the outbreak. The 
Journal des Assurances devotes much of its space to statistical 
questions, and its knowledge of insurance matters seems wide 
and sound. We are surprised, therefore, that it should have 
shown itself ignorant of so fundamental a principal as that to 
which we have made reference. — London Insurance Record. — 
The Sanitarian. 



HOW TO LEARX AND HOW TO REMEMBER 
ANATOMY. 

In a verv instructive lecture on the above subject by Dr. E. 
Souchon, in the Xezi' Orleans Medical and Surgical Journal 
for December, tv^e find the following useful guide to describe an 
organ : 

1. Definition — Synonymy, Etymology, History. 

2. Division of the Organ into separate portions. 



464 The Peoria Medical Monthly. 

3. Number. Single or Double — Supernumerary organs. Ab- 
sence of the organ. 

4. DiMENsioxs — I St. Relative Size, or size compared to other 
organs or to familiar objections. 2d. Absolute Size : Diam- 
eters: transverse, vertical, antero-posterior. CaHbre. 

5. Situation — ist. General Situation or region it occupies. 
2d. Relative Situation or compared to the surrounding or- 
gans. 

6. Direction — ist. Compared with axis of the Iwdy. 2d. 
Compared with its ozvn axis. 

7. Means of Fixity — Vascular Connections. — Adhesions. — 
Ligaments. — Supported b}^ other organs. 

8. Immobility of the whole organ — of a part of it — Intrinsic 
immobility. Rxtrinsic Immobilit}^ or Communicated by 
other organs — Extent of Immobility, Exceptional Immobility. 

9. Shape — ist. Compared to a geometrical figure. 2d. Com- 
pared to the shape of a familiarly known object. 

10. Surfaces: 
— Synonvmy: 

- — Direction : forwards or backwards. — Above or below. — 
Intermediate direction. 

• — Shape : Plane, Concave or Convex in the vertical or trans- 
verse direction. 

— PecuHarities: Projections (folds, processes, ridges or 
crests, tubercles, protuberances). Depressions, orifices 
(size, shape, boundaries, structure, contents), bhnd fora- 
mina — grooves and canals (depth, extent, contents, vessels 
or nerves or organs ) . 

When enumerating pecuharities, begin on the median hne 
and then on the sides: proceed from before backwards 
or from within outwards; or from above downwards. 

— Relations: With skin (/. e. to what part of the surface it 
corresponds) or with bones, joints, muscles, viscera, ves- 
sels and nerves. 

11. Borders: 
— Synonymw 
— Dimensions. 

— Direction: ist. Relative Direction, vertical, horizontal 
oblique, forwards or backwards — or above or below — or 
inwards or outwards. 2d. Absolute direction: straight, 
sinuous, concave, convex. 

— Shape : Blunt or Sharp, or Bevelled at the expense of one 

surface or the other. 

— Peculiarities, / . „ 

Ti 1 ■• ■ as tor surfaces. 

■ — Relations, ( 

All Thick Borders ouijht to be subdi-sided into tzco cdo'es or 



Periscope and Abstract. 465 

lips and an interstice. Give for each: peculiarities, inser- 
tions and relations, 

12. Angles or Extremities: same as borders. 
Base and apex: same also. 

13. Structure: 
—Color. 

■ — Consistency: Density, Friability, Elasticity, Retractility. 

— Envelopes or Coats: Thickness, Resistance, Elasticity. 
External Surface (relations, adhesions). Internal Surface 
(relations, adhesions, processes from internal surface). 
Reflection into the interior of the organ. 

— Stroma: Is delicate or apparent; is composed of connec- 
tive tissue, or elastic, smooth muscular fibres. 

— Proper or characteristic Elements: Cells, Tubes, Fibres, 
Prisms. 

— CapiUiarv Arteries: Veins, Lymphatics, Nerves. 

— Excretorv Duct of Glands (as a separate organ). 

— Lining Membrane of a Hollow Organ: Thickness, Con- 
sistency, Elasticity, Adhesive Surface, (degree of ad- 
hesion); Free Surface: color, pecuHarities, epithelium, 
glands. 

14. Chemical Composition: Organic, Inorganic Elements. 
i"5. Development of the Ages. 

16. Peculiarities of Varieties, or anomalies due to Sex, 
Habits, Trades, Constitutions, Individualities, Nationahties, 
Races. 



CORROSIVE SUBLIMATE AS A SURGICAL 
DRESSING. 

While we are all familiar with the fact that the bichloride 
of mercurv is a most valuable disinfectant, yet we doubt whether 
its full power is realized and whether it holds that high place in 
the estimation of suri^eons to which its undoubted etlicacv enti- 
ties it. 

Considering it as one of the most valuable aids to the sur- 
geon, we deem that all should be familiar with its merits, and we 
therefore desire to call notice in an especial manner to its use. 
In one of our hospitals in this city, solutions, varying from i to 
1000 to I to 5000, are kept constantly on hand, and v»hen cases 
of bruised and lacerated limbs are iDrought in they are at once 
enveloped in these solutions and the results are truly remarkable. 
One case is so striking as to merit special note. 

A small child was brought in with his leg so mangled (bones 
comminuted, etc., ) that the whole surgical staff (three prominent 



466 The Peoria Medical Monthly. 

surgeons ) decided that amputation was imperative. To this the 
parents so strongly objected that the surgeons were forced to 
yield. Explaining to the parents the almost certainty that the 
child would die, and placing the responsibility where it rightly 
belonged, the limb was encased in bichloride sawdust. Presto, 
result! an absolutely perfect limb. 

Many such cases could be cited, but sutiice it to sav that by 
the use of corrosive sublimate we can save many limbs that 
would otherwise be sacrificed. 

In this connection it will be well to note that Dr. R. J. Levis 
has great faith in the potassio-mercuric iodide. He has tablets 
prepared of such strength that one dissolved in a pint of water 
gives him a yg JiiTr solution, which with hydro-naphthol constitute 
his antiseptic armamentarium. — Medical and Surgical Reporter. 



PREVENTION OF BAD TEETH. 

A foreign exchano-e savs the troubles which arise from disease 
of the teeth, or from their loss, are not ahvavs directly referable 
to their cause. When actual toothache is present there is of 
course little doubt, and the remedy of extraction at once presents 
itself. At the same time it must be remembered that the for- 
ceps does not undo the work of disease or make amends for its 
ravages. A jaw which has lost the best part of its function with 
its teeth, or which bites unequally with the scattered survivors 
of its former armament, is but a deceitful guardian of the pas- 
sage to the stomach; while it seems to do duty in mastication, it 
passes intact much that is unfit for the immediate action of the 
gastric juice. Were the relationship between bad teeth and dys- 
pepsia, with its consequent discomforts, better understood, we 
should probably hear less of the prevelance of dental caries. 
Greater attention would then be paid to the small organs whose 
obscure influence on the general health so fully justifies their 
preservation. Specific constitutional disease, drugs, and other 
special factors no doubt account for a certain amount of dental 
decay. Neglect, however, accounts for much more. Want of 
care in choosing food, and particularly in cleansing the teeth, has 
nearly everything to do with the dental worries of a great many 
people. x\ point well worthy of note in this connection is that 
most of the permanent set of teeth come into active operation 
during childhood or earl}- youth. It is hardly to be expected 
that children, if let a.one, will pay much attention to the state of 
their mouths, unless driven to notice an aching stump. Thus it 
happens that most children have lost one or several teeth before 
they are well into their teens. tiere, then, there is need for pa- 



Periscope and Abstract. 467 

rental supervision, Mr. W. M. Fisher, of Dundee, has been led 
by certain observations, which proved the defective condition of 
the teeth in a majoritv of school children, to suggest that some 
regular svstem of supervision bv a dentist be adopted as a part 
of school management. The expenses he would have defrayed 
bv the parents, or, should thev be too poor, by the State, out of 
the education grant. This plan has actually been adopted in the 
parochial school at Anerlev, in Surrev. We have long been of 
opinion that it would be most desirable if the health of children 
in all schools could bv some plan be periodically passed under 
review by a medical inspector. The possible obstacle to such 
an arrangement would be the expense. This may not prove 
insuperable, and if it do not, we mav hope that this method, and 
also some plan of dental supervision, mav lind then* place among 
the recognized forms of school discipline. — J/cd/ral and Surgi- 
cal Reporter, 



LITHIASIS. 

-It is generallv understood that physicians, when sick, are 
slow to take medicine, either of their own prescribing, or on the 
prescription of a brother practitioner: and in many cases, even 
when not dangerouslv sick, thev are poor prescribers for them- 
selves. The following case illustrates this, and at the same time 
contains a -practical lesson. A physician in regular practice, was 
sick with backache and headache, with some fever, with slight 
evening exacerbation, which would go off with a sweat at night. 
He had also some tenderness of liver and stomach, urine very 
high colored. Giddiness or swimming in the head was also a 
prominent svmptom, and had been, even before he took down. 
A dose or two of calomel, with morphine at night, gave 
some relief, but the tenderness over the liver and stomach became 
much worse. In this condition a brother practitioner visited him. 
Though sick, he was able to talk, and in the course of the day, 
the conversation turned on Lithiasis, and he (the sick one ) took 
occasion to make a few plain remarks on the diagnosis and treat- 
ment of this condition, citing several cases in practice, and laying 
special stress on the value of colchicum and alkalies in the treat- 
ment of such cases, and referring many symptoms of derange- 
ment of various organs, such as indigestion, palpitation, pruritus, 
eczema, et id omne genus to this peculiar condition of system. 
He threw such Hght upon the subject in general, and upon his 
own case in particular, that though he never once thought of 
that being his trouble then, (^notwithstanding he had treated him- 
self several times through the summer for that particular condi- 



468 The Peoria Medical Monthly. 

tion and with marked relief. ) the visiting brother saw enough ta 
cause him to ask, " Don't you think that treatment would suit 
your case?" He quickly assented. And it struck him as the 
clearest thing he had ever seen, and before night, without further 
consultation, he took two or three doses of wine of colchicum 
and bicarb, potassium, and by next day, with the help of a little 
cream of tartar, his bowels were moved verv actively and often, 
and in twenty-four hours he was up, readv for light duty, the 
soreness of the liver and stomach having gone, as if by magic. 
And during all his sickness of about a week he never thought of 
this, his old complaint, till it w^as suggested by a brother. 

I would not be understood to sav that eczema is always or 
even generally of a goutv nature, but it frequently is, and there 
is one form that is almost pathognomonic of the goutv diathesis. 
I refer to eczema of the ears, in plethoric, ruddy adults; and con- 
gestion, redness and burning of the ears, no/ amounting to 
inflammation, is often the precurser of an attack of gout some- 
where; and when present, it is an index of the peculiar diathesis, 
and will afford a kev to the situation in manv cases, the nature 
of which, would be otherwise doubtful. 

And when we remember that congestion or inflammation of 
a purely gout}- nature, is liable to attack anv of the internal 
organs, as the stomach, or liver or lungs, etc., which will yield 
readily to treatment addressed to the gout}- condition of the sys- 
tem, we see the importance of recognizing at a glance, these 
surface indications of such condition as furnishincr a kev to the 
proper therapeutic measures. For whatever treatment may be 
demanded to meet certain sympto'ns, such as pain, cough, rest- 
lessness, vomiting, etc., etc,, it is all-important in order to a 
speed}^ cure, where such condition of system exists, that it be 
treated with colchicum and alkalies, especially the salts of potas- 
sum and lithium. — Southern Practitioner, 



BILIARY CALCULI. 

The folowing is an abstract of the histories of three cases 
of biliary calculi, with remarks, that were read before the New 
Orleans Medical and Surgical Association: 

Mrs. B., age 34 years, a seamstress, widow, and the mother 
of ten children, began complaining of pain in the riglit side, the 
top of the head and the eyes. For four vears she was subject to 
every imaginable form of treatment, but with no relief. Finalh', 
she began to suffer ever}^ seven davs with a chill, followed by 
fever and pain in the right h3'pochondrium. Still the diagnosis 



Periscope and x\bstract. 469 

was not correctly made until one evening she was suddenly taken 
with every svmptom of an attack of hepatic colic, which was 
fully established b}^ further observation. 

The second case was that of an Irish washerwoman, sixty 
years of age. Her attacks, which were frequent and severe, 
were ushered in by a chill followed by high fever, and were at- 
tended by a choking sensation and pain over the region of the 
heart. Finally, a consulting ph3'sician during a particularl}' vio- 
lent attack made a diagnosis of gall stones, which was later veri- 
fied by the finding of the calculi. 

The third case was a policeman, thirty-two years of age. 
He gave a history of headaches, dull pain over the liver, lack of 
relish for meats, espeically fat meat, constipation, and occasional 
shooting pains through and over the entire abdomen. A diag- 
nosis of biliary calculi was made, and under the use of olive oil 
abundant stones were passed. 

The pathology, the supposed causes, and the diagnosis of 
bilary calcuH were passed in review. While stating the several 
symptoms which are commonly relied upon for a diagnosis, 
special stress was laid upon the aversion to fats on the part of 
sufferers from the affection. This symptom was marked in all 
of the above cases. The only author that alludes to this symp- 
tom is Trousseau, and he does so only slightly. 

In the matter of treatment, morphine was recommended to 
ease pain. Large doses should be administered; nothing less 
than one-half grain h3-podermaticalh-, and repeated in fifteen 
minutes if necessary. Atropia, in the fashionable combination of 
atropia, -ji^ gi"ain and morphia | grain, was especially discoun- 
tenanced, on the grounds of being unscientific and preventing 
frequent administration of the opiate. After pain is relieved olive 
oil in pint doses should be used to expel stones. The use of 
chloroiform, ether, turpentine, phosphate soda, etc., are in the 
opinion of the writer utterh- useless. To prevent a recurrence of 
the stones, the waters of Carlsbad and Vichy are of much ser- 
vice; to the same end a vegetable diet and open air exercise are 
recommended. — T. S. Darney, M.D., in N. O. Med. and Surg. 
Jour. 



EUCALYPTUS IN TYPHOID AND OTHER FEVERS. 

Dr. Leighton Kesteven, contributes his observations in this 
subject to May number of The {^London') Practitioner : 

While treating cases of typhoid fever in the Brisbane Gen- 
eral Hospital, the idea occurred to him that the oil of eucalyptus 
would be efficacious. In the next eighteen months he treated 



470 The Peoria Medical Monthly. 

220 cases of the fever with it, with onlv four deaths, and these 
four cases would probably have died from other causes than the 
fever. His dose is now about ten minims e^"erv ten hours. It 
does not agree well with all stomachs when given simply with 
mucilage: but trouble in this respect can be entirelv overcome by 
hrst carefullv emulsifving the ten drops of oil with mucilage, and 
then the addition of a half drachm each of aromatic spirits of 
ammonia, spirits of chloroform and glycerine — the latter entirely 
removing the rough semi-resinous taste of the oil. 

This medicine acts, first, bv steadil}' and permanentlv re- 
ducing the force and frequency of the pulse, — incleed acting 
with marvellous rapidity in some cases: sccoudlx, bv lower- 
ing the temperature, which occurs less rapidlv and may be 
secondarv to, and dependent on the lowering of the pulse: f/iirdiv, 
bv the beneficial effect on the tono-ue — almost immediatelv alle- 
viating the distressing drvness so universal in tvphoid fever, and 
removing the thick brown coating, leaving, relativelv, but little 
fur, frequentlv cleansing the tongue entirelv in a verv short 
while; ?ind, f'oiirf/ilx. the skin becomes moist and soft, giving 
comfort to the patient. 

The Doctor also pins great faith to the liberal use of whisky 
from the bemnnin"; of attack — even as much as thirtv ounces in 
the twenty -four hours. Ordinarilv, he feeds on milk thickened 
with isinglass, beaten up eggs, milk and soda, cocoa, and — where 
diarrhoea exists — oround rice and milk. In asthenic cases ounce 
doses of chicken broth (concentrated to ten ounces from a whole 
foul) everv half hour or longer, the juice of half cooked mutton, 
or beef tea made in a pot without water strained through a fine 
muslin should be used. For the abdominal tenderness, apply 
ice-cold compresses, and allow ice to suck. Apply ice to the 
shaved head for cephalagia, and use frequent cold "packs" from 
head to knees if temperature rises. Change the bed linen night 
and morning without letting the patient get out of a horizontal 
position. 

The Doctor thinks probably the eucalvptus acts as a germa- 
cide. In most cases, the fever is entirely over in ten or twelve 
days, although he keeps his patients in bed the traditional three 
weeks. 

Experimentallv, he has used eucalyptus oil in two or three 
cases of pneumonia, with the most marked benefit. — Canada 
Lancet. 



SUBCUTANEOUS INJECTION OF THE SALTS OF 

QUININE. 

The occasional necessitv for the injection of quinine subcu- 
taneouslv, not onlv in severe malarial affections, but also for anti- 



Periscope and Abstract. 471 

pyretic purposes, must have compelled many physicians to reflect 
on the best methods of avoiding the disagreeable consequences 
which too often follow such a use of most of the salts of that drug. 
It is generally in violent and pernicious malarial complaints, 
in which both the stomach and rectum are so irritable that med- 
icines are not retained long enough to permit of its satisfactory 
absorption into the system; or where, without such irritability 
there is some mechanical obstacle to the administration of food 
and medicine by the mouth, and we wish to reserve the rectum 
for the purpose of nourishing the patient; and occasionally, too, 
in a few cases of hyperpyrexia, in which the danger from excess 
of heat is imminent, while other methods of reducing the tem- 
perature are contra-indicated, and every minute is of value, that 
the resort must be made to the h^^podermic injection of such 
powerful antlp^'retics as quinine, in quantities likely to produce 
a rapid fall of temperature. There are probably great differ- 
erences of opinion as to the doses required under such circum- 
stances, but I have thought it necessary, more than once, to put 
as many as thirty grains of quinine under the skin in a few hours' 
time. As it is scarcely possible to inject more than live grains 
at any one point — smaller doses indeed, such as two or three 
grains, being distinctly preferable — the number of injections and 
the pain produced, are matters of no small importance. The 
method I have latterly adopted has given decidedly better re- 
sults than any previously tried, and can be stated in a few words. 
The two best salts of quinine to use are the bisulphate and the hv- 
drochlorate. Both are fairly soluble without acids, but the bisul- 
phate has the advantage of being considerably cheaper. One 
grain of that salts will dissolve readily in six minims of equal 
parts of the purest gh'cerine and of distilled water at the temper- 
ature of the body, and when thrown at that temperature into the 
looser subcutaneous cellular tissue — the only part into which 
quinine should be injected — will be rapidly absorbed without de- 
position of an}' crystals of the. drug. To this solution two per 
cent, of pure carbolic acid must be added. Thirt}'^ minims of 
such a solution, containing five grains of the bisulphate, may then 
be used for one injection from a syringe of double the average 
capacity — -now, as a rule, just, about fifteen minims; an^l although 
it is probablv better, as previouslv mentioned, to inject less at one 
point, no local or general injurious effects have followed the nu- 
merous applications of the maximum quantit}' stated, which have 
been made since I have been in the habit of adding the carbolic 
acid to the diluted glvcerine solution of the quinine. The local 
anesthetic action of the carbolic acid, too, is unquestionably of 
great value in diminishing the pain attending the hypodermic 
use of such an irritating medicine as quinine. — British Med. 'Jour, 



472 The Peoria Medical Monthly. 

THE TREATMENT OF NIGHT SWEATS. 

I send herewith a prescription for night sweats, which I 
have used for many \ ears and found to be very efficient. It is 
very rare that more than three pills in the twentv-four hours are 
necessary to promptly stop the trouble: and, notwithstanding the 
fact that these pills are directed only for the relief of a disagree- 
able s^•mptom. many patients suffering from phthisis declare that 
they are of real benefit in aiding a case of the disease, and con- 
tinue to persist in their long use after night sweats have ceased. 

This prescription I have found very efficient, also, in reliev- 
ing the ner\ous prostration that is so often seen in those who 
drink alcoholic liquors to excess: 

R. Oxide of zinc, 1 2 grains. 

Pyrogallic acid, 24 grains. 

Sulphate of atropia, 1-24 grain. 

Extract of liipulin, 48 grains. M. 

Make 24 pills and silver coat. — Dose, one pill three times a 
day, soon after meals. — Dr. Sinit/i, in GaiUard's Medical yotir- 
nal. 



INIQUITOUS DECISIONS. 

The legal and medical professions are generally on veiy 
good terms with each other, in this country at least. But there 
are at times some most extraordinary' and unjust decisions sent 
down from the bench upon us. One of the most glaring instances 
of this was the case of Dr. Bradley, in whose behalf the medical 
profession of England has shown so nuich sympathy and gen- 
erous help. 

Now we hear of a case in California quite as iniquitous, 
judging from the facts given in the Paripr Medical and Siirg'ical 
"Joiinial. 

In April. 1884. Dr. Graves, of Petaluma. Cal.. was called to see 
Mrs. Winters, the wife of a laborer whose family he had attended 
gratuitously for nearly sixteen years. He found that the woman, 
who was Hftv-eight years of age, had fallen from a height and 
injured her ankle. The limb was ver^* much swollen, so as to 
interfere with examination, but no crepitus could be elicited, 
neither was there any displacement or shortening: and, as the 
swelling continued, the limb was placed in position and wrapped 
loosely in cloths saturated with anodyne lotions. The patient, 
we are told, received ever}- attention from Dr. Graves, but there 
was left some stiffening of the joint and a very slight inversion of 
the foot. No complaints were made until a new doctor arrived 
in the town, who told the patient that the limb had been badly 



Periscope and Abstract. 473 

treated, and advised her to sue for malpractice. " The case," 
continues the yoiirnal, " was examined by ten of the chief sur- 
geous of the State, including Drs. Lane, McLean, Morse, and 
Dennis, all of whom said that there might have been a sprain oi* 
an incomplete fracture of the external maleolus, but that the ends 
of the bone were in perfect apposition and never had been sep- 
arated, and that the stiffening was probably due to inflammatory 
adhesions. 

"Two other doctors, one of them being he who had advised 
the suit, testified that there was shortening of the limb, and that 
the lower fragment of the tibie had been driven up and behind 
the fibula. One of these would-be surgeons. Dr. Wells, is nearly 
eighty years of age, and had not read a work upon surgery for 
nearl}^ thirt}- 3'ears; the other, Dr. Ivancovich, confessed that he 
had no special experience in surgerv. Their incompetence may 
be judged from the way they measured the patient's limb in 
court. This was done bv taking a carpenter's rigid rectangular 
rule, and measuring the limb as she maintained the upright po- 
sition. 

" The result was that in the opinion of nine jurymen the 
testimony of two unknown, inexperienced general practitioners 
outweighed that of ten specialists in surgery, all of whom are- 
well known throughout the State, and some of whom possess 3. 
national reputation, so that a verdict was returned in favor of the 
plaintiff, awarding her $8,000 damages." 

It appears to us, from the facts given, that this decision is 
so gross an outrage upon the profession, as well as so great a 
personal injustice and misfortune to Dr. Graves, that the physi- 
cians of California are in duty bound to help straighten out the 
matter. They should either get the decision reversed, or con- 
tribute to the needs of Dr. Graves. — The Medical Kecord. 



NEURASTHENL\. 



By this term me mean the condition of nervous exhaustiun. 

It mav be manifested in a variet\- of ways. Its symptoms 
will depend upon the type which exists — cerebral exhaustion or 
spinal exhaustion — and also upon special idios3ncracies peculiar 
to the patient. No two cases exhibit identical manifestations of 
nervous depression. Some patients who are suffering from ce- 
rebral neurasthenia manifest its effects in the voice, others in 
mental disturbances. The heart's action may be alone disturbed 
in some cases, the stomach mav give out in others; some ma}.^ 
complain alone of muscular troubles; some may notice its effects 



474 The Feoria Medical Monthly. 

in the eyes: some are rendered sleepless: a few complain alone 
of skin disturbances, and so on throu<^hout the different parts of 
the entire human oro-anism. 

You can understand how these apparently discordant facts 
ma}- be reconciled when you consider the fact that, by means of 
the brain and spinal marrow and the nerves which unite these 
centres to the different parts of the bod^-, we are enabled to see, 
hear, taste, smell, appreciate, touch, swallow, breathe, and per- 
form \-oluntarv muscular acts. 

It is by means of our nerves alone that the heart beats: the 
digestive processes go on, without our knowledge or control, 
through the same agencies: the blood-vessels contract and dilate 
in accordance with the demand for blood telegraphed to the 
nerve-centre by the different organs and tissues: and everv pro- 
cess pertaining to life is thus automatically regulated. Now it 
is eas}- to see how a debilitv of so complicated an electric me- 
chanism as the nerve-hbres and the nerve-cells of a living animal 
are, can upset all or any one of the individual functions enumer- 
ated. Many of our houses are furnished to-dav with electric 
bells, by means of wires distributed in the walls. In some houses 
we light the gas-jets, and even the rooms themselves bv means 
of the same subtle fluid. When the batterv becomes weak, or 
when the wires are disarranged or broken, what mav be the re- 
sult.- Some of the bells mav cease to ring when the button is 
touched, while others work properlv. Perhaps the electric hght 
may fail in some rooms and burn with its accustomed brilliancy 
in others. The gas-jets may not be properlv ignited. So 
it is with the nervous apparatus of man. From the same cause, 
one patient may have nervous dyspepsia, another sleeplessness, 
a third sexual debility, a fourth weakness of the eye-muscles, a 
lifth disturbances of the skin. — A^ez<.' I'ork Medical "Jounial. 



PTOMAINES: THEIR ORIGIN, CHARACTERS, AND 

REACTION. 

Profs. Anrep and Poehl {^London Medical Record] sum up 
their investigations and the literature on this subject thus: 

1. Putrefaction, fermentation, and other vet indetinible alter- 
ations of albuminous substances, are accompanied bv the genera- 
tion of alkaloid-like bodies, termed ptomaines. 

2. The number of ptomaines is verv great, and their chem- 
ical and poisonous properties are very different. 

3. There are known fixed, and volatile, fluid and solid, am- 
orphous and crvstalline ptomaines. All fluid ptomaines do not 
contain oxvgen. 



Periscope and Abstract. 47S 

4. Almost all ptomaines change red litmus to blue, and 
syrup of violets to green. 

5. Like all alkaloids they form salts with acids, the forma- 
tion proceeding without giving off water. 

6. In regard to their solubility, ptomaines behave very dif- 
ferently ; some of these are soluble in water, others in ether, alco- 
hol, benzine, chloroform, and amyl-alcohol. Ptomaine salts are 
easilv soluble in water. 

7. Some ptomaines are tasteless and colorless; others again 
possess an intense bitter taste, or aromatic sweetish odor; others 
again evolve a cadaveric odor, or one resembling coniine or nic- 
otine. When treated with acids they sometimes emit a pleasant 
floral odor. 

8. Ptomaines obtained from rye meal which has been sub- 
jected to fermentation, give the same reaction as the ptomaines 
oT any other extractions. These reactions are as follows.- 

(f?) A solution of iodide of potassium with biniodide of 
mercury produces a whitish precipitate in a ptomaine solution 
slightly acidulated with hvdrochloric acid. Twenty-four hours 
later, microscopic examination detects that the precipitate con- 
sists of minute prismatic crvstals. 

{d) A solution of iodide of potassium with iodide being^ 
added to an acidulated ptomaine solution, produces either a floc- 
culent or a finely granular red-brown precipitate, which is in- 
soluble in diluted hvdrochloric acid. 

(V) A solution of phospho-molybdate of sodium gives a 
yellowish amorphous precipitate which is insoluble in diluted ni- 
tric acid, but on the addition of liquor ammonige in excess, at 
flrst takes a blue-green color, and afterwards dissolves, giving 
either a bright blue or green solution. The blue color is mostly 
observed during the first stages of the putrid decomposition. The 
original precipitate produced bv phospho-molybdate of sodium on 
being heated assumes a green color without any of ammonia. 

(c/) Phospho-tungstic acid gives whitish or greenish pre- 
cipitates which are insoluble in dilute sulphuric and hydrochloric 
acids, but easily soluble in ammonia. 

(V) A solution of tannic acid gives a white precipitate; and 
the latter does not appear if tartaric acid be present. 

( /' ) A solution of iodide of potassium with iodide of bis- 
muth in presence of diluted sulphuric acid, gives a ^-ellowish pre- 
cipitate, part of which passes into solution on heating, and reap- 
pears again on cooling. 

( o") A solution of iodide of potassium with iodide of cad- 
mium sometimes produces precipitates which are so luble in th 
excess of the reagent, and which bv degrees assume a crystalln^* 
structure. This reagent precipitates the products of the 



476 The Peoria Medical Monthly. 

stages of putrefaction, wliich are not precipitated by iodides of 
potassium and cadmium. 

(//) In some cases a solution of corrosive sublimate gives 
precipitates which gradually take a cr\stalline structure: in other 
cases ptomaines are indifferent to this reagent. 

(/') A solution of chloride of potassium gives, with some of 
the ptomaines, precipitates which are usually crystalline and 
soluble in hydrochloric acid and consist of a double salt. 

9. Ptomaines are optically inactive bodies. 
10. The color reactions of ptomaines are as various as those 
of the veo-etable alkaloids. — Detroit Lancet. 



DIAGNOSTIC VALUE OF THE WHITE STREAK IN 

SCARLATINA. 

This phenomenon, which can be produced by rubbing a 
soft bodv upon the skin which is affected with the scarlatinal 
eruption, is considered bv the author an important diagnostic 
siixn of scarlatina which has hitherto been overlooked. When in 
the normal condition one draws a line upon the skin with a smooth 
surface, as the rounded extremity of a pencil, and uses moderate 
pressure, there may be observed at the points touched a white 
line which lasts for some time. This paleness is due to the mod- 
erate excitation of the vasomotor nerves and the contraction of 
the small vessels which follows it. If the pressure has been very 
strong, in place of a white line a red line bordered bv two white 
ones is produced. The excitation in this case has paralyzed, 
temporarily, the small vessels in place of contracting them, while 
in the area which is contiguous where the pressure has been less 
strong the excitation has led only to constriction of the vessels. 
In certain diseases the effects which are obtained by this pro- 
cedure \-ary greath'. Trousseau, for example, has shown that 
in patients suffering from meningitis a red line is produced b}^ 
pressure with the greatest ease, and this has been called the men- 
ingitis line. It may also be produced in all tiie diseases which 
lead to perturbation of function in the nervous system. Thus, 
it may be produced in many cases of typhoid fever, in erysip- 
elas, variola, rubeola, and the diphtheritic eruptions. But it is not 
the same in appearance in scarlatina during the entire period of 
the eruption. In place of getting the red meningitic line, a pale, 
rather persistent line is produced, which extends plainly to the 
bottom of the eruption. This fact was long ago noticed by Bou- 
chut, and was considered a valuable sign as a means of diagnosis, 
both in children and adults. It is not equalh' prominent and dis- 
tinct at all periods of the eruption, A'elpean ha\-ing observed 



Periscope and Abstract. 477 

that it is not produced when the efflorescence of scarlatina is at 
its hii^hest degree of development. In the diphtheritic eruption, 
which resembles that of scarlatina accompanied with angina, the 
excitation of the skin produces a red line and not the white one 
of scarlatina. This sign is especially valuable in those cases of 
measles in which the eruption closely resembles that of scarlatina. 
The same is true in variola, in which other differential signs are 
often absent. It must be borne in mind that the important fea- 
ture in making this test is that the white line appears upon the 
surface which is covered b}' the eruption. — Archives of Pedia- 
trics. 



CAPSICUM IN H.-EMORRHOIDS. 

A case is mentioned by a correspondent of a Peruvian med- 
ical journal of a case of bleeding piles cured bv capsicum. The 
patient was a man of 28 vears of age. He was much distressed 
by passing variable quantities of blood after going to stool, and 
suffered a great deal from anal irritation and tenesmus. No 
tumor could be detected. He had formerlv been in the constant 
and dailv habit of using a ^•iolent purgative for ten months, and 
after he left it off, obstinate constipation followed, and it was 
under these circumstances that the haemorrhage commenced. 
The writer tried all kinds of remedies and regulated the diet 
without producing any great improx'ement, and at last was con- 
templating surgical measures when he happened to mention the 
case to a hospital phvsician, who suggested a trial of capsicum, 
as he had himself been cured of a verv obstinate form of chronic 
dysentery by its means, and he felt sure that it possessed the 
property of acting on the rectum. This was consequently pre- 
scribed with meals, and the doses gradually increased. A marked 
improvement soon was observed, and at the end of a couple of 
months a complete cure was effected. — Marvland Jled. journal. 



A LITTLE LEARNING IS A DANGEROUS THING. 

The smart young ladv who \^■rote a note to the doctor, ask- 
ing him to visit her brother and bring his urethra with him, has 
been discounted bv a well-informed medical student of Indianap- 
olis, who was asked recently bv his sweetheart to examine her 
throat for some slight ailment. Being anxious to t-xhibit his em- 
bryonic medical talents to his fair inamorata, he called for a 
spoon, dexterously depressed her tongue, gazed knowingh' into 
the yawnincf chasm thus broui^ht into view, and then, with a look 
of profound wisdom, informed her that //er vulva zvas greatly 
elongated. — Ind. JSIed. yoiiriial. 



478 The Peoria Medical Monthly. 

A PROMINENT PRACTITIONER SUED. 

Dr. A. E. M. Purdy, a prominent practitioner in New York 
City has recently been sued, and a judgment for five hundred 
dollars obtained by a patient \vhom he caused to be sent to the 
eruptive hospital, suffering from what the doctor diagnosed 
smallpox. The patient was sick only a short time, and on being 
discharged sued the phA^sician for ten thousand dollars, claiming 
that the diagnosis was incorrect and that the disease was simply 
a dermatitis due to a preparation containing acetic acid coming 
in contact with the face. 



THE TREATMENT OF NIGHT-SWEATS. 

Good results have been obtained in the treatment of the 
night-sweats of non-phthisical patients in the following manner: 
Two drachms of chloral are dissolved in two tumblersful of a 
mixture of equal parts of brandy and water. The patient is 
bathed each evening with this solution, or night clothing satu- 
rated with a solution and then dried is worn. 



THE KLEPTO-COCCUS. 

We learn with pleasure that Professor Meandra has suc- 
ceeded in isolating the bacillus of kleptomania. It has long been 
thoucrht that this disease owed its origin to an organism of a 
snaky, elusive nature, which rendered detection difficult, but it 
remained for Professor Meandra to first demonstrate its existence. 
The difiicultv was. of course, to obtain pure cultivations. At 
length Professor Meandra secured a magpie of well-known 
thievish propensities, and removing a small portion of its brain, 
under the spray, he began the first of his long series of experi- 
ments. The organism can be readily grown in beet- juice (pre- 
pared by beating beets and straining) or in cabbage infusion. 
It stains easily of a deep steel color. Under a power of eighty 
diameters this organism presents a hook shape, thus ?, which 
gives it the name of Meandra's Interrogative Micrococcus; we 
would, however, suggest (with due deference to the professor's 
taste ) the name of hookey-coccus, both as more euphonious, and 
as applicable, no matter what position the organism may assume; 
it also indicates its character as well as shape. Injected subcu- 
taneously into cats the effects of the hookey-coccus were remark- 
able. Several of these animals, let loose in a back-yard, were 
seen two days after to creep surreptitiousl}- into some of the 
neighboring houses and kleptomize pieces of meat, fish, etc. 
While we cannot quote the whole of this important article, we 



Periscope and Abstract. 479 

relate one interesting event. A quantity of beet-juice in which 
a cultivation was far advanced, was spilled on the floor of the 
laboratory. Three days after the professor missed his pocket- 
book, w^atch, and other articles of value; it was also noticed that 
several houses in the place had been visited and valuables taken. 
Mr. Lastees, the professor's assistant, a man of the highest re- 
spectability, was also missing. Professor Meandra thinks he 
must have inhaled some of the dr}- dust from the spilled cultiva- 
tion. There was much excitement when the affair leaked out, 
and, as there are two banks in the town, the people petitioned 
the ma^^or to pre\'ent all communication between the professor 
and the cashiers. There is no doubt that an attenuated cultiva- 
tion can be obtained, in which case the criminals confined in the 
prison at Moros wall be vaccinnated. We agree with this great 
investigator when he sa^^s, " the bacillus opens a wide field for 
thought — an almost unfathomable vista." "Many generations 
must pass," he continues, "before the last microbe is stained and 
mounted, drawn and photographed, and stamped with the name 
of its discoverer." "The next two hundred years will be known 
in history as the Microbian age." — The Birmingham Medical 
Reviezv. 



DIAGNOSIS OF PREGNANCY. 

Well, now this unmarried girl comes to us because she 
thinks she is pregnant, and hopes we can do something " to put 
it away." 

" What makes you think ^^ou are pregnant?" Dr. G. asks. 

" Because I have placed myself in a position to become so, 
and have not seen m}^ courses for two months," the girl replies. 

As a rule, we cannot swear to pregnancy until we hear the 
foetal heart sounds: but there is strong presumptive evidence if 
the OS is soft like one's lips. When the os is as hard as your 
nose, 3^ou ma}- be reasonabW sure that there is no pregnancv. 
Once in a long while a fibroid tumor will give us a soft os and 
cervix, but this is very exceptional. This condition we will find 
as early as the end of the first month, though it becomes more 
marked as pregnancy is further advanced. No matter what 
station in society a woman ma}^ occupy, no matter howsoever 
exalted her position, when we find a soft os and cervix, we have 
a right to suspect pregnancy. Here there is a litde softening, 
but verv little. Her abdomen is too fat to circumscribe the womb 
and discover whether it is enlarged, so that evidence is here lost. 

There is onlv a shade of darkness about the nipple, not as 
much as there ought to be in pregnancy. This woman may not 



480 The Peoria Medical Monthly. 

be pregnant and may be suffering only from amenorrhcea. We 
■will give her Blaud's pill — 

Dried sulphate of iron. 

Carbonate of potassium, aa 2 drs. 

Glucose, q. s. 

y\. ft. pil. No. xviili. S. — Two thrice daily for one week, and 
then increase one at each dose. 

If she is not pregnant, this will bring on her menses, while 
if she is pregnant, it will not cause a miscarriage. Remember 
that a natural abortion is not very dangerous: it may be likened 
to a ripened apple dropping from the bough. For some reason 
the oyurn has -become detached from the womb, and it passes 
harmlessly away. But if you pluck a green apple, you will tear 
also the bough or break the stem from the fruit: so when you 
produce abortion, you tear the oyum from its tirm adhesions to 
the uterus and cause lesions that may result in septicaemia — Jfi'c/. 
a)id Surg. Reporter. 



THE CAUSES AND TREATMENT OF QUINSY. 

F. P. Atkinson, M. D.. writes as follows in the Lo)idon 
Praetltio}ter : Haying been in ^•ears past a frequent sufferer 
from quinsy I ha\-e taken special interest in determining its cause 
or causes and the best methods of treatment, and I belieye I can, 
after twent}- years of experience, speak \\ith confidence as to 
the correctness of my present yiews. First of all then I would 
say, it is essentially a disease of debility, and is more or less asso- 
ciated with adolescenee and a strumous habit. The exciting 
causes are sexual excesses, bodily fatipue. irreoularity of meals, 
long continued fasts, or in other words, excessiye neryous or 
muscular exhaustion. Cold and rheumatism play little or no 
part in its production — neryous and muscular exhaustion, as I 
haye said, are the imntediate causes of quinsy, and both these 
make the person liable to take a chill and also rheumatic feyer. 
However, I have rareh', if ever, in the whole course of my expe- 
rience, seen these two co-existing in the same person. Again, it 
cannot be the result of cold acting directly on the throat, because 
laryngitis would then be a much more frequent accompaniment 
than it now is, and a second attack rarely follows till after the 
lapse of some months, no matter what the amount of exposure. 
The treatment I have to advise can scarcely be termed otherwise 
than a specific: one, since I can with perfect truth albrm that very 
few, if any, of the cases have gone on to suppuration which have 
come to me at an early period. 

Xhe effervescing citrates will be found useful in alhuing not 



Periscope and Abstract. 48 i 

only this, but all other kinds of glandular inflammations, and I 
order twenty grains of bicarbonate of potassium to be taken with 
fifteen grains of citric acid every four hours in a state of efferves- 
cence. Guaiacum, which has long been known to be beneficial 
in throat cases, is best given in the form of lozengers made up 
with black-currant jam, in accordance with the directions of the 
pharmacopoeia of the Throat Hospital, Golden Square. One of 
these lozengers should be sucked frequenth'. Iodine, when ap- 
plied locally in cases of glandular inflammation, is known either to 
reduce the enlargement or to hasten suppuration, according to 
the stage in which it exists: and a gargle, containing from twenty 
to twent\-five minims of the tincture to the ounce of water, will 
be found particularly useful. This may be used by taking a 
little in the mouth, and shaking the head from side to side. Port- 
wine is an essential part of the treatment, and it is necessary for 
the patient to take from four to six ounces in the course of the 
day, besides plenty pf beef tea and milk. By this method reso- 
lution is almost always brought about, and the patients are, with 
scarcely a single exception, able to resume their usual duties 
about the fourth day. The usual duration under the old methods 
of treatment was almost always from nine to ten days. I 
would particularly urge upon those who are wiUing to give the 
above mentioned method of treatment a trial not to be discour- 
aged if the patient complain of feeling no better, or even worse 
for the first two days, but to presist with it all the same, and they 
will be certain to meet with the success the}- and their patients 
desire. Though the bowels are -almost always confined it is not 
advisable to administer aperients, since as soon as recovery takes 
place they are moved as regularly as possible. \Nithout any ex- 
traneous assistance. When suppuration has commenced in the 
tonsils (which maA' be looked for about the sixth day, and made 
out by great throbbing in the ear on the effected side ) it is best 
to omit the effervescing citrates and guaiacum lozengers, and de- 
pend upon the iodine gargle, together with the port wine and 
beef tea. Suppuration is by this means hastened and suffering 
curtailed. In conclusion I would ask those who put this method 
of treatment on trial, to keep a record of their cases, and after a 
time make a report both of the successful and unsuccessful ones, 
so that we may arrive at really truthful conclusions concerning 
this disease. — Lancet and Clinic. 



BETA NAPTHOL IN THE TREATMENT OF 
SCABIES. 

Josias has made a series of experiments on animals with 
napthol to determine whether the case of Neisser's, where he- 



482 The Peoria Medic at^ Monthly. 

moglobiniiria supervened when a child affected with prurigo was 
treated with it was or was not exceptional. Though both rab- 
bits and cobayes died as a result of subcutaneous injections of 
an alcoholic solution of napthol. none showed symptoms of he- 
moglobinuria. When dogs were similarly treated none died, and 
he concludes from his observations on these latter that napthol 
can not engender serious accidents which may end in hemoglob- 
inuria and death: and further, that napthol in the doses employed 
in practice is an excellent remedy for scabies, and absolutely 
harmless. The ointment" used consists of beta napthol, tifteen 
parts: lard, one hundred parts: soft soap, lift}' parts, and pow- 
dered chalk, ten parts. This ointment has given results incom- 
parably superior to all other methods in the cutaneous affections 
to which dogs are so liable, and which are so obstinate. Itch, 
eczema rubrum, psoriasis, and auricular catarrh yield, as a rule, 
very rapidly to frictions with it. More than a hundred dogs 
have been so treated by M. Xocard: in some the creneral inunc- 
tions have been repeated for eight or ten days without any bad 
result even when dogs licked themselves. The efficacy of the 
ointment has seemed to be heightened when after its application 
the skin was moistened once or twice, at twenty-four hour's 
interval, with a two per cent, solution of chloral. — Aunalcs dc 
Dcnuatologie et de Svphiligrafhie. 



The Peoria yoiirnal oi recent date contains the following: 
The French '' lady doctors " have carried the day. Hence- 
forth the female medical students will be " mesdemoiselles les 
internes," and as such they will be admitted to hospitals on the 
same terms as their male colleagues. Sixty aspirants of the M. 
D. degree are at present rejoicing in the victory, among them a 
young negro lady of '• plus beau noir," who is said to be one of 
the most zealous students in Paris. Among the different types 
of female medical students in France, which a French contem- 
porary describes with much humor, there is only one who has 
any chance of succeeding in her studies. This is the " serious " 
student, she who, at an age between 25 and 30, tights for her 
existence, is simple and reserved, avoids the fashionable " pin- 
cenez." holds aloof from both familiarity and prudishness, and 
works steadily and courageoush". It is to be hoped that the ma- 
jority of the sixty are of her turn of mind, for the description of 
the rest, who appear to be short-haired and pugnacious damsels, 
will probably profit little by the new honor conferred on them. 



The Peoria Medical Monthly, a practitioner's journal. 
Two dollars a year in advance. 



Therapeutic Notes. 



483 



THERAPEUTIC NOTES. 



SUPPURATIVE OTITIS. 

In the course of a report on the pro- 
gress of otok)gy, by Laurence Turnbull, 
ST. D., in the Reporter, we find the fol- 
lowing : 

A recent Italian writer, E. Gianpe- 
tro, advises the following treatment in 
'■ suppurative middle otitis, with per- 
foration of drum membrane " : 

R. Acid carbol crj'st., }4. ^^'■ 
Aquadest., fi 3 ozs. 

SiGNA. — Keep in a flask for external 
use. 

By appropriate tube, at every irriga- 
tion, not less than a quart of the solu- 
tion should be used, and its application 
should be made morning and evening. 
Immediately after the use of the douche 
three or four drops of the following mix- 
ture should be dropped into the middle 
ear : 

R. Glycerini purae. 

lodoformi, aa i^ *^'i"- 

After cure of the suppurating pro- 
cess, cicatrization of tympanic mem- 
brane should be promoted by painting 
the margin of the preparation with 
iodized glycerine, tincture of benzoin. 
or with the following mixture : 

R. 01. torebinthime, 4 drs. 

lodoformi pulverat, 15 grs. M. 
SiGXA. — Apply to the margin of the 
perforation with brush. 

DYSPEPSIA. 

Dr. J. H. Bundy says: If vou have a 
case of indisposition in which your pa- 
tient throws up everything taken, give 

R. Fluid ext. cascaia, 1 oz. 

Ext. of malt, 2 ozs. 

Fluid ext. berberis equi- 

Iblium, 1 oz. 

Acid hydrocyanic dil., 1 dr. 

M. SiG.— Teaspoonful directly af- 
ter meals, or oftener if there is pain or 
distress, with belching of gas or wind 
from the stomach. If with any ot the 
above symptoms there seems to be a 
sluggish liver, give nux vomica in 
proper quantity. 

PLUSH POWDERS, 

Dr. Tilt, in his work on the " Change 
of Life in Women," recommends the 
following formula for what he calls 
"flush powders," to be used by women 
who suffer much from flushings of the 
face and other parts of the body, as 
well as sweatings of the face, hands 



and feet, especially at the change of 
life : 

No.l. 
R. Carmiue, }4 gi' or less. 

Nitrate of bismuth, 1 dr. 

Camphor, ^o *^^r. 

Oil of bitter almonds, 2 drops. 

Starch, 2 ounces. 

No. 2. 

Carmine, \i, gr. or less. 

Camphor, ^a dr. 

Oxide of zinc, 1 dr. 

Attar of opresso, 1 dr. 

Starch, 2 ozs. 

SCI.\TirA. 

Dr. .James E. Wilson (New England 
Medical Monthly) recommends— 
R. Chloral Hydrat, 3 dr. 

Bromide of soda, 3 dr. 

Morphia sulph, 6 gr. 

Quinia sulph, 54 gr. 

Pulv. camphor, J dr. 

Elixrtaraxicum comp6 ozs. 

Tinct. aconite, 24 drops. 

M. Sig. — A dessertspoonful every 
three hours until relieved. 

H.K.MOPIIILIA. 

Pr(jfessor Roberts Bartholow reco ai- 
mends — 

R. Acidi gallici, V^ dr. 

Acidi sulphuric! dilut 40 min. 
Tinct. opii deod, 20 min. 

Infus digitalis, 2 ozs. 

:M. Sig— Two teaspoonfuls every 
three hours. 

ACUTE PLEURISY. 

Professor Da Costa often orders — 
R. Tinct. Aconiti rad. 30 min. 
Potassi acetatis, Yi oz. 

^Morphia sulphaiis, y^ gr. 
Liq. potassi citratis, 3 ozs. 
Syrupi tolu, 1 oz. 

M. " Sig. — Two teaspoonfuls every 
three hours. 

CHILBLLAINS. 

R. Tinct. iodi, 10 min. 

Acidi salicylic), 10 gr. 

Tinct. benzoini comp, 1 oz. 
M. Sig.— Use externally. 

NEURALGIA. 

R. Tinct. aconiti, 8 min, 

Tinct. gelsemii, 12 min. 

Ext. cimicifug* fld. 1>^ oz. 
Spts. etheris comp., }i o^- 
31. Sig. — One teaspoonful every 

hour. 



THE 



Peoria Medical Monthly. 



THOS. M. McILVAINE, A. M, M. D, 

Edilnr-hi-Chief. 

O. B. WILL, M. D., 

Associate Editor. 

J. H. COULTER, A. B., M. D., 

Business Manager 

204 S. Jefferson St., Peoria, III. 



*:i-.*The Editor is not responsible for the statements or opinions of contributors. 

***Short original articles are invited from any reader, whether a subscriber or not. 

***If extra copies are desired by a contriliutor, the number must be specified when the 
article is sent to the Editor. 

*:j,*An exchanges, hooks for review, and communications nnjst be addressed to the Peoria 
Medical Monthly. 

***The publication day of this journal is on or about the 'ioth of each month. 



EDITORIAL. 

A RETROSPECT OF THE YEAR 1885. 

We had partially written an article with this heading, but 
hnding the same ideas so much more elegantly expressed in the 
editorial pages of our brilliant contemporary, the Mar\1aiid 
J/cdical yoiiriiaL that we concluded to giye our readers an ex- 
change of editorial matter this month. 

" All along the journe}' of life positions are reached from 
^yhich the trayeller may look back oyer trodden footsteps to re- 
yiew the progress made. The retrospect may serye the double 
purpose of strengthening his faith in achieyements won and his 
courage for those ahead of him. The sum of human endeayor 
is measured by the results of efforts expended and the forces in 
reserye for subsequent outlay. Thus, by contrasting the work 
done wath that which awaits him, one is preparad to renew his 
energies for duties ahead. 

At this season of the year it is eminently proper that pro- 
fessional workers should take stock of the year's returns. What 
haye I done and how stands my stock in trade at the end of the 
year.^ This is a pertinent question for each one to ask. It is 
not to be presumed that each one is prepared to giye a fayorable 
answer to such an inquiry. It is too true that the professional 
hiye contains its drones; but. as a rule, the medical profession is 
remarkable for its energy, actiyity and untiring industry of its 
many members. Whether impelled by force or necessity, habit 
or inclination, medical men, as a class do yast sums of labor and 



Editoriai. Department. 485 

achieve important results, whether measured by the standard of 
their services to the sick, to their professional interests, or to sci- 
ence. The medical profession has a record for its humane and 
benificent labors which, when measured bv the standard of use- 
fulness to society, places it in the highest rank among human 
avocations. It is a record of which each phvsician, however 
humble his sphere mav be, should feel that he has had a part in 
making. No higher spirit should actuate a physician than the 
consciousness of knowing that he has worked faithfully and 
earnestly in professional dut}' and that he has contributed to the 
alleviation of suffering humanity. It may not be reserved for 
each member of the profession to add largely to the stock of 
scientific knowledge or to write his name among the great men 
in science, but each and every practitioner of the healing art is 
in duty bound to contribute his mite to the perfection of the 
system of scientific results. In the development of scientific 
progress it is the multitudinous host of individual skilled observ- 
ers W'ho must flood the world wMth precise individual observa- 
tions. The age in which we live is one of intense criticism and 
experiment. It is within the power of the individual to aid in 
this work of precise obser\-ation and test. The science and the 
practice of medicine are undergoing a state of transition. The 
immense mass of accumulated knowledge is as yet a heteroge- 
neous pile of rubbish in which the facts of medicine are hidden 
and from which thev must be o-leaned bv the united labor of 
many individual workers. 

Looking back over the progress of the year the profession 
nas much to encourage it in its earnest labors. The 3'ear has 
been bv no means an idle one. In each department of the sci- 
ence practical results have been presented which have added to 
the fund of accumulated facts. Looking over the literary field 
we observe a great display of literary effort in book-making, in 
compilations, and in journalistic efforts. The year has intro- 
duced to the profession several medical works of decided value, 
which appear in print for the first time, whilst new editions of 
well-known works vie with their new competitors. It seems to 
us that more than the usual number of monographs has appeared 
during the year. Among the Journals several new^ publications 
have entered the field for professional favor, whilst several 
which were once known to fame are now known only in 
deed not in name. In the department of surgery the use of an- 
tiseptics has been a favorite subject for discussion, and, at the 
present time of writing, the bi-chloride solution holds the vantage 
ground. Anaesthetics have not fallen into disrepute or lost in 
interest. Local anaesthesia has attracted well merited attention 
and gives promise of encouraging results. In operative surgery 



486 ' The Peoria Medical Monthly. 

deep interest has centered upon the various procedures within 
the cavities of the body. A triumph was recorded early in the 
vear in the removal of a mloma from the cerebrum. The abdo- 
minal cavit}' has been ruthlessly in^•aded by the scalpel with re- 
sults which astonish the imagination. The record of the vear in 
abdominal surgery cannot be excelled in achievements bv any 
other character of medical or surgical work. 

In the practice of medicine antipyretics have received a 
large share of attention and criticism ; whilst materia medica and 
therapeutics have brought to notice several agents which further 
investigation may deem worthy of a permanent position among 
the resources of the healing art. 

The epidemic of cholera in Southern Europe has kept up 
the interest in bacteriological studies and led to the introduction 
of conflicting theories in regard to the etiology, prevention and 
treatment of this disease. The practical outcome of this study 
has been a thorough investigation of disinfectant agents, and an 
increase of conhdence in disinfection and cleanliness as the means 
of combatting the disease. Marked attention has been given to 
sanitation throughout the large American and European cities 
during the year with a practical result in the reduction of the 
death-rate from all zymotic diseases. Whilst our own country 
has been spared the horrors of the cholera scourge, and of the 
small-pox epidemic which has decimated our neighbors in 
Canada, the Plymouth epidemic has fallen upon a small commun- 
ity with such power as teach the importance of attention to the 
local sanitary condition of all small towns and cities. 

The year records the usual number of deaths in the pro- 
fession. jMany honored and esteemed laborers in professional 
work ha\e entered into the rest prepared for the just, leaving 
behind the memorv of their lives and deeds, and the admonition 
that the harvester is ever near at hand to o-ather in the <rolden 
blades. The births into the profession have exceeded its deaths. 
Each year the profession is reminded of the loose and irregular 
methods which prevade our educational systems. We are unable 
to record any satisfactory progress in the direction of correcting 
an evil which is sapping the vitality and influence of professional 
usefulness in our country. A few of the states have succeeded 
in securing the passage of laws regulating the practice of medi- 
cine within their borders. In Pennsylvania, "Virginia and West 
Virginia a much needed system of protection has been secured. 

The record of the year has been marked by a controversy 
on the subject of the International Medical Congress which has 
been a humiliating spectacle to the fair-minded members of the 
profession. We have witnessed an upheaval of demagogism and 
petit jealousy which should find no encouragement in profess- 



Editorial Department. 487 

ional opinion. The differences which have divided the pro- 
fession on the Congress controversv have been unwise and un- 
necessarv. They have tauc^ht no important principle of ethics, 
and have cast lasting discredit upon the fair name of American 
medicine. 

We have freelv expressed our views on this subject in the 
interest, we beheve, of scientific medicine and not out of consid- 
eration for the ethical points raised. Ethics are rules of conduct, 
not theoretical trueisms which have no force in action. The 
science of huinan duty is broad, liberal and tolerant, not a fixed 
code which prescribes opinion bv rules more rigid than the In- 
quisition. 

We cannot close our remarks without turning attention to 
the faithful work in progress in France, in the laboratory of the 
eminent bacteriologist, M. Pasteur. The old year may ring out 
before the practical value of INI. Pasteur's experiments have been 
fullv demonstrated, but we may look to the year upon which we 
are about to enter for the full realization of the fact that in the 
line of bacteriological investigation we have the promise of the 
most important achievements which science can render to 
humanity."' 



NOTES AND COMMENTS. 

The vapors of nitrous ether are recommended by M. Pey- 
russon as a disenfectant and antiseptic. They have neither a 
disagreeable nor a hurtful smell. 

A physician in Maryland put a human skull in a tree for 
safe keeping during a temporary absence and forgot it. When 
he thought of it again and went to get it he found that a sparrow 
had taken possession and raised a familv in it. 

From statistics collected in the abattoirs of Munich and 
Augsburg, Strauss has found that no more than one calf in 100,- 
000 is consumptive. The danger of con\eying consumption with 
vaccine obtained from these animals is, therefore, slight. 

The value of vaccination is illustrated by the registers of an 
old hospital in Prague, where the mortalitv from small-pox from 
1670 to 1S15, that is, in the pre-vaccination period, was 27 per 
cent., while from 1815 to 1885 it had been only 4.53 per cent. 

A newspaper exchange says: A cure for delirium tremens 
has been discovered in an alkaloid extracted from pickled cab- 



488 The Peoria Medical Monthly. 

bage. This is the roundabout scientific way of getting at it, but 
human instinct an-ived unerringly at the same resuh centuries 
ago when it de\eloped sauer krout. 

Dr. Adam Chirk, who hatl a strong a\-ersion to pork, was 
called upon to sa\' grace at a dinner where the principle dish was 
a roast pig. He was reported to have said: '• O Lord, if thou 
canst bless under the g(^spel what thou didst curse under the law, 
bless this pig." 

Oleoze, the favorite German preparation for disguising the 
taste of the most unpleasant remedies, is said to have this com- 
position : One part each of the oils of lavender, cloves, cinnamon, 
thyme, citron, mace and orange-flowers; three parts of balsam 
of Peru, and 240 parts of spirits. 

The brain weight of man exceeds that of all animals except 
the elephant (4,500 grammes), and the large Ceteceit (2,500 
grammes). The brain weight of the largest apes is hardlv a 
third of man's. Professor Bischoff's data comprise the weights 
of brain of 559 men and 747 women. 

Boston has gone crazy over the mind cvu"e and is about to 
erect a temple to it that will cost $100,000. Now this is some- 
thing like it. We do not see why thev should call it a temple, 
though. Wh}^ not erect a hospital and trv Tvndall's " prayer 
gauge '■ at once. This would be something like it. 

The Germans have nearly stamped out small-pox. In the 
vears 1870- 1874 ^^^^ number of deaths from the disease per 100,- 
000 inhabitants in London, Paris, Viena, Prague and St. Peters- 
burg was 101.05. ^'^ Berlin, Breslau, Hamburg, Munich and 
Dresden during the same period it was but 1.44. 

A mad dog ran through the streets of Newark, N. J., some 
days ago, and bit sexeral children. Divers and sundry Amer- 
icans interested in the claims of Pasteur, the French scientist, 
who has made hydrophobia a specialtv, have raised $1,000 to 
defray the expense of their transportation to France and for their 
maintenance while there, and the children were sent at once to 
Paris under the care of Dr. Billiniis. This is a blow aimed at all 
the madstones in America. 

Professor A. Vogel <)bser\es that the hemlock plant w hich 



Editorial Department. 489 

yields conune in Bavaria, contains none in Scotland, and he con- 
cludes that sunlight plays an important part in the generation of 
alkaloids in plants. This view is confirmed bv the circumstance 
that the tropical Cinchonas, if cultivated in feeblv-lighted north- 
ern hot-houses, yield no quinine. The formation of tannin seems 
to be influenced b}- exposure of the growing bark of the beech 
or of the larch having been found to increase from the less illu- 
minated to the more illuminated parts. 

A Texas doctor gave the Medical BitUetlu an account of the 
ease with which doctors are made in that state. He took a six- 
hours' ride with a Texan villager, who asked him a great manv 
questions about the medicines used for certain diseases then pre- 
vailing in the localitv. On the following week he had occasion 
to visit a neighboring village, where he found his recent com- 
panion with his shingle out as a full fledged doctor. He had 
graduated in that six miles ride. 

Brains. — Men of ordinarv intelligence can have very large 
brains. Of 150 brains of Scotch artisans the heaviest was that 
of a tailor, 62 ounces. The heaviest brain yet known belonged 
to a brickmaker named Morris, who died in the Universitv Col- 
lege hospital. It weighed 67 ounces. He commenced life as a 
poacher: could neither read nor write, had a good memor^' and 
an itch for politics. The brain of Joachim, the giant, weighed 
only 61 3^ ounces. Borca lavs down, at its full development the 
mean average weight of brain for a man is 50 ounces, and for a 
woman 44^ ounces. 

When the vaccination inspector was making his rounds on a 
train from Montreal to Toronto, he accosted a gentleman in the 
Pullman car with the usual question: "Have you been vaccin- 
ated?" The gentleman, who had ver^- convincing e\idence of a 
three weeks' development of the operation on one of his arms, 
offered to let the inspector feel the sore places through his coat 
sleeve. The inspector, however, compelled the gentleman to re- 
move the coat and shirt sleeves in order that he might be satis- 
fied about the gennuineness of the vaccination, stating that trav- 
elers had attempted to mislead him b}' sewing two or three but- 
tons in their sleeve's. — C/iicao^o Times. 



490 The Peoria Medical Monthly. 

A Merry Christmas and a Happy New Year to every 
reader of the Monthly. May the comintr year be lackincj in 
the disappointments, and double the pleasures and successes of 
the past. 

The outlook for the future of the Monthly was never 
brighter than now. The number of our readers is constantly 
increasing, and the original department is better with each suc- 
ceeding issue. We promise that every number will be better 
than the last, until the " standard of our high ambition is attained." 

Many cases of heroism occurred in the city of Saragossa, 
Spain, during the recent cholera epidemic. Every citizen gave 
money, food or labor to the suffering. A poor washerwoman, 
bringing home clothes to a lady whom she found in a state of 
collapse, in which it ^^ as impossible to warm her, threw off her 
dress, jumped into bed, took the dying woman into her arms, and 
chafed the clammy limbs until circulation was restored. When 
the disease had spent itself the Spanish government offered re- 
wards to the principal otficials, who promptly refused them. It 
then betowed the grand cross of the Order of Benificence on the 
entire city. This cross is given only to a few individuals, who 
have risked their lives for the help of others: there is no order 
more highly valued in Spain. Never before has it been con- 
ferred on an entire town. 



BOOK NOTICES. 

Ax Atlas of Clinical Microscopy. — Bv Alexander Peyer. 
M.D. Translated and edited by Alfred G. Girard, M.D., 
Assistant Surgeon U. S. A. First American from the man- 
uscript of the second German edition with additions. Ninety 
plates with one hundred and hve illustrations, chromo-litho- 
graphs. Square, 8vo. Cloth: pp. 191. D. Appleton & Co., 
New York. 1885. Price $6.00. 

There is probably no work in any language that will prove 
of as much real service to the beginner in Microscopy, as the one 
before us, and this value is due to tne number and excellence of 
the plates with which it is literally crowded. One ordinary plate 



Book Notices. 491 

IS often worth ten pages of explanation; who then can reckon the 
assistance lent by a life size, well colored plate such as we have 
here? We have studied microscopv under an excellent teacher, 
but even he failed to furnish us with as good, clear ideas of mi- 
croscopical objects as we have in these plates. Anv phvsician 
with a good microscope can become almost an expert from the 
studv of this work alone. 

The work consists of the following parts: 

I. Microscopic examination of the Blood. 

II. Microscopic Examination of the Mammarv Secretions. 

III. Microscopic Examination of the Urine. 

IV. Microscopic Examination of the Sputum. 

V. Microscopic Examination of Intestinal Contents. 

VI. Microscopic Examination of the Contents of the Stom- 
ach. 

VII. Microscopic Examination of Fluid Contents of Ab- 
dominal Tumors. 

VIII. Microscopic Examination of the Secretions of Female 
Sexual Organs. 

IX. Various micro-organisms provoking Disease. 

The author has given especial attention to spermatorrhoea, 
which he believes can be diagnosed by means of the microscope. 
The text accompanving these plates is short and to the point. 
Koch's tubercle bacillus is well illustrated, and the methods of 
preparing phthisical sputum for examination fullv explained. 
This work should be in the hands of everv phvsician who de- 
sires home or self instruction in microscopv. 

Climat()lo(;v and Mineral Waters of the United States. 
— By a. N. Bell, A.M. M.D., Editor of the Sanitarian, 
etc., etc. With nrwips, illustrations and many tables. 8vo, 
cloth: pp. '}^>>6. 

Diseases of the Lungs (of a specific not tuberculous na- 
ture), Acute Bronchitis; Infectious Pneumonia, Gan- 
grene, Syphilis, Cancer and Hydatid of the Lung. — 
By Prof. Germain See, Member of the Academy of Medi- 
cine, and of the Facultv, Phvsician to the Hotel Dieu, Paris, 
France. Translated by E. P. Hurd, M.D. With appendix 



49^ The Peoria Medical Monthly. 

by Geo. M, Sternberg, M.D., and Prof. Dujardin Raumetz. 
8vo, cloth; pp. 398. 

Dia(;nosis OP' Diseases of the Brain and of the Spinal 
Cord.— By W. R. Gowers, M.D. F.E.C.P., etc., etc. 8vo, 
cloth; pp. 300. 

These three works comprise the October, November and 
December volumes of M^ood's Librarv for 1885, and close the 
sixth and we believe the last series of this great undertaking. 

The fortunate possessors of Woodh Librarv complete have 
a librar\' in everv sense of the word and one that will always be 
of value. The range of subjects has been almost as wide as that 
of medicine. All special branches. Surgery, Gynecolog}-, Oph- 
tholmologv and Otologv, Pharmacology, Botan}-, Microscopy, 
Legal Medicine, Chemistry, have volumes devoted to their con- 
sideration. The price has been wonderfully low, but we notice 
is beino- advanced. 

The volumes above noted need no further introduction, for 
we believe eveiy phvsician in the country acknowledges the 
worth of this great library. 

Clinical Notes on Uterine Surgery, with special reference 
to the management of the sterile condition. By J. Marion 
Sims, A.B. M.D., etc., etc. Memorial edition: 8vo, paper; 
pp, 401. Wm. Wood & Co., New York. 1S86. Price 
$1.00. 
No library should be without a copy of this classical work. 

The style of Dr. Sims is a model of simplicity and strength. 

Practical Suggestions REspECTiNti the Varieties of Elec- 
tric Currents, and the Uses of Electricity in Med- 
icine. With hints relating to the selection and care of 
electrical apparatus. By Ambro*;e L. Ranney, M.D., 
etc., etc. i2mo, cloth; pp. 150. With many plates. D. 
Appleton & Co., New York. 1885. 

This volume is made up from a series of lectures delivered 
before the classes of the Medical Department of the University 
of Vermont, and published in the A'^czv York Medical yournal 
during the past year. In their present shape they will prove very 
useful for ready reference. The author is well known as an able 



Book Notices. 493 

writer on nervous diseases and his previous works have met with 
a hearty reception. The title explains the aim and contents of 
this work. 

Cutaneous Memoranda. By Henry G. Piffard, A.M. M,D., 

etc. Third edition: 32mo, cloth; pp. 264, with index. Wm. 
Wood & Co., New York. 1885. $1.00. 

Venereal Memoranda. A Manual for the Student 
and Practitioner. By P. A. Morrow, A.M. M.D., etc. 
32mo, cloth; pp. 332. Wm. Wood & Co., New York. 
1885. $1.00. ^ 

These handy little volumes belong to Wood's series of 
Pocket Manuals, and will be found very convenient for hasty 
reference. The student will be particularly well pleased with 
them. 

Official Formul.*; of American Hospitals. Collected and 
arranged by C. F. Taylor, M.D., Editor of the Medical 
World. i6mo, cloth; pp. 238. Pubhshed by The Medical 
World, Philadelphia. 1885. Price $1.00. 

The pharmacopoeias of the various large hospitals of this 
country must contain much that is of well proven value, and 
their formula? cannot fail to furnish many useful hints for private 
practice. Dr. Taylor has done a good work in collecting them 
into an available shape. 

The Pedigree of Disease. Being six lectures on Tempera- 
ment, Idiosyncrasy and Diathesis, delivered in the Theatre 
of the Royal College of Surgeons in the Session of 1881. 
By Jonathan Hutchinson, F.R.S., etc. 8mo, cloth : pp. 
112. Wm. Wood & Co., New York. 1885. 

Epitome of Diseases of the Skin. Being an abstract of a 
course of lectures delivered in the University of Pennsyl- 
vania during the Session of 1883-84. By Louis A. Duhr- 
iNG, M.D. .Reported by Henry Wile, M.D. i6mo, cloth; 
pp. 130. J. B. Lippincott Company, Philadelphia. 1885. 
Price 60 cents. 

A very useful little work for hasty reference. 



494 'I'he Peoria Medical Monthly. 

Milk Analysis and Infant Feeding. A Practical Treatise 
on the Examination of Human and Cow's Milk, Cream, 
Condensed Milk, etc., and Directions for the Diet of Young 
Infants. By x\rthur V. Meigs, M.D., Physician to the 
Pennsylvania Hospital and to the Children's Hospital, etc., 
etc. i2mo, cloth; pp. 102. P. Blakiston, Son & Co., Phil- 
adelphia, Pa. 2885. Price $1.00. 

A valuable contribution to a subject which has in the past 
received too little attention. Dr. Meigs' experiments and anal- 
yses have done much to settle disputed points in the compo- 
sition of milk and to determine the best methods for the artificial 
feeding of infants. 

Essentials of V^accination : A Compilation of Facts relating 
to Vaccine Inoculation and its Influence in the Prevention of 
Small-Pox. By W. A. Hardaw^\y, M.D., Professor, etc., 
etc. Small i2mo, cloth; pp. 146. J. H. Chambers & Co., 
St. Louis, Mo. 1886. 

We commend this work especially to those physicians who 
profess no faith in the efficacy of vaccination, and to that larger 
class whose faith is wavering. Its statements are plain and based 
on statistics covering sufficient time and a sufficiently large num- 
ber of cases to make them incontrovertable. Every physician 
should have it for the rules and suggestions laid down for the 
operation of vaccination. It is also a good work to put in the 
hands of intelligent laymen. 



NOTICE TO SUBSCRIBERS. 

Receipts for the month have been omitted. We hope all 
to whom statements have been sent will remit at once, if the}' 
have not already done so. All errors in statements will be 
cheerfully corrected, as we do not wish to overcharge anyone. 
If anyone is unable to remit at this time, please send us word 
and we will be glad to wait your convenience. All who can pay 
will greatly oblige us by prompt payment, as we wish to clos^i: 
our books for the year and begin square xvith the world. 



The Peoria 
MEDICAL MONTHLY. 



Vol. VI. : : JANUARY : 1886 : : No. 9. 



CLINICAL LECTURE. 

HYSTERIA— OXALURIA— INCIPIENT LOCOMOTOR 
ATAXIA— GASTRALGIA. 

BY PROFESSOR J. M. DA COSTA, M. D., PHILADELPHIA, PA. 
PECULIAR CASE OF HYSTERIA. 

It is with great satisfaction, gentlemen, that I bring this case 
before you to-day. You will remember this woman as the case 
of hysteria that I had before a^ou some weeks since, when I told 
you the patient did not seem to have any desire to sham\ that 
the affection was, in her case, a real disease. She would be fre- 
quently seized with uncontrollable paroxysms of twisting and 
twitching, screaming and would fall to the floor, not, however, 
losing consciousness. You may remember that when I applied 
the sthethoscope to her chest one of these spells was thereby ex- 
cited and putting her hands to her head she screamed maniacally 
for some seconds, the whole S3'stem, the while, evidencing great 
purturbation. I bring her before you to-day, I say, with great 
satisfaction, for our therapeutic procedures have produced won- 
derful results. She was ordered two grains of valerianate of 
zinc thrice daily, and she was treated for an erosion and lacera- 
tion of the cervix uteri that was found. To-day she walks w^ell, 
having previously suffered from hysterical paralysis; there is no 
tremor, no loss of power; she has gained flesh, and has had no 
" spells " since the beginning of treatment until about one week 



496 The Peoria Medical Monthly. 

ago, when she had a very light attack. Her tongue is still 
somewhat coated and her bowels costive. We have had here 
much more marked and rapid improvement than we had an}- 
right to anticipate; this I attribute to the zinc and to the local 
treatment. As the tendency towards these attacks is now broken 
up, we can abandon the zinc and resort to remedies better calcu- 
lated to improve the general health and build up her nervous 
system. We will order for her 

R. Liq. arsenici chlor., 5 drops. 

Tinct ferri chlor., 15 drops. 

Syr. simpl, 10 drops. 

Elixir simpl, ad 1 fl. drachm. M. 
S. Thrice daily, after meals. 

For the costiveness we will give her, every night, ^^q grain 
aloin and J^ gi'^iin extract belladonna, with two grains of rhu- 
barb, If this acts inordinately, we will only give it on alternate 
nights. 

OXALURIA. 

Here is a case presenting some interesting features. This 
3-oung man, aged 29, has prepared his own histor}- and from it 
w^e learn that there is some vague histor}^ of kidnev disease on 
his mother's side: his digestion is poor, he is costive, he belches, 
and suffers from acidity, from directly after to two or three hours 
after meals. He complains of soreness in the epigastrium, 
which is not aggravated by taking food: he is loosing flesh and 
has a curious appetite — when he sits down to the table he feels 
as though he could not eat fast enoug-h to satisfy his hunirer, but 
he is soon satiated and becomes distended. His sleep is dis- 
turbed, and he complains of soreness about the back. He has 
chilly sensations and his breathing is, at times, oppressed and 
irregular. He has a dull, throbbing pain in the temples and an 
occasional sensation as of clamps about the heels. He sweats 
all over the body. I wish particularly to call your attention to 
a marked symptom in this case — his great depression mentally: 
he also complains of impotency, extreme difficulty in concentra- 
ting the mind on one subject; he has no virtigo or headache. 
The urine has a specific gravity of 102 1 to 1036; it is dark red, 
but contains neither albumen nor sugar, it is full of urates and 
he has a constant desire to urinate: he passes about fort}^ ounces 



Clinical Lectures. 497 

per day. He complains of roaring in the head and floating 
specks before his eyes, not present when he feels at his best. 
His heart is somewhat irritable, and there is a soft cvstolic left 
basic murmur. The tongue is large and flabby, showing the 
marks of the teeth. His liver and spleen are normal and there 
IS no CEdema. This case impresses me as one of oxaluria, which 
is a form of non-assimilation, of non-oxvgenation of food. In 
nearly all such cases we find excessive quantities of urates, but 
in order to clear up the diagnosis, beyond any possibility of 
doubt, we must examine the urine under the microscope. The 
great mental depression, the roaring in the head, defective eye- 
sight and dyspeptic symptoms ( sometimes very slight ) are all 
significant of oxaluria, as is also the constipation. But the urine 
offers the most characteristic signs. In all these cases the urine 
has a high specific gravity. 

In forming a pi-Dgnosis, we must alwavs take into consider- 
ation, the occupation and habits of the patients. This disorder 
is very common among those who are industrious and lead 
sedentary lives, among brain workers, and particularly, if to a 
sedentary life, we conjoin the excessive use of tobacco: the 
gouty diathesis also plavs a prominent part in its causation. 
Sexual abuse, as excessive venerv and masturbation are common 
causes. We must have all these facts in mind, because, though 
we may cure a case, it will not remain cured unless we remove 
the cause. In the treatment we must insist on easily digested 
food. In place of three meals daily he should take four and 
eat sparingh" at each. He should consume but a moderate 
quantity of underdone meat, relying uiainh' on green vegetables, 
fish and oysters. Sugar must be forbidden. He may use tea 
and coffee, indeed they are said to have a tendency to limit the 
disease. He may also use milk, but no wines or liquors. Active 
exercise is a most important therapeutic procedure, particularly 
such as tends to produce a free action of the skin, as brisk walk- 
ing and friction with a coarse towel, the action of the skin in 
burning off this non-oxygenated nutriment will greatly help our 
other measures. Of drugs, nitro-muriatic acid is the best in 
this condition; it acts partly, no doubt, by aiding digestion, 
partly by its alterative action on the liver, and on account of the 
chlorine which it contains, directly on the blood as well. We 



498 The Peoria Medical Monthly. 

will give this ^^oung man five drops of the strong acid, diluted in 
a wine glass of water, thrice daily, to be taken through a tube, 
before meals: and we will also give him ^\ of a grain of strych- 
nia thrice daily. Cocoa will also prove valuable in such cases. 
We must also attend to the bowels, and for this purpose small 
doses of the salines will prove most efficacious. He will take 
from one to two drachms Rochelle salts, two or three times a 
week. 

INCIPIENT LOCOMOTOR ATAXIA. 

This stout blacksmith, aged 46, presents an exceedingly in- 
teresting case for our study. He complains of pain, originating 
in the back and shooting down his legs, which are present about 
one-third of the time, being absent the other two-thirds ; he will 
have them for a few days and then they will vanish; they are 
not influenced by the weather. It is sharp and griping at times, 
while, at others, it is as though a dull knife were being drawn 
over the bone. This pain never ascends to the arms. He can 
walk well, as you see, and kick both legs with considerable force. 
He can walk equallv well with his eyes shut or v/ith the head 
thrown back and the eyes fixed on the ceiling. He stands per- 
fectly well with the feet in juxtaposition and the eyes closed. 
His urine has a specific gravity of 10 10; it is acid, and there 
neither albumen, sugar, nor sediment. He has no dyspepsia, 
though he is somewhat costive. There is no heart lesion; the 
tongue is coated in streaks; his eye-sight is good; he has very 
little headache and very little vertigo. No causeless vomiting. 
There is a doubtful history of syphilis when he was a very 
voung man. He has a verv peculiar state of the pupils; they 
are contracted, but not at all influenced by light; yet when he 
brings into play the powers of accommodation, the pupils do 
contract and dilate. This is called the Argyle-Robinson pupil, 
after the two men who first observed this peculiar condition. 
Ophthalmoscopic examination reveals sclerosis of the fine arteries 
and dilatition of the veins of both retinee. Patella-tendon-reflex 
is almost abolished on the left side and entirely absent on the 
right. Here we have the very earliest possible stage of loco- 
motor ataxia, the diagnosis being made solely from the condition 
of the vessels of the retina and the state of the pupil, in con- 
junction with the absence of the tendon-reflex. This Argyle- 



Clinical Lectures. 499 

Robinson pupil is one of the most significant signs of the early 
stages of locomotor ataxia, and when found in connection with 
absence of the patella-tendon-reflex and pain in the lower ex- 
tremeties, the diagnosis is sure. There is no disturbance, in sensa- 
tion or locomotion in this case yet. When we see a case so early 
we ought to make an attempt at radical treatment, and as we 
have some idea of a specific history, we will order this man 
twenty grains of iodide of potassium, thrice daily, commencing 
with ten grain doses, to see how his stomach will tolerate it, and 
increasing to twenty. Following this we will give him nitrate 
of silver. 

GASTRALGIA. 

Here is a woman who complains of epigastric pain, coming 
on two hours after meals and neuralgic in character, and lasting 
for an hour. She is not costive; does not vomit, but suffers 
some from acidity in the morning. She thinks, though she has 
never tried it, that she would not suffer from this pain if she 
abstained from food. It is not any more severe after a hearty 
than after a light meal, and the epigastrium is not tender on pres- 
sure. All her functions are normal. Here we have a case of 
gastralgia. We rarely see a case so purely nervous, where 
there is so little gastric derangement. It is a most difficult dis- 
ease to treat and you must not make light of it; it will some- 
times linger for years. The most useful drug that I know of in 
these purely nervous cases is cannabis indica, of the extract of 
which we will order J grain along with ^1,, grain of arsenite of so- 
dium; the more the case approaches the nervous type, the more 
useful will be the arsenic; while, when there is much gastritis, 
bismuth and similar preparations will do more good. The diet 
must be exclusively milk, or at the most, if this be too irksome, 
milk toast and soft boiled eggs. Cannabis indica is a drug that 
is very likely to be adulterated, and you must be careful to pro- 
cure a pure article, else you will be disappointed in its results. 



Subscribe for the Monthly — a thoroughly reliable practi- 
tioner's journal; $2 per year in advance. 



500 The Peoria Medical Monthly. 

ORIGINAL COMMUNICATIONS. 
THEORIES OF THE PRODUCTION OF THE SEXES. 

BY SILAS HUBBARD, M. D., HUDSON, ILL. 

Dr. John Stockton Hough, of Trenton, N. J., recently in 
writing to me says: "I am making a collection of books and 
pamphlets on generation, production of sexes, etc., having now 
about 5,000.'" He further says: "So far as my reading goes 
you were the hrst to announce the theory that the sex of fcetus 
depends on the degree of maturation of the ovum at the time of 
fecundation." I would add that I believe every thing that has 
been written on the subject of the maturation of the ovum and 
the times of the menses and intermenstrual periods as relates to 
the sexes begotten, descended from what I published in the Buf- 
falo Medical yoiirnal from 1850 to 1855, inclusive: and now I 
propose through your valuable Monthly to make some addi- 
tions on the above subject to what I have heretofore published. 
I will here sav that I shall proceed according as thoughts occur 
to me, and not according to any system. In this paper I shall 
repeatedly refer to remarks of Dr. Hough, all of which can be 
found in the American Jon Dial of Obstetrics and Diseases of 
Women and Children, vol. xvii., February, March, May and 
June, 1884. 

I will, then, here say first that tight lacing of women is so 
oppressive to the fallopian tubes that they are not likely to carry 
semen up to the ovary, consequently such women are more likely 
to produce girls than boys and likely to be unprohfic. 

Some women are so weakly that their fallopian tubes will 
not take the semen up to the ovaries, and their husbands are so 
weakly that their spermatozoa are so weak they will not ma4ce 
their way up the tubes to the ovary, therefore they produce no 
boys. If such parents insist on having a boy, tell them to have 
coition only shortly before the menses, and then at night on go- 
ing to bed, that the semen may gravitate to the fundus of the 
uterus and find its way up the fallopian tubes to the ovaries. I 
have known some cases of sterility of the woman to be cured by 
such a proceeding. 

The sexual propensity of women is usually stronger shortly 
after the menses than before, which accounts for many cross and 



Original Communications. 501 

feverish women who might have boys, having nearly all girls; 
they are not willing to accommodate their husbands only when 
it accommodates themselves, consequentlv the most of their chil- 
dren are girls, while the good-natured woman with an equally 
vigorous constitution has more boys. 

Occasionally an extrauterine fetation is a female, and this 
is because the ovum was arrested from descending into the 
uterus until it became old and mature, and if thus it is impreg- 
nated it grows to be a female. Quadrupeds very rarely have 
extrauterine foetations, because the uterus and tubes Ivino" hori- 
zontalh' the ovum does not have to travel up hill, and because 
the}' always obey the laws of nature. Thev never have placenta 
praevia, because of their uterus lying horizontal and because they 
obey the laws of nature. They are more certain of impregna- 
tion than are women, because their uterus and fallopian tubes lay 
horizontally, and neither ovum nor semen has to travel up hill, 
and because they do not disobey the laws of nature. 

Occasionally the child in a placenta praevia case is a bov: 
this is because the ovum was detached from the ovarv in a very 
immature state and hastily transferred through the fallopian tube 
into the cavitv of the uterus, and being impregnated while in that 
immature condition, and falling low into the neck of the uterus, 
a placenta praevia case is produced and the child is a boy, and 
such accident in which the child is a male is caused bv excessive 
sexual intercourse shortly before the courses, which aids to de- 
tatch the ovum from the ovary and hurrv it through the fallopian 
tube in an immature state; but where the child is a female in a 
placenta praevia case the acci-^ent is usualh' caused by excessive 
intercourse shortly after menstruation, causing the mature ovum 
to fall too low, where it makes it attachment, and in \-ery many 
instances the intercourses are so excessive that they cause the 
ejection of the ovum. Pleasureable coition of the woman pro- 
duces an action of the uterus and fallopian tubes towards the 
ovary; but excessive intercourse becoming disagreeable reverses 
the action and produces an expulsive effect, therefore a rape 
being repulsive to the woman would likely be unfruitful. 

All sexual intercourse if agreeable to the female has a ten- 
dencv to hasten and invigorate the grasping of the ovary bv the 
hmbriated extremity of the fallopian tube, and if an ovum is 



5o2 The Peoria Medical Monthly. 

formed, to aid in detaching it from the ovary and conveying it 
into the fallopian tube: however, shortly before such menstrual 
period the fimbriated extremity of the tube ordinarily does grasp 
the ovar}' and helps to detach the ovum and convey it into the 
uterus even without sexual intercourse, and normally it always 
does this, but occasionally this order of exercise is not per- 
formed and then the ovary is liable to become diseased by the 
ovum dying within it, or even peritoneal iritation produced by the 
ovum dropping into its cavit}-. During menstruation and shortly 
after, the action of the fallopian tubes are towards the uterus, to- 
convey the ovum into the uterus. 

One of the reasons that illegitimate children are more likely 
to be females is that the mother is more likely to have intercourse 
at that time which pleases herself most, which is usually shortly 
after menstruation; however, American women are so virtuous- 
that but very few of them would risk the impregnation of an 
ovum out of wedlock, and even then they are so smitten in con- 
science that the fallopian tubes would fail to cary the semen up 
the ovary, which would be another reason for the children being 
females. Unprincipled women who encourage impregnation out 
of wedlock, expecting to make their fortunes, are more likelv to- 
have boys than in ordinary cases of illegitimacy. The desire to 
conceive offspring encourages an action upwards of the uterus 
and fallopian tubes to convey spermatozoa to an ovum in the 
ovary, if there is a gratiian vesicle there. 

The Israelites have a law given through Moses that a man 
shall not have intercourse with a woman durincr her menstrua- 
tion nor short of se\'en days after, ( Lev. 15, 19, 24, also 18, 19) ; 
also if a woman is irregular, having a show of blood every few 
days, she shall not have intercourse during such irregularity, 
(Lev. 15, 25, 28.) I suppose some of the reasons why they 
should not have intercourse durinfj menstruation were that co- 
ition then sometimes reverses the action of the fallopian tubes, 
thus sometimes causing extrauterine conceptions, also sometimes 
carrying menstrual blood to the ovary to the damage of the 
health of the woman, for the sake of cleanliness, and also that the 
offspring should have the distinct characteristics of one sex or 
the other. Some of the same reasons, and also to permit her to 
recover, would apply to the woman who is having a show of 



Original Communications. ' 503 

blood every few da^'S ; and that she shall not have intercourse short 
■of seven days after menstruation is to make them temperate in 
.sexual intercourse, and also largely increase the prospects of their 
begetting a large majority of boys, as they were to be a nation 
•ot wariors, and they could save the captive virgins to cross the 
breed for the benefit of the nation. So far as I have consulted 
the ancient and modern history of the Jews there have always 
been a large majority of males among them. 

The Mosaic law makes the following difference in regard 
to a mother after the birth of a male or female child: After the 
birth of a male child "she shall be unclean seven days" (Lev. 
12:4); " but if she bear a female child, then she shall be unclean 
two weeks, as in her separation; and she shall continue in the 
blood of her purifying three score and six davs." Dr. Hough 
gives as the reason for the above difference that the placenta 
which belongs to a girl is larger usualh' than the placenta which 
accompanies a male child. I will admit his statement, but I will 
account for its being larger and more expanded on different prin- 
ciples from what he does, viz., the ovum which grows to be a 
male is fecundated while in the fallopian tube or ovary, conse- 
quentlv it attaches itself to the fundus of the uterus as soon as it 
has entered the uterus, where it does not have as much room to 
expand and grow as does the placenta which accompanies the 
female child, which is ordinarily situated nearer the center of the 
uterus where it has more room to expand; and it being larger 
and more expansive, she w^ould on an average flow more and 
longer than after the birth of a male. According to the law as 
given bv Moses there was a particular honor bestowed on the 
first male child born in a family; I suppose that one reason was 
that temperance, industry, vigor and health favor the production 
•of boys; however, both parents can maintain all these excellences 
.and have girls if they choose. 

Dr. Hough gives some respectable authority as saying that 
fat sheep produce more ewe lambs than males, while lean sheep 
produce more males. I will say that there are some grounds 
for believing the statement. Fat women produce more girls 
than boys, and I will give the reason why. It is because the 
pressure of the fat not only retards the progress of the ovum into 
the uterus, but also retards the progress of the semen up the 



504 The Peoria Medical Monthly. 

fallopian tube to the ovary, consequently the semen rarely 
reaches the ovum until it arrives in the uterus in a very mature 
state. Fat women are frequently sterile. 

I recently interviewed a number of horse breeders in this 
vicinity. They all agreed that mares impregnated in the begin- 
ning of heat usually produced males, and those in the latter part 
of heat produced females; but thev preferred the middle of heat 
because that time would prove more certain. Excessive service 
of the stallions caused them to be uncertain, and when they did 
beget colts they were usually females, and I will give the reason 
whv, viz., their excessive congress so weakened their sperma- 
tozoa that thev could scarcely impregnate an immature ovum, 
consequentlv the ova; they did usually impregnate were very 
mature and hence developed into females. 

I will here publish for the first time something important to 
stock -raisers, viz., the sow which is admitted to the boar on the 
first dav of heat will have a majority of male pigs, but if on the 
second or third day she will have the largest number of progeny 
and the sexes will be about equal in number: but if she is ad- 
mitted on the fourth day, or as she is going out of heat, she will 
have the fewest number and the^' will be sows. She ought not 
to be admitted over half an hour on any da}'. 

I tried some experiments with setting hens. I found that 
when the first half of a batch of eggs laid by a hen were hatched, 
thev principallv developed into hens, but the last half laid mainly 
developed into roosters. According to my theory the first half 
of a batch of eggs of the hen turkey would develop into hens 
mainlv, and the last half into males. 

It would be well if phvsiologists would observe in what order 
the sexes were born of bitches, and sows, and also to observe in 
what order the sexes lav in the uterus: it might throw some light 
on the situation of the placenta in women as regards the sex of 
the child. 

So far as I have observed the birth of twins, in women, 
where they were of different sex the male was always born first, 
I suppose because thev are usually heavier and therefore sink 
lower in the uterus and therefore engage first, and if one of them 
was presenting right and the other wrong, the boy would be 
right and the girl wrong, for the head and shoulders of the boy 



Original Communications. $0^ 

being heavier than the same parts of the girl would sink his head 
tw the outlet of the uterus, while the hips of the girl being heav- 
ier would be more likely to cause her to present lower extrem- 
ities or breech first. 

It sometimes happens that shortly after menstruation an 
ovum is cast off which w^ould have grown to be a girl, and in 
that case spermatozoa might sometimes be retained in the fallo- 
pian tubes waiting for an ovum to be formed, and thus impreg- 
nation occur seven or eight days after the coition, for the sperma- 
tozoa will sometimes live as long in the fallopian tubes as they 
will in- the vesicula? seminales, hence there is no positive time 
that a fertile woman, if exposed, can say she is exempt from im- 
pregnation. Sometimes an ovum within the uterus which would 
grow to be a female is fecundated, and ver}' soon after another 
ovum within the ovary is also fecundated, as a superfetation, and 
carried by one of the tubes into the uterus, and thus there would 
result a twin case of a bo}- and a girl. Ordinarily an ovum is 
monthly alternately formed in the right and the left ovary. If 
two are matured and fecundated at the same time they will de- 
velop into the same sex and the sex will depend on the degree 
of maturation of the ova at the time they w^ere fecundated. 

[to be continued.] 



AMENORRHCEA. 

BY AV. H. TATE, M. D., GREENSBUR(t, OHIO. 

Having read an article in the August number of the Month- 
ly on manfranese in the treatment of amenorrhea, by Dr. A. R. 
Hicks, it reminded me of several cases in my hands treated with 
potassee permanganas, one or two of which I will refer to. 

About the tirst of March, 1885, Miss H., a girl about iS 
years of age, called at my office for treatment, her menses hav- 
ing been absent for several months, from the effects of getting 
her feet wet which resulted in suppression of the monthly flow. 

Although she had been remarkably healthy previously, and 
had menstruated regularly, yet at the time she presented herself 
for treatment there were evident symptoms of decline, viz., ner- 



5o6 The Peoria Medical Monthly. 

vous chills, a cough characteristic to such ailments, night sweats, 
emaciation, etc. I prescribed the following: 

R. Potassie permang., 1 dr. 

Aqua pura, . 8 ozs. 

Dissolve. 

SiG. — One teaspoonful every four hours, commencing a 
^veek or ten days before the expected return of the catamenia. 

If necessary this amount may be continued for two or three 
weeks if it does not interfere with the functions of the stomach. 

About the latter part of August last Mrs. B., a married 
woman about 20 years of age, also stated that she had not ex- 
perienced her menstruation for about three months and applied 
for treatment. I resorted to the permanganate which was con- 
tinued for a week or ten days with the most happy result, pro- 
ducing a most copious discharge of the menstrual fluid. 

I have since treated quite a number of cases suffering from 
suppression of the menses and have found the remedy above 
alluded to, as eflicient and reliable as any other that I have ever 
resorted to for such purposes. All of the cases alluded to 
yielded very promptly to the drug, which brought about results 
far more pleasing than I had anticipated. 



CAPILLARY BRONCHITIS WITH LOBULAR 
PNEUMONIA. 

BY J. E. marsh, M. D., portage, W^IS. 

The following report of a case of capillary bronchitis with 
lobular pneumonia which occurred in my practice last spring, 
may be of interest to some on account of the remarkable fre- 
quency of the pulse and respiration, with final recovery. 

I was called on the eve of March 16, 1885, to see Leroy 
Simmons, aged 13 months. Previous health had been good to 
within a few days, since which he had suffered from a severe 
cold, as the parents described it. They said there had been a 
good deal of rattling in the lungs for a day or two. He had 
been getting worse from day to day, and was very bad during 
the two previous nights. 



Original Communications 507 

I found him with symptoms of pain in the head, much pain 
in coughing, wishes to lie on left side, has the expiratory moan, 
countenance indicates much suffering, urine scanty, pulse 130, 
respiration 60, temperature loi. Examination of chest revealed 
abundant subcrepitant rales over entire chest, with here and 
there some dr}- rales; right lung most affected; no dulness on 
percussion. 

Gave potassium bromide and spirits cetheris nitr, with a ver}- 
little tincture aconite. 

March 17. — Patient worse than day previous. Gave in ad- 
dition syrup rhei aromat to move bowels, and a little F. E. 
ipecac. 

March 18. Symptoms worse. Prescribed the following: 

R. Spts. ^theris nitrosi, 1 drachm. 

Syrup ipecac. 

Olei ricini, aa 2 drachms. 

Syrup simplicis, 7 drachms. 

M. Sig. — A teaspoonful every two to four hours. In addition 
left digitalis and am. murias. 

March 19. — Respiration and pulse more frequent; counte- 
nance indicates great suffering. Left tincture opii camphor, to 
relieve. Continued the medicine of previous day. 

March 20. — Failing. Coldness, cyanosis. Ordered heat, 
friction and brandy. Continued the digitahs and am. murias. 

Earch 21. — Takes but little nourishment — milk from bottle. 
Respiration more frequent and shallow, and pulse more rapid 
and feeble. Rattling caused by mucous in lungs can be heard 
very distinctly. Continued treatment of previous day. Com- 
menced the use of poultices of linseed meal and a little mustard a 
few days previously and they were continued. 

March 22. — Symptoms more unfavorable. Larger quantity 
of mucous in lungs. Respiration 85; pulse 160. Spells of cold 
extremities and cyanosis. Struggles hard in a fit of coughing 
and succeeds in throwing off a large quantity of mucous. Soon 
appears some better. I remained during the night. Applied 
large hot onion poultices to chest anteriorly and posteriorly. 
Gave 10 drops of brandy ever}^ hour or two in milk. Instead 
of paregoric gave tincture opii, f. e. ipecac, and pot. bromide, 
which reheved head symptoms and gave rest. It would pre- 



5o8 The Peoria Medical M'.^nthly. 

vioiisly put its hand to its head and roll it from side to side. Pro- 
fuse perspiration soon commenced lasting two or three hours. 
As the child was too weak to nurse, I held the nursing bottle 
containing the milk and brandy and forced it through the tube 
into its mouth. Gave one drop tincture digitalis and one grain 
am. carb. every two hours. A few minutes before giving the 
milk and brandy gave the following: 

R. Brandy, 10 drops. 

Glycerine, 12 drops. 

Quinine, i grain. 

Every two hours, alternating with the ammonia and digitalis. 

The accumulating mucous embarrassed the respiration more 
and more, and towards morning I gave 2 grains hydrag. sub- 
sulph., and as vomiting did not result, I repeated the dose in 
fifteen or twent}- minutes, which caused vomiting, freeing the 
lungs from large quantities of mucous, but nevertheless the res- 
piration grew more shallow and rapid, counting lOO to the min- 
ute: pulse i8o and very weak. Ordered same treatment con- 
tinued during the dav except that the quinine mixture was to be 
given every four hours instead of two. 

March 23. — Respiration rose to 115 per minute, pulse too 
weak and rapid to be counted. It had as much milk and brandy 
as it could stand. Onion syrup with a little ipecac caused vom- 
iting two or three times. It coughed up and swallowed a good 
deal of mucous. Had a large evacuation of mucous from the 
bowels. For a few hours towards evening it appeared very 
hungry or thirsty. Gave slipery elm tea to drink for thirst in 
addition to milk and brandy. At 5 p. m. respiration was becom- 
ing less frequent and within three hours had gone down to 80; 
pulse 155. Applied linseed meal poultice containing mustard 
during the following night. Gave ^\, drop liq. strychnia at the 
time of giving ammonia and digitalis. I remained during the 
ni<yht. Patient continued to improve until morning when res- 
piration was 55, and pulse 135. 

March 24. — Patient gradually improved and was soon con- 
valescent. Some dullness remained on right side but soon dis- 
appeared. Continued treatment with pot. iodide and a tonic 
mixture containing iron. Patient made a good recovery. 



Original Communications. 509 

ANGINA PECTORIS. 

BY EMIL BRENDEL, M. D., CEDAR RAPIDS, IOWA. 

In the Medical News (Nov. 28, 1885) before me I find a 
note, translated from the BuUetin general de Therafeiitiqiie^ 
headed. Cure of Angina Pectoris, which induced me to review 
four cases of a hke disturbance. The afflicted persons, farmers, 
are two brothers, between the age of 70 and 80 vears, and two 
sons of the older brother between 35 and 40, hving 10 or 12 
miles from town. In all four I found irregular action of the 
heart, sharp pain and oppressive feehng of narrowness and cold- 
ness near the apex of the heart, which was paroxvsmal respect- 
ing the pain. 

The first case in spring, 1882, to which mv attention was 
drawn, was that of the oldest son of the elder brother, who had 
given up being treated for his complaint, because of having con- 
sulted several physicians without an}- benefit, and I could not 
make out the true nature of his complaint by his refusal. 

The second case in February, 18S4, was his father, 80 years 
old, who presented the symptoms of a severe bronchitis and that 
irregular action of the heart, which I treated in the usual wav 
respecting bronchitis and b}' subsequent use of digitalis, ferrum 
jodatum and quinia. He recovered from his bronchitis, but the 
heart's action, though improved in the volume of the beat and 
rythm showed still one intermission in about 18 minutes. 

The third case in June, 1884, was the second son of that 
gentleman who presented that same irregularity of heart's action 
and the paroxysmal oppressive feeling of narrowness below the 
heart. 

The fourth case, two months later, was his uncle, about 69, 
vears old, presenting the same symptoms and grasping painv 
irregular paroxysms. As I treated these two last cases essen- 
tiallv alike, I will only report the statement of uncle John. 

The examination of the urine showed no albumen, no casts, 
but uric acid and scantiness. The paroxysms of pain irregular, 
though ahvays towards night. I prescribed 

R. Fluid ext. digitalis, •} drachm. 

Kali jodati, 2 drachms. 

Tr. scikae, \ drachm to 1 oz. fluid. 

S. — 1 drachm ter die, with as much water. 



5IO The Peoria Medical Monthly. 

Which increased the volume of the heart's beat, and the flow 
of urine exhibiting reddish urate sediment. 

The third day gave persulphate, quinine et ferri, which had 
no effect whatever, and I returned to kali jod., digitalis and col- 
chicum, which seemed to mitigate the pain; the urine became 
more copious and clearer of sediments. The examination of the 
urine gave nothing abnormal. 

But soon he complained of increased pain and sleeplessness. 
I prescribed ■ 

R Kali bromat, 4 drachms. 

Tr. digitalis, 1 ounce. 

Glycerine, 1 oz. in 8 oz. fluid. 
S. — One-half ounce per die. 

Which did tolerable good service, together with local appli- 
cation of morphia, and in addition of kati jodatim was contin- 
ued for more than three months, at the patient's request, to give 
him the same medicine in larger quantities. Afterwards they 
came often and asked for more medicine. The heart acts 
remarkabl}' — more regular; the pain is gone, only an oppressive 
feeling left. 

Though I was sure of a correct diagnosis in the third and 
fourth case, for the irregular action of the heart. Of the case 
No. I I have found out but lately, and the second case was veiled 
by bronchitis. I cannot say that I used the iodide for " modif}'- 
ing the arterial condition," as it is indicated in the above named 
article of the JMcdical JVews, neither did I regard the disease as 
an affection of the coronary arteries of the heart — which idea 
Avas entirely new to me, but I took it as a nerve-reflex action, local- 
ized on that particular spot — a neurosis. And the cause of that 
neurosis was what I tried to make out, which after not finding 
any disorder in the kidneys, nor malaria, I laid it to a rheurriatic 
diathesis or irritating action of the uric acid, which I found in 
the urine. 

That amAd nitrate would relieve the pain was known to me, 
but I was afraid to leave that remedy in the hands of mv pa- 
tients. That M. Nuchard, the author of that article in the Biil- 
/etin, refused digitalis, which I employed from beginning to end 
with the same result, would indeed testifv to me the beneficial 
action of the iodides. 



Original Communications. 511 

That this disease occurred in one family, if not in all its 
races: but in regard to the irregularity of the heart's action, is a 
fact, the explanation of which my Latin does not reach. 



MALIGNANT PUSTULE. 

BY F. W, MOFFITT, M. D., RANDOLPH, WIS. 

On the 26th day of May, 1885, a six-3'ear-old daughter of 
H. Z., German, came in to dinner with a slight scratch on the 
left side of her nose. She had been playing with some chickens, 
dead from chicken cholera. She complained of some pain in a 
short time, and in a few hours a pustule had formed, containing 
dirt}-, yellow pus. In a few more hours the pus had become 
clouded with dark colored masses, and some eedema had set in. 
B}' morning of the 27th, the aidema involved the eyelids and 
whole upper part of face, the pustule had a livid, indurated bor- 
der, and there was some fever. The parents being averse to run- 
ning a doctor bill, treated it with local sour-milk applications, and 
internally some herb tea. The case of course continued to grow 
worse, and on the morning of the 29th, I was called in. 

The histor}', so near as I could learn, was as I have given 
above. I found in the seat of the pustule a black crust sur- 
rounded by a livid, raised, indurated area three or four lines thick. 
The «dema had closed both eyes so completely that I could 
scarcely open them, and had extended into the frontal region 
nearly to the coronal suture, near which another pustule wasi 
forming, and another had formed over the right orbit, about an 
inch above it. When the crust was removed from the original 
sore, it revealed an ulcer with a sloping floor, perforated at the 
bottom by an orifice about the size of a pin hole. By pressing 
upon the indurated base this orifice gave exit to a bloody pus. 
There was a general depressed state of the system with a tenden- 
cy to coma. The urine was acid, high colored and scanty. Evac- 
uations semi-solid and possessing a terrible stench. 

From the history and present symptoms I pronounced the 
case malignant pustule. Excised the ulcers and cauterized. 
Iron, quinine, and stimulants with carbolized water dressings. 
Also freely opened a sinus connecting first two pustules. 



512 The Peoria Medical Monthly. 

Prognosis unfavorable, because I thought the pus had already 
entered the ethmoidal sinuses: hence the head symptoms. 

May 30. Case appeared somewhat improved; ccdema 
much less; pulse slower and stronger, but coma still impending. 

May 31. Considerable stupor, muscular twitchings, ner- 
vous starlings; urine retained, and when voided was done so in- 
voluntarilv, as also were the feces. 

From this the case passed very rapidlv on a downward 
course, which resulted in death on the 2d of June. 



SOCIETY TRANSACTIONS. 
CHICAGO MEDICAL SOCIETY. 

Stated Meeting, December 7th, 1885. The President. C. T. 
Parkes, M. D., in the chair. 

Pneunwnic Abscc^^s was the title of a lengthv and instructive 
paper b}- Dr. Edward F. Wells, of Minster, Ohio. He incor- 
porated in his paper the histories of a number of cases which 
recovered under expectant and medicinal treatment. In an ex- 
perience with 413 cases of pneumonia, abscesses occurred nine 
times. In closing his paper, the author said that he had arrived 
at the following conclusions: 

1. The issue of pneumonic fever in abscess is rare, but this 
rarity has been greatly overestimated. 

2. These abscesses var}- much in size and are most fre- 
quently found at the base of the lung. 

3. They may in some instances, after pneumonia, be caused 
bv excessive jarring or other motion. 

4. They are usuallv formed rapidlv. 

5. In some rare instances the purulent contents may degen- 
erated into a cheesy mass, to again soften, liquif^" and be dis- 
charged. 

6. The s}-mptoms and signs are quite distincti\-e and sufh- 
cient for an accurate diao-nosis. 

7. The majority of cases recover, but in a certain propor- 
tion a cure is impossible. 

8. Expectant and medicinal treatment, thus far. has given 
the best results, and the majority of cases should be managed 



Society Transactions. 513 

upon this plan, but, under certain conditions, the most radical 
measures for relief are not only justifiable but imperatively de- 
manded. 

Dr. Christian Fenger said that an interesting point in the 
paper is, that the author takes the ground of the clinical, and per- 
haps, the conservative man. Dr. Wells claims that we should 
not operate on the small abscesses, but only on large ones, as the 
latter are the more dangerous. Dr. Fenger believed that we 
should operate on all of them when indicated. Buhl, in Chris- 
tiania, has operated on nineteen cases in which there were cav- 
ities. Up to the present time, we have reports of about thirty 
cases in which operations have been performed, but only seven 
of these cases have been such as reported by Dr. Wells, or ab- 
scesses incident to pneumonia. Since there have been only seven 
cases of abscess of the lungs, incident to pneumonia, it stands 
to reason that these cases were severe ones, and that the ab- 
scesses were large. Dr. Fenger did not believe there had been 
much operating on small abscesses as yet: however, he would 
advocate it in case these abscesses were accompanied by a fetid 
bronchitis. There is an abscess-cavity, which Rokitansky calls a 
chronic abscess, in which there is not connective tissue enough 
to allow the cavity to close. This cavity is a source of danger 
to the patient, as sometimes, for one reason or other, septic mi- 
crocci gain entrance, accute inflammation or gangrene follows, 
and the patient dies. In such a condition, we should trv to ob- 
literate the cavity. Operative treatmenf of these abscesses has 
been so infrequent -that we cannot say that it possesses any ad- 
vantage over medical treatment. The important point to be de- 
cided in the future is how to get an understanding of where the 
danger-Hne is: how long can we afford to wait and how much 
strength can we afford to let the patient lose before we operate.' 
It is, perhaps, well to put in a word of warning against operating 
too early, as we are all aware that patients who reco\'er without 
an operation do better than those on whom there have been op- 
erations. Dr. Fenger said that, in case a cavity gives rise to 
fetid breath, frequently a fetid bronchitis is developed, and sub- 
sequently an inter-lobular pneumonia in the other lung, or in the 
upper part of the lung in which the abscess exists. Relative to 
Dr. WelFs remark that he never suppresses the cough, Dr. Fen- 



5 14 The Peoria Medical Monthly. 

ger stated that it is a fact that the cough ceases almost instantly 
after the abscess is opened. 

Dr. R. Tilley said that he could not see of what benefit in- 
halations of turpentine could be in such cases, as the abscesses 
are analagous to those which occur in the more external portions 
of the body, and we never expect to benefit them by using tur- 
pentine. He would expect better results from administering this 
medicine internally, as he had, recently, read that the German 
physicians are using turpentine very successfully, by giving it 
internally, in diphtheria. 

Dr. Wells, in closing the discussion, said that he wished to 
recall the attention of those present to the important point, that 
these abscesses occur most frequently in the lower lobe of the 
lung, similar to pneumonia. The principal object of his paper 
was to do what he can to counteract the tendency among the 
medical journals to advise early operation in pulmonary abscesses. 
He thought the statistics, so far, do not prove the operative treat- 
mentto be superior to the expectant and medicinal treatment, and 
he thought surgeons were too prone to take the cases into their 
own hands, and that they do not leave enough to the vis medica- 
trix natiirce. 

A case of Expulsion of a Large Suh-mucoiis Fibrous Tumor 
of the Uterus^ per vias jVahirales^ or C oIpo-Myomotomy , was 
title of a paper read by Dr. J. H. Etheridge. Mrs. A. B., aged 
43 years, married 28 years, mother of three children, suffered 
from menorrhagia for six years, past. She has had frightful 
hemorrhages, but otherwise she has been healthy. In 1882, the 
first examination which he was permitted to make disclosed a 
large submucous, fibrous, uterine tumor, at the top of the fundus 
uteri, extending one inch above the umbilicus, its lateral diameter 
equaling its longitudinal diameter. A uterine sound was intro- 
duced eleven inches. There was no rectal or vesical disturb- 
ance. The only inconveniences experienced were the hemorr- 
hages and a "high stomach." The hemorrhases have repeatedly 
brought her to death's door, but her recuperative powers were 
astonishing. Dr. Etheridge then detailed her history for two 
years, during which time she had had several hemorrhages,, 
which were controlled by sponge-tents, rest and ergot. He de- 
tailed also the treatment by a homoeopathic physician, which had 



Society Transactions. 515 

consisted of incisions into the cervix uteri, and the administration 
of sulphuric acid and fluid extract of hydrastis canadensis, the 
latter remedy being extolled as a sure cure for uterine fibroids. 
On November 12, 1884, Dr. Ethridge was called to see the pa- 
ient, whom he found in a pitable condition. She was exsan- 
guinated, feverish, and dvspeptic. She was placed on tonic treat- 
ment and rapidly convalesced. In October, 18S5, she had an 
other hemorrhage, which lasted twentv-four hours before a 
sponge-tent was introduced. This tent was speedih' forced out. 
Three more sponge-tents were subsequently introduced, and an 
enema of thirty ounces of fluid extract of ergot was given. 
Powerful uterine contractions ensued; the capsule of the tumor 
was ruptured, and the hemorrhage ceased. Three days after 
that one pound of the tumor was pulled and cut away. The tu- 
mor was pultaceous, friable, and accompanied by a disgusting 
odor. On the day following, one-half of a pound of the tumor 
was taken away, and two days later as much more. Three days 
later the patient was put under the treatment of ether, and Dr* 
Ethridge attempted to remove the remainder of the tumor, but 
only succeeded in removing two pounds more. After this op- 
eration, the patient went into collapse and nearly died. How- 
ever, she recuperated so rapidly that in five days thereafter he 
removed another pound of the tumor. Five days later he suc- 
ceeded in getting awav another pound and the pedicle. The 
uterus, during the ten davs past, had decreased rapidly in size, 
and the fetid vaginal discharge had lessened. During the three 
weeks in which the six pounds of gangrenous mass were removed, 
he expected the patient would develop sepsis, but none occurred. 
As the patient was continually under the influence of ergot, and 
shreds of the tumor came away between the times of the opera- 
tions, it is safe to estimate the weight of the tumor at thirteen 
pounds. The points of interest in the case were, that the hem- 
orrhages recurred most severely in the autumn, which was prob- 
ably due to the changes in the circulation incident to the occur- 
rence of cold weather; and also that, in order to remove these 
tumors expeditiously, it is imperative that we should be enabled 
to draw the tumor down into the vagina, where it can be grasped, 
and, at the same time, to continuously contract the uterus behind 



5i6 The Peoria Medical Monthly. 

the descending tumor so as to facilitate traction and to avoid 
hemorrhage. 

The President remarked that this case teaches the lesson of 
the importance of early interference in fibrous tumors of the 
uterus, especially those that are large and accompanied by hem- 
orrhages, which facts indicate that thev are close to the mucous 
membrane, and under the effect of the contraction of the mus- 
cular fibres of the uterus, and thus susceptible to the influence 
of ercTot. 

Dr. Jacob Franks then detailed ^4 case of ]'esical Calculus, 
in which lithotrity was attempted. A Bigelow lithotrite was in- 
troduced, which grasped a stone measuring two inches. Upon 
turning the screw the instrument broke, and in consequence of 
this accident a portion of the instrument was left in the bladder. 
On the next day the lateral operation of lithotomy was performed, 
and the calculus and the broken piece of instrument removed. 
The patient made a good recovery. 

The Society then adjourned. 



PERISCOPE AND ABSTRACT. 
LOCATION AND TREAT^fENT OF RANULA. 

Dr. E. Sonnenburg, in the Archives fur Klinische Chirurg'ie, 
xxix. 3 p. 627, treats the above subject. He relates the follow- 
ing case: 

A six-year-old girl showed, in a widelv-opened mouth, a 
tumor, which fluctuated and was of a bluish color. It was sit- 
uated in the floor of the mouth, and was elastic to the touch. 
This pressed the tongue upwards, and made speech and the tak- 
ing of nourishment quite impossible. Wharton's duct was on 
both sides of the tumor, free, visible, and readilv sounded. The 
submental region was distended clear to the upper part of the 
thyroid cartilage. The extirpation was made through a six cm. 
long transverse incision in the region of the lower jaw. Still it 
was possible to free only the lower part of the cvst from the 
surrounding parts. On account of the great distension upwards, 
it was found necessary to evacuate the milco-purulent contents, 
and then through pulling forward of the cyst walls, which 
causes the tongue also to follow, but finally freed the cyst from 
the soft parts. By means of examination by the finger it was 



Periscope and Abstract. 517 

found that the cyst was contained entirely in the substance of the 
tongue, and that only a thin shell of the muscles of the tongue was 
present. The bone substance of the lower maxilla was atrophic, 
and it projected past the superior maxillarv three-fifths of an 
inch. On account of the falling back of the tongue, it was 
found necessary to draw this member forward with a thread. 
The wound, which was drained, healed in about fourteen days. 
The tongue appeared small, but in a normal condition, while the 
swallowing was good; but the speech was not yet distinct. The 
walls of the cyst showed a layer of epithelium. The contents 
consisted of mucus and pus cells. 

The author has examined about fifty cases of ranula, and 
comes to the conclusion that they are in direct connection with 
the Blandin-Xuhn glands. There are two glands situated at 
the apex of the tongue beneath the mucous membrane, and the 
longitudinal muscular fibres formed by the styloglossus and lon- 
gitudinalis inferior muscles. 

In the operation the author recommends the following pro- 
ceeding: One inserts a ~ curyed needle into the cyst-wall aboye 
and parallel with the duct of Wharton, fixes the cyst-walls by 
means of threads, which, if possible, also fix the tongue sub- 
stance: then make a cut parallel with the duct of Wharton, and 
•dissect the anterior wall, which one can draw out by means of 
the thread. Cauterization or drainage are then unnecessary. 
Quite large cysts are best extirpated /;/ toto from the regio-sub- 
mentalis, which is not difficult. 

In the author's fifty cases he observes no relapse. — Med. 
and Surg: Reporter. 



A PECULIAR EFFECT OF CORROSIVE SUBLIMATE. 

The bichloride of mercury is at present used a great deal 
for disinfecting purposes, and it is especially employed in large 
hospitals, where strict antisepsis is faithfully carried out. It has 
always been maintained that the drug, if diluted in the usual 
manner, caused no bad after-effects. Generally i in 1,000 is the 
solution applied to wounds, while i in 4.000 answers all antiseptic 
purposes. But that the first solution is not so innocuous as most 
seem to belieye, is plainly proyen by the following case : 

Dr. J. C. Biddle, the well-known surgeon-in-chief of the 
State Hospital at Ashland, who is perhaps to-day, outside of 
Philadelphia, the most rehable authority in our State on injuries, 
treats all his numerous surgical cases on strictly aseptic princi- 
ples. Last week he had a patient with a lacerated wound, ex- 
tending from the upper part of the thigh to below the knee, and 



5i8 The Peoria Medical Monthly. 

connected with two large pus cavities. After these had been- 
laid open, they were thoroughly washed out twice daily with a 
corrosive sublimate solution of i in i,ooo. By the twelfth day, 
the thermometer showed an incri»ase of 4 degrees above normal, 
which temperature soon became continuous. The patient besides 
suffered from a severe diarrhoea, which did not yield to any 
treatment. Finally, Dr. Biddle, on reflection, concluded that the 
symptoms, though greatly resembling septicaemia, were really 
caused by corrosive sublimate poisoning. He at once ordered 
the substitution of carbolic acid for the bichloride, with the result 
that within twenty-four hours the diarrhcea ceased, and the tem- 
perature became about normal. About the same time. Dr. Biddle 
made a similar observation in a milder case, so that there is no 
doubt of the casual relation between the drug and the morbid 
svmptoms mentioned. As a contribution to the literature on the 
subject the facts quoted are decidedly of great interest. — Med. 
and Surg. Reporter. 



LEUCOCYTH^MIA,— LEUKEMIA. 

This disease, until recently, was regarded as a form of scrof- 
ula. In the year 1845, Dr. Hughes Bennett first called atten- 
tion to the fact that cases characterized by great excess of white 
corpuscles in the blood, coupled with hypertrophy or hyperplasia 
of the spleen, and of the lymphatic glands in various parts of the 
body, was not ordinary anaemia, but a true leucocytha^mia or 
leukaemia. About the same date Virchow described the same 
pathological condition, and called it leucaemia, or leuka?mia, 
(meaning white blood). The name by Bennett, meaning white 
corpuscles, is the more appropriate. 

This disease was never before this period differentiated from 
anaemia and scrofula, yet this peculiar condition had occurred in 
all civilized countries from the earliest medical history. Its di- 
agnosis having been estabhshed by the use of the microscope. 
The name of this condition having been suggested by the altered 
condition of the blood only, is improper, inasmuch as the glands 
are as constantly altered from their normal state as is the blood. 
Oh this account Trosseau calls this disease adenie; Gresinger 
calls it anaemia splenica; Jaccoud calls it a lymphatic diathesis, 
and some w^riters call it anaemia lymphatica, medullo-splenic dis- 
ease, etc. 

Causes. — The etiolog}' of this affection is quite obscure. It 
has been thought that mental and physical exercise to excess, 
coupled with bad ventillation, tends to the production of this dis- 
ease, by impairing the general tone of the digestive organs. 



Periscope and Abstract. 519 

Symptoms. — One of the first indications or this disease is a 
state of great debility, variable appetite, impairment of digestion, 
disturbed sleep, nervousness, increased cardiac action from exer- 
cise, and paleness or an anaemic color. After some time, the 
spleen and lymphatic glands become very greatly enlarged. In 
a few months the patient complains of a great shortness of breath, 
palpitation of the heart, and a sense of fatigue from very slight 
exercise. About this time he, or she, may have febrile spells, 
with disorder of digestion, and perhaps diarrhoea, wandering 
pains in the head, back, limbs, with vertigo and dimness of vis- 
ion. The urinary secretion is variable, being sometimes profuse, 
then again scant in quantity. 

At this time, an examination of the heart's action wi 
soft blowing sounds over the base of this organ, with qui 
pulse. In most cases the enlarged spleen causes fullness in 
left hypochondriac region. And at this time the lymphatics are 
enlarged, especially over the groins and abdomen. 

These symptoms rapidl}" intensify. The glandular swellings 
are from the size of a pea , up to that of a hen's egg, and less hard 
than those of scrofula. >The spleen increases in size, and some- 
times fills the left side of the abdomen. In some cases the liver 
also becomes enlarged. The patient at this stage is liable to be 
troubled with diarrhoea, and sometimes more or less nausea and 
vomiting. Hemorrhage from the gums, kidneys, nostrils or 
bowels now takes place. Petechial spots appear on the bod}-, 
and extravasations of blood may take place in the areolar tissue. 
And, in some cases, large extravasations of blood may take place 
upon the brain which prove fatal. Or death may result from 
dropsical effusions taking place in the areolar tissue, and in the 
serous cavities, but sometimes patients may linger for some time, 
then die from asthenia alone. Some cases prove fatal in five or 
six months, while others linger several 3'ears. 

Post Mortem. — One of the most important changes is that 
of the blood, which consists of an increase of the number of the 
white corpuscles, and a diminution of the red blood discs, so 
much so, that the red blood discs maj^ not equal the white cor- 
puscles. The blood is paler than natural. The urine may con- 
tain an excess of uric acid, traces of formic acid, and even lactic 
acid and hypoxanthin. And in some cases leucin, tyrosin and 
minute colorless octohedral crystals have been seen in the blood. 

Great changes are found in the spleen, lymphatic glands, and 
the medulla or marrow of the bones. These changes consist of 
an increase of lymphoid cells and reticulated tissue and hyper- 
trophy of the glandular structures, but the marrow of the bones 
is so inclosed as to prevent unnatural fatty matter, and is of a 
redish or creamy color. In some cases the lymphatic glands are 



520 The Peoria Medical Monthly. 

affected with hyperplasia, while the spleen is only slightly altered ; 
these cases have been called lymphatic, leucocytha^mia, etc. 

Special Pathology. — The pathology is quite obscure, 
from the fact that we are comparatively ignorant of the physiolo- 
gical process by which the corpuscular elements of the blood are 
formed. It is understood that the white corpuscles are increased 
during the passage of chyle through the lymphatic glands, but 
just how and where the red corpuscles are elaborated is un- 
known. It was once supposed they were formed in the spleen. 
It is believed that the first step in the morbid process leading to 
pathological changes in this complicated disease, is the failure to 
complete the transformation of white into red corpuscles. This 
may consist in an imperfection in the composition of the said 
white corpuscles by which they fail to attract haemoglobin. This 
failure of conversion of the white corpuscles into the red allows 
the white to rapidly accumulate in the blood, and in the adenoid 
tissues or reticulated tissues, causing hyperthrophy of some part, 
as seen in the enlarged spleen and lymphatic glands. Inasmuch 
as the red corpuscles are not developed, and the existing ones 
slowly disappear, paleness, muscular weakness, shortness of 
breath, palpitation and general functional inaction result in this 
protean disease. 

Diagnosis. — Leucocythemia may be mistaken for other 
span^emic conditions of the blood, or impairments of nutrition, 
such as chlorosis in girls, scrofula, pernicious anaemia, etc. But 
it may be distinguished from any of these affections by the in- 
creased number of the white corpuscles, and the diminutio 
the red, as seen on the field of a good microscope. Although 
the relative proportion of red and white corpuscles varies in dif- 
ferent cases, but, in this disease the proportion may be said to 
be one white to twenty of the red corpuscles. But in health the 
relative proportion may be stated to be about one of the white to 
fifty, or even five hundred of the red corpuscles, according to the 
vigor of the assimilation. 

It is believed to be necessarily fatal by old-school writers; 
but as the disease principally consists in a failure of the produc- 
tion of haemoglobin, and its union with other constituents of the 
colored corpuscles, it is our duty to try to correct this diseased 
condition. 

Treatment. — Prof. Nathan D. Davis, of the Chicago Med- 
ical College, recommends the following: 

R. Hydrargyri chloridi corrosivi, 1 gr. 

Tinctune cinchonfe comp., 3 ozs. 

Eilixir siruplicis, 1 oz. M. 

SiG. — Give 1 drachm in water before each meal. 



Periscope and Abstract. 521 

No wonder the doctor should consider this disease incurable'. 
Why prescribe the hydrargyri chloridi corrosivi in such a dis- 
ease? In the first place, the corrosive subhmate is incompatible 
with the comp. tinct. of cinchon^e. (See Bartholozv's Materia 
Mediea, p. 220). On p. 230, the same author states that where 
a considerable quantity of mercurv is administered, in a sufficient 
time it will affect the blood: the red globules are diminished in 
number, the fibrin loses its placticity, the proportion of water is 
increased, and various effete materials accumulate. And he says, 
'•it interferes with the nutritive processes. A marked degree 
of anaemia, loss of flesh, muscular weakness, ulceration of the 
skin, loss of hair, eczema, diarrhoea, etc., are characteristic svmp- 
toms of mercury."' H. C. Wood says, in his Materia Medica: 
"The blood suffers ver}- decidedh^; becoming more fluid than 
normal, and having its power of coagulation impaired." Dr. 
Wright found " that its solid constituents are notablv diminished, 
including the albumen, fibrin, and the red corpuscles."' But the 
outlook from a rational standpoint is more hopeful. The nitrum 
sulph. is a valuable remedy, (the sulphate of soda — Glabas salts ), 
in doses of ^<^ to ^-^ grain, everv three hours. 

Thuja, O. C, in doses of one or two drops everv three hours, 
is also a good remedv, especially after gonorrhoea. If the pa- 
tient is very susceptible to cold, nux vomica, in doses of 3 to 5 
drops of the saturated tincture will aid the cure. The nitrate of 
soda is also worth a trial, and where there is much water in the 
blood, the acetate of soda is indicated, and it may be alternated 
with the nitrate of potash. In some cases pulsatilla will do good 
service in doses of 5 drops everv three hours. The patient should 
have a rich animal food. And in most cases the sulphate of sodium 
and the thuja will be sufficient to cure this obstinate disease. — • 
y. M. Goss, A.M. M.D., in Eastern Medical yournal. 



VERATRUM IN TYPHOID FEVER. 

Almost everv practicing physician knows the great and never 
failing effects of the fi. ex. veratr. vir. in all acute inflammations, 
where there is a full and bounding pulse, flushed face, etc., with 
high temperature; also a great manv physicians prize it highly 
in the treatment of various forms of ervsipelas, etc. 

But I wish to speak of its effects in t3'phoid fever with a 
high temperature, a dry skin, sordes on teeth and a dry parched 
tongue, with pulse frequent and feeble. (Now I am aware that 
some one will sav that something else would have succeeded bet- 
ter, and that the plan of treatment I shall here lay down, is not 
simon pure Eclecticism : but I care not what is said if m}' treat- 



522 The Peoria Medical Moisthly. 

ment succeeds; it is wjjien the treatment fails that criticism hurts.) 
In seven cases treated, I used the fl. ex. veratrum vir. in suffi- 
ciently large doses to hold the temperature down to 103 degrees, 
beginning its use as soon as the fever reached that point, and 
continued its use until the temperature in the morning came down 
to gS}4 degrees, let that be two, three or even tive weeks, giving 
it as follows: 

R. Fl. ex. veratr. vir., fl 3 dr. 

Simple syr. squill, fl 6 dr. M. 

SiG — Begin with nine drops every three hours, and increase one 
drop every dose until the fever is controlled and held below 104 degrees. 

I have administered as high as twenty-one and twenty-two 
drops every three hours for a whole day and night. As soon as 
the least moisture appears on the skin, or the temperature starts 
down, I decrease the dose of veratrum at the rate of three drops 
at a dose. Of course I have a thermometer at the house, and 
have the temperature taken before each dose while giving the 
large doses. 

Alternated with the above, I alwa3's give tive to seven drops 
of turpentine (the oil ) in mucilage of acacia every three hours. 
Also, a flannel cloth wrung out of a mixture of spirits turpentine 
and mutton lard, equal parts, is kept constantly on the bowels 
until the skin becomes reddened. Then this is left off a few 
days, and reapplied if t^'mpanitis continues. 

JVourishniciit. — Sweet milk, alone, generally is given just 
before or just after the turpentine emulsion, every three hours, 
with as much regularity as the veratrum, and as much as the 
patient will take, too — the more the better. 

Never let a t3'phoid patient remain in one position too long, 
but have him turned — not turn himself — from one "side to the 
other every three hours. This last refers only to patients who 
linger, and by lying too long on one side or the back causes con- 
jestion of the lungs. 

In a practice of nearly live years in this county (Franklin), 
I have treated twenty-three cases of typhoid fever, with a loss of 
only one case — treated with quinine — and the plan above indi- 
cated is the one that has given the best results. Fever usuall}^ 
begins to decline abouf the fifteenth, or anyhow the twent3'-first, 
day. In the above plan I have never been troubled with hem- 
orrhage, strangury — as in cases where blisters were used — and 
very little trouble has arisen from diarrhoea. Patients sleep well 
generally, and make a rapid recovery. 

One case treated as above indicated — except the local ap- 
plication — was a lad\' five and a half months pregnant, as she 
then declared, and as was after proven to be so by the birth of a 



Periscope and Abstract. 523 

fine lo-pound boy at the time designated bv the mother, whose 
fever on the mornino- of the sixteenth dav was one full degree 
lower than the previous morning, and continued to decline at that 
rate until clear of fever, when recovery followed. 

This is now the treatment that I pursue. Under it the weak 
pulse becomes strong, slow, and soft: the dry, rough skin be- 
comes soft and pliant: in fact is all that could be desired; but 
understand, I am not an enthusiast, and should this treatment fail 
Avould not hesitate to try another. There are other conditions 
for which I use veratrum, of which I mav sav something some- 
time in the near future: provided, however, that this escapes the 
editor's waste basket. — J/. M. Haiuliii^ M. D., in A/ner. Med. 
Journal. 



DL\GXOSIS OF PREGXAN'CY. 

Well, now this unmarried girl comes to us because she 
thinks she is pregnant, and hopes we can do something •' to put 
it away." 

-• What makes you 'think vou are pregnant?"" Dr. G. asks; 

'• Because I have placed mvself in a position to become so, 
and have not seen mv courses for two months,"' the girl replies. 

As a rule, we can not swear to pregnancy until we can hear 
the foetal heart-sounds; but there is fair presumptive evidence if 
t\\^ OS is soft like one's lips. When the os is as hard as your 
nose, vou mav be reasonablv sure that there is no pregnancy. 
Once in a long while a tibroid tumor will give us a soft os or 
cervix, but this is very exceptional. This condition we will find 
as early as the end of the iirst month, though it becomes more 
marked as pregnancy is further advanced. Xo matter what 
station in society a woman may occupy, no matter how exalted 
her position, when we find a soft os and cer\ix, we have a right 
to suspect pregnane}'. Here there is a little softening, but very 
little. Her abdomen is too fat to circumscribe the womb and 
discover whether it is enlarged, so that evidence is here lost. 
There is only a shade of darkness about the nipple, not as much 
as there ought to be in pregnancy. This woman may not be 
pregnant,, and may be suffering only from amenorrha'a. We 
will give her Blaud"s pill: 

Dried sulph. of iron, carb. of pota.<., aa 3 dr. 
Glucose, q. s. 
M. Ft. pill No. xlviij. 

SiG. — Two thrice daily for one week, and then increase one at each 
do.<e. 

If she is not pregnant, this ^'ill bring on her menses, while 
if she is pregnant, it will not cause a miscarriage. Remember 



524 The Peoria Medical Monthly. 

that a natural abortion is not very dangerous: it mav be likened 
to a ripened apple dropping from the bough. For some reason 
the ovum has become detached from the womb, and it passes 
harmlessly away. But if you pluck a green apple, you will tear 
also the bough or break the stem from the fruit; so when you 
produce abortion, vou tear the ovum from its lirm adhesions to 
the uterus and cause lesions that may result in septicaemia. — Dr. 
Wni. Goodcll in Med. and Siii'g. Reporter. 



RELATION OF LUPUS VULGARIS TO TUBERCU- 
LOSIS ANr3 TREATMENT OF FORMER BY 
PARASITICIDES. 

In the transactions of the x\merican Dermatological Associ- 
ation, as reported in the Western J/ed/rci/ Reporter, we find the 
following reference to the paper of Dr. J. N. H3'de, of Chicago: 

He began with a detailed statement of all the cases of lupus 
reported to the Statistical Committee of the American Dermat- 
ological x\ssociation during the last seven years, and compared 
the frequency of the disease in this country with that reported in 
the Vienna Hospitals. He then gave details of twenty consecu- 
tive cases observed by him in Chicago. The clinical deductions 
from these records were then added, showing, according to the 
author, that there was a remarkable absence of pulmonary tuber- 
culosis, scrofula and allied diseases in the famih' histories of the 
last twenty cases reported. 

The teachings of the two schools, represented in the past, 
b}' prominent German and French authors, were then referred 
to, and finally the latter investigations demonstrating that lupus 
vulgaris was the result of bacillus infection, not to be differen- 
tiated in external appearance from the parasite of the bacillus 
tuberculosis. 

The following clinical facts were then cited in support of 
the later teachings on this subject, as bearing on the vital point 
in the author's argument, viz., that lupus vulgJiris was not the 
result, as had long been taught, of tuberculosis or other system- 
atic diathesis, but was the product of a local infection by bacilli, 
entirely unassociated with any constitutional evidence of diathe- 
sis or predisposition, i. The unimpeachable character of the 
family record in by far the larger number of cases of lupus vul- 
garis. 2. The fact that the disease is in its inception a disorder 
of the period of childhood, when for the most part, the habits of 
the child are favorable to infection. 3. The several sites of pre- 
dilection are those most favorable to such infection. 4. The 



Periscope and Abstract. 525 

failure of the disease to spread by inheritance. 5. The remark- 
able tendency of lupus vulgaris to cutaneous limitation. 

Dr. J. C. White, of Boston, read a paper on " the Treat- 
ment of Lupus by Parasiticides." He briefly interviewed the 
evidence in favor of the parasitic nature of the affection. All 
previous plans of treatment which had proven most successful,. 
were those which would have the effect of destroying any para- 
site which might be present. 

A number of cases were then reported in which the local 
use of corrosive sublimate in the strength of two grains to the 
ounce of water or unguent had been used with beneticial results. 
The ointment was especially recommended. It had been rarely 
necessary to prolong treatment over two months. As regards 
the permanency of the cure, the author was unable to speak, as 
the experiments had been continued for only eighteen months".- 

Dr. S. Sherwell, of Brooklyn, expressed his profound disbe- 
lief in the parasitic nature of the disease, and did not think that 
the theories of Koch had been entirely proven. It seemed to him 
that lupus and the scrofulous diathesis represent some form of 
S3'philitic hereditar}- influence. 

Dr. S. Wigglesworth, of Boston, suggested that the oleates 
might be more efficient than ointments, on account of their pen- 
etrating power. 

Dr. Hyde said that at the last meeting of the Association, 
Dr. Taylor suggested the use of a solution of corrosive subli- 
mate in tincture of benzoin. He had used this in cases of lupus 
and in cases of infecting chancre. It makes an excellent 
application. 



CLINICAL NOTES ON "CHOREA LARYNGIS."— 
WITH CASE RECORD. 

Laryngeal chorea, recognized as such, is of comparatiAcly 
rare occurrence. It is within the limits of possibilit}', however, 
that a small percentage of all cases of spasmodic cough occurringr 
in persons of neurotic habit is of a choreic nature, and that if the 
act of coughing were investigated laryngoscopically, more numer- 
ous instances of this affection would be recorded. An uncon- 
trollable desire to cough, especially if of a barking character, 
when developed in a person the subject of chorea, should at once 
suggest its probable nature. 

In forming an opinion, it is essential that the hysterical ele- 



:;2 6 The Peoria Medical Monthly. 

nient should be carefully excluded, a task not very easih" accom- 
plished, as one condition frequently coexists with the other. 

A typical case of lar3'ngeal chorea ma}^ be defined to be one 
in \Nhich there is an involuntar}' and uncontrollable cough during 
waking hours, absent during sleep, spasmodic, in character and 
iiccompanied bv various sounds resembling the noise produced 
when straining, the barking of a dog, and so forth. There is 
associated with it spasm of the expiratory muscles of the chest, 
imd abdomen. The speaking voice is normal, articulation is per- 
fect, and the general health usually good. 

On lar^-ngyscopic examination, which is generally well 
borne, the act of coughing is found to be preceded by spasm of 
the larvngeal adductor muscles bringing the vocal cords into 
close relation, often with an audible click, when the action of the 
expiratory muscles suddenly forces them apart, producing the 
somewhat characteristic cough. Between the acts of coughing 
the glottis assumes a variety of shapes, constantly changing its 
outline, indicating choreic movements of the intrinsic laryngeal 
muscles. The lar3nx itself presents but slight departure from a 
state of health, if we except trifling congestion of its mucous 
membrane, and occasionally, perhaps, a moderate degree of 
swelling. 

Under the designation of chorea laryngis a number of cases 
have been improperly described, as, for example, those in which 
the expirator\' muscles of the abdomen, or of the chest and ab- 
domen, have alone been affected, producing a spasmodic cough, 
it is true, but in which no larvngeal evidence of chorea was ob- 
tainable. Strictly speaking, the term should be confined to those 
in which we find by direct inspection motor implication of the 
intrinsic muscles of the larynx, whether accompanied by spasm 
of the' muscles of expiration or not. In other words, the diag- 
nosis of chorea of the larynx should depend upon recognized 
choreic movements of the laryngeal muscles, and the existence 
of a general chorea preceding, accompan3-ing or following the 
lar\ngeal motor neurosis should strengthen and fort^if}' rather 
than detract from the accuracy of our diagnosis. In the absence 
■of spasm of the expirator\' muscles, one must be prepared to 
make a diagnosis without the assistance of cough as a symptom. 
•Such cases are, however, exceedingh' rare, as the whole range 
of medical literature furnishes but one (Knight's) solitary in- 
stance. 

For the better illustration of this uncommon neurosis there 
is appended a short clinical report of a case which recently came 
under observation, a perusal of which may be found interesting: 

Mile. R., a healthy-looking }'oung lady of sixteen, was seen 
in consultation with her medical attendant. Dr. Proulx, on Octo- 



Periscope and x\bstract. 527 

ber 27, 1885. She was suffering from a cough of a barking 
character, which was not only a source of discomfort to herself 
but of great annoyance to her family. The cough, which had 
alread}^ lasted two months, occurred at regular intervals of three 
or four minutes and was entirely absent during sleep. All the 
ordinar}' remedies, local and constitutional, had already been re- 
sorted to without perceptible improvement. On critical obser- 
vation the cough was found to be explosive as well as barking, 
and was followed bv a decidedl}^ lar^^ngeal sound resembling that 
of oedematous laryngitis. The young lad}- complained of some 
slight distress of breathing when recumbent. All attempts on 
the part of the patient to control the cough were unavaihng. Ar- 
ticulation was perfect, and at the time of the consultation there 
was an absence of symptoms of hysteria, general chorea, or other 
nervous affections. 

On making an examination of the larynx — a matter. b\' the 
wa}-, of easy accomplishment — moderate congestion of the lining- 
mucous membrane, especially in the neighborhood of the aryte- 
noid cartilages, was found. The vocal cords, though not of nor- 
mal pearlv lustre, were not h^-perttmic. 

The act of coughing was observed with the mirror, and 
presented the following features: The vocal cords were first 
thrown into violent contact, and after so remaining for a few sec- 
onds were as abruptlv forced apart, when the cough took place. 
During the act, the spasm of the adductors never thoroughly 
relaxed, but varied in degree. The laryngeal sound which fol- 
lowed closelv in the wake of the first respiratory effort may thus 
be accounted for. Spasmodic action of the abdominal expiratory 
■muscles coexisted. In the intervals between the acts of coughing 
the glottic space presented a varied configuration, without, how- 
ever, in anv wa}^ interfering with the function of healthy respira- 
tion. Throughout this kaleidoscopic period of glottic images 
there predominated in a marked degree the well-known outline 
of double thyro-arytenoid paralysis, wdth paresis of the arytenoi- 
deus. This latter condition may have had no direct connection 
with the neurosis, and probably had not, but was more likely a 
secondarv result of continued strain and fatigue, extending over 
a long period of unnatural activity. 

Laryngeal chorea was diagnosed. On expressing this opin- 
ion, Dr. Proulx cordially endorsed it, and in support of it stated 
that preceding the stage of cough there had existed a well defined 
more or less general cliorea, which necessitated the withdrawal 
of the young lady from the convent school in which she was a 
pupil. 

On December 4th, in reply to a letter of inquiry concerning- 
the progress of the case, the doctor reported decided improve- 



528 The Peoria Medical Monthly. 

ment under the use of liquor arsenicalis, supplemented occasion- 
alh' by valerianate zinc. There had been a gain in weight and 
an improvement in appetite. The cough also showed decided 
iimelioration. Altogether, he considered the patient as speedily 
convalescing;. 

Laryngeal sprays of cocaine did not afford anv relief — as 
<jood an argument in favor of the neurosis of motion theory of 
chorea larjmgis as it is against the theory of reflex action from 
laryngeal hyper^estheia. 

The foregoing clinical historv is most instructive, as it groups 
in a very complete manner the characteristic, though not always 
constant, features of chorea of the lar3'nx — a condition the recog- 
nition of which is extremely important, as it mav exist independ- 
ently of any other chronic symptom. The treatment of this dis- 
ease must be carried out on the general principles found useful 
in controllinor chorea in other or^-ans. Works on o-eneral med- 
icine do not treat of this local manifestation of chorea, nor, indeed, 
do the authors of standard publications on diseases of the nose 
and throat. For information on this obscure phenomenon we 
are dependent upon rather less than a score of articles (the ma- 
jority of which are case reports ) that have appeared from time 
to time in the medical journals. 

Five investigators only have recorded their observations in 
our language. — Canada Med. and Surg. ^Journal. 



AMMOXIA-POISOXING. 

On Frida}', p. m., November 27, 1S85, my little son two 
years old, came running to me in mv office adjoining my sitting- 
room, and crying, stuck his finger into his month, at the same 
time making ineffectual attempts to vomit, during which he spat 
out considerable mucous, which I noticed was tinged with blood. 
Believing he had swallowed some irritating substance, I at once 
forced him to drink considerable warm water, followed by syrup 
of ipecac. While administering these I accidentally got the 
fumes of ammonia from the clothing, and at once saw the serious 
nature of the case. In twenty or thirty minutes after taking the 
ipecac copious ^'omiting occurred, once only. In about five min- 
utes after vomiting he began to have great dithcult}- of breathing, 
which increased so rapidly that in less than three minutes I 
thought the child moribund. 

The difficulty of breathing I at tirst thought to be caused 
by a spasmodic croup, but further observation satisfied me that 
it was an oedema of the glottis. His breathing was as difficult 
as in the worst case of membraneous croup I ever saw, and of 



Periscope and Abstract. 529 

course identical in kind, being caused by an obstruction in the 
trachea. I at once sent for counsel. Three physicians arrived 
in about ten minutes, b}' which time his breathing was slightly 
easier. They all advised steaming with lime-water to relieve 
the irritation of the tracheal mucous membrane. While under a 
blanket with the child I noticed that his pulse suddenly became 
weak and intermittant. We immediately gave stimulants per 
rectum, brandv, one grain of quinine, one or two drops of tinct. 
nux vomica, and, later, digitalis. The force and rate of the pulse 
was reduced verv much, and it was very irregular, beating three 
•or four beats in rapid succession and then skipping two or even 
three beats. Sinking attacks developed, in one of which the or- 
dinary tracheal rales that accompany death were very loud, and 
the child became verv livid. He rallied, however, only in the 
course of half an hour to pass into another similar but milder at- 
tack. Death seemed imminent several times, but I believe it to 
have been averted bv the stimulants injected into the rectum, and 
hvpodermicall}'. 

The breathing continued ditiicult until I obtained a steam 
atomizer in which I used a mixiure of glycerin and lime-water, 
which seemed to relieve very promptly. From the fact that no 
symptoms of pain in the bowels were manifested and that there 
was neither vomitino- nor purging, we concluded the child had 
not swallowed anv of the ammonia, but the caustic action of the 
alkali was plainlv visible on lips, tongue, and even fauces: there 
was difficult deglutition for forty-eight hours. Of course it was 
the fumes of ammonia only that reached the tracheal mucous 
membrane. I should be pleased to have the opinion of the readers 
of the A^^-e, who have had similar cases, as to proper management 
of cases of this kind. What caused the heart-failure at least forty- 
live minutes after the inhalation of the gas occurred? I am well 
aware that over-stimulation induces paralysis, but it seems to me 
that it ought to follow more promptly, or not at all. — Medical 



DIFFERENT FORMS OF PARALYSIS MET WITH 
IN YOUNG CHILDREN. 

The following abstract of a paper by Dr. Wharton Sinkler, 
read before the Obstetric Society of Philadelphia, is found in 
the Obstetric Gazette for December, 1S85: 

The most frequently met form is infantile spinal paralysis or 
poliomyelitis anterior. This term indicates the pathology of the 
disease, which is an inflammation of the nerve cells of the ante- 
rior horns of the white matter of the spinal cord. This affec- 



530 The Peoria Medical Monthly. 

tion may come on at any period in life, but is generally seen in 
children, and usually at the age of ten years. The children are 
generally strong and apparently health}^, and the paralysis is^ 
sudden in its onset. Fully two-thirds of the cases I haye seen 
have been attacked in the summer months, hot weather and 
teething seeming to be predisposing agents. Dr. Barton, of 
Manchester, Eng., reports that of fifty-three cases in which he 
noted the time of onset, twenty-seyen occurred during the 
months of July and August. The attack is preceded by fever 
of greater or less mtensity, with pain in the head and limbs, and 
with general soreness when moved or lifted. After a few days- 
paralysis more or less complete occurs, but in a few days a 
regression of the paralysis from some of the afflicted parts oc- 
curs. Sensation is undisturbed. i\trophy of the muscles is 
soon apparent, in fact, the paralyzed portion stops growing for a 
time. The temperature of the affected portion is low and the 
skin is blue and mottled, but there is no tendency to ulceration,, 
and wounds or scratches heal readily. The skin and tendon re- 
ilexes are lowered or abolished in the affected limbs. At first 
response to the faradic current is last, but later on the galvanic 
current produces but little muscular contraction, except when a 
powerful current is used. 

When atrophy has set in the reaction of degeneration is 
seen. Most of the cases of club-foot are the result of infantile 
palsy. Deformities of the upper extremeties are rare, this dis- 
ease differing in this respect from cerebral palsies. 

The exact causes of infantile pals^' are unknown. Over- 
fatigue often precedes an attack: sudden chilling is considered 
by Seguin to be a frequent cause. 

The prognosis as to perfect recovery is only moderatelv 
good. In many cases the most faithful treatment fails to relieve 
the paralyzed muscles, but in almost every case we can expect 
more or less improvement. 

In the early stages of the paralysis, after the subsidence of 
the fe^'er, the treatment should consist of mild stimulation of the 
spine: ergot and small doses of bromide of potassium should be 
given internally. Later in the disease iodide of potassium 
should be given instead af the bromide. When the palsy is 
established, electricit\' and massage are the means to be depended 
upon. They must be persisted in for months, or even years. 
Internal treatment is of little or no value unless there is some 
failure in the general health of the child. 

Spasmodic Paralvsis, as seen in children, is of two varieties. 
When of primary spinal origin, or when there is a descending; 
degeneration of the cord from a primary cerebral lesion. Some- 
times there seems to be a conirenital defect in the motor tract of 



Periscope and Abstract. 531 

both brain and cord. In the spinal variety there is often seen, 
soon after birth, rigidity of the limbs: at first this is only occa- 
sional, but as the child gets older eyery effort to move a limb 
■causes muscular rigidity in it. The child does not attempt to 
walk until three or four years of age. Then, when it is sup- 
ported under the arms and tries to stand or to walk, the move- 
ments are vej-y peculiar and characteristic. The feet are 
extended and inverted, so that the child rests on the toes. The 
knees are strongly adducted and lock together, so that the legs 
become entangled. Bv degrees the child becomes able to walk 
by the aid of apparatus or some form of crutch. The hands and 
arms are often affected, and every effort causes muscular rigidity 
to come on. The mind is unaffected in these cases, and the 
speech may be distinct, although it is often very defective. Sen- 
sation is unimpaired, and the patella reflex and ankle clonus are 
exaggerated. There is no wasting of the muscles. 

By these symptoms we infer that the disease is localized in 
the lateral columns, but exactly what is the nature of the lesion 
we do not know, for no, post mortem examinations have been 
made in these cases. The cause is unknown. Hamilton found 
three of seven cases which he had collected were premature 
births: adherent and contracted prepuse has been thought by 
some to be caused by reflex influence of the spasmodic paralysis, 
but operation has not given relief. 

The treatment should consist of massage, galvanism of the 
spine, ergot and cod-liver oil. Fluid extract of conium may be 
given to allay spasm. In some cases great improvement follows 
this treatment. 

Even where we can do no particular good to the limbs, ver}' 
much can be effected bv the aid of apparatus. Properly adjust- 
ed braces to the legs will enable a child to walk on crutches or 
in a Darroch wheel crutch. 

There is a form of spasmodic spinal paralysis in which the 
child is imbecile. In these cases there has probably been con- 
genital defect in the cerebral development. The head is small 
and there is no evidence of intellect. Often mystogeneses is 
present. 

Paralvs/s from Potts' Disease. — Parah'sis of the lower ex- 
tremeties may result from caries of the spine. The lesion may 
be either a meningitis or a myelitis. If meningitis alone, there 
is considerable pain and contraction of the legs. Generally there 
is a transverse myelitis. The symptoms are numbness and 
pricking of the legs, with loss of sensation: gradual increasing- 
loss of power, with wasting of the muscles: incontinence of 
feces with retention or incontinence of urine. Sometimes there 
are ulcers over the sacrum or on tlie limbs. 



532 The Peoria Medical Monthly. 

The indications for treatment are- evident. An apparatus 
which will take the weight of the body from the spine is neces- 
sary, and is sometimes sufficient of itself. Frequently, however, 
the emplovment of the actual cautery over the spine brings im- 
provement in the symptoms when an apparatus has done no 
good. Massage and electricity should be used to restore the 
atrophied muscles. 

Paralysis from Rachitis and DipJitheria is seldom complete. 
The former is often spoken of as the pseudo-paralvsis of rickets. 
Negro children, who are very subject to rachitis in cities, often 
have richitic paralysis. The child at three or four vears, is una- 
ble to walk or stand. Sometimes it has not sufficient muscular 
development to sit upright. It can move e^'er^' limb and has no 
loss of sensation, but has no power. Cod liver oil and massage 
bring about the most satisfactory results in these cases. 

Difhtheritic Paralysis usually begins in the muscles of the 
soft palate and pharynx, and extends to the extremities. It is 
generally bilateral and incomplete, but I have seen a case in 
which it was hemiplegic. It is considered peripheral in charac- 
ter, and is believed bv some to be connected with the altered 
condition of the blood consequent upon the original attack. 

Diphtheritic paralysis is rarely fatal, and lasts in most cases 
onlv a few weeks, although it may continue for months. Strych- 
nia and electricity are the means to be employed, and the case 
usuall}' responds promptly to these remedies. 

Pseudo-Jixpcrtrophic Paralysis is a rare affection, but is of 
much interest. The disease belongs almost exclusively to infan- 
cy. It is characterized by muscular paralvsis with great in- 
crease in the bulk of the muscles. This enlarjjement is due to 
fattv deposits while the muscular tissue proper is atrophied. 
The affection begins with weakness of the legs, a peculiar bal- 
ancing of the trunk, and separation of the legs in walking. 
There is great ditficult}' in getting from a sitting to a standing 
position. Later in the disease the muscles become wasted and 
shrunken and the general health begins to suffer. Death results 
from implication of the respiratory muscles. 

The skin is mottled like a piece of castile soap. The ten- 
don reflexes are abolished and electro-muscular contractility is 
impaired. There is often a greater or less amount of mental 
weakness. There is no loss of power over the bladder and rec- 
tum, and sensation is not affected. Heredity influences the dis- 
ease, which is slow in its progress, but the course is steadily 
downward. 

Frederick's Disease is still more rare than the preceeding. 
It is practicallv locomotor ataxia in childhood. Here is evidenced 



Periscope and Abstract.* 533 

also a hereditary disposition, and the female children seem most 
liable. 

Cerebral Palsies. — Hemiplegic ma}- result from some injury 
at the time of birth, either from the forceps or from the pressure 
of a prolonged labor. A child may be born hemiplegic after a 
perfectly natural and easy labor. Under these circumstances we 
■must regard the paralysis as the result of imperfect cerebral 
development. Hemiplegic under these circumstances is gener- 
ally permanent. The side affected grows less rapidly than the 
x)ther. The flexors of the arm and hand are usually contracted. 
The leg becomes rigid in the act of walking. 

Convulsion is most always associated with cerebral paraly- 
sis, either immediately preceeding the attack or occurring soon 
after. The convulsive movements are most violent on the side 
which is subsequently paralyzed. The child will have an idiotic 
•expression and speak indistinctly, but their friends think them 
intelligent. 

The convulsions are liable to return when the child is older, 
and then assume an epileptic form. The walk is peculiar and is 
called the spas/ie gait. The patient plods along looking as if he 
were about to pitch forward. The affected limbs are smaller 
and shorter, the growth of both bone and muscle being affected. 
In the choreic variety, where the arm is in constant motion, the 
muscles may become hypertrophied. but the bone remains short. 

Prognosis. — As a rule, the prospect of recover}- is bad, 
•even if the patient gets well the hemiplegic side remains 
.awkward. 

Treatment. — Cod liver oil and massage, which always re- 
laxes the contracted muscles. The affected limbs should be used 
as much as possible. 



a gunshot wound of the lumbar vek- 
tebr.f:, with recovery. 

It is not so long since the occurrence of a case where the pos- 
.sibility of recovery after a gunshot wound of the lumbar vertebra; 
was discussed as a matter of international interest, that the sub- 
ject has been forgotten. A renowned foreign surgeon — Esmarch 
- — was by many taken seriously to task for uttering the belief 
that in this particular case the wound was not of necessity fatal, 
although he showed that similar wounds in many of the lower 
animals were recovered from. Recently a case has been reported 
by Albers [Dea/r/i. Mllitarzlch. Zeitschft.). which must forever 
settle this question. It is, in other words, the first case of the 
■ kind recorded in surgical literature. 



534 "TiiE Peoria Medical Monthly. 

A man received a bullet wound during a duel, the ball, of 
large size, entering two centimeters above the right iliac crest. 
Hemorrhage was immediate and profuse. Thick wads of sali- 
cylic cotton were tightly bound on, and the bleeding thus checked. 
On the instant of reception of the wound, the man fell, half faint- 
ing, and motionless below the waist. He was carried nearlv a 
mile to a conveyance, and then as much farther to a hospital. 
There ice was applied to the abdomen and morphine administered 
on account of pain. The next day he had a sharp attack of peri- 
tonitis, and urine was suppressed. After the sixth dav, the peri- 
toneal inflammation subsided, and now, on dressing the wound, 
it was found that a little pus escaped. Now, for the first time, 
the probe was used, and passed easilv to third lumbar vertebra, 
where at a depth of three centimeters the ball was felt. On 
withdrawing the probe it met with an elastic resistance. It was 
therefore determined bv the findings with the probe and bv the 
general features of the case, that the bullet had passed between 
the coils of intestine, had pierced the third lumbar vertebra, enter- 
ing the spinal canal between the bone and the cord, had passed 
out of the bone and lodged in the soft tissues bevond. No effort 
was made to remove the ball: onh' a drainage tube was intro- 
duced. 

This diagnosis ^^'as verified h\ return of power to urinate, 
and very gradual return of mobilit\' in the lower extremities, 
though onl}^ after months was the patient able to walk with a 
cane. Perfect recoverv was onh* attained after three vears and 
a half. 

In view of the results thus gained, Dr. Albers emphasizes 
the necessitv for special care as to the following points, when 
dealing witli shot wounds of the spine: 

1. Immediate ha-mostasis for the preservation of life. 

2. Transportation to the hospital soon as possible. 

3. Prompt antiseptic occlusion with change of dressing as 
often as every da^', if necessary. He prefers salicylic cotton. 

4. Probing c^;//r in case there be suppurtion, and then witli 
a thick knobbed sound. 

5. This probigg should be most cautioush' done, and should 
at the same time open up a path for drainage. 

6. Isolation from other surgical or fever cases, with rigid 
precautions against bed sores. 

7. I'he remo\'al of the ball mav be generallv left to the ex- 
trusive effect of granulations, \\ hich ma^• remove bv degrees a 
heavy piece of lead. 

8. Recoverv from paralvsis due to contusion of the cord is 
possible, even after a ^'ear. — Medicdl Press. 



PERISCOPE AND Abstract. 535 

A CURIOUS MISTAKE. 

The following anecdote is related as an actual occurrence: 
A young- man fresh from college, whence he came with honors 
and medals, was sent by his father, a practitioner of fift}^ years' 
standing, to attend a woman in labor. On making a digital ex- 
amination, he found the os uteri undilated. After waiting an 
hour, there being no improvement, he applied belladonna oint- 
ment, and endeavored to make forcible dilatation. At the end 
of another hour there was still no dilatation; and being alarmed, 
he sent to his father for assistance, but bc^fore thev returned the 
child was born. On examination, the father found that the 
child's anus was red and patulous, and was liberally besmeared 
with belladonna ointment. The young practitioner had met 
with breech presentation, and had mistaken the child' anus for 
an undilated os uteri. — Obstetric Gazette. 



ENURESIS NOCTURNA AND NASAL OBSTRUC- 
TION. 

That enuresis nocturna'is frequently associated with imped- 
iment and obstruction to free breathing through the nose has been 
claimed b}^ Major, a Canadian physician. ' Dr. Zeim, of Danzig, 
corroborates this in the Allgxiu. Medical Centrah'cit/iiio-. 

Appropriate local treatment of the nasal cavities is said to 
lead to relief and cure of the enuresis. 

This is a practical suggestion that certainly merits our at- 
tention. 

The connection between the two troubles and the causal 
relationship to the enuresis is sought in the relative respiratory 
deficiency, and consequent carbonic acid intoxication, that follows 
in individuals that breathe throuo-h the mouth. — Medical Reviezv. 



"PROFESSIONAL." 

In view of the fact that an esteemed contemporarv once got 
itself into hot water because of its reference to the pap-sucking 
habit of certain Texas mothers, we ought not, herhaps, to pub- 
lish the following report of a cannibalistic performance \i\ two 
Texas doctors : " Dr. Palmer, who, in a fight with Dr. Calloway, 
at Bloomington Grove, had the end of his finger bitten off by the 
latter, is in a critical condition, owing to blood-poisoning having 
set in." Inasmuch, however, as the quotation is from the Texas 
Courier-Record of Medicine., we presume the report is not libel- 
ous. Nothing is said of the effect of the toothsome morsel on 
Dr. Calloway, and it is presumed it did not contain enough 
ptomaines to disturb his stomach. ^ — Medical Age. 



THE 

Peoria Medical Monthly* 



THOS. M. McILVAINE, A. M., M. D., 

Editor-in-Chief. 

O. B. WILL, M. D., 

Associate Editor. 

J. H. COULTER, A. B., M. D., 

Business Manager 

204 S. Jefferson St., Peoria, III. 



***The Editor is not responsible for the statements or opinions of contributors. 

***Short original articles are invited from any reader, whether a subscriber or not. 

***If extra copies are desired by a contributor, the number must be specified when the 
article is sent to the Editor. 

***A11 exchanges, books for review, and communications must be addressed to the Peoria 
Medical Monthly. 

***The publication day of this journal is on or about the 2.5th of each month. 



EDITORIAL. 

SOCIETY WORK. 

It may be that 

" A little nonsense now and then 
Is relished by the best of men," 

but for men of at least ordinary intelligence, it will not answer as 
a steady diet. The mental digestion of the average doctor is 
sufficientl}^ good to chylify a moderate amount of solid food, and 
he mN<.t have it. Societies are, in many respects, like individ- 
uals. Thev are weakly or robust, in proportion to the character 
of the regimen to which they are subjected. That which is 
protitable to a ^art is profitable to the whole; that which is prof- 
itable to the individual, is protitable to the association. Com- 
munity of interest is the cohesive attraction of societies. Feed 
the individual, and you feed the society; furnish that w^hich is 
of interest and profit to the individual, and 30U furnish that which 
is of value to the society. 

Medical associations are no exception to the general rule. 
All are convinced of the desirability, not to say necessit}-, of pro- 
fessional organization. As individuals, we owe something to our 
profession and our professional brethren; the question is, Iwzv ean 
we best compass tlie paxment of our debt f It is one of vital im- 
portance to the welfare of an}- medical organization, and the prac- 
tical answer to it will put upon such organization the seal either 



Editorial Department. 537 

of success or failure. The debt which we owe to our profes- 
sional brethren, our profession and ourselves, is an honest, earnest 
effort to widen the boundaries of medical science and art. In 
a union of effort there is strength. Each individual views a mat- 
ter in a different light from any other. Every man sees from a 
different standpoint from any other; but the aggregate of views 
tones down the colors of misconception, and presents a picture 
approximately perfect. 

The true principle of society work must embodv a recogni- 
tion of the truth of the foregoing. 

Eschewing all reference to the purely common business 
routine of medical society organization, the writer confesses to 
an opinion that, in the first place, in societies of this kind, more 
time than is desirable is consumed in the formal and, strictly 
speaking, scientific work of the evening, and not enough, if any, 
devoted to an informal, and more strictlv social intercourse be- 
tween members. Dignified, honest, sincere social communica- 
tion, involving an informal discussion of matters of mutual interest^ 
and the consequent suggestion of material for serious and com- 
bined consideration, is one of