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I 



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THE WESTERN 



JOURNAL OF MEDIOm, 



(^Formerly Qiivoinnfati Journal of Jfedioine.") 



BDITSD BT 



THEOPHILUS PARVIN, M. D. 



VOLUME IV, 



INDIANAPOLIS, INDIANA; 

PUBLISHED BT THE EDITOR. 

ROBERT CLARKE & CO., 65 West Fourh St., Cincinnati. 



flSMTUixi. nm, onnAMAPOus, ixd. 



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'"^ . .. V - 



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CONTRIBUTORS TO YOLUME IV. 



BUkCKHAir Paor. GSa C. 

BlUKS Dm. O. M 

BUKSYTT Dwu J. B 

CAB80N Db. Wm 

CATLIS Dk. B. H 

OOMKGTS Pbof. C. O 

CONVKR Ftof. p. 8-. ^.. 

OOKSETT D». W. T- 8..... 

CRAIG Bm. A. O 

IPHUTS I>B .«.. «.... 



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ETKRT8 Db. OBPHEtJS 

mtLD Db. N - 

rrn6ERAI«D Db. J. W. (A. 8. U. 8. A.) 

ITLLESTON Db H. 8 -.- 

GADDT Db. K- - -. .. 

6ARDNEB I>B. J 

6RISC0X D«. J. - 

GUSVOLD DR. WAYNE 

HATHOND Db, W. 8 

RIBBRRD Db. JAMES F 

HGBB8 Db. WILSON 

HUD0OK D«. J. Q. A « 

JACSSOK I>B. JOHN D 

JOnSDB. W. E -. - 

KXLHEE Db. OEOBOE... 

KEMPER Db. O. W. H 

LAMME Db. D. W 

LIMON D». W. H 

McBLROT Db. Z. « 

McMBICHAM Db. J. C 



.^.^ dnclnnatl, 0. 

..Salpfanr Springs, Ind. 

Nawmrk.'K. J. 

....Oincinnatt, 0. 

.^ Meriden, Gonn. 

Cincinnati, 0. 

Cincinnati, O. 

MadiMn, lod. 

..Ghent, Ky. 

...........0w6naboro% Ky. 

.........Fort Wayne, Ind. 

.........Indianapolli, Ind. 

.......«JeffenoBTllle, Ind. 

..Fort Wallaee, Kansas. 
...............Sinrlngfleld, 0. 

...... ..........Tomon, Ind. 

...Bedford, Ind. 

, New York City. 

CtreleTille, 0. 

MonaceUo, Ind. 

............Btchssond, Ind. 

OsTthage, Ind. 

Cincinnati, 0. 

.. ......DanTille, Ky. 

................CircIeTille, 0. 



......JBniUTaB, III. 

.Mnttde,'Ind. 

- ~ El Paso* HI. 

— — .. — ... J..........Brasll, Ind. 

.- ZanesTille, 0. 

— ~ — ~ Cinoinaati, 0. 

XBARS Dm. J. EWINO Philadelphia, Penn. 

lULLEB Db.C. B ^.^^ Lawrenoebnrv, Ind. 

MOORMAN Db. J. W Hardlnabuv, Ky. 

ircSCEOFT Db. 8. C Cincinnati, 0. 

VICKIES PBor. 8AMITEL „ Cinoinnatl, 0. 

PA RVIN Db. TgEOPHILUS Indianapolis, Ind. 

PATTEB80N Db. A. W „..„ Indianapolis, Ind. 

PIXLET Db. M. 8 - - « Portsmonth, 0. 

IKKTE Db. J. C. -, ...« Dayton, 0. 

KITBB pBor. BDWABD... ....Cincinnati, 0. 

ROBBIES Db. 8. B Lawrencebnrg, Ind. 

ROGERS Db. COLEMAN Lonlsvllle, Ky. 

BOGERS Db. J. G «. „...MadIson, Ind. 

ROOKEB Db. J. F Castleton, Ind. 

RUMBOLDDB. T. P St. Louis, Mo. 

WITH Db. J. C Klrklin, Ind. 



iv INDEX. 

THOMAS Da. 8. C Milroj, Ind. 

THOKPSON Db. JA8 Harrison, 0. 

THOMPSON Bb. W. S Vandalia. 0. 

WSIST Pb. J. B Bicbmond, Ind. 

WHTTTAKIB Da. JAMSS T - — — ....• Cincinnati. 0. 

WOODWOBTH Da. B. S Port Wajne. Ind. 

WOOLEN Da. L. J Mooreafleld, Ind. 

WEIGHT Da. CHABLBS E „ Indianapols, Ind. 

YANDBLL Pao^. L. P., Sa LoutoTllle, Ky. 

TANDELL PaoF. DATID W LoulBTllle, Ky. 

YANDELL Paor. L. P., Ja «.. .. Louifrllle, Ky. 



INDEX TO VOLUME IV. 



PACK 

AccommodatfTe ABtbenopia 2(>3 

Action of American Medical Association, Criticism of. 603 

Address of Judge Dickson 165 

Address of Prof. D. W. Yandell, M. D 645 

Address of Sir Wm. Jenner 559 

Aneurism P<^liteal, Cored by Manipalatlon 1 

Anns, Tlssntes of. 285 

Aphasia, Case of. 276 

Astringents, Internal Administration of. 271 

BIBLIOOBAPHY— 

Address on Education 307 

Address of Dr. Jackson before Boyle Co. Medical Society ~ 309 

American Medical Association, Transactions of. 44 

American Pharmaceutical Association, Proceedings of. 304 

American Ophthalmolog:lcal Society, Transactions of. 575 

Anal Fissure, Bodenhamer, on ^..^^ 443 

Carbolic Acid, Dr. Wm. B. Darli, on Uses of 400 

Cazeaux*s Midwifsry „ »....^^ 122 

Chronic Bronchitis, Oreenhow, on ^ 175 

CleaTeland, Pronouncing Lexicon ^ 174 

Clinical Lectures, Sir Henry Thompson 59$ 

Cullerier's Atlas— Pwrt Y 121 

Connecticut Medical Society, Proceedings Sizty-serenth Annual Conrentlon of. 180 

Cbnstlpationiof the Bowels 120 

Dalton's Physiology for Schools 50 

Damon's Structural Lesions of the Skin 308 

Diseases of the Bye, Treatise on 622 

Diseases of the Bar, Yon Troltsch, on «... 244 

Diseases of In&ncy and Childhood, Smith 240 

Embolism, Dr. Seelye, on 600 

Erichsen^s Science and Art of Surgery 736 

Female Sexual Organs, Klob's Pathological Anatomy of. 245 

FeTer, Study of, by Dr. Hudson 221 

Flings Practice 54 

Fownes' Manual of Chemistry 737 

Fnnctions of Digestion, Treatise on...„ w 072 



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INDEX. V 

Uukd-Book of TacciDAtloQ « 

Hill OD Syphilis^ 384 

Hjficjie in Ita Belatkmtto ThenpeiMls - 628 

iBdwnaSlato 3Udical Society, Trannetioiia of. 613 

JoiDed Twins - IW 

Kratnckj State Medical Society, Proceedinge of. 677 

Manhaire Phyelology «. - «M 

JUckeasie on the Laringoscope " 170 

Medkal FormnUry « ~ 183 

Kcdical Society of Wheeling, Oonatltation and By-Lawi of 308 

Xembrana T^'mpani in Health and Diseaae ~ 680 

McBioranda of Unireraity Clioic, Charity Hospital, New Orleans 623 

Hyzoina, or Hyperplasia of the Villi of the Chorion 729 

OBcinal Cantharis ^ 124 

Opiom Habit 62 

PennsyWania tSlate Medical Society, Transactions of 678 

PcnasylTania Hospital Beports— Vol. II 246 

Practical Manual on Treatment of Club-Foot -. 679 

Practical Chemistry, a Coarae of. 679 

Practical Medicine, a Text-Book of. 681 

Beport of Board of Sute Charities, to Governor of Ohio 306. 

Seportaon the Dinases of Cattle in the United States ^ 732 

St. Aagnatine, Florida, Sketches of its History, kc » 676 

The SalifeeUre Utility of Medicine 61 

Therapentic Yalns of CerUin Articles of Materia Medica Beoenlly Introdacod 173 

Trichina, Yirehow, on « 386 

Uterine Catarrh, by Dr. Gantillon 126 

Uterine Therapeatics, by Tilt 246 

Wylhe*s Does and Symptom Book 175 

Btographica] Sketch of Dr. Shomard 738 

Blighted Ora, Protracted Betention of. 406, 696 

Boay Anchylosis, Barton,s Operation for ^ 469 

Bnnideof Potaaslnm, Bemorkson Therapentic Yaluoof 692 

Cases of Fever in Bichmond, Obserratioos in Belation to 706 

Cataracts 6C8 

CStfbancle, Treatment of. 166 

Ckkroform, Death frcaa 401 

Chloroform, Clinical Lecture on Death from 23 

Clacho-Qnlnine 414 

Cfatnmcislon 330 

GoMerraliTo Snrgery - 728 

Coagestion, Conh«im*s Besearches on 221, 342 

CoBpetition Downward 346 

OOBBBSPONDJEKCE— 

Latter from Anna, Ohio « „ 675 

Letter in anawar to Prof. Bowling Terans the Ohio Doctor Law 417 

Letter from Dr. CalUn 187 

Letter from Prof. Conner. „ « „ ^ 114 

Letter from a Coantry Doctor 41 

Letter from Prof. Blackman, Beply to Dr. Hartshomo*8 Criticism.. 489 

Letter from Europe 20, 238, 286, 373, 494, 660 

Letter from J. W. Fitsgerald, U.S. A 110 

Letter from Dr. H. 8. Fallerton 303, 490 

Letter frvm Dr. Wayne Oriswold, Discussion on Diphtheria 116 

Letter from Dr. McSlroy, on Hypodermic Syringe 42 

Letter fr«m Madison, Indiana 768 

Letter from Hew York ^ ^.86, US, 300, 419, 666, 690 

.,y,u..uuy Google 



Tl INDSX. 

Letter from PhtladelphU .....^ 222, 868, i91 7fl2 

Letter from Dr. Pixley, Medical Uw of Ohio 113 

Letter from Dr. J. 0. Beere „ 119 

Letter from Zaoeiyille, Ohio 674 

DfauThoBa, Uie of Salphite of Soda in ^ i70 

Diphtheritic Croop, Operation, Death „ 201 

Djientery, Uae of Ipecacuanha in.. « ., i73 

Dyienteric Anthritle....^.. « ^ ^ 556 

EDITORIAL AND MBDIGAL »IWS— 

AdTertiaementt of Medical Oollegee 515 

A Note 760 

A Few Words to Snbacribere 58 

• A Hint tor Sabaeribera 130 

A Hint for Money 130 

A Jnet Penalty 515 

Alcohol In Alcoholiim 188 

A New Trap to Catch Medical Stodenta 613 

Anesthetic Action of Chloral 702 

Annonnoemant from Dr. J. D. Jackson „ 262 

Apology 468, 643 

Arrangements for ConTeynnce to New Orleans 269 

Arsenic in Bemorrholds 320 

Bills Sent to all Delinqnents „ 284 

Boston Oyneoological Society 310 

Boston Medical and Snrglcal Journal on Dr. Hibberd's Bssay 684 

««Braithwalte'* 889 

Bromide of Potassinm in the Nursery 62 

Oardfrom Prof. J. W. Hamilton 892 

Causes of Retention of Urine after Confinement • 322 

Changes in Medical College of Ohio 321 

Changes in the Jomrual 764 

Chinorlc Acid 63 

OircuUrNo.2 810 

Circular from Permanent Secretary American Medical Association 258 

Commencement Exorcises Medioal College of Ohio 191, 266 

Compliment to Prof. L. P.Tandell 390 

Coccygeal Tumor 467 

CouTention of Editors of Medical Journals 253 

Conveyance to New Orleans 102 

Correspondence between Drs. Baldwin, Nott and Gaillard 201 

Creosote in Typhoid ferer 326 

Criticism upon the Proposed Indiana Medical Law 260 

Death of Catherine Budd 769 

Death of Prof. Dnngllson 820 

Death of Mr. CoUis 322 

Death of Dr. Wm. Hays 194 

Death of Mr. James 820 

Death of Dr. March 467 

Death of Dr. F. Schurmann 129 

Death of Mrs. Sutton , 61 

Death of Dr. Wm. C. Wlllard 749 

Delinquents, Attention 389, 616 

Digitalis 63 

Discoveries in Science by Medioal men 453 

Dr. B«ale*8 Successor in King's College — M7 

Drs. Beatty and Stokes on Treatment of Rheumatism. ...~ - 54 

Dr. T. W. Belcher as a MinUter 



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INDEX. Vll 

Dr. Gludwkk to Dr.Plnknoj 700 

Zhr. SlBtvn** Appotntment 61 

Dr. AmOn Flint's Trinfi ;. 616 

Dr. mbberd's Prisa TTtmy '. 314 

Dr. Wray on LagmllstDg DiMoetioni 769 

Dr. Al«x. H. 8teT«n« ^ „ 325 

EBlugenrat of the JburiMl ^ 262 

Irvptkm from Um of Bromide of Potusivm 421 

bperiments on the Piuicreatle Juice „ 704 

Kxtnct from a I«ettor from Dr. Hlbberd - 684 

Ixtraoftlfnsry Pecnndlty 333 

Iitract from a Iioetnre by l>r. Thomas Addison 192 

Koeetlon of the Knee-JoInt In 1825 193 

fwTlc lodata 466 

»w 8»le.. 130. 194. 326, 684 

Vsroign CrltJeism on **Thomas** 192 

Gobicehrs Prof.^ Introdnctory „ 60 

OmdBstas of Medical OoUege of Ohio— Hospital Appointees 257 

Hsmatoa Prof. Frank«an L. L. D 617 

«*HaIf.Teari7 Compendium" 389 

HsRditary Toii8iia.Tie..... „ « 61 

Hydrate of Chlond 704 

Hydncephalos, • Cure of, 389 

lB4«iries as to a form of Drnnkard's Dropsy 260 

1»«BM Medical College 301, 7C8 

latBraatlonal Medical Oongrass of 1809 510 

latsstima Panotnre in Tympanitis 517 

lediae in Inftannittent Fever 612 

Jeamal of tke GynsBcological Sooiety 515 

Lift flawed by Transftision 64 

Uft Insaiaace Companies and Medical Bxaminera 450 

iMgerity - 191 

644, 704 

IBUIa before the Indiana Legislature 126 

MsdIcalGMetteBeetored toLMb ~ 194 

Kedkal College of Ohio M3 

IbdlGslCollsgeof Ohio, BxamlnaUons, Queetions 254 

lisdkal Obstetric Ethics 516 

Herenry and Iodide of Potassium in Syphilis 617 

XetUag of Medical Oelleges « 458 

Xlnnssota Medical Law '. 828 

Hltrsl iBsnMciea^, Latest Osse of. 194 

Huaifleenoe of Bothsehilds 194 

Xntnsl Lilb lasorsnoe Company of New York 130 

VewMedleal OoUege -389 

KewMedlealJenmal J»4, 889 

EevVermilhge 389 

Bew Orleans Meeting of American Medical Association 263 

Eew Use of the Laryngeal Mirror 618 

Koties from Dr. Woolen 391 

Ohio Doctor Lav ~ 828 

Onof Twpentine in Aflbelions of the Skin 893 

OigsBisaUon of Medical Editors. 886 

FiyUp 769 

PoitafsoBtheJoamal - 180 

PoiMBiBg by NiooUne 64 

Priority in Ligators of FsoMNral Artery - ISO 



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VIU INDEX 

Prostitution and Yonereal DiaeuM fiOO 

Proceedings of the Shelby Gonnty Medical Society 510 

Prospectus of the New Journal 7GC 

Prolonged Anuria ~.. 325 - 

Pulse in Capillaries and Veins 457 

Purulent Infection Treated by Quinine ~. 456 

"Kanklng" ^ 389 

Seduction of Dislocations by Manipulation 701 

Bemoval of Prof. Ere 389 

Removal of the Tongue 53 

Resolutions on the Death of Dr. Wm. Hays 261 

Remarks on Transactions of Indiana State Medical Society 644 

Remarks on the Case of Dr. Schoeppe m 767 

Resignation of Dr. Lionel S. Beale .^ 321 

Sentence of Dr. Kraus ^ 702 

Spina Bifida ., 702 

Suggestion 324 

The Academie de Medicine 62 

Thanks to Drs. Lomax and Oraig » 644 

The Kentucky School of Medicine on Fees 302 

The Doctors of Herat* in Afghanistan 699 

The True Physician a Student 698 

Trichlnie 64 

Turpentine as an Antidote for Phosphorus 322 

Two Anecdotes fhim Raclborskl^s Treatise ^ 509 

Vaccine Agent of Western Virginia ^ 262 

Virisection 325 

Wanted ., 194,380, 518 

Wardrop James, Esq., P. R. 8.... 324 

What Becomes of Medical Students 770 

Epilepsy, Treatment of. 100 

Epilepsy. Gases of, their Treatment 137 

Epistaxis Obstinate 671 

Epistaxis, Obstinate Oase pf. 519 

Entropium, Use of Collodion in 412 

Epithelium and other Cells, Relationship between 661 

Female Physicians «.. 702 

Femur, Fracture of, with Dislocation of Patella 600 

Fibrous and Fibro-Cartilaginous Structures— Vessels and Nerves of 99 

Forty Years' Practice ....156, 405 

Forces of Organic Life, Ac 267, 542 

Funis Umbillcalis, Prolapse of. 585 

Funis Umbilicalis, Partial Prolapse of; Restored by position 670 

Gall-Bladder, Lithotomy of. 83, 210 

Gangrene, Hospital .90, 142 

Gunshot Wounds, a Synopsis of Some 538 

Hernia, Strangulated 11 

Hiccough, Obstinate 327 

Hip-Joint, Artificial 402 

Hip-Joint, Dislocations Reduced by Manipulation 554 

Hooping-Cough, use of Belladonna in 89 

Hypodermic Medication 556 

Intra-Uterine DeTelopmont, Arrest of. 206 

Impermeable Stricture of Urethra, Operation for 278 

LiTer, Abscess of. « 590 

Malignant Tumors, Treatment of by Electrolysis 610 

Medicine, the True and False In ^ 463, 532 



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INDXZ. IX 

MfBteBM TrapAoI, ArtliicUl Opening of. 650 

MUwtfery, tan Oue of. - « 331 

MIBCBLLAinr— 

A DnppedFM M 

Aim of Modern ICedldne MO 

Bwm SotbKbUd - 56 

iBgntitade, Sir ThomM Browne on 447 

HetMrolocicAl Baports 67,448, G42 

Puit: Senntor KelAtoD and tlio MicroaoopUts 761 

Tkikoceneria and Troatmont of Sterility in the Hiunan Female sai, 683 

Pofertj, Blei«ing(r) of. 506 

QoKke end Qttackeriee 58 

Icfort of Beginlar Phyeiciana of Onmt Goanty 638 

Icport of Begnlar Phyiiclane of Decatnr Goanty • 641 

Sydenhem to Doctors 447 

Tobeeco, Phyelolosical Belatlons of. 445 

Tread* 810 

Tdodpede Moremeiat, New Pbaae of. - 404 

WoBea,Prof. XlUoti*a AddreaaSon - 313 

Saila,rQrrowB on. ^. 102 

OUtaaiy, Dr. Henry W. DavU 64 

OUtaaiy, Mr. Wm. H. H. AoaUn A... 66 

Opbthalaic Practice, Gaaaa in 478 

Fhyiiea] and Tital Foroae, Correlation of. ~ 200 

n«iMl Sm, Sffwions into 65 

PkesDancy, lfaviM«and Yomiting in '. 30« 

Pnlaatlon in IIm ThoFBcio Walla and Aortic Aneoriam 17 

fiwaadingaoC Allen Goanty Medical Society 263 

Pnwaadlngavf the AflMrican Medical Aaaodation 349 

PiMeadittfaof Brainard Medical Society ^ 892, 488 

PvooMdinga of Dearborn Goanty Medical Society 364 

Pteocedinga of Grant Goanty Medical Society 108 

hoceedinga of Indiana State Medical Society ^ 439 

Prpcaadinffi of Jay Goanty Medical Society 487 

Proeecdlngp of Jobnaon Goanty Medical Society 366 

Proeeedinsa of New OMtle Medical Society 438 

Proeeedlnga of Union Medical Society, Knightatown 287 

PnwcedincB of Weat Virginia Medical Soceity 440 

Phthida Ab Hsmoptyai 347 

FMaoalng, Singular Gaae of. 7 

SkaU, KxtenalTe Fractnre of. » 79 

SpmaatoBoa. 726 

Spine, GoB-ahot Wonnd of. — -. 131 

SaBNroke, Treatment of. „ 482 

Boiphita of Soda.. 719 

Srphilia, Uae of StUlingUin «. 87 

Torch, Prof. Lndwik, Tranalationa from - - 148 

Typboid Ferer, PerlbraUon of Inteatinee in 19 

Uriaary Infiltration 715 

Wei^t Sxtenaion, Priority in Uae of. 277 

^^te Corpnaclea, Identity of wltb Pna, Ac ^ 150 

Vomblaaa Women 163 

VoBb, Polypooa Tumor of. - 686 

Tariola, Gontagtoaaneaa of. 337 

Yentrielea, Diaatole of. 480 



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NOW BBABT FOB 1870. 



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THE WESTERN JOURJfAL OF MEDICmE, 

{Formerlif, "CiNoiNNAri Joukkal op Medicine.") 



Thvt it ▼ill be seen that if nutn baa passioiiB whicb impel him to the deitraction of man, if 
he be the only anim*l who, deepiBing his natural means of attack and defence, has devised new 
■eau of deatrnction, he ts also the only animal who has the desire, or the power, to relioTO the 
taieriiij;* of his fellow citizens, and in whom the co-existenoe of reason and benoTolence attests 
aaionl as well as an intellectual soperiority.— Obavu* GLimcAL MxoxcxinB. 



Vol I?. INDIANAPOLIS, JANUARY, 1869. No. L 



*A CASE OF POPLITEAL ANEURISM RAPIDLY CURED BY 
MANIPULATION, FLEXION AND DIGITAL COMPRES- 
SION. 

BY GEO. C. BLACKMAN, M. D., 

Fnftaur of Snrgety In the Medical College of Ohio ; Surgeon to the Samaritan Hospital, Cin- 
cinnati, Ohio, etc. 



We have recently treated a case of popliteal aneurism according to 
the aboye methods, which possesses at the present time, many points 
of interest, especially in connection with the cases lately reported by 
Dr. Mapotber, of Dublin, Dr. Murray, of Newcastle- on -Tyne, Eng- 
land, and Sir Henry Thompson, of London. Before giving the details 
of oar own case, we will present an abstract of Dr. Mapother's, as pub- 
lished in tbe Brituh Medical Journal^ October 5, 1867, and re-pub- 
lislied in Braithwaite's Retrospect^ part 56, page 157. The same jour- 
nals also contain the particulars of Dr. Murray's views and treatment. 

Br. Mapother's first case was one of ilio-femoral aneurism. " Dig- 
ital and partial instrumental pressure having failed, I tried to stop the 
common iliac with an elastic compressor, the patient being kept under 
chloroform for twelve hours. No clot formed. An anthracoid slough 
formed at the point of pressure. Five days afterward, another attempt 

*** The term given to ihle paper means a particular manipulation of an anenriem, whereby 
tke Sbrla vithia may poeelbly be so displaced as either in pari or in whole to block «p the maim 
utMj oa the diatal side of the diseaM."— CbmmeNeeiiMfil qf Mr. Ftrguuon*$ paper^ 1867. 

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2 WESTEKN JOURNAL OP HBDICINJf. 

was made, after the followiDg preparatory steps : The abdomen wa» 
made lank bj emptying the bowels and bladder; the limb was raised, 
bandaged and fixed to aid venous return, and to render increased flow 
of blood for muscular action unnecessary; and the sac was compressed 
by an elastic roller, so as to contract the space to be bled by the clot 
as much as possible. At Dr. CFerrall's suggestion, the superficial 
femoral was stopped, so as to keep the sac full. Signoroni's clamp was- 
then fixed over the common iliac artery for four and a half hours, when 
the tumor was found solid and pulseless, the common and internal iliacs 
being still pulseless. Absorption and complete cure followed." 

The Doctor's second case was one of popliteal aneurism. Pulsa- 
tion was arrested by pressure maintained for five hours as firmly as 
could be done in a restless patient, but thirty-six hours afterwards the 
pulsation returned. ^^After three other attempts, unsuccessful because 
chloroform was refused, the femoral at Scarpa's triangle was compressed, 
and the flow of blood out of the sac was impeded by tight bandaging- 
and elevation of the leg, distal pressure on the popliteal not being 
possible. The patient was kept apathetic, not insensible, with chloro- 
form, for nine and a'half hours, when the sac was found hard and pulse- 
less. At the compressed point a superficial slough formed ; but with 
this exception, the recovery was rapid and perfect." 

Dr. Mapother suggests, that as distal pressure is impracticable in 
popliteal or '^antecubital" cases, Mr. Hart's flexion plan may achieve 
the same result. Nearly seven years before he treated his case of 
popliteal aneurism just quoted, we tried the flexion method in a similar 
case, but the cure was delayed because we trusted to bandages and in- 
strumental, rather than digital compression, until three hours before 
the pulsation of the tumor was arrested, at which time the digital com- 
pression was adopted. It is also to be taken into consideration that 
we had a restless patient to treat. But as bearing upon the history of 
this combination of methods in the treatment of aneurism, we re-pro- 
duce here, from the Cincinnati Lancet and Observerj March, 1861, the 
report of a case treated by us in June, 1859, and in which we were 
ably assisted by Dr. John S. Billings and Dr. Charles Oreenleaf, then 
medical students, but now accomplished surgeons of the regular army : 

In Jane, 1859, I was consulted by Joseph Humbrick in reference to a 
large pulsating tumor in the lefl popliteal space. He was an American, and 
was twenty-seven years of age. Jfor some years he had been engaged in 
carting lumber, and consequently was often compelled to sustain heavy 
weights. He was not aware, however, that he had ever received any injury 
'jpon the part affected. About thirteen months before I saw him he suffered 



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A CASE OF FOPLITSAL AinSUBISM. 3 

ezcniciating paiD, which extended along the inner part of the thigh and calf 
of the leg as far as the heel. Ahout three days afterwards he noticed a small 
ralsating tumor, about the size of a pigeon's egg, in the middle of the pop- 
liteal space. His case was regarded as acnte rheumatism, and he was treated 
aecordmgly. The swelling continued to increase ; and when I first saw him, 
on the 5th of Jane, it measured ahout four and a half inches in the axis of the 
limb, and ^we and a half in its transverse direction. It had a pyriform shape, 
the apex being above. For two months the pain had been severe; and at 
the time of his visit he was unable to extend his limb completely. 

Having noticed the favorable reports of cases which had been treated by 
the London surgeons by flexion, I determined to unite this to the combined 
method of compression, manipulation, and the internal administration of 
Terttram viride, which I had successfully employed in a case of femoral 
laeiinsm of large size. On the 7th of June, after having given four drops 
of Norwood's tincture, I broke up and dislodged some of the layers of fibrin 
in the sac, by means of pressure with my thumbs and fingers (Fergusson's 
Manipulalion); after this I applied a bandage, as recommended by Prof. 
Dudley, of Lexington, in 1818. The foot and leg were bandaged from the 
toes to the inferior margin of the aneurism, over which a compress was 
pUeed, and a still firmer^one along the course of the femoral artery reach- 
tng to Poupart's ligament These were covered by the bandage which ex- 
tended to the groin. The leg was stronglv flexea upon the thigh, and se- 
enred in that position. The only effect of the veratrum was to cause an 
intermission of the heart's action every thirteenth beat For an hour after 
the numipulaiion the pain was intense; but morphia freely administered 
enabled him to pass a comfortable night On the following day, however, 
the patient became exceedingly restless, and the compressor and bandage 
becsme deranged. After a week's trial, Dudley's dressing was abandoned 
tad Petit's toarniquet substituted. At the expiration of another week this 
Vis changed for Skey's.* At this time the tumor had diminished somewhat, 
bnt still pulsated strongly. Under the use of digitalis the patient's pulse 
rote from eighty-fiv^ to one hundred and ten, and it was discontinued. Com* 
prasion was continued for another week, by the alternate use of the tourni- 
qnets above mentioned. The patient now left for his home in Newport, 
Kentocky, the tumor having diminished about one-third in size, but the 
pulsation being quite distinct 

On the first ot July, I requested my pupil, Mr. John Billings, and Mr. 
Charles Greenleaf, then medical students, to go to the patient's house and- 
trj digital compression at the groin. This was employed for three hours, 
vhen the pulsation entirely ceased. On Monday last (Februarjr 14, 1861,)^ 
the patient came before the class of the Medical College of Ohio, and de- 
dared that his left leg was as good as the right The contracted and indu- 
nted aneurismal tumor can still be felt, but'pulsation has never returned. 
It is a question whether this indurated mass will ever disappear, for Mr. Paget 
hai reported an examination of a case fifty years after the cure by ligature 
--John Honter's fourth patient — and even after this long perioa, a hard, 
ofive^aped mass still occupied the popliteal space. 

Shortly after the treatment of the above case, a patient came under our 
care, having an aneurism of the innominata of small size. Instead of ligat- 
lAg the subclavian and carotid on the distal side, I applied Bourgery's 
tourniquet, or compressor, for the subclavian, while a truss was adjusted to 
the neck to compress the carotid. Veratrum, in this case, had a happy effect 
in moderating the force of the circulation; and, with the compression above 
mentioned, I succeeded in producing a temporary consolidation of the aneur- 

*Tor slnKMt the exact eoonterpart of Skey's Initrnment, rid. the illustration of H. Searle*i 
ia Jshason's Med. Ckir. Seview, 1S24. Hr. 8. adds that **8ir Astley Cooper constrnoted an Iiu- 
*<miWBt on a similar principle, about twenty years ago, to comprsss a popliteal anenriun." 



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4 WESTERN JOURNAL OF MEDICINE. 

ism. In a few hours, however, pulsation returned, and in the course of a 
few days it became again consolidated. Thus alternating, matters progressed 
for several weeks, when, after trying digital compression for some hours, at 
several trials, it became evident that all our efforts were in vain. The patient 
left for the country, the tumor constantly increasing; and, in a few weeks 
more, after reaching an enormous size, it burst internally and suffocated the 
patient. A post mortem revealed an aneurism of the innominata; and the 
opening communicating with the sac was of large size. 

In connection with this case, we have read with much interest, the 
report of a case published in the Dublin Quarterly Journal of Medical 
Science, November, 1867, in which Mr. George H. Porter treated a large 
aneurism of the right subclavian artery, by acupressure on the first 
stage of the axillary artery, and subsequently by direct compression 
on the arteria innominata. The consolidation of the tumor, however, 
was not complete, and only temporary. The disease at length termin- 
ated fatally. 

We now give the details of our recent case, as reported by Dr. "W. 
J. Murraj, resident physician of the Samaritan Hospital : 

Elliott Black, American, SBt 25, admitted October 21, 1868. He states 
that until two years before, he had always enjoyed good health. At that 
time, he suffered from an attack of asthma, which, however, was soon relieved. 
Ten weeks before his admission, he first noticed the swelling, and he bad 
pain in the knee-joint Three weeks previously, he had injured the leg by 
a fall sustained while he was engaged in rolling logs. To this fall and the 
accompanying twist of the leg, he attributes the origin of his difficulty. A 
swelling soon appeared in the popliteal space, which continued to increase 
until the time of his admission, when it had attained the size of a large 
orange. The aneurismal bruit was very distinct, and all the symptoms such 
as to leave no doubt of the character of the tumor. Prof. Blackman re- 
marked to the class, that he would try, in this case, the obstruction of the 
artery on the distal side of the tumor as recently practiced by Dr. Mapother, 
of Dublin, and then he would combine, however, as he had done in other 
cases, manipulation of the tumor, with digital compression at the groin. 
He added, that as from the distribution of the arteries of the leg it would 
be impossible to shut off the current of blood completely by compression on 
the distal side, he would adopt Hart's method by flexion of the leg upon the 
thigh, by which the force of the current would be materially lessened. He 
hoped, also, to promote this object still further, by dislodging some of the 
layers of fibrine in the sac, through the manipulation of the tumor as first 
proposed and practiced by Sir Wm. Fergusson. 

October 22. — The latter method having been carried out, Prof. B. flexed 
the leg strongly upon the thigh, and then re(}uested Prof. Conner and Dr. S. 
G. Muscroft to keep up firm digital compression upon the femoral artery just 
below Poupart's ligament At the end of thirty minutes, only a slight thrill 
could be detected. The digital compression was continued for sixty-eight 
minutes, when the leg was secured to the thigh by a strong band of adhe- 
sive plaster, and the patient was carried to his bed. Prof. B. remarked, 
that in all probability the digital compression had been sufficient to secure 
the formation of the dot which was to fill and consolidate the tumor, but to 
make the matter still more certain, he would continue the flexion treatment 
ior a short time longer. 



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A CASS OF POPUTEAL ANEURISM. 5 

October 23. — Patient had no sleep in consequence of the severe pain he 
soffered, alihongh he took 2} grains of morphia during the night It was a 
Dotieeable fact, that immediately after the operation, the temperature of the 
leg and foot became greatly diminished, while the sensibility of the parts 
was greatly increased. For some hours, the foot and leg had a mottled 
sppearance. On the day following the operation, the adhesive plaster was 
removed and the limb was extended until the leg and thigh were at right 
assies to each other. This change of position gave the patient great relief, 
and was maintained by a renewal of the application of the plaster. 

October 24. — Pretty comfortable this morning, although occasionally 
some pain is felt in the knee. Tumor decreasing in size. 

October 25. — Rested well last night with i grain of morphia. No pulsa- 
tion in tumor. 

October 26. — Still improving; tumor much diminished in size; no pulsa- 
tioa whatever. Takes at night t grain of morp^iia. 

October 30. — ^Discharged— cured — ^the tumor not being more than half 
of its original size. 

On the seventeenth of December, this patient came from his resi- 
dence in Indiana, to show me the excellent condition of his lim]^. He 
stated that for some weeks after leaving for home, he suffered much 
pain in his leg and foot, and that it was easily affected by the cold. 
Prof. Conner and Dr. Dodge carefully examined the patient with me, 
and we were all fully satisfied that the cure was perfect. The tumor 
was thought to be about one-third its original size. It was quite solid 
to the touch. 

The case illustrated to us the facility with which a superficial ob- 
server might be deceived, in reference to pulsation in the tumor. The 
collateral branches being quite enlarged, if pressure was made over one 
of these, there was evidently pulsation. The real condition of the 
tamor, however, was readily determined by pressing on it just beyond 
the Une of the enlarged collateral branch. 

We find in the Monthly Medical Reprint, (N. Y.,) October, No. iv, 
page 254, a report of a case of popliteal aneurism, treated by flexion 
and pressure, under the care of Sir Henry Thompson. The case is 
copied from the British Medical Journal, date not given, and is headed 
"cured by pressure in twenty-eight hours." As will be seen, however, 
by the brief abstract we furnish, the case was under treatment for sev- 
eral days: 

"As the tumor was small, it was thought expedient first to adopt the 
treatment by flexion. Accordingly, on the following day, the limb was band- 
ajged, acutely flexed upon the thigh, and retained in that position by addi- 
tional bandages. The flexion caused no pain. The limb was kept in this 
position four days, until two p. m. on the 21st, by which time no difference in 
the pulsation was perceptible. Mr. Ernest Hart saw the case, and flexed it 
Bore completely. The limb, however, was set free on the 23d, as the knee 
had become swollen and painful. On the following morning, at eleven o'clock, 
the leg having been previously bandaged with stocking elastic, a Corte's corn- 



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6 WESTERN JOU&NAL OF MEDICINE. 

fl 
pressor was applied oyer the femoral artery just opposite Poupart*8 ligament, 
and another one about four or five inches lower down. The patient himself, 
a very intelligent man, changed the compressure about every three-quarters 
of an hour, and felt a little discomfort from its application. By half-past 
three^ on the follounng day^ twenty eight hours after the first application of 
the compressor ^ all pulsation in the tumor had ceased" 

Is it not very probable that thie cure in this case was expedited by 
the previous flexion of the leg? And would not the obstruction on 
the distal side of the aneurism have been much greater, had Sir Henry 
adopted the process of manipulation? For the benefit of those still 
unacquainted with this method, we make the following extract from 
the paper of this distinguished surgeon, published in the Transactions 
of the Eoyal Medical and Chirurgical Society of London, vol. xl, 1857. 
The patient had subclavian aneurism. '* The patient was seated in a 
chair; and I placed the flat end of the thumb on the aneurism tumor, 
so as to cover the prominence. I then pressed, until all the fluid blood 
had passed from the sac, and I could feel that the upper side of the 
aneurism was pressed against the lower. I now gave a rubbing motion 
to the thumb, and felt a friction of surfaces within the flattened mass. 
The movements were little more than momentary, but they were such 
as I had pre-conceived." Giddiness and mental confusion immediately 
followed, and for a time, it is stated, that the patient was unable to stand. 
These symptoms, together with a cessation of the pulsation in the arte- 
ries of the arm, proved conclusively that some of the layers of the 
fibrin had been carried into the artery on the distal side of the aneurism. 
We resorted to this method of producing obstruction on the distal side 
of the tumor, as long ago as 1857, as may be seen by referring to the 
Western Lancet, June of that year, in which a case of femoral aneurism, 
treated not only by manipulation but by compression, was followed by 
the most brilliant results. The chief points of this case, as reported 
by Dr. N. J. Sawyer, (at that time resident physician of the Commer- 
cial Hospital, Cincinnati,) have been copied into Holmes^ System of 
Surgery, vol. iii, page 431 ; also, into the Nouveau Dictionnaire de Med, 
et de Chir. Pratiq., now in publication in Paris. 

We claim that we were the first to make known through the med- 
ical press, Sir William's views in reference to this method of treating 
certain cases of aneurism. During our attendance on his lectures at 
King's College Hospital, in 1846, we heard him state that this idea was 
suggested to him in consequence of the dislodgment of the layers of 
fibrin in aneurism, (subclavian,) by the movements of the patient's 
arms as in swimming. A cure was the result, and hence the practice 



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filNOULAB CASE OF FOISONINQ. 



irhicli has been carried out as yet, but in a limited number of cases. 
Id our correspondence for the American JourncU of Medical Sciences, 
April, 1847, may be found our account of what we heard upon this 
sabject in the lecture to which we have already referred. 



A SINGULAR CASE OF POISONING. 



BT DR. W. HOBBS, GABTHAQB, IND. 



Daring the first week of May, 1868, Mrs. L , of this place, 

▼isited her friends at Dayton, Ohio, taking with her her infant son, 
a hal)e about twelve months old, who was still nursing On the eighth 
«f the month, her child was taken with convulsions, which contin- 
ued at interrals for two or three days. The case was under the care 
«f a "little piir' doctor in Dayton, and I have not learned his opinion 
d the pathology of the case, or the treatment which he used. I sup- 
pose, however, there was very little of either. The child was so seri- 
OQslj sick, however, that the father was sent for, but in a few days he 
was BO much better that the family came home, of course bringing the 
babe. 

A short time afterward, I was consulted by the father, to know 
vbether it might not be feared that this attack of his child was the 
beginning of habitual epilepsy. My reply was, that children often 
baye such attacks from intestinal irritation, and, such as this one, with 
large head and predominant nervous temperament, were peculiarly 
liable to them during the summer months. He said his wife was set- 
tled in the opinion that her child had epilepsy, and she would expect 
a return of the spasms in a few weeks. 

The child was hearty and grew well, until the morning of the 8th 
«f June, when it was suddenly taken with sick stomach, a foul, foetid 
diarrhoea, and after a few discharges, was again seized with convul- 
sions. Dr. P was first called to the case, but in the evening of 

ihe same day I was called in counsel, and afterward retained the man- 
agement of it. The convulsions occurred at intervals of three or 
four hours for two days. Few of them continued more than twenty or 
tbirty seconds, and after half an hour's stupor, consciousness was f\illy 
Testored. During the whole attack, a high state of intestinal irritation 



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8 Western journal of medicine. 

was maintained, and I could not otherwise conclude than that the con- 
Yulsions were reflex actions from this cause. 

After a few days, he was apparently well again, and so continued 
until the 10th of July, when the convulsions again returned, preceded 
and accompanied by the same symptoms as before. This regular peri- 
odicity perplexed me very greatly and thoroughly confirmed the parents 
of their child in the fears of established epilepsy. There being, how- 
ever, no reason why I should change my views of the pathology of the 
case, I could but insist upon my opinion, against theirs, and await fur- 
ther developments. 

In a few days, the patient was better again, and continued well for 
some weeks. The mother told me that about the 10th or 12th of 
August, he would have "fits" again; and, sure enough, on the 12th of 
that month, the worst attack of all made its appearance, preceded and 
accompanied by the same symptoms as before. This greatly added to 
my perplexity — it was the fourth attack, and the three intervals were 
just one month and two days each. How could this be explained? 
The convulsions could be easily accounted for, by the intestinal irrita- 
tion, but what irritant could act thus punctually at exact periods? 
That was the great question. The child was nursing and taking about 
the usual amount of other food for one of his age. I had before 
ordered special care given to his diet, about the occurrence of these 
periods, when only milk, starch, and animal broths weie allowed him, 
besides the breast. The mother was in good health — the state of his 
dentition was no cause of disease. 

In my perplexity, I inquired of the mother by what rule she had 
predicted the occurrence of the paroxysms. She replied that she did 
it by the phases of the moon — that the interval was one lunar month and 
halfway to a change. This suggested to my mind, an inquiry into her 
own catamenial periodicity. I found that she had been menstruating 
regularly since her babe was a few months old — that she became ^^un- 
welly** at Dayton, while her babe was siclc, and that since then, in June, 
July and August, the sickness of her babe at each attack, preceded her 
flux but a day or two. 

My perplexities were now at an end, and I saw clearly, that the 
periodic functional changes in the reproductive organs of the mother, 
so altered the chemical constitution of her milk, that it, at a certain 
period, became poisonous to her child, and by its irritating qualities, 
BO afiected the intestinal canal of my patient, as to produce the train 
of symptoms observed in these attacks. 



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smOrLAR CASE OF POISONING. 9 

This was about the middle of August, and a very serious epi'demio 
of ^' bowel complaint" was prevailing among the cbildren in tbis part of 
the country, but notwithstanding this fact, I ordered the child weaned 
at once. This order the mother carried into execution, but still she 
could not quite shake off her fears of epilepsy. During the remainder 
of August and the whole of September, we courageously fought death 
at the door, through the whole range of drugs and diet, and in Octo- 
ber, we gained the victory. 

My little patient is now fat and hearty, and has had no spasms since 
the 12th of August attack above mentioned. The bowel troubles which 
followed the weaning, made little or no impression on the nervous 
centres. 

This case has been one of peculiar interest to me, and as I do not 
remember to have seen a similar one reported, I thought it worth the 
notice of the profession. 

With others, I have often seen instances in which the mother's 
milk became unhealthy af1:er the establishment of the menstrual flow, 
so that the child had to be weaned ; but this case differs from such, in 
the fact that the milk was healthy and nutritious up to a certain period, 
which was within twenty-four or thirty-six hours of the commencement 
of the ''flow," when it quickly changed its qualities, and became pow- 
erfdlly irritating and poisonous. These qualities it certainly retained 
but a very short time, perhaps not longer than until the '^flow" began, 
if even so long, as the convulsions of the child and the intestinal irri- 
tation which caused them, continued but a short time, if at all, after 
the ''flow" was established. Indeed, I can not see that the irritation 
in either attack which came under my notice, continued longer than 
might have been expected as the effect of a single portion of irritant 
poison taken into the stomach. That the milk was suddenly changed 
from a nutrient to a poison, is shown by the fact that the child was well 
nourished to a certain period, when it became as suddenly sick as though 
it had taken arsenic, or almost any of the mineral poisons. That this 
quality of the milk did not long continue, is further proved by the fact 
that the child nursed often during his sickness, a portion of which was 
retained in the stomach. Eepeated doses of so virulent a poison, would 
certainly have destroyed the patient, or maintained the irritation for a 
longer period. Will some kind chemist tell us what this poison was» 
and by what process it was formed in the vital laboratory? 



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10 WESTERN JOURNAL OF HEDiaNE. 

CASE OF PERFORATION OF THE INTESTINE IN TYPHOID 
FEVER— DEATH. 

BY A. G. CRAIQ, M. D., GHENT, KY. 



Cases of perforation of tlie small, and occasionally of the large 
intestine, in typhoid fever, are not very rare, and yet not of as fre- 
quent occurrence as some writers would lead us to believe. I have 
known but few physicians who have met with this accident in their 
practice, and during my term of service as an interne of the Commer- 
cial, now the Cincinnati Hospital, I do not remember to have seen a 
single case. Of two hundred and five fatal cases of typhoid fever col- 
lected and analyzed by Bristowe, Murchison, Louis, Pfeufer of Munich, 
together with the records of the London Fever Hospital, perforation 
occurred in forty-three, the proportion being a fraction under one- 
fifth. The following brief report of a case, occurring in my practice, 
may not prove uninteresting to the readers of the Journal: 

On the morning of the 25th of August, 1868, I was called in con- 
sultation to see a little girl whom I found with congestion of the brain. 
The case terminated fatally on the following day. Her little brother, 
aged about ten years, had typhoid fever, but was at that time, conva- 
lescent, though there were marked tympanitos and great tenderness 
on pressure over the whole abdomen. I was requested to attend the 
patient until he had entirely recovered. Hygienic and supporting 
measures, such as fresh air, rice-water, wine-whey, beef-essence, etc., 
together with small doses of turpentine emulsion, formed the most 
important part of the treatment. About nine o'clock, on the evening 
of the 30th of August, I called to see my patient; I found him cheer- 
ful, disposed to talk, and seemed to be doing as well as I could expect, 
except there was enormous distension of the abdomen, and the tender- 
ness on pressure, had considerably increased since the day previous. 
His skin was moist; pulse 103, and moderately full; breathing tran- 
quil; tongue moist, and gradually cleaning; some appetite; very little 
thirst; bowels inclined to be loose; urine scanty and high colored; 
deeuhituB dorgaL After congratulating the parents at the prospect of a 
speedy recovery, I took my departure. At two o'clock on the follow- 
ing morning, I was summoned to the bedside of my patient. I found 
him in a state of collapse. His pulse had ceased to beat; his counte- 
nance had assumed a ghastly, hippocratic aspect; his extremities were 
cool, and the whole surface was bathed in clammy sweat; he was mori- 



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CASK OP STRANGULATED HEBNIA. 11 

bond. His father informed me tbat at about ten o'clock lie heard a 
gmgling in the bowels, which probably was caused by the escape of 
the liquid contents, and that in a few minutes afterwards, he was sud- 
denly seized with severe pain in the abdomen, and vomited freely and 
frequently. His pulse soon became quick, and fluttering, and scarcely 
perceptible, and he rapidly sank into a state of unconsciousness. Death 
took place at daylight. 

The practitioner can not be too guarded in giving an opinion as to 
the probable termination of a case of typhoid fever. Perforation 
occurs oftener in the mild than in the aggravated cases of the disease, 
tod the severity of the fever does not correspond with the amount of 
the intestinal lesions. After perforation has taken place, the case is 
hopeless, though life is sometimes prolonged for several days. 



REPORT OF A CASE OF STRANGULATED HERNIA— OPE- 
RATION, &C. 

BY J. B.^WEI8T, M. D., RICHMOND, IND. 



On the evening of September 22, 1868, I was requested to see Mr. 
R. Lyon, at Millville, Henry county, Indiana, who was said to have 
strangulated hernia. 

On my arrival, about midnight, I found the patient to be a thin, 
^re man, weighing about one-hundred and twenty-five pounds, thir- 
ty-two years of age, who gave me the following history of his case: 
" Have had a small inguinal hernia on the right side for about thirty 
years, which has always been reducible until within the last year. The 
bemia has never given me trouble, and I have never worn a truss. 
On the eighth of September, I fell from a fence, and was immediately 
afterward seized with severe pain in the region of my hernia. On ex- 
amination I found the protrusion greater than ever before. I made an 
effort to reduce it, but failed to accomplish reduction. The pain grew 
rapidly worse, and extended over the entire abdomen. I sent for Dr. 
Ouisinger, who gave me chloroform and tried to reduce the hernia, with- 
out success. He then gave me a large quantity of morphine, from 
which I received some relief. The next day Dr. Ouisinger sent for Dr. 
Jones, of Anderson. On his arrival, they gave me chloroform again, 
and tried to return the bowel, but failed as before. Dr. Ouisinger con- 

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12 WESTERN JOURNAL OF MEDICINE. 

tinued to treat me, principally with opiates and fomentations to the 
bowels, until yesterday, when I came on the cars — twenty-seven miles 
— ^intending to go to Cincinnati and consult Prof. Blackman, as I was 
convinced that nothing short of an operation would give me relief; but 
the tenderness and pain in the tumor and abdomen became so great 
that I could go no further. I walked half a mile to the depot, and 
one-fourth of a mile from the cars here. While Dr. G. treated me, I 
had several black discharges from the bowels after taking salts. Vom- 
ited a great deal for the first two or three days after I was hurt, and 
but little since, until I came here. The vomiting has not been so bad 
to-day as it was soon after I was hurt. Since I came home no physi- 
cian has seen me, as there is no one here whom I could trust in a case 
of this kind." 

The patient seemed to be well posted on the subject of hernia, and 
on my expressing some surprise at this, he informed me that he had at 
one time studied medicine. 

(The above is the only history obti^nable of the case at the time ; 

but some ten days after, I received from Dr. Guisinger the following 

letter in answer to one of inquiry from myself, which I here insert, in 

order to render more complete the history of the case prior to the time 

of my seeing it) : 

Florida, Indiana, October 2, 1868. 

Dr. Wbist — Sir : I received your note and will cheerfully comply with 
your request. 

"Dr. Lyon came to this settlement on September 8tb, cat an over-gorge 
of peaches, fell off the fence and got hurt. I was called in the night to see 
him ; found him laboring under all the symptoms of strangulated hernia. He 
was suffering with a feeling of stricture across the bowels, and very sick, 
with stercoraceous vomiting, complaining more of his bowels than any case 
I had ever seen in twenty five years' practice. I gave him a heavy portion 
of morphine, and sent for my chloroform. After the messenger returned, I 

Eut him under a partial influence, and mode use of the taxis to reduce the 
ernia. After working with him about two hours, using all the precaution 
I could, the bowel gave evidence of returning, by a distinct gurgling noise 
at two different times, but to my mortification, there appeared to be a some- 
thing in the ^ac that I could not reduce. As his vomiting subsided and he 
appeared to be pretty comfortable, I gave him an opiate and left him until 
morning. 

In the morning, I found him pretty comfortable. He had slept well 
through the night The hernia had returned as large as when I first saw 
him. I sent for Dr. Jones, of Anderson. When he came, we put the patient 
under the influence of chloroform, and reduced the hernia as before. We 
both concluded from his symptoms, that the strangulation was overcome, and 
that the sac contained old adhesions of long standing, as the history he gave 
us was, that it had not been any more reduced for years. We ordered an 
injection. When I returned on the morning of the tenth, I found him in 
Tather a precarious condition. He had slept well and had his rectum un- 
loaded ; but he had a dry skin and a bad pulse. I gave him calomel, ipecac 



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GASS OF STBANQULATSD HERNIA. 13 

and opiam, and ordered fomentations. When I saw him in the evening, he 
tppeared smart, skin moist, pulse eighty-five, and no pain except over the ab- 
domen I ordered senna ana salts, which moved his Dowels four times during 
the night— each time freely — matter very dark and faecal. I continued the 
treatment, with the addition of quinine. The next day when I called to see 
him, he had got up, dressed himself and was out of doors. After reprimand- 
ing him for his indiscretion, I left him medicine, with the promise of seeing 
him again in the evening. When I saw him in the evening, he appeared 
vorse than he h ad been at anv time. His bowels became tympanitic, pulse one 
handred and fifteen, and all the symptoms of peritonitis. I continued the 
cabmel, ipecac and opium, with fomentations, until the eighteenth, when I 
ditmissed him, thinking he would get along if he observed the proper care; 
but in a few days he walked to the station, got his ticket and left for home. 
"The ease is a very interesting one. When I dismissed him, he appeared 
TSij smart — slightly under the influence of the calomel — ^appetite good and 
wia cheerful I have no doubt but that the adhesions were of long stand- 
ioj^ He never complained of any soreness of the sac. Are you not mis- 
taken in regard to gangrene of the bowels? Please inform me of the result, 
ete. Very respectfully, J. S. Guisinger.'* 

On examination of the patient, I found the face presenting the 
hippocratic aspect; the skin moist^ tonguevery dry and shining; pulse 
one hundred and thirty and very small ; the abdomen tympanitic and 
intolerant of pressure; on the right side there existed a hernial pro- 
tofiion, extending from opposite the internal abdominal ring, into the 
upper part of the scrotum, of about four inches in length by two inches 
in width at the widest part; just below the middle of the swelling was 
i Blight depression, about half an inch in width, extending transversely 
over it; at the upper end of the tumor, percussion elicited a tympan- 
itic Bound— elsewhere, the sound was dull ; everywhere^ except at the 
npper portion, the swelling had a feeling of solidity, such as I have 
never before met with in a case of hernia — this was particularly marked, 
It and below the depression above described; the entire tumor was 
Tery tender ; during the preceding twelve hours, there had been some 
itercoraceous matter ejected from the stomach — this, however, had 
not been a marked symptom ; bowels had not been opened since his 
Tetnm home. 

This examination satisfied me that strangulation of the bowel ex- 
ited, and that there was present, adhesion of the bowel to the sao, of 
Bnck character as to render a return of the bowel within the abdom- 
innl cavity by the taxis, impossible, even were it advisable to do so. 
Yet, it was clearly evident that death was impending, and that if any- 
thing was undertaken for the relief the patient, it must not be delayed. 

The patient and his friends were informed of the difficulties in the 
cue, and that an operation gave him the only chance for his life, and 
that the result of even this was doubtful ; that at best it would likely 



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14 WESTERN JOURNAL OF MEDICINB. 

entail on him the inconyenience of an intestinal fistula, for a time at 
least. After hearing my statements, both patient and friends decided 
that the operation should be done. The patient had previously decided, 
that without an operation, he must die. 

An operation having been determined on, a new difficulty presented. 
The only physicians in the town were two young irregulars. The pa- 
tient at once vetoed the suggestion of his friends that they be sent for 
to assist. I, of course, heartily endorsed his decision. The nearest 
regular physicians were six miles distant — the night was very dark and 
the roads bad. To send, therefore, for them, would cause a delay that 
I felt might be fatal to my patient. So, in compliance with my own 
sense of duty, and the urgent desire of patient and friends, I deter- 
mined to proceed at once with the operation. 

Selecting three assistants from the persons present, the room was 
cleared, a table prepared and three or four kerosene lamps lighted. It 
was now two o'clock in the morning. It is needless, perhaps, to say 
that I duly appreciated the responsibility of my position. 

The patient was placed on the table and the parts shaved, after 
which, I administered chloroform. When well under the influence, the 
anaBsthetic was entrusted to my most intelligent assistant. 

The operation was performed in the usual manner. After the skin 
was divided, the coverings were carefully raised, one after the other, 
and divided on the director. Six or seven layers were thus raised and 
divided. The sac was opened to the extent of about an inch in its 
upper portion. An examination of the parts now disclosed that a 
small portion of the anterior surface of the bowel at this point, was 
gangrenous; the stricture was found to be at the internal ring; this 
was divided in the usual way without difficulty. An exploration of the 
interior of the sac was then made with the finger. This examination 
was scarcely commenced, when the bowel gave way at the gangrenous 
portion, permitting the escape of, at first, a small amount of gas, then 
of about half a pint of matter, looking precisely like pus, and without 
fsecal odor ; after this, some fsdcal matter, having a darbcolor and a most 
villainous smell, escaped. Further examination made evident the fact, 
that from a point just below the opening in the sac, sac and bowel were 
everywhere adherent. The adhesions could be easily broken up down 
to a point corresponding to the constriction noticed on the exterior of the 
swelling. At this point they were so firm that they could not be broken 
up without endangering the integrity of the bowel, consequently they 
were not interfered with. The opening in the bowel was now enlarged 



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CASE OF STHANGULATED HEBNIA. 15 

hj picking away its softened stmctore with the thumb and finger. T^e 
finger was then inserted into the bowel and passed down to the point 
of eonstraction, in order to determine if its caliber at that point was 
BerioQslj encroached upon — this was found not to be the case. The 
finger was next passed into the upper portion of the bowel as far as 
the internal ring, in order to assure myself that the stricture had been 
sufficiently divided. No omentum was detected in the sac. 

Not more than half an ounce of blood was lost during the opera- 
tion. This small amount came almost entirely from the divided super- 
ficial external pudic artery. The bleeding was easily arrested by 
torsion. 

The opening in the intestine being in direct relation with the ex- 
ternal wound, there was no occasion for the use of sutures to retain it 
in proper position. Two silver sutures were placed in the lower angle 
of the wound and one in the upper, leaving between them an open, 
external wound, about an inch and a half in length. 

The parts having been cleansed, the patient was removed to bed, 
having a better pulse than at the beginning of the operation. The 
operation lasted about twenty-five minutes. 

As soon as the patient recovered from the e£fects of the chloroform 
— ^which he did promptly — half a grain of morphine and an ounce of 
whiskey were administered. As soon as consciousness was fully re- 
stored, he stated that he felt greatly relieved, and that he now believed 
that he would get well. 

I left him at half-past five in the morning, resting comfortably, pre- 
▼iooflly giving some directions for the relief of a bad sore that had formed 
o?er the sacrum, and ordering a quarter of a grain of morphine to be 
given every two hours, in case he suffered much pain, and simple water 
dressing to the wound. 

On visiting my patient at two o'clock the next morning, I found 
that he had rested pretty well since I left him; the portions of the 
morphine had been given, some nourishment had been taken during the 
day; abdom^ but little distended, and much less tender than before 
the operation ; wound looking well ; but little faecal matter had passed 
the wound ; the bladder had been emptied naturally. At three o'clock 
on the preceding day — twelve hours after the operation— flatus and 
faecal matter had passed by the natural channel. At half-past five 
o'clock in the morning the skin was moist, pulse eighty, tongue moist. 
Left the same directions as before. 

At two o'clock, Saturday morning, September 26th, visited patient 



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16 WEJSTERN JOURNAL OF MEDICnOfi. 

again; found him comparatively comfortable; there had been but 
little pain since my last visit; no distension of abdomen; pulse nine* 
ty; tongue dry, but was informed this dryness was only present be* 
twecn ten and three o'clock each night; fla^tus and fsecal matter had 
passed at intervals through wound, but an equal quantity had passed by 
the natural passage ; the portions of the WDund brought together had 
united; the remainder showed healthy suppuration. Left quinine to 
be administered (grs. xv within twenty-four hours) and ordered light, 
yet nourishing diet. 

. At one oclock p. M., Tuesday morning, September 29th, saw patient 
again, and found him doing well ; there had been but little pain since 
last visit; bowels had been freely moved on Saturday; but little fsecal 
matter had passed by the wound since Saturday; pulse eighty-five; 
tongue moist, but red ; no distension or tenderness of abdomen ; tumor 
free from tenderness; wound showed healthy granulations. Left no 
medicine. 

On the second of October, I learned by letter that my patient "was 
getting better fast, that his wound did not discharge much," and that 
he had that day been removed to the poor-house at New Castle, a dis- 
tance of some seven miles. 

A few days later I wrote to Dr. Ferris of New Castle, requesting 
him to visit the patient and report to me his condition. In reply, I 
received a letter from Dr. F., dated October 6, from which I make the 
following extracts: 

"I visited Dr. Lyon to-day, in company with Dr. Reed, the attending 
physician of the poor-house. Your patient is doing remarkably well up to 
this time, in every respect; his pulse eighty-six, fall and soft; tongue red 
and smooth, but not dry ; skin good condition; artificial anas healed, and the 
wound is looking well ; he had two operations by the natural anus last night 
— they caused considerable pain, sicxness of stomach, and some prostration, • 
but he is now feeling quite comfortable; we ordered morphine or opium in 
sufficient quantity to keep his bowels quiet for four or five days; the cold 
water dressing to be continued; light, yet nourishing diet prescribed; he 
manifested much gratitude for your kindness and skill in his behalf, and 
directed me to say that he will visit you as soon as he is able. I am informed 
that his money failed and that he had to be shipped to the poor-house. He 
will receive good nursing," etc. 

Under date of October 17, Dr. Ferris again writes : 

"For three days, October 5, 6 and 7, there was neither gas nor faecal mat- 
ter passing through the wound, and to all appearances, union had taken place, 
for during this time he had two or three large evacuations of fascal matter 
from the bowels, by the anus; also, discharged gas freely by anus, but no 
symptoms of any discharge through the wound from the bowel. October 8, 
the superintendent of the poor-house informed me that he ate very freely of 
rice, crackers, &c. ; this seemed to fill up the stomach and bowels, and caused 



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PULSATION IN THB THOBACIO WAILS. 17 

fwo OT three alvine discharges; ihak the patieilt beeame impatient be- 
, erase he thoaght he was not waited on as constantly as he desired; wonld 
more himself about on the bed and help himself over the chamber, and that 
daring these nnnecessary and imprudent exertions on his part, the new 
adhesions gare war, and some faecal matter and gas passed from the bowel 
throagh the wound. The patient and Dr. Reed, the attending physician, are 
both of the opinion that adhesion had taken place, and that this was broken 
up by undue exertion. Since that time, a small ajfrount of excrementitious 
matter has escaped from the wound, at each stool In other respects,- he is 
doing remarkably well." 

Nothing more was heard from the patient until November 25, when 
he presented himself at mj office, well. He reported that the fistula 
elosed soon after the date of Br. F.s' letter, but opened twice afterward, 
ander circumstances similar to those narrated by Br. F. above, permit- 
ing the escape of a small amount of faecal matter, but that since five 
weeks it has remained closed, during which time the stools have been 
passed regularly, and during that time no soreness or pain in the abdo- 
men has existed. On examination, a short, firmly contracted and de* 
pressed cicatrix was found marking the point of operation. Just below 
this cicatrix, and in the upper part of the scrotum was found a hard 
globular swelling about three-fourths of an inch in diameter, in all 
probability consisting^of the remains of the fold of intestine found in 
the sac at the time of the operation. There was no evidence that this 
eommunicated with the intestine within the abdomen. The patient's 
genera) health was excellent. 

The many points of interest connected with this case, render it 
worthy, in my opinion, of the detailed report here given. The princi- 
pal of these points are found — in the history of the case before falling 
into my hands, in the difficulties met with in the operation, and in its 
progress since, and especially, in the early closure of the intestinal fis- 
tula, and the present condition of the parts ; but I forbear comment- 
ing on them. 



PULSATION IN THE THORACIC WALLS, AND AORTIC 
ANEURISM. 

BY DR. WM. CARSON, 
Fhyaician to the Good Samaritan Hoipital, Cincinnati. 



As the diagnosis of aneurism and pulsating tumors is confessedly 
difficult in many instances, we give the following case bearing on the 
subject: 

(S) 



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18 WE8TEEN JOURNAL OF MEDICINE. 

James Hopwood was admitted into the Good Samaritan Hospital on De- 
cember Slstj 1867; a native of Ohio, aged twenty-seven years, five feet ton 
inches in height; wei<i;hs now one handred and fifty pounds, six weeks ago 
weighed one handred and seventy-six pounds; laborer since ten years of 
age; had led a wandering life and was recently a deck hand on a steamboat; 
father and mother living ; two brothers and two sisters had died— -one brother 
of dysentery— -causes of death of remainder unknown to him; patient had 
typhoid fever when sixteen or seventeen years of age. and rheumatism be- 
tween two and three years ago in ankles and knees; had no pain or evidence, 
so far as he knows, of cardiac trouble at that time ; the ordinary state of his 
functions was good up to the date of his present illness ; appetite good ; bow- 
els regular; no cougti, no headache, &o. 

His account of his present illnesa was, that six weeks ago he had 
"taken cold," bad aching in his bones, headache and fever. Three 
weeks ago he got wet at work, and was taken with pain in his right 
side, severe enough to prevent full inspiration about the nipple ; codgh 
dry at first, and then with a slight expectoration ; also, has headache. 

His condition, at our first examination, was as follows : Is thin and 
sallow ; sits bent, usually, with an expression of discomfort in respira- 
tion; right pupil larger than the left; pain in the track of the fifth 
pair of nerves on the right side of the temple and nose, which he says 
is almost constant; digestive organs healthy, with a fair appetite ; pulse 
one hundred; right radial pulse weaker than th^ lef%; systolic murmur 
very loud at the base of the heart, and transmitted along the carotids 
— ^very distinct throughout the right infra-clavicular region, diminish- 
ing towards the apex ; the murmur was loudest at the third intercostal 
space and adjoining the right border of the sternum, where were per- 
ceptible a decided pulsation, of an inch and a half or two inches in 
extent, and also a thrill on palpation ; two sounds were audible at the 
point of pulsation; the second sound was somewhat obscured at the 
base, but clear at the apex; the apex beat was below the sixth rib, 
though it was by no means strong, nor was there any unusual heaving 
impulse ; we could not detect any difference in time between pulsation 
at apex and the aneurismal thrill, nor between the radial pulse and it. 
After several examinations with reference to the point, we thought we 
could discover that from the point of pulsation and thrill, towards the 
apex beat, there was a space where the intensity of the sound was di- 
minished, followed by an increase as we carried our stethoscope towards 
the apex beat; a condition which encouraged the idea of two centres 
of pulsation. 

Percussion over the right infra-clavicular and upper part of superior 
mammary regions, was decidedly dull ; respiration thirty-two , auscul- 
tition showed feeble respiration, but generally in the infra-clavicular 



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PULSATION IN THE THORACIC WALLS. 19 

region, harsh rather than bronchial at a few points. Once or twice 
there was heard a slight creaking sound ; slight sinking under right 
claTiele. 

January 10. — General condition and the thoracic symptoms much 
the same ; has had a hemorrhage from the lungs, amounting to a half 
pint of pure unmixed blood ; rather more cough ; still speaks of pain 
on right side of face ; in about half of frequent examinations of the 
ndial pulses, there was no difference perceptible ; the inequality of the 
pupils remains more constantly than the inequality of the radial puls- 
ations; the pulsation and thrill in the intercostal space, are as when he 
entered the hospital. 

January 20. — Has had another hoemoptysis, but much smaller than 
the first; his sputa are still tinged; sits very much bent, and respira- 
tion difficult; appetite good; sleeps tolerably well. 

Subsequently to this, the progress of the case was marked by 
nothing unusual, until a month before his death, when evidences of 
disorganization of the right lung supervened in increased cough and 
expectoration, and physical signs of second stage of turberculization. 
Eight days before his death, the pulsation in the intercostal space was 
Dot visible, a change which we attributed to the formation of a cavity 
in the right lung, and consequent recession of the pulsation from its 
superficial position. For five days he was unable to lie down, and fre- 
quently during that time, he had a peculiar laryngeal spasm. He died 
March 23d. Autopsy nineteen hours after death.* 

Deceased was pretty well developed physically, btft had become 
.somewhat emaciated. 

Nothing abnormal in external appearance of thorax and abdomen. 
On opening the abdominal cavity, a singular derangement in the 
position of the colon was disclosed: the transverse colon running per- 
pendicularly in the mesial line to within three inches of the pubes. 

Stomach — Epithelium normal, except in some places where the con- 
ical appearance, known as mammillated, was found; some degree of 
TCDOUB congestion in the sub-mucous coat at the lower part of the 
greater curvature. 

Liver — Enlarged, and old peritoneal adhesions were found on left 
lobe; its capsule was easily detached, and its substance presented a 
very granular appearance. 

Spleen — Splenic pulp rather paler and slightly firmer than normal ; 
malpighian bodies were visible upon close inspection; numerous old 
adhesions also found. 

*By Prof. Bartholow. 

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20 WESTEBN JOURNAL OF MEDICINE. 

Kidney — Pale in color; cortical portion in a more than normal pro- 
portion. 

Lungi — ^One large abscess found in superior lobe of the right lung 
and numerous smaller abscesses scattered thoughout the pulmonary 
tissue. 

Heart and Aorta — Ascending aorta distended into a pouch-like 
form, with walls very thin and distensible ; aortic orifice much narrowed, 
its yalves incompetent and calcareous deposits upon them; calcareous 
deposits also on the posterior segment of the mitral valve ; semilunar 
valves of the pulmonary artery competent and no deposit upon them; 
tricuspid valves not competent; orifice excessive in size; no calcareous 
deposit on valves ; a mass of enlarged bronchial glands was found be- 
hind the aorta and pressing against the posterior part of the ascend- 
ing portion. 

Brain — Some fluid eiFusions found in the sub-arachnoid space; su- 
perficial veins of the brain all congested and full of blood, which con- 
dition arose from the obstruction to the return of the venous blood. 

Our diagnosis was aortic aneurism for the following reasons : There 
was a co-existence o^^ First — Pulsation and thrill at third intercostal 
space, though without any projecting tumor. The murmur was unusu- 
ally loud and rough at that point, and very distinct over right infra-cla- 
vicular region. Second-^^QeWe respiration throughout the summit of 
right lung, and dullness, which we supposed might be due to pressure. 
Third — Inequality in radial pulses and in the pupil's, was often ob- 
served. Fourth — Hemorrhages at different times, which are accompa- 
niments of aortic aneurism, where communication with the bronchi ha8 
taken place. Fifth — Generally dyspnoea — not paroxysmal, however — 
but towards the last, the peculiar spasmodic breathing alluded to above. 
Sixth — The pain in the temple and face, referable as we thought, to an 
indirect implication of the fifth. Seventh — The recognition of two 
centres of pulsation, as there seemed to be between the apex beat of 
the heart and the abnormal pulsation to the right of the sternum, a 
minimum point to the right and left of which the murmur increased. 

The post-mortum explained most of these points, as follows : 

The pulsation was from an unusually superficial right auricle — ^an 
illustration, we think, of Dr. Qairdner's view, that when the right side 
of the heart is enlarged it becomes more superficial and the apex beat 
less distinct. The unusual murmur was at and near the aortic orifice, 
from the calcareous deposit upon the valves and the obstruction pro- 
duced by the mass of enlarged glands, pressing against the aorta and 



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PULSATION IN THE THO&ACIO WALLS. 21 

turniDg the blood current still more towards the anterior part of the 
aorta, where there was some thinning of the wall, but no aneurism. 
The inequality of radial pulses and the pupils, is not explained by our 
examination. The feeble respiration was owing to tubercular depos- 
its, and not aneurismal pressure. The hemorrhages were owing to 
the same causes, and probably also to the heart difficulty. The dysp- 
noea must have had the same origin, unless the peculiar laryngeal 
spasm during the last week, originated from an implication of the re- 
eurreat laryngeal nerve in the enlarged mass behind the aorta. Possi- 
bly the pain in the temple and face originated in the same way, though 
oar examination was not extended to that point. The post-mortem 
showed that there were not two centres of pulsation — the absolute cer- 
tainty of which is one of, if not the best, of the evidences of aortic 
aneurism in the thorax. The disappearance of the pulsation, was 
probably due to the fofmation of the large cavity in the right lung, by 
which a recession of the auricle was allowed. 

This ease is an unusual one, and we have not found any precisely 
like it We here give, however, an abstract of two cases, involving 
points that arose in our case : 

The first is reported in Med. Chir. Transac., vol. xl, page 167.* 
The patient had, for many years, shown evidences of organic dis- 
ease of the heart in secondary troubles of circulation and respiration. 
When Dr. Markham saw the patient, it was within a few days of his 
death. ^' The heart was felt beating, with an extensive heaving impulse, 
quite in the left lateral region of the thorax ; it was also felt over the 
whole precordial region, but indistinctly near the sternum." "At a 
point about an inch and a half or two inches from the right edge of the 
sternum, and in the fifth intercostal space, a pulsation was observed, 
spchronous with the ventricular systole. This pulsation was visible 
along a space about three-quarters of an inch ; it communicated a strong 
thrill to the finger placed upon it, and likewise forcibly raised the fin- 
ger. The stethoscope, placed over it, transmitted to the ear, a loud, 
prolonged, rough murmur. There was also observed a loud bruit over 
the whole precordial region ; and a slight impulse of the heart was per- 
ceptible at the epigastrium. It was evident that there was great enlarge- 
ment of the heart, and valvular disease. The character of the pulsa- 
tion, and of the thrill, and of the bruit which accompanied it, naturally 
at once suggested the idea of its being aneurismal ; but then, how could 
the existence of an aneurism at such a point, be explained? " '' On the 

•Bj Dr. W. O. Uftrkham, PhTsiclM to St. Harj^g Hotpit*!. 

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22 WESTERN JOURNAL OP MEDICINE. 

other hand, that the pulsation had no origin from any part of the heart 
itself, seemed clearly indicated from the position of that organ, which 
as described, was felt beating quite in the left lateral region of the 
thorax, and by the fact, also, of the clear percussion sound over the 
sternum. This consideration led me to the conclusion very guardedly 
expressed, that the pulsation was aneurismal. 

The autopsy showed enormous dilatation of the auricles. "The 
right auricle reached far away to the right of the sternum, and occu- 
pied that portion of the thorax, beneath the parietes, where the pulsa- 
tion had been felt. Hence, it became manifest, that the pulsation, the 
thrill and the loud prolonged bruit, took their origin from the right 
auricle." There was disease of the mitral and aortic valves. 

The question came up in my own case, could such a pulsation and 
thrill come from the right auricle? Dr. Markam attributes them, in 
his case, "to the account of the blood rushing into the auricle from 
the venao cavae, during its diastole," and he suggests "that the mur- 
mur and the thrill arose from the fact of clots of fibrin having been 
formed in the auricle at the time I saw the patient, which clots were 
thrown into vibration by the blood flowing into the auricle from the 
venaB cavaa." This explanation would not apply to our case, because it 
was continuous for months, and we have another of the murmur in the 
existence of aortic valvular disease and pressure upon the blood current 
by the enlarged glands. 

The second case is one given by Dr. Fuller,* of a woman, aged 
forty-eight, complaining of dropsy, dyspnoea, palpitation and sickness. 
"She was complaining of pain and pulsation, referred to the upper part 
of the stomach, and to a spot just to the right of the sternum, between 
the second and third ribs. Distinct pulsation could be felt in that 
situation and there was an imperfectly defined tumor. "Taking the 
murmur in connection with the dullness on percussion, the distinct and 
to some extent circumscribed pulsation between the second and third 
ribs to the right of the sternum, and the obviously obstructed cardiac 
circulation, all who saw her inferred the presence of an aneurismal tu- 
mor." Post-mortem showed a mass of malignant disease. This mass 
was pressing in some measure on the heart itself, and also on the large 
vessels ; and while this pressure produced alteration in the form of the 
aorta, which, weighed by abundant atheromatous deposits, gave rise 
to the murmur so distinctly heard, pulsation was communicated to the 
malignant mass and thus was felt to the right of the sternum." This 

^Diitimoi of the heart and great blood tasmIi, paga 213, London Edition, 

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LECTUBE ON DSATH FBOM CHLOROFORM. 23 

vafi not a case of pulsation of the right auricle, simulating aneurism ; 
but a loud murmur was produced by pressure of a tumor upon the 
aorta^ thus tending to confirm the impression of an aneurism. 

We ma J here state a remarkable instance of an aortic aneurism, 
pulsating in the fiflh intercostal space. It occurred in the practice of 
Dr. Bright, at Guy's Hospital. Dr. Sibson, who makes mention of it, 
remarks that it is the only instance, out of five hundred cases, that he 
has met with. 



CLINICAL LECTUKE ON A CASE OF DEATH FROM CHLO- 
ROFORM. 

BY DR. BILLROTH, 
ProfBaior of Surgery at th« Tienna UniTeraity. 



It is customary to divide chloroform-narcosis into certain stages, 
bat these, both in regard to the mode and the rapidity of their sequence, 
yiry much in different individuals. In the first stage, the patients are 
usiudly thrown into a state of excitement^ which chiefly influences the 
psychical and motory spheres, for I know of no case in which excite- 
ment of the sensitive nerves through chloroform, has produced hyper- 
aesthesia. In only quite exceptional cases are the nerves of the senses 
abnormally excited, and subjective personations induced. Commonly, 
the moU^ry stimulation is so combined with the psychical, that mental 
images are conjured up, in consequence of. which, the individuals con- 
ceive the idea that they are fettered or impeded in their actions, and 
execute movements for their liberation. The physical stimulus exhib- 
its itself in various ways in different individuals, just as drunkenness 
vill render one man quarrelsome or violent, another loving and maud- 
lin, and a third melancholic. Purely individual conditions thus exert 
great influence. The motory effects, besides the struggles due to psych- 
ical influence, are chiefly of a spasmodic character, exhibiting them- 
selves in convulsive movements of the muscles of the extremities, and 
especially of the muscles of deglutition and mastication. 

Anaesthesia commences in this stage, but the patients are usually 
restless, and sometimes so unmanageable as to require to be restrained 
by three or four men, so that any of the more delicate operations could 
aot be undertaken. When I inhale chloroform myself, I am sensible 
at this stage, of a tremendous feeling of internal restlessness, vibration 
and beating at the fingers' ends, and of an overpowering sense of the 
loss of all capacity of will or action. So little tractable are most pa- 
tients in this stage, that we have to carry them into the next — that of 
ioUrance, The convulsions cease, and there is muscular quietude. The 
mental disturbances continue, but they have lost their connection with 
the motory apparatus. The condition of dreaming is set up, and, just 



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24 WESTERN JOUKKAL OF MEDICINE. 

like in sleep, when the narcosis is slight, vivacious images are attended 
by movements; when this is deep, all spontaneous motion ceases. This 
condition of deep sleep is the most favorable one for operations, and 
the one we seek to maintain. 

To this, succeeds the paralytic stage, in which all traces of the power 
of movement have ceased ; for while during the stage of tolerance, reflex 
movements are not infrequently met with, now there is absolute rest. 
Only breathing and the heart's pulsation continue, and if the narcosis 
be too prolonged, even these will become paralyzed. The possibility 
of making a practical use of chloroform, depends entirely upon the fact 
that the muscles of the extremities and of the trunk are first, and those 
of the heart and respiration last paralyzed. This paralytic stage is 
seldom resorted to for therapeutical purposes, and it is so chiefly for 
the reduction of old dislocations or the rupture of anchyloses. Be- 
tween this paralytic stage and paralysis of the heart, there is, however, 
always a large interval, the passage of the one into the other not usu- 
ally taking place suddenly. The cessation of respiratory activity, is 
announced first by stertor, and then by irregularity or incompleteness 
of the respiratory movements; and that of the heart by the gradually 
approaching feebleness and slowness of the pulse — the respiration ceas- 
ing prior to the action of the heart. 

The practical rules for the employment of chloroform, are founded 
upon the observation of these stages in thousands and thousands of 
cases. Yet there are individuals who, standing apart from all such 
rules, after a few inhalations quickly perish. It is said of such, that 
they have an idiosyncrasy, as regards chloroform. And there is no 
reason why this should not be the case, or that all persons should be 
alike sensible to the action of chloroform, while the various other nar- 
cotics act so differently on different individuals. Enormous individual 
differences, in fact, exist as to sensibility to the action of poisonous 
substances employed as medicines. Thus, I am attending a lady in 
whom one-eighth or one-sixteenth of a grain of morphia excites such 
suffering, uneasiness and vomiting, that, in spite of the severest pain, 
she dares not take it ; and yet upon any of us such a dose would produce 
scarcely any effect. Another patient, for whom a mixture of half a 
drachm of iodide of potassium in six ounces of water was ordered, after 
every spoonful was seized with aphonia and a splitting headache, and 
when I persuaded her to continue the medicine, after a few spoonfuls 
the entire head became eryethematous, and weeping, discharge from the 
nares, with cough, etc., ensued. So belladonna, in the dose of y^^j gi'sin, 
may induce symptoms of poisoning. In cases in which individuals 
manifest such excessive sensibility to chloroform that a few inhalations 
prove fatal without any premonitory symptoms, we are powerless, al- 
though even in these, artificial respiration must not be neglected. Much 
stress is laid upon the purity of the chloroform employed, and rightly 
so ; but whether impurity produced by products of decomposition, is 
dangerous, has not been proved. Chloroform that has been kept long 
and exposed to the light, always contains free hydrochloric acid and 
chlorine, and although this may not be dangerous, it should not be em- 
ployed, for patients can not inhale it, as it immediately induces severe 



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LECTURE ON DEATH FROM CHLOROFORM. 25 

eoaghlDg, bnrning in the throat and constriction of the larynx. These 
sjmptoms, as well as one's own sense of smell, lead us to reject it. 
Whether some material that is specifically daDgerous, is generated in 
chloroform by long keeping, is unknown ; but that chloroform is very 
variable, both in smell and its eflfects, no one can doubt who has much 
to do with it. 

Danger may arise in all the stages of chloroform-narcosis. Dur- 
ing that of excitement, violent muscular efforts may give rise to apo> 
plexy, especially in individuals with disease of the heart, rigid arteries, 
or emphysema. Of most consequence in this stage, however, are the 
contractions of the muscles of mastication and the posterior muscles 
of the tongue. By means of the stylo-glossi and the glosso-pharyngei, 
the tongue is drawn spasmodically backwards, pressing the epiglottis 
down so as to mechanically close the aperture of the larvnx. Such 
patients become blue in the face, and die suffocated, not through the 
direct action of the chloroform, but from the mechanical privation of 
air. Such cases have been often observed in the Klinik, rendering it 
necesary to force open the mouth with Heister's speculum and draw 
out the tongue. When the narcosis is continued too long, there is 
danger of paralysis of the heart and sudden collapse. It is a rule not 
to prolong the narcosis when the upper eyelid allows itself to be raised 
witiiout any muscular resistance. Individuals in which this can be 
done only at a late period, or perhaps not at all, and in whom a para- 
lytic condition of the respiration takes place simultaneously with mus- 
cular quietude of the extremities (which happens especially in drunk- 
ards), require to be watched with the greatest care. There are sub- 
jects in whom complete muscular quietude can never be attained. Be- 
fore the utter stagnation due to paralysis of the heart and respiratory 
muscles is brought about, there are changes due to the paralysis of the 
muscles of the face to be observed. The jaw sinks, the features become 
corpse-like, and the face pale, and we have the facies Hippocratica be- 
fore us; and so characteristic is the change of physiognomy that, once 
seen, it can never be forsotten. It is, therefore, of the greatest import- 
ance that the face of the patient should be well watched. Another 
warning sign is, that the blood, during an operation, either ceases to 
flow from the arteries or is of a dark blue color. 

The case we met with yesterday does not, in my opinion, belong to 
this category, as it did not give the impression so much of a case of 
intensely aggravated chloroform poisoning as of one of sudden col- 
lapse — ^a view rendered probable also by the very anaemic condition of 
the individual. This man, twenty -six years of age, but looking much 
older, had, while drunk, cut his finger with a china pot, and, according 
to account, lost a great deal of blood. At all events, when he came to 
the hospital two or three days after, his ansDmic appearance was re- 
markable, and this condition was further shown by his excessive sensi- 
bility to pain, leading to the belief that one of the digital nerves might 
be exposed. It was on this account chloroform was given, and all at 
first went on as usual. Convulsive movements ensued, and, as during 
these, neither an examination nor operation can properly be performed, 
the chloroform was continued, with the object of obtaining the stage 



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26 WESTERN JOURNAL OF MEDiaNE. 

of tolerance. But as soon as the convulsive movements had ceased, the 
patient assumed the appearance of a corpse. The mouth was opened, 
and the tongue was drawn out in the belief that closure of the larynx 
had produced the effects observed. This did no good, and the contrac- 
tion of the stjlo-glossi and the constrictores pharyngis prevented the 
passage of a catheter into the larynx. Tracheotomy was at once per- 
formed, and a canula passed in, but all in vain. The narcosis had lasted 
a very short time, and, at the autopsv, there was scarcely any smell of 
chloroform. Evidently, a sudden collapse had occurred, his condition 
giving the impression of a deep swoon. It is a rare thing for a healthy 
man to die during syncope, although this happens with old people and 
during convalescence, and especially after pneumonia. Death from 
sudden collapse is also met with after typhus. I am under the im- 
pression that the present case was one of such collapse, occurring dur- 
ing the narcosis, in consequence of anssmia. G-enerally, there is not 
much learned from the autopsies of those who die from narcosis. The 
blood is pretty constantly found not to be coagulated, and sometimes 
of a cherry-red appearance. This non-coagulation of the blood gives 
rise to numerous consequences, which formerly were supposed to be 
. characteristic of death from chloroform, such as hyperssmia of the post- 
erior part of the lungs, kidney, and spinal marrow, etc., which are 
really post-mortem appearances due to the fluidity of the blood. In 
the present case, these appearances were present, although the heart 
and large arteries were strongly contracted, and almost empty of blood. 
The heart is found in different conditions. In animals it is commonly 
dilated, especially the right ventricle, but in the present case, as in all 
an»mic subjects, it was strongly contracted. There is no distinctive 
sign of death from chloroform, and if an individual were killed by it, 
and no other non-medical proof of this existed, the anatomist would 
not be in a position, from the condition of the body, to declare that 
this had been the case. Even the odor of the chloroform is a worth- 
less sign, for Rokitansky states that the brain especially sometimes 
gives out an odor exactly like that of chloroform, without any ground 
for supposing that this substance had been employed. 

With respect to the administration of chloroform, the employment 
of the chloroform inhaler constitutes the best, the quickest, and most 
convenient mode. The singular idea that a mixture of chlorform and 
ether is less dangerous than either of these substances used separately, 
has been abandoned. Above all things, never administer chloroform 
alone, but always have at least one assistant with you. When there 
is rattling in the throat, blueness of countenance, and irregularity of 
breathing, remove the apparatus and throw open the windows and doors 
so that plenty of air may gain access to the patient, which is further 
to be aided by forcing the mouth open and drawing forth the tongue 
— ^a manoeuvre often attended with the best effects. Let the patient, 
and especially if there are- not plenty of assistants at hand, always be 
in the lying, not the sitting posture. The dashing the surface with cold 
water or applying ammonia, can only be of service when the narcosis 
is slight enough to admit of the excitement of reflex movements ; but 
in the paralyzed condition, all such means are only a dangerous loss of 



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LECTURE ON DEATH FROM CHLOROFORM. 27 

time. Here, artificial respiration must be at once resorted to, and exe- 
euting this by mouth to mouth, with compression at the lower part of 
the thorax, is a preferable procedure Jto Marshall Hall's method. It is 
true, that in this mouth to mouth procedure, much. of the air passes 
into the stomach ; but the plan with all its disadvantages, is found prac- 
tically useful, and, at all events, resorting to it is better than doing 
nothing. The access of air may be facilitated by passing a catheter 
into the larynx, which, in the paralyzed condition, is as easy as after 
death. A great part of the air passes out again by the side of the 
eatheter, but a considerable portion enters the lungs in tolerable force. 
When the catheter can not be introduced, tracheotomy should at once 
be performed, and a large canula passed in. Artificial respiration must 
be exercised in a regular rythmical manner, and its efficacy as much 
depends upon the respiratory movements being forcible enough as upon 
admission of the oxygen to the blood. In this case, artificial respira- 
tion was continued for half an hour; but really, after from ten to fif- 
teen minutes of inefficacious efforts, all hope had ceased. The duration 
of the asphyxia is not, however, always easily estimated ; for at such 
a time the watch is not looked at, and seconds become minutes and 
minutes hours. Stimulating the phrenic nerve by means of electricity, 
19 undoubtedly a useful means for exciting the respiratory movements; 
but unfortunately, an apparatus is seldom ready when wanted. 

Fortunately, we may regard death from chloroform as a very rare 
occurrence, and one becoming more rare every year. Eeckoning that, 
during my fifteen years of clinical teaching and the two last years of 
my student life, I have been present at two administrations of chloro- 
form per diem (which is a low and certainly not an exaggerated esti- 
nate), I shall have witnessed twelve thousand five hundred cases of 
Barcosis, and this is the first fatal one I ever saw. We must regard 
chloroformisation as an operation by means of a chemical agent, as 
with arsenic, chloride of zinc, etc., and compare its results with those 
<rf other minor operations. I am convinced that the mortality statis- 
tics afler the application of leeches, blistering cupping, and bleeding 
(through erysipelas, hospital gangrene, tetanus, etc.), is greater than 
one in twelve thousand five hundred; but no one, on that account, has 
thought of prohibiting these means, and the use of chloroform can not 
be prohibited because of these seldom occurring fatal cases. The psych- 
ical impression which such a death produces is, by its very suddenness, 
a Tery powerful one, and exerts especial influence upon those who have 
not been accustomed to see men die before their eyes. Unfortunately, 
we have in surgery only too often occasion to be convinced of the in- 
completeness and the impotence of our present amount of knowledge. 
A mere cut of the finger, especially if this opens into a joint or 
the sheath of a tendon, may give rise to phlegmonous inflammation, 
which during the last twenty years has caused far more deaths than 
chloroform. Urged by the patient's vanity, we remove a small tumor 
from a man's scalp, and he dies of erysipelas, or another dies from 
tetanus brought on by some slight injury — perhaps only the prick of 
t thorn ; and, as regards the cause and action of these circumstances, 
we are as ignorant as we are regarding death from chloroform. 



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28 WESTERN JOURNAL OP MEDICINE. 

But while such cases are sad to reflect upon, they should not, any 
more than the one of yesterday, lead us to despair in our art and 
means of investigation, nor to settle down in desponding resignation. 
Let them act as a great warning cry of nature, rousing us, ashamed of 
our hitherto pigmy efforts, to renewed action and restless labor. — Jded- 
real Times and Gazette^ November 28, 1868. 



CORRESPONDENCE, 



Berlin, November 18, 1868. 
It scarcely requires a reference to the past ages of the world, to 
prove the intimate connection between the art and literature of a 
country, and its politics. Rome stood forth, the proud Niobe of nations, 
some two hundred years before Christ, in the supremacy of her power- 
Greece, Asia, Egypt, lands which, in their day, had experienced the 
same vicissitudes of rise and decline, lay at her feet. To her mandates 
were turned the obedient faces of the inhabitants of the earth. Scienoe 
and art reached a perfection which in many branches has never since 
been attained. Every field of literature was cultivated. Medicine, 
which had lain for so many generations concealed by the fearful igno- 
rance and superstition which overclouded her, loosed herself under the 
fostering hands of government, and shone forth in the full beauty of 
maturity. Galen, the great master, was hospitably received within her 
walls, and his doctrines disseminated far and wide. But the golden 
age of Augustus was succeeded by the tyranny and oppression of his 
successors, among whom a Nero. It had already become the brazen age. 
Philosophers were exiled, the treasures of libraries burned in public 
places, statesmen put to death, the votaries of science oppressed, doors 
opened to the delusive doctrines of Egyptian mysticism and the super- 
stitious juggleries of a succeeding priestcraft. Subsequently, hordes of 
barbarians from the north, swept over the land like a desolating si- 
moon, obliterating almost the last traces of civilization. The light of 
science paled and was extinguished. The history of the world exhib- 
its parallel cases throughout her every epoch. The most powerful is 



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CX)REEBPONI)£NCE. 29 

u it has always been, the most enlightened land. The government of 
Frederick the Great, has gradually enlarged its borders and strength- 
ened its resources, from its inception on. The lamp of science has ever 
been preserved in the purity of its lustre upon her altars. Prussia 
claims to-day, a place high in the first rank among the nations of the 
eartL The brilliant successes of the late wars have placed her in the 
verj lenith of her power. She possesses, without doubt, the greatest 
fiualities of instruction. America is, perhaps, her superior in the lower 
hranehes ; but beyond that, America lacks the hand of authority which 
is empowered to pluck the ever encroaching tares. Charlatanism is in 
bad savor here, even with the common people. The names of her great 
men in medicine, as in every other department of science and art, are 
household words. Everybody knows Grraefe and Langenbeck, and 
every one is familiar with the names of Yirchow, Du Bois Raymond, 
Freriehs and Traube. Their photographs are in every window with 
those of the King and Prime Minister. The city has mourned for 
Griesinger, the great authority on nervous diseases, just dead, far too 
soon. A long illness of some three or four months duration, termin- 
ated fatally last month. A fistulous orifice in the lumbar region, with 
a purulent and urinary discharge, confined him during nearly the whole 
of his illness to his bed. It was variously diagnosticated by the 
attending physicians, as pelvic abscess, abscess retro-peritoneal, wan- 
dering kidney, abscess of the pelvis of the kidney, &c. The autopsy 
rerealed a retroperitoneal abscess with perforation of the appendix ver- 
miformis and involvement of the ureter; kidneys intact. He was 
hmied with all the honors of the profession, the rector of the faculty, 
nearly all of its members, and a large number of students, following 
the remains to the grave. His late work on Infectious Krankheiten, is 
eoosidered one of his ablest efforts. His place in the hospital is tem- 
porarily filled by Dr. Westphal. 

The new session has opened at last, with flying colors. Two weeks 
have elapsed since the announcement of commencement, but with the 
genuine Teutonic tardiness which is utterly irreconcilable with any- 
thmg American, the lectures have been delayed. The machinery is 
ponderous, however, nearly four hundred courses altogether, of which, 
over one hundred are in medicine. Every department of science and 
art is represented, all the languages, ancient and modern, religion, theo- 
retical, jurisprudence, music, even riding, dancing and fencing. The 
libraries, museums, zoological and botanical gardens, are all rendered 
eabservient to instruction. The new anatomical and chemical edifices 



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30 WESTERN JOITRNAL OP MEDICINE. 

approach a palatial splendor; their chief lecture rooms would rival 
many an opera in the elegance, even luxury of their appointments. 
The chief medical attraction of Berlin is, the opportunity afforded for 
the study of pathology. Her reputation in this regard is, perhaps, 
unequaled in the world. A commodious building, known as the Leichen 
Haus, erected in a style which might make some pretensions to archi- 
tectural beauty, stands apart from the others in the handsome grounds 
of the Ckarite. The basement is the general receptacle, and contains 
apartments also for the dissection of animals. The regular school for 
comparative anatomy and veterinary instruction, is the handsome build- 
ing across the street. The first story contains the Monday morning 
lecture room and the chambers for the study of microscopy. The 
upper story is divided into a central amphi theatrical lecture room, the 
didactic hall, large square room in the right wing, provided with long 
tables and little railways, for passage of the microscope, and the large 
room in the left wing, the chemical laboratory. Every Monday morn- 
ing an autopsy is conducted by Prof. Virchow, suis manihus^ in the first 
mentioned room. The body is placed on a revolving table, at which 
the professor stands, and the students are gathered around on standing 
platforms, elevating as they recede. This is the most practical, inter- 
esting and instructive lecture of the week. Connected with this, is 
united the proper descriptive pathological course, illustrated by fresh 
specimens from the cases of the week. The didactic course comprises 
four lectures a week, occurring in hours at noon. Then a course on 
practical pathological histology, also by the professor himself, fills the 
remaining unoccupied morning hours. The lectures on the microscopy 
of the normal tissues, being delivered by the assistants in the after- 
noon. Prof. Virchow has also a small ward in the Charite which re- 
ceives his daily visit, so that from morning till high noon he is engaged 
at the hospital. Politics engages him in the afternoon, during the ses- 
sion of Parliament, as he is an active advocate of the people ; at one 
time so active as to have necessitated a temporary sojourn in a foreign 
land. He is said to have lately expressed an intention to retire from 
politics, as peace once more reigns over the land, and stated that he had 
experienced a contrition for the neglect of his medical works, some 
fourteen of which he had commenced and left unfinished. He is a 
man of most indefatigable industry, and seems so to have systematized 
his life as to have made its every nook and corner of avail. He reaches 
the lecture room in hot haste and begins his discourse panting. His 
style can hardly be said to be pleasant — in fact, under a two hour's ses- 



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CORRSSPONBSNOE. 31 

sion, rather tedious; his diction is of course polished ; there is no at- 
tempt at oratory, rhetoric being among the few branches which he has 
n^leoted in his early edacation ; but then, eloquence is rare in every 
field of literature. In Germany, most of the teachers at the University 
read their lectures from a chair. Du Bois Raymond, the celebrated 
lecturer on physiology, being among the few exceptions. Yirchow is 
not a believer in Christianity ; neither, alas, are most of the great men 
of Germany. It militates some against natural philosophy. Some of 
his bitterest satires are leveled against it ; not loud, but quiet and deep. 
He would make an exceedingly ugly opponent to encounter, on this or 
a&j other subject. 

Id person, small, below medium, a peculiar head, flattened behind, 
itB longest diameter between the ears, hair thin, traces of gray, forehead 
expanded in every direction, small twinkling hazel eyes, mouth small, 
lips tbin, a complexion which in a lady would be called a clear brunette ; 
though fifty, he possesses the vivacity of youth. He celebrated a few 
days ago the twenty-fifth year of his medical life. In social life, what 
the Germans call a zuganglicher man — that is, a man of easy access. 
There is nothing in his appearance or address which would betoken 
the man; indeed, nature's only gifts seem to have been an indomitable 
energy and an untiring application — the rest is self-made. 

The subject of to-day's discourse is syphilis. Hitherto, we are 
informed, the outward manifestations of the disease have been the only 
ones receiving attention. We now know that there exists a whole series 
of symptoms affecting the internal organs, characteristic of the disease. 
The brain suffers a softening ; the root of the tongue looses its gland- 
alar characteristics, smoothes off to a polished surface from atrophy of 
its glands ; a chronic pharyngitis, the result of the increase of paren- 
ehpial connective tissues; the tonsil is likewise attacked and becomes 
almost obliterated ; the heart assumes an hypertrophy ; the pleurce pre- 
^nt cicatrices on their surfaces, from the contraction and retraction of 
ehronic pleuritis; the liver reduces in size and presents the same cica- 
trices, in the cases before us, extending completely through the right 
lobe at its outer third, forming a new lobe ; the kidney suffers atrophy, 
becomes exceedingly pale and granulated on its external surface — the 
sttrface of section remains smooth ; the atrophy is likewise induced by 
an increase of the connective tissue, an indurative interstitial nephritis. 
Melanosis is divided into three classes — melanoma, melanotic sarcoma, 
and melanotic carcinoma. The first is benign ; the two latter, malign 
tumors. The difference between them is the order or sequence of attack. 



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32 WESTERN JOURNAL OF MEDICINE. 

A melanotic carcinoma of the eye, for instance, would next attack the 
glands and then the lungs, before the liver was reached. A melanotic 
sarcoma in the same position, would maintam no such succession of 
attack ; the liver might be the second object. 

It is, of course, impossible in a letter of this heterogeneous charac- 
ter, to present anything like a detailed report of several lectures; so 
that I must fain be content with the transmission of the novel, in the 
form of isolated aphorisms or the regular account of individual lec- 
tures on some specific subject, which latter shall be forwarded, if any 
of unusual interest occur. 

Cohnheim, Virchow's first assistant, has lately received an appoint- 
ment as Professor of Pathology at Kiel. His late discovery of the 
escape of the white corpuscles of the blood from the vessels, has ex- 
cited the liveliest attention. It has appeared in the last edition of 
Virckow'i ArchiveSy some seventy pages. As I had the opportunity 
of hearing his lecture on the subject during the microscopic course of 
last session, I shall attempt to send you a condensed account. The 
white cells, which ai;e always nearer the walls of the vessel, are ob- 
served under peculiar conditions, to become stationary and adherent; 
shortly after, a protrusion in the wall denotes the presence of a cell 
there ; the wall is then ruptured and the corpuscle is seen, partly within 
and partly without the calibre of the capillary, after which the cor- 
puscle escapes entirely and is connected to the vessel by a fibrous 
attachment, which is finally separated and the cell floats free : thus the 
white blood corpuscle, while still within the walls of the vessels, be- 
comes or rather is in the lymphatics the lymph cell and in an abscess 
the pus cell. The fact of the identity of the three cells, is one of long 
acquaintance; but the identity of origin or entity, is the new develop- 
ment. If the discovery be verified, it will shake parts of Virchow's 
cellular pathology doctrine to the center. 

Perhaps the finest and most systematic clinic of the session, is that 
of Prof. Traube, the most American of all the medical faculty. From 
nine to eleven every morning, the proper propsodeutic or initiatory clinic ; 
three days in the week before the whole class, and three days with a 
third of the class at the bedside. The old surgical clinic room of the 
Charite has been appropriated for the lectures before the class. The 
professor and patient inside a large balustrade, behind which a single 
long bench for the students. There are however, two galleries of simi- 
lar construction above, so that a large number of students are accom- 
modated with the additional advantages of an equally good view for 



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CORRESPC^NBENCE. 33 

«very one. Never having seen the lecturer before, illness prevented 
his sammer course, we obtained a seat opposite the door to secure a 
fair opportunity for the formation of first impressions. In the mean 
tiaie^ we take occasion to notice that the little stand in the corner is 
filled with tubes and tests and divers colored litmus, the stethoscope, 
Traube's own, a handsome hard rubber cylinder, with movable ear- 
piece, a small but deep concave, and an exceedingly small bell, in gen- 
eral use throughout the city and in the pocket of every student, the 
hammer and pleximeter, likewise everywhere employed, with brush and 
ink for marking purposes. While bewildering ourselves in a vain 
attempt at the solution of the enigmatical problem of forming an equal 
for the great minds of the place, from the dull and sleepy material 
around us, the double door is flung open and the procession enters. Pre- 
ceded by an attendant with two large mouthed flasks containing urine 
and spata, follow four nurses carrying the patient in a handsome iron 
bed, with covers of spotless purity, and then the professor and his three 
assistants. He i9 of medium stature, perhaps fifty-five years of age, 
rather careworn, somewhat nervous look, hair cut short and combed 
forward like a monk, a full, prominent, penetrating eye, a recklessness 
of gait anfl a slovenliness of attire. 

He is evidently master of the situation — his gait informs you 
that at once — ^you see it daily on Fourth street among that class of 
men who consider that they have traveled and are familiar with the 
movements of things. He is a man who has suffered, and yet, is 
scarcely a man who has much sympathy for suffering. He carries 
always a sober mien which is reflected over the class as he enters. A 
stadent is called into the arena — he enters without much alacrity — 
there are evidently some unpleasant occurrences occasionally. The 
professor takes his measure at once, and having induced in him the 
uncomfortable supposition that perhaps some portion of his attire is 
&iling, he requests him rather abruptly to inform him the striking 
features of the case before him. Should he be a man of nerve, it is 
well, if not, there are cooler and pleasanter climates for a permanent 
residence. But Trauhe is a splendid clinician; not a symptom or a 
feature escapes him; every case receives the most thorough revision. 
He examines the patient from vertex to toe. He is a panopticist. He 
is a physician of the old school, animated by the fire of the new. He 
is right square up to the times. He has served his apprenticeship 
aad his journeyman life as student, assistant and private dooent, and 
has eome to his position as master workman, by dint of time and toil. 
(8) 



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34 WESTERN JOURNAL OP MEDICINE. 

The case is the Basedow disease, a most exquisite case, the enlarged 
thyroid, the prominent cornea, the depression of the planes of vision, 
the impaired movement of the levator palpebrse, the radial tension, the 
ventricular hypertrophy, and the general congestion of the capillaries, 
as evidenced by the pink hue of the skin, are all Beautifully marked, 
and then he elicits so handsomely the nervous irritability of the dispo- 
sition. He views, reviews, recapitulates, and requests a diagnosis — 
fortunately, it was correctly given. Then follows a slight history of 
the disease, symptoms, differential diagnosis, prognosis, and treatment. 
The treatment is, roborant and tonic, quinine and iron, with the proper 
observance of all those hygienic measures which would quiet the excited 
nervous system^ The treatment of Trousseau, the antiphlogistic, with 
digitalis, is of all the least successful. He fears that Trousseau, like 
many of the French physicians, actuated by a desire to be the first to 
describe a disease, have allowed, on many occasions, their vanity to> 
interfere with their veracity. The etiology, he prefers to leave un- 
touched. So many and so diametrically opposed are the alleged causes, 
that it is better in these days of great discoveries in physiology, to de- 
fer an attempt. That it is a disturbance of nervous centres, is but too 
plain ; but of what character, is a question for the future. Two cases 
of paralysis follow, one the result of an old diphtheria, and one of 
syphilitic origin. In the latter case, he speaks of the importance of 
establishing the existence of secondary symptoms — refers in assistance 
thereto, to an important discovery of modern times, the glazed and 
shiny appearance of the post portion of the dorsum of the tongue, as 
revealed by the laryngoscope. The paralysis of diphtheria is always 
transitory. As to the relation of a brain trouble, he states that the 
nearer an extravasation or tumor in the brain is to the periphery, the 
more complete will be the paralysis, by reason of the implication of 
a greater number of its fibres. In the present case the complete par- 
alysis of the facial on one side, would indicate the seat of the affection 
at or near the stylomastoid foramen. Age predisposes to brain affec- 
tions, the inner coat of the artery thickens, or the caliber fills with 
fibrin. Endocarditis in its early stages, is a frequent cause of brain 
emboli. The existence of an embolus in the brain for more than 
twenty-four hours, would certainly cause paralysis. Brain affections 
from arterial difficulties, give no alterations in temperature. The use 
of opium in brain affections, to be very cautious on account of the 
tendency to narcotism. The Tr. Opii Benz., although one of the weak- 
est is still one of the most dangerous. 

In a subsequent lecture were presented cases of icterus and puer- 



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CORRESPONDENCE. 35 

penl fever. In jaundice, the yellow color of the foam of the urine is 
a Ttlnahle diagnostic symptom. The test for bile in the urine consists 
in letting fall in a deep wine glass quarter filled with nitric acid, a few 
drops of the suspected liquid; the play of colors, green, violet and 
brown, is characteristic. Treatment — mild saline cathartics, baths, &c. 

Puerperal fever he divides into three forms: periphlebitic, (here 
rare); endo-metritic and peritonitic — the two latter often combined. 
( Virchow often speaks of a diphtheritic.) The occurrence of a pleu- 
ritis duplex always renders the prognosis of Feb. Puerper., exceed- 
ingly grave. He speaks of the mortality of the disease under either 
the tome or expectant treatment as colossal. He is an advocate of the 
antiphlogistic and mercurial — the mercury by inunctiou, and this to 
be immediately discontinued on the first appearance of constitutional 
:^piptoms. He applies leeches to the abdomen freely, but allows no 
after bleeding. 

The next hour is devoted to Frerichs. The lecture-room is always 
crowded, every seat taken and the aisles full. Frerichs himself is a 
man of very tall stature and exceedingly awkward and ungainly ap- 
pearance; a face which is nearly half forehead and almost juvenile in. 
expression. He is also far past bodily prime, though still in highest 
mental vigor; a large, full eye, face perfectly smooth, mouth just a 
little sensual. He is a man who combines some of the pleasures of 
life with its pains. Although having occupied a public position for 
many years, and extend'ed his travels in foreign lands, he is still a man 
of exceeding diffidence. It is easy to conceive what actual misery 
it must have cost him before he arrived at even his present posi- 
sion. He sits on the corner of a table to lecture, and in the interval 
of its removal for the presentation of a new case, appears in the great- 
est embarrassment. His hands are in the way and so are his feet. 
<)nee seat him, however, and give him material, and he forgets himself 
eompletely. He is then in the full possession of the medical mng froid. 
His every word is treasured, for it is the result of years of the ripest 
experience. His voice is a deep bass, in slow and measured tones, be- 
ginning a sentence with a slight elevation and gradually fading off to- 
a sound almost inaudible. Heard for the first time at the back part of 
the room, it only requires the solemn intonations of an old organ to 
remind one of the service of the old Baptist church. But it becomes 
even agreeable in time, presented as it is, with the full ore rotundo, in 
^entenoes pregnant with richest import, axioms as it were, it is easy to 
understand the secret of his success. Here, also, every facility for 






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36 WESTERN JOURNAL OF MEDICINE. 

explanation and illustration exists. The microscopes arc placed on the 
stands, while drawings and specimens are passed around the class. 
The perfect nonchalance with which he pricks the finger of a patient 
to ascertain if the drop under the microscope evidence a simple ansemia 
or a leucocjthemia, is a matter of at least surprise to the uninitiated. 
Every attempt to improve the blood in the latter condition, he informs 
us has hitherto proven futile, hence the importance of a proper diag- 
nosis. To exhibit the peristaltic movements of the stomach in a 
case of carcinomatons stenosis of the pylorus, whereby the organ was 
enormously displaced and in proof that the tumor below the umbilicus 
was really the distended stomach, he administered a carbonate, followed 
by an acidulated drink; the effect was almost instantaneous, the move- 
ments of the walls under the attenuated integument being palpable 
to all. 

The length of this letter already totally precludes any attempt at 
a report of further procedures, which I may, perhaps, transmit in a 
future letter. Whittaker. 



New York City, December 15, 1868. 
Dear Journal: When last we wrote, the sessions at the different 
medical colleges of this city were about commencing. Now, the lec- 
tures are nearly one-half over, and the lecturers are looking forward, 
with pleasure, to a short period of repose during the approaching holi- 
days. While the students will hail them no less eagerly, as a golden 
opportunity for writing the dreaded and long-thought-of thesis. If 
they only knew, as do we who have passed through the mill, how often 
the thesis that has cost so much labor and so many wakeful nights, is 
neglected and packed away without ever having been read, they would 
not feel so much anxiety about it. A thesis does not amount to much, 
at any rate, in these days, when they can be bought by the dozen in 
alanost any second-hand book store ; nor, in fact, does an examination, 
for too often the poor student, on thes^ awful occasions, has frightened 
o«Lt of him the little that he does know. The system of daily recita- 
tions, so often urged in our medical journals, seems to us the most 
feasible way of ascertaining the true status of the student's acquire- 
ments, and it is certainly a most improving and instructive method of 
driving home the great truths to which the student is daily listening. 
The system of daily quizzes, is now an established institution in our 
•city colleges, and one from which the inquirer after medical knowledge 



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CORRESPONDENCE. 37 

will derive great benefit. During the holiday week, many of the stu- 
dents spend their hours in making fine dissections, as their time in the 
dissecting room (that great store-house of instruction, in which so many 
distinguished men have laid the foundation of their renown) during 
the active lecturing season is necessarily somewhat limited, as then the 
evening is about the only time they have to dissect. Classes are formed 
during Christmas week, and also at the close of the term, for practical 
instruction in the various surgical operations that can be performed 
upon the human body. Subjects are plenty with us, being obtained firom 
the great chanty hospitals, and, for a reasonable sum. All have an 
opportunity of practicing upon them the different amputations, liga- 
tions of arteries, operations upon the eye, &c., before they go forth to 
actual practice and to try their skill upon the living. Dr. Valentine 
Mott, in all his operations, even in the hight of his illustrious career, 
and in operations that he had performed over and over again, was in 
the constant habit of going through the operation with the most scru- 
pulous care and precision upon the cadaver, before he performed it upon 
the living patient; and so should every good surgeon do if it be a pos- 
sible thing — ^and in this city it is. 

Ah ! what a beautiful example to us young men of the profession, 
was that aged patriarch, with his lofty enthusiasm for his noble calling, 
with his pure, high-souled advice, and his fervid eloquence I What an 
example to us of indomitable energy, of ceaseless perseverance, and 
never-tiring industry ! Well do we remember in our student days, how, 
on a certain occasion, upon examining some most beautiful and intri- 
cate dried anatomical specimens, prepared by himself, we asked him 
how he ever found time to do such work, amidst the multiplicity of his 
many pressing duties. "My dear boy," was his reply, with one of his 
old genial smiles, "these things I did, while others slept!" To us, 
that answer contained a mighty lesson. His form was bowed with age, 
and his head whitened with the frosts of many winters; but like the 
great old patriot that he was, he stood stoutly at his post of duty, till 
death struck him down. All honor to his memory, and to the many 
virtnes of his life which shed abroad on every hand an external fra- 
grance! 

Each winter witnesses more or less change in the lecturing corps of 
our different medical colleges. New blood is constantly being infused, 
and some of the veterans in the service are gradually retiring from full 
service in the field. Last spring, at the Bellevue Hospital Medical Col- 
lege, Prof. James R. Wood resigned his position as lecturer in that in- 



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38 WESTERN JOURNAL OF MEDICINE. 

stitution, although he still holds his valuable clinics there, and this win- 
ter, Prof. Fordyce Barker resigns his chair. He however, like Prof. 
Wood, much to the satisfaction of students generally, and of his nu- 
merous friends in this city, will still continue his clinical teachings. 
Dr. Barker is an eloquent lecturer, a profound scholar, a genial gen- 
tleman, and one of the most popular men in the profession in New 
York. For a number of years, he has been suffering from a partial 
loss of voice, occasioned by lecturing while laboring under a severe 
cold, and this has made public lecturing a great exertion for him. This 
misfortune, we presume, is the cause of his resignation, which will be 
a great loss to the college* Dr. Barker spends each summer traveling 
throughout Europe, and it is a singular fact, that no sooner does he set 
foot upon that continent than his voice is restored to its natural tone 
and vigor, so much so, that friends meeting him in some European city, 
often have congratulated him upon the recovery of his voice. No 
sooner, however, does he return to this country, than his old hoarse- 
ness returns. His clinics are always most entertaining and instructive. 

The opening exercises last month, of the Woman's Medical College, 
which is located at No. 126 Second Avenue, were of a most interest- 
ing nature. The session consists of the usual period of five months. 
The introductory address was delivered by Dr. Elizabeth Blackwell, 
and was listened to with fixed attention by a large and fashionable 
audience. In the course of her remarks, she stated that the college 
comprised nearly twenty female students, and required a thorough three 
years' course of study. When desirable, it availed itself of both the 
water-cure and botanic treatment, and has been the first institution in 
the country to install a Professor of Hygiene. Dr. Blackwell alluded 
to the increasing liberality experienced by society at large, upon the 
subject of woman as a medical practitioner, and concluded by the hope 
that soon all obstacles to her finding occupation in any sphere suited 
to her powers, would entirely disappear. 

Interesting addresses were also made by Hon. Henry J. Raymond, 
and by Prof. Willard Parker, who warmly welcomed women to medicine, 
as one of those spheres to which they are peculiarly adapted. A doc- 
tor is born, not made, remarked the professor, and is found naturally 
in both sexes. 

Miss Putnam, a daughter of a member of the well-known publishing 
firm of Putnam & Son of this city, has recently been admitted to her 
first medical examination in Paris. The Minister of Public Instruc- 
tion, some time since, opened the gates of the University to her, and 

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OOR&ESPONDENCS. 39 

oov thej are opened to all female medical students. Since she has been 
in Eiurope, Miss Putnam has contributed several admirable medical 
articles to journals in this country. 

Several of the charitable institutions of this city, have been lately 
holding their anniversary meetings. The New Yorl^ Society for the 
relief of the ruptured and crippled, held their sixth semi-annual meet- 
ing, at their rooms, No. 39 Bible House. There has been contributed 
ten thousand dollars of the one hundred thousand dollars required to 
complete their hospital, now in course of erection at the corner of Lex- 
ington Avenue and Forty-Second street. Dr. James Knight, the resi- 
dent physician, stated in his report, that one thousand two hundred 
and sixty-nine patients had received treatment during the past six 
months, and that the office of the institution was not large enough to 
afford, at times, even seats for the cripples applying for relief. Hence, 
tliere was great necessity for enlarged accommodation and means to 
sustain this great charity. 

There are, at present, in the New York State Soldiers' Home, (Ira 
Harris' Hospital), over three hundred maimed and crippled soldiers, 
collected from all portions of the State, but more especially from this 
city. This Home commends itself to the consideration of the benevo- 
lent and patriotic everywhere, and bespeaks for itself that warm sym- 
pathy and material aid to which the men who have sacrificed so much 
are so justly entitled, and should immediately receive. 

Last month, the annual sermon for St. Luke's Home for Women, 
was preached in Trinity Chapel, west Twenty-Fifth street, by Rev. 
^Morgan Diz, D. D. This institution is located in Hudson street, oppo- 
«te Grove street, and is well known in certain circles for its care of the 
aged poor women of the Episcopal £&ith, and is supported by the dona- 
tions of the various churches of that denomination in this city. 

At the annual meeting of the Woman's Hospital Association of 
New York, Dr. Emmet's report for the year, was as follows : Admit- 
ted, two hundred and twelve patients; discharged, one hundred and 
sixty-eight; cured, one hundred and thirty; dismissed as unsuitable 
easefl, sixteen ; left without permission, eight ; not materially benefitted, 
seven; deaths, six; remaining in hospital on November 1st, forty. 

"The governors of the 'New York Hospital, on firoadway, between 
Buane and Worth streets, finding the income of the institution inade- 
quate to its support, have determined to lease or sell the property now 
occupied, which has become immensely valuable, and to obtain a less 
expensive locality for building. Such a change may be necessary as a 



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40 WESTERN JOURNAL OF MEDICINE. 

matter of economy 3 but the removal of the hospital to an extreme part 
of the island, as is proposed, would greatly impair, if not destroy its. 
usefulness. Just such a hospital is required in the very heart of the 
city, where it will be accessible in all cases of emergency. We hope 
this valuable humane institution will not be taken out of the city.'' 

This hospital was chartered as long ago as the year 1771. Contri- 
butions were made towards it from London and other places in Great 
Britain, chiefly at the solicitations and through the efforts of Drs. Foth- 
ergill and Duncan. Unfortunately, in February, 1775, when nearly 
completed, it was almost totally destroyed by fire. Owing to this mis- 
hap, and the revolutionary war, the hospital was not re-built and ready 
for the admission of patients until January 3d, 1791. Since that time^ 
many additions and improvements have been made, such as the South 
Hospital, erected in 1806, and subsequently demolished and re-built in 
1853-55, and the North Hospital, erected in 1841. The grounds are 
handsomely laid out, and the site high, and well adapted for free ven- 
tilation. The main hospital is built of gray stone, in the simple Doric 
style, and has three stories with a basement. In the third story is the 
operating theater. This, the principal building, has accommodations 
for one hundred and fifty patients. From its cupola can be obtained a 
fine view of New York City, harbor, and surrounding country. The 
South Hospital will accommodate some two hundred and fifty patients,, 
affording each patient one thousand cubic feet of space. The North 
Hospital will accommodate about one hundred and fifteen patients. 
The hospital is under the management of a board of twenty-six gov- 
ernors, elected each year at the annual meeting. There are two sur- 
gical divisions, each of which has a resident surgeon, with a senior and 
junior assistant. There is one house physician who has charge of 
the medical wards, who also has under him two assistants. For it-s 
visiting physicians and surgeons, it has some of the best talent in the 
city, as for instance, Drs. Willard Parker, W. H. Van Buren, Thomas 
M. Markoe, Gurdon Buck, Ac. The New York Hospital has been prin- 
cipally devoted to the reception of those patients whose diseases were 
considered curable — ^with the exception of cases of accidents, which 
are received at all hours. "The following three classes only are re- 
ceived : First — Those without means of payment, who are admitted 
according to the judgment of a committee on their several cases. Such 
patients constitute about forty per cent, of the whole number under 
treatment. Second — Seamen, paid for at the rate of seven dollars a 
week from the "hospital money" collected under the laws of the United 



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0ORRl»PO?n)£NCE. 41 

States; and. Third — Pay-patients" — male patients pay six dollare per 
week board, and female patients five dollars. Strangers in the city, 
^ddenly attacked with sickness, avail themselves of the advantages of 
this hospital. Clinical instruction is given regularly throughout the 
wards. 

In 1796, a lihrary was founded, and now contains between seven 
thousand and eight thousand volumes, and in 1840, a pathological cab- 
inet was commenced, which has grown to immense proportions. 

The two operating theaters, the one already spoken of, in the main 
building, and the other in the South Hospital, will accommodate three 
hundred students. ''It is thus that this great charity becomes not 
merely a hospital for the relief of the sick and infirm, but is now 
recognized as a centre from which is derived a large share of that 
practical knowledge for which the American physician has become so 
famous." In this description, and in others that are to follow, we wish to 
aekoowledge our indehtedness for many of ou^facts, to a valuable work 
not long since published, entitled "The Charities of New York." -Thia 
work is a most interesting one, and contains much useful information. 
But, Mr. Editor, space will not allow us to proceed further, and there- 
fore, wishing you and every reader of the Western Journal — especially 
our fair lady readers — a very merry Christmas and happy new year, we 
will bid yon an affectionate farewell. 

Yours, very truly, 

James B. Burnet, M. D. 



♦ Castleton, Inwana, December 21, 1868. 

Br. Parvin — Sir: I have been interested in reading a report of 
"A Singular Case," by Dr. Wm. Mason Turner, of Philadelphia, in the 
December No. of your Journal. Inasmuch as I was once called to 
treat a similar case — one that not only baffled me, but a number oif 
other physicians — and as Dr. T. asks "what was it?" I will state that 
the conclusion I came to in my case was. Cardiac Neurosis. Had I 
time I might bring forward quite an array of evidence upon which I 
predicate this opinion ; but like a certain Indiana Quarter-Master once 
did, I will content myself by simply referring to some of the evidence, 
leaving Dr. T. and the reader to "straiten it out for themselves." 

C. Handfield Jones, on Functional Nervous Diseases, (^Cardiac Neu^ 
Totw,) pages 218, 219, 220, cases 102, 103, 104, &c., &c. In the his- 



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42 WESTERN JOURNAL OF MEDICINE 

tory of these cases he will find a striking similarity to his. In this 
connection, I think, had he examined the ^'old man's'' urine, he might 
have found some assistance, for be it remembered, the ^'oldest inhabit- 
ant" said the "old man" once had "rheumatiz." 

I suppose if the Doctor has not pretty thoroughly tonicised the 
*'old man," he will have, if he has not already had, an opportunity of 
looking over his morning paper at him, in another "hullaballoo." 

Respectfully, 

Country Doctor. 



THE HYPODERMIC SYRINGE IN GENERAL PRACTICE. 



Mt Dear Prof. Paryin: When a student of medicine, an anec- 
dote was related from one of the professional desks in the University of 
Pennsylvania, to the effect that Dr. Physick was once called to reduce a 
luxation of the lower jaw of a woman who was a common scold; luxa- 
ted in one of her fits of scolding. Chloroform being then unknown, and 
the patient very irritable, his efforts at reduction failed ; so, prescrib- 
ing a pint of gin, to be taken in half tumbler full doses every half hour 
until she was tipsy, he left her, to return again in two hours. Upon 
his return at the specified time, he found the gin all gone and the 
woman sober I Trying again to reduce her jaw, a second failure was 
made. Taking a cigar from his pocket he lit it, and commenced smok- 
ing, puffing the smoke in her face, requesting her to take very full 
breaths. In ten or fifteen minutes she became sick at the stomach, 
was relaxed, and then he found no difficulty in re-placing the jaw. 

The moral of the story was, that it required a gqpd deal more gin t^ 
make a regular gin tippler, though a woman, drunk, than a teetotaler, man 
or woman. But not having added smoking to her other accomplish- 
ments, this brought about the necessary relaxation. This was re-called 
to my mind by reading Dr. Catlings letter, published in your most 
excellent Journal for the month of December. 

From a somewhat extended experience with the hypodermic syr- 
inge, in general practice, having used it perhaps, not less than five 
hundred times during the last five years, I am positively prepared to 
assert that people who are not habitual opium eaters, in central Ohio, 
will not tolerate such doses of morphia as Dr. Catlin uses, without the 
occurrence of the most distressing sequelse, in a majority of cases* 



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CORRESPONDENCE. 43 

If Dr. C.'s patients are not regular opium eaters, or he is not mistaken 
about the doses used, or the quality of morphia different from that 
supplied to physicians in this city, then the people among whom his 
lot is east, bear larger doses of morphia by hypodermic injection, than 
those among whom the writer resides; for, if he used such doses in 
central Ohio, he would speedily reduce them, or there would soon be 
some proceedings before a coroner in which he would have some per- 
sonal interest. 

Dr. C, in his letter, states that he treated cholera morbus in 1825; 
therefore, he has been in practice forty-three years certainly, possibly 
more, and must have attained that period of life when enthusiasm on 
most subjects has been very much toned down, and all statements con- 
tribated for publication and for the instruction of his peers in the 
pTofesaon, should partake of the gravity becoming to advancing life ; 
and yet, though the writer is just a little enthusiastic on the subject 
of hypodermic medication. When the results of Dr. C.'s experience 
is contrasted with his own, they are found to differ so widely, as to 
make it absolutely needful to conclude that Dr. C. is mistaken in some 
way. And the purpose of his letter is to caution any of your readers, 
inexperienced in the use of morphia hypodermically, from using the 
doaea he names. They are not only unnecessary, but positively haz- 
ardous. It is seldom that the same dose as would be proper and requi- 
site by the mouth, can be used by the hypodermic syringe, without 
the most unpleasant sequelae, as great prostration, alarm at the abrupt 
ebange of feeling, and prolonged and distressingly sick stomach. My 
own experfence teaches me that one-half the dose by mouth need sel- 
dom be exceeded by the hypodermic syringe, unless utterly regard- 
less of consequences. 

A very carefully prepared article by the writer, on the subject, was 
read to the Mitskingum County Ohio Medical Society^ at its meeting in 
September last, and published in the St Louis Medical Reporter, for 
tbe first October following, which may doubtless be had by any desir- 
ous of knowing the results of a somewhat extended experience. 

A small monograph, entitled "On the dynamics, principles and 
philosophy of organic life — an effort to obtain definite conceptions of 
"How do medicines produce their effects?' " will be published by Mr. P. 
M. Fmckard, No. 510 Pine street, St. Louis ; and by Messrs. Balliere 
Brothers, New York; and by Messrs. Balliere, London and Paris, 
tbottt the first of January, 1869, written by your present correspond- 



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44 AVESTERN JOURNAL OP MEDICINE. 

ent, which, among other things, traces morphia by hypodermic injec- 
tion into, througli aud out of the human system, trying to show what 
it does and how it does it, a copy of which will soon reach you, for 
criticism and review. Z. C. McElroy. 

Zanesville, Ohio, December 22, 1868. 



BIBLIOGRAPHY. 



THE TRANSACTIONS OF THE AMERICAN MEDICAL ASSO- 
CIATION. 

iDBtltQtod 1847. Yol. XIX. Philadelphia: Printed for the AwociatioD, U68. Pp. 497. 



The National Medical Congress met in Washington last May, and 
had an interesting and instructive meeting. The next meeting is to 
be held in New Orleans, beginning on Tuesday, the 4th day of May. 
No session of the Association has ever been held in New Orleans; and 
for that and other reasons we may expect a large attendance, notwith- 
standing the remoteness of that city from the residences of those who 
have been the most constant attendants in past years. 

President Gross' address is the first paper in the volume. The 
President very properly regarded himself as bound to look over the 
interests of the Association, and make such recommendations as, in his 
judgment, might tend to increase its usefulness, and add to its dignity 
and importance. 

His first recommendation was, that more care bo exercised in the 
admission of members. Personally he would be very liberal in this 
behalf, but the habit of admitting almost anybody that applied had 
been complained of, and, it was thought, had kept some old and influ- 
ential members of the profession at a distance. 

He recommended a more critical editing of the volume of Trans- 
actions, so as to keep out papers that had no substantial merit of origin- 
ality. 

He reviewed the subject of Medical Education, urging concert of 
action on the part of all the schools in amending the present course of 
study. 

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BIBLIOGBAPHY. 45 

He adyi:»ed the establishment of means to educate persons to the 
profession of nursing; be suggested that efforts be made to have a 
suitable medical man appointed in every judicial district, to assist the 
authorities in getting at the truth when medical facts and theories are 
involTed in any Fuit at law; he desired to see something like reason 
and justice have a voice in fixing the rank and pay of surgeons in the 
Davj; he thought great good would come of the establishment of a 
naval medical st liool; he was anxious that the Association should 
derise a method tor preparing and publishing a register of physicians 
for the whole country; he earnestly advocated the organization of so- 
eietiesfor the relief of the widows and .orphans of indigent medical 
men; he wished i<> see the Association lend its influence toward the 
institution of vitorinary colleges; he was of the opinion that the 
oipinie law of li.o Association should be altered so as to have the 
President electeil by ballot instead of, as now, merely confirming the 
selection of a committee; he was opposed to what he termed the 
stringent restrictions placed upon the social aspect of the Associa- 
tion by a vote at the annual meeting at Cincinnati; and, finally, he 
was impressed with a conviction that the annual meetings were too 
short to insure xha highest good they were capable of conferring. 

We are more and more convinced of the propriety and good sense 
of this address, and the Association did wisely in appointing commit- 
tees to investigate many of these points, and report to the next an- 
nnal meeting. 

Rqtort of th' Committee on the Rank and Rtfjulations of the Med- 
ical Staff of th Cnited States Navy, In this short paper the chair- 
man, Prof. N. S. Davis, states that he furnished the Heads of Depart- 
ments and memlx-is of both Houses of Congress with a copy of the 
address of Dr. \\ ood, made to the Association last year. 

Report of the Committee on Medical Ethics. Dr. H. J. Bowditch 
Bade the report, dosing with two resolutions: First, that we should 
look to the qualilications of those who sought professional fellowship 
vith us, and igi'.' re sex in deciding the point. This resolution was 
indefinitely poslj-'ued. But the Association need not hope to get rid 
of women doc to i in this way. They may indefinitely postpone the 
sabject, but it v. '11 definitely come back until they have the mora! 
courage to mec^ die issue squarely, and define their position to the 
world. 

The second r* jlution was in reference to Dr. Homberger, who was 
expelled with grr t good will. 



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46 WESTERN JOURNAL OP MEDICINE. 

The Committee on Prize Essays received four papers, bjit none of 
them were deemed wortliy the prize. 

Report of the Committee to Revise the Flan of Organization^ was 
laid over for consideration next year. It proposes many important 
changes in the organic law of the Association. 

Report of the Committee on Medical Education was made by ProF. 
A. B. Palmer, chairman, who expresses his disapprobation of wk&t 
was proposed by the convention of teachers in Cincinnati in 1867, and 
in lieu thereof, presents a plan of his own concoction that he deems 
feasible, and feels sure would accomplish the end desired. 

The Committee on Medical Literature began their service by re- 
((uesting all the publishers of medical books and journals in the Uni- 
ted States to send to the chairman "a copy of all medical books, pamph.- 
lets, essays, monographs, periodicals, reports, lectures, proceedings of 
.«90cieties, etc.," that they might issue, as early as convenient after pub- 
lication. Up to the time of writing the report, no publisher had found 
it 'convenient' to comply with this simple, not to say modest, request. 
By some means, however, not clearly defined, the committee came to 
the knowledge of the existence of thirty-five journals, which they 
name by title, and of the publication of one hundred and eighty-nine 
books and pamphlets, which they give the title of, also. The commit- 
tee declare that it was a pretty good year for medical publications, but 
a very poor period for sending them around to committees. , 

Report on Insanity^ by Chas. A. Lee, M. D., is a scientific consid- 
eration of the subject, giving the proportion of the insane to the whole 
population in various countries, etc. He considers the insane in the 
States of this Union severally, and the provision made for them, and 
finds it inadequate. He points out a better and less expensive plan 
of caring for the insane than that now in vogue in this country. 

John B. Chapin, M. D., contributes a paper On the Provision for 
the Chronic Insane. He argues that the State is as much j^ound to 
care for its chronic insane as for its acute, and, like Dr. Lee, advocates 
a simpler and more economical plan of providing for most of them in 
communities on a large farm. 

Report on Topography^ Climatology and Epidemic Diseases of West 
Virginia, by Dr. E. Hildreth. West Virginia is a State of mountains, 
and has a great deal of topography and climatology, but not much epi- 
demic disease. It is full of minerals and mineral springs. We notice 
that in 1856 nearly sixty- two inches of rain fell in the western part of 



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BIBLIOGRAPHY. 47 

(he State, and in 1863 bnt about thirtj-seven inches. Quit« wide ex- 
tremes. 

A short and interesting Report on the Climatology and Epidemic 
Diaeasts of the Dist. of Columbia^ is made by Prof. Antisell. Prof. A. 
thinks consumption especially rife in Washington City — not among the 
permanent inhabitants, but among the department clerks who come 
from the rural districts. 

Report on Medical Topography^ Meteorology^ and Endemic Di$- 
fata of Texas, by T. J. Heard, M. D. This opens with a brief account 
of the general subject, and then treats at great length of the epidemic 
of yellow fever in 1867, The mean annual average of rain fall for 
eight years, 1856-65, was 30.67 inches. 

Dr. Condie's Report on the Diseases of Pen 7i«y/t?ani a,. presents nothing 
peculiar, but the Doctor thinks consumption is relatively on the in- 
crease. 

Tke Conveyance of Cholera from Hindostan through Asia, to Europe 
aiuf America, illustrated by four fine diagrammatic maps, is quite in- 
telligible and very likely true. 

A Series of Plans for the Collection and Statistical Arrangements of 
Facts in Regard to Climatological and Sanitary Conditions of the va- 
rious StateSy were prepared by Wm. R. Thoms, M. D. There can be 
no doubt that the time has fully arrived when the Am. Med. Ass. ought 
to adopt some uniform method of having its statistical and scientific 
reports of this character made. Whether the plan presented by Dr. 
Thoms is the best, we can not decide, but the Doctor has paid much 
atteation to these affairs, and seems to take hold of them con amore. 
The past volumes of the Transactions contain immense papers on these 
subjects, but so irregular and confused in their arrangement as to be 
bat of very little value. 

Report on American Medical Necrology, made by Dr. C. C. Cox, 
records the death of eighty-eight of the members of the Association 
irhich had come to his knowledge since the last annual meeting. The 
chairman had given such obituary notices of them as he was able to 
obtain — some pretty full, others a mere mention of time of decease. 
During the year, many eminent men of the profession went to their 
final rest. 

Dr. J. 8. Hildreth of Illinois, read the Report of the Committee on 
OpJuhalmology. The object of his paper is to arouse attention to the 
claims of ophthalmology upon the profession, and does so by showing 
the advances made in this branch of medical science, and what is re- 



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48 WESTERN JOURNAL OF MEDICINE. 

quired in order that diseases of the eye may receive the attention they 
demand from the profession. This demand is to he met, ^'First — By 
increased accommodations for this class of patients, the present heintr 
entirely inadequate. Second — By providing for a more general, thor- 
ough instruction." The author thinks that the instruction given on 
this subject in our medical schools, entirely insufficient, and that a 
general understanding of ophthalmology should be required by all can- 
didates for the degree of Doctor in Medicine. 

Dr. L. A. Sayre of New York, presented a Report on the Treatment 
of Cluh'Foot without Tenotomy, Dr. Sayre holds that in the vast ma- 
jority of cases of club-foot, the essential lesion is paralysis and not 
spasm of a certain muscle or group of muscles. The correctness of 
this idea being admitted, the indications for treatment are, ^^First — To 
restore the foot to its normal position, and to so retain it; and Second — 
To seek to develop the paralyzed muscles, that they may at last be 
sufficient of themselves to counteract those acting in opposition." He 
insists that the earlier we begin the treatment, the more surely and 
more rapidly will success follow. Various methods of treatment are 
noticed and objections to them pointed out. In the majority of con- 
genital deformities, if taken immediately after birth, the hand can 
readily bring the foot into its normal position, while it can be easily 
retained there by the simple application of adhesive plaster. Full di- 
rections for applying this are given. Cases occur in which the muscu- 
lar rigidity will not yield readily to manipulation ; in these, a constant 
tractile force becomes necessary. For keeping this up, the plan sug- 
gested by Mr. Richard Barwell of London, is considered by far the 
best. In this plan, the elastic force of rubber tubing is employed. 
Full directions are given in reference to the plan of treatment. 

Dr. Sayre believes that in most cases, tenotomy is not only useless, 
but positively injurious — that only in those cases where the muscles 
heve become permanently shortened or the fascioe have become con- 
tracted as the result of inflammation, is tenotomy justifiable. 

An improved club-foot shoe is illustrated and described, and a num- 
ber of cases reported in detail, illustrative of Dr. Sayre's plan of treat- 
ment. 

We regard this report as a valuable one, and believe that it is well 
calculated to lead to a more philosophical treatment of club-foot than 
that usually instituted. 

Dr. Gurdon Buck presented A Neio Method of Recomtructing the 
Lovser lAp^ after its Removal for DiseasCy illustrated hy Two Cases of 



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BIBLIOGRAPHT. 49 

Epithelioma. With the accompanying drawings, Dr. B. has made a 
Tery plain presentation of a very neat and satisfactory operation. 

A New Treatment for Congenital Talipei^ by Dr. I. N. Quimby, con- 
sists of the application of adhesive straps and a roller, when the child 
is from three to four weeks old. 

fkt Treatment of Syphilid by Hypodermic Injection^ is recommended 
by Dr. L. Elsberg; but we question whether the method has any spe- 
cial advantages. 

Br. P. F. Eve's Safe and Effectital Operation for the Radical Ours 
of Varicocele, consists of cutting away of a part of the thickened scro- 
tum, and, if necessary, tying the enlarged veins with animal ligatures. 



A HANDBOOK OF VACCINATION. 



BY EDWARD 0. BEATON, M. D., 
H«41cdIi»pMtor to the PriTj Council. PhiladelphU: J. B. LippUoottikCo. 1868. Pp. 38S. 



For two generations no separate work on vaccination has issued 
from the press. It is true that nearly every standard work on the prac- 
tice of medicine has treated the subject more or less fully, but still 
much has been left unsaid that was imperiously demanded for the full 
cultivation of the student in this branch of medical science. 

As the consequence of this state of affairs, there is now existing 
imong practising physicians, a great want of a clear, well-defined and 
unravering idea of what vaccination is, and how far it can be relied 
on to prevent variola. To one who has made no inquiry in this direc- 
tion, this declaration may seem like a wanton and unsupported charge 
agtinst the profession. But let any one investigate the premises, and 
be will be surprised to find how many practitioners in good standing 
there are who have no well-settled convictions whether it were better 
to Taecinate a child within the first year of its age, or wait until it be 
fire; nor are they sure whether vaccination is a certain protection 
tgainst variola; whether we should re-vaccinate ; whether it is possible 
to tell, by examining the cicatrix, the amount of protection ; whether 
the vims recently from the oow is better than that long descended 
thioogh human systems; whether scrofula may be transmitted through 
▼leeinatioB, or, worse still, syphilis; and have no definite oonolusions 
OB Many other points relating to vaeoination, whereoft fhey should be 



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50 WESTEttK JOURNAL OF HEDICINK. 

satisfied, if possible, both for the ease of their own consciences, and 
the welfare of those who are committed to their professional care. 

Now, here is a manual on vaccination that begins at the beginning, 
and pursues the theme systematically to the end. In its fourteen 
chapters, one hundred and fourteen sections, and then various sub-di- 
visions, the reader will find everything pertaining to the subject fully, 
but not tiresomely, discussed, and even the busy practitioner will dis- 
cover the numerous sub-divisions so clearly head-lined that he can, 
in a moment, refer to any part of the subject he may desire. 

Let us hope that this manual will find its way to the library of 
every physician who has not already fully studied vaccination in all its 
relations, and that it will prove the harbinger of that better day when 
the priceless boon given to mankind, through the instrumentality of 
Jenner, may be perfectly understood, and its real merits fully appre- 
•ciated. J. F. H. 



A TREATISE ON PHYSIOLOGY AND HYGIENE, FOR COL- 
LEGES, SCHOOLS AND FAMILIES. 



BY J. C. DALTON, M. D., 

Prof, of Physiology in the Oollege of PhyalcUni and Sorgeoni, Mew York : with Illosttations. 

Mew York : Harper dt Brothon. 1868. Pp. 390. 



It is gratifying to know that our common schools and colleges have 
within their reach a work on physiology, written by the best author 
in that branch of medical science who uses the English language. 

There can be no doubt that Prof. Dalton has done more to give a 
correct knowledge of physiology to medical students than any prece- 
ding author, and we find he has brought the same scientific accuracy 
the same good common sense, into this little work, that is so marked a 
feature in his more elaborate treatise. 

He has always manifested a remarkable aptness in the force and 
simplicity of his language lo illustrate the ideas he wishes to present, 
and in the work before us, he has lost nothing of this good reputation. 

He has avoided the use of professional terms in this school-book 
as far as possible, and at the end of the volume has added a glossary 
to explain such as could not be dispensed with. 

The book is divided into four sections: I. The mechanical struc- 
ture of the human body; II. Its nutrition ; III. The nervous system; 
and IV. The developement of the body. 

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BIBLIOOBAPHT. 51 

There are eigkteen chapters, eaeh followed bj a series of questions 
pertinent thereto, the whole illustrated by sixty-seven wood-cuts, admi- 
rably adapted to the end in view. 

We hope, to see this excellent book introduced into, and adopted 
bj, our common educational institutions at an early day. J. F. H. 



INTRODUCTORY ADDRESS, DELIVERED BEFORE THE 
CLASS OF THE MEDICAL COLLEGE OF OHIO, TUES- 
DAY, OCTOBER 6, 1868. 

BT THEOPHILUS PARVIN, H^., 
Profeisor of Medical and Sorgical Diseaaes of Women. 



This address will commend itself to every right-thinking man, as a 
cbaste, earnest, truthful effort to present the real status of the physi- 
cian ; to declare the end that all should seek, and the means whereby 
that end may be attained. 

We are not of those who think the physician is a better or a wiser 
man than his fellow-men ; that he is npt appreciated by the community ; 
that he makes sacrifices which pass unnoticed; and that he performs 
much service that goes unrequited. On the contrary, we regard doc- 
tors as a fragment of the human family, who are just as good, and no 
better than a like fragment taken from the same walks in Gfe, and 
trained to any other business. It is not the calling [that makes the 
man, but the faithfulness with which one performs the duties and ful- 
fills the responsibilities that pertain to the position he occupies, that 
sesls his manhood, or marks him for reprobation. 

It is because Prof. P. declares, "It is my desire to show that med- 
ical study and practice meet the highest purpose of earthly existence," 
and then, with artistic skill, draws the picture of the humanly perfect 
physician, that we so much wish that every one could have this ideal 
before his eyes continually, and never feel satisfied with himself except 
when striving to attain to its excellence. 

Some one has said that the study of medicine tends to produce 
atheistical notions,* but to us it seems a preposterous idea; the study 
of the starry heavens themselves does not more surely lead to the con- 
viction of one omnipotent, allwise, everlastiag Ood, than does the study 



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52 WESTERN JOURNAL OF HEDICINE. 

of medicine. After enforcing] this view, the speaker gives us this sen- 
tentious phrase: ^^An undevotU physician is mad,** 

The address teaches ns, top, that the study 'of medicine expands 
the intellect, enlarges and enlightens our moral nature, cultivates our 
sense of the heautiful, and brings us into harmony with all that is no- 
ble, just and true. And certainly the practice of our profession should 
stimulate our benevolence, increase our humanity, excite in us humility, 
banish all idleness, mental and physical, and fairly fill our souls with 
charity, the greatest of human virtues. 

But, alas I how few of us have lived up to onr privileges, and given 
domicile in our souls to these enumerated virtues ! How many of us 
have failed to act the censor to ourselves, severally, and, instead of 
introverting' our visioiAind searching out, condemning and amending 
our own shortcomings, have busied ourselves with seeking out the foi- 
bles of our professional neighbor, and striving to make mountains out 
of his molehills, that in their dark shadows we may have some chance 
to hide our own imperfections. That such ignobility exists among us 
is nothing against the science or the art of medicine, but every- 
thing against the individual who has failed to be inspired by its ten- 
dencies. Perhaps some of us would be better if the perfect ideal were 
more frequently brought home to our observation; let us, therefore, 
give thanks to the author of this address for the bright picture he has 
drawn, and make a hearty welcome to the lesson of improvement he 
has given us. ^ 



THE OPIUM HABIT, WITH SUGGESTIONS AS TO THE 
REMEDY. 

PabliBhed by Harp«r A Brothert, Tew Tork. BeoeiTed through Bowen, Stewart * Co., l»di- 

anapoUt, Indiana. 



This is a patch-work book. The first seventy-six pages are the 
experiences of the unknown author in his successful attempt to aban- 
don the use of opium; then follow some two hundred and fifty-nine 
pages from De Quincey,* Coleridge, Fitz Hugh Ludlow, with nar- 
ratives, in reference to the use of opium, of William Blair, of Ran- 
dolph, Wilberforce, etc., etc. We certainly can approve the wisdom 
of the^ selections, for they are both pertinent and interesting. Take 

•We notiee that lome of our contemporaries write Terj ilaently of Be Qoinoey, hut mieepell 
tlie name, making ^t De Quincy. 



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BIBLIOORAPHT. 53 

the book as a wbole, and we heartily commend it to both lay and pro- 
fessional readers. 

Not the least interesting portions, though for many years familiar 
to OS, are those relating to De Qaincey and Coleridge. It is some- 
wbat reoiarkahle that these two men of such wonderful endowments 
and culture, between whom there existed for years an ardent friend* 
ship, should both have been opium-eaters, and in each the habit induced 
by originally taking the narcotic for the relief of physical suffering. 
The genius of the ^'rapt one of the God-like brow,*' for thus Words- 
worth speaks of the wonderful Coleridge, Attracted De Quincey when 
quite a young man to him, coming with something of that old spirit 
of discipleship which Carlyle so berates the present age for being 
deficient in; even hitf residence in the "Lake Country" of Eng- 
land, a region of romantic beauty, was determined on partly that he 
might be near his great master. There is still standing, or at least 
there was standing in 1852, when with a knapsack upon our back we 
visited that part of England, the house in which De Quincey lived, 
and where we believe his terrible struggles to emancipate himself from 
the dominion of opium-eating occurred — struggles which in spite of 
his own statements and of popular belief to the contrary, were in vain. 
On this point we are glad to find the author of this book quoting Mrs. 
Oordon, the daughter of Prof. Wilson, who in the life of her father, 
states that while De Quincey asserted to the last he had abandoned his 
pernicious habit, it was only modified — never abandoned. When in 
Edinburgh in 1864, we received from *one who knew De Quincey inti- 
mately and at whose house he was a frequent visitor, a similar state- 
ment—he would beg for laudanum at night, and then continue his 
literary labors under its inspiration until the dawn ; pursued by bailiffs 
to be arrested for debt, he would seek pecuniary favors which he would 
never have required had he properly cared for his patrimony, or indeed 
faithfully performed all his literary engagements, and carefully hus- 
banded their results. 

€oleridge, on the othbr hand, did reform, and in the calm evening 
of his days was wholly exempt from the vice which for many years 
had marred his usefulness and his happiness, and made him so shame- 
Ally negligent of his duties as husband and father. 

Let a man study the lives of these two men if he would justly ap- 
preciate the terrible curse of opium-eating, even when indulged in by 

«1liM Blacltvood, daughter of the orltfinal publisher and alater of the preeent paVUsher of 
Bttkwood'B K^gaaliM. 



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54 WESTERN J0I7RKAL OF MEDICINE. 

those whose richly stored minds and wonderfiil genius could elicit the 
highest pleasure and the most magnificent visions possible under suchi 
indulgence. He will thus be all the better fitted, should he be in peril 
of the habit) to trample it in the dust, and all the better fitted too, to 
warn others who may be treading the verge of a fearful abyss from 
whose depths so few are ever permanently rescued. 

One day, this by the way, however, we hope to have the time to 
show that medicine owes somewhat to Coleridge, more especially as it 
pertains to his theory of life, a theory which, with some modifications, 
we believe, has within a few years been adopted and advocated by one 
of the leading London physicians. T. P. 



A TREATISE ON THE PRINCIPLES AND PRACTICE OF MED- 
ICINE; DESIGNED FOR THE USE OF PRACTITIONERS 
AND STUDENTS OF MEDICINE. 



BY AUSTIN PLINT, M. D., 

ProfMSor of tb« PiinclplM and Practice of Medicine, in the BelleToe Boepltftl Medical College, 
Mc. Pablithed bj Henry C. Lee, PhUadelphla. Beoeired through C. P. Wilder, Indianapolis. 



The second edition of "Flint's Practice," was issued only two years 
since, and now the third edition, thoroughly revised, is given to the 
profession. Such a demand for this work is unequivocal evidence of 
the high appreciation entertained for it on the part of physicians, and 
also would seem to render needless all critical consideration of it. The 
previous editions have received hearty commendation in this Journal, 
vnd now we can but reiterate those praises, adding that this last edi- 
tion evidences the careful revision of its author, so that the work is 
brought fully up with all the recent advances in medicine. We heart- 
ily trust that its able, eminent and most industrious author may be 
spared to see many subsequent editions of this, the great crown of his 
professional life. T. P. 

OBITUARY. 



Paris, Illinois, 1868. 
Died, in this place, on Tuesday, November 24th, after a brief ill- 
ness, of congestion of the stomach and bowels, Henry W. Davis, M- 
D., in the forty -second year of his age. 

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OBrruABT. '55 

Dr. Davis began the study of medicine in Carlisle, Indiana, with 
his ancle, Dr. Helms, and concluded while attending Medical College 
in Baltimore, as private student of Prof. Samuel Chew, M. D., and 
graduated at the same college in the spring of 1852. In 1854 he loca- 
ted in this place, and began the practice of his profession (associated 
with Dr. John Tenbroeck,) which he pursued with great credit and sat- 
iB&ction to himself and his patrons until April, 1861. On the break- 
ing out of the rebellion, he entered the service as a private, company 
B., twelfth Illinois infantry volunteers. Shortly after reaching Spring- 
field, he went before the State Board of Medical Examiners, and was 
made a surgeon of volunteers, and immediately became a member of 
the board, which position he held until, by his request, he was ap- 
pointed surgeon of the eighteenth regiment Illinois infantry volun- 
teers, with which he served until made assistant surgeon United States 
Tolanteers, and assigned as Inspector of the sixteenth A. C. 

In 1865 he was promoted to surgeon United States volunteers, and 
assigned to duty as Medical Director, Department West Kentucky, 
with head-quarters at Paducah; where he continued until the close of 
the war. 

Since Dr. Davis became a citizen of this State, he has been notably 
identified with all medical organizations of county, district and State, 
and his name is recorded in each as the author of valuable contribu- 
tions to their medical archives. 

From the effects of a dissection-wound, received while on duty at 
Little Book, Arkansas, he was disabled from engaging in the general 
practice of medicine; but he gave his attention to surgery, in which 
he excelled, and to which he was specially devoted. Few men enjoyed 
more of the confidence and admiration of his associates than Dr. Da- 
vis, and none died more lamented for his professional, literary and so- 
cial accomplishments. 

At a meeting of the class of the Medical College of Ohio, the fol- 
lowing resolutions were adopted as a mark of respect for the memory 
of William H. H. Austin, a fellow-student, who died of typhoid-fever, 
on Wednesday, December 16th, 1868, between the hours of eight and 
nine a. .m 

WHsaKAS, It has pleased Him whose mysteries are past finding 
out, to remove from our midst our classmate, William H. H. Austin, 
in whom we recognized a faithfal student, genial companion and chris- 
tian gentleman. Therefore, be it 



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56 WESTERN JOURNAL OF MEDICINE. 

Resalvedy That in the death of Mr. Austin the class has lost a good 
and much respected member, and the community in which he lived a 
much esteemed citizen. 

Retolvedj That while we submit to the will of Him who ruleth all 
things, we deeply sympathize with the friends of the deceased — ^we ten- 
der them our sincere and unaffected condolence in their sad bereave- 
ment. 

Reiolved, That a copy of these resolutions be presented to the pa- 
rents of the deceased, and that they be published in the Western Jour- 
nal of Medicine, F. A. Powell, 

G. F. Thomin, 
W. E. De Courcy, 
E. J. Galbraith, 

Committee. 
B. W. Sullivan. Secretary, 0. H. Saxton, Chairman. 



MISCELLANY. 



Baron James de Rothschild. — The great financier had much to 
do with our profession. Dupuytren owed to him a great part of the 
large fortune which he left his daughter. The great surgeon treated 
the great financier for a fractured thigh, and Rothschild paid him one 
hundred thousand francs for his attendance. Moreover, Dupuytren 
left his fee in his patient's bank, where it multiplied enormously by 
participating in the good fortune of a house that never knew reverses. 
To the five million francs which Dupuytren left, Rothschild's one hun- 
dred thousand francs contributed not a trifle. Dupuytren knew this 
well, and was terribly mortified when he learned that Astley Cooper 
had left a fortune of eleven million francs, the whole of it acquired by 
practice. M. Rayer was, until his death, the physician as well as the 
friend of the Baron, who persuaded him to buy, when it could be had 
at a low figure, the beautiful hotel of the Rue de Londres, which has 
since quadrupled in value. Rothschild has been the efficient patron 
of many of our confreres, especially those of his own persuasion, MM. 
Madl and Gruby among others. In his later years he fell into the hands 
of the homoBopathists. The Paris sight-seeing public had been terri- 
bly disappointed at not seeing the splendid funeral procession it ex- 
pected. It was of the humblest kind; but that this has not resulted 
from parsimony, the liberalities which have been showered upon the 
poor of Paris by the Baron's widow testify. — Union Medicale. 



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58 WESTERN JOURNAL OF MEDICINE. 

A Dropped Fee. — A celebrated surgeon was called in consultation, 
a few days since, to the house of Count B., who slipped a louis d'or 
into his hand as he was leaving. This was poor pay, and oui; surgeon 
is no lover of poor pay. Making a grimace, he let his louis fall, and 
the Count stooped down, picked it up and restored it to the Doctor. 
The surgeon, however, stooped down in his turn, and pretended to be 
looking for something. "What do you seek. Doctor?" was the ques- 
tion. "I am looking for the other." — Presse Beige. 

Quacks and Quackeries. — It may be expected from what I have 
already said, that I shall forthwith proceed to call in question the 
consort of the people with quacks; or pass an anathema on quacks and 
quackery individully and collectively. From this I abstain. Consort 
of the community with quacks is so obviously the result of ignorance, 
that if the most moderate share of attention were given to the subject, 
if a tithe of the attention I have prayed on behalf of the profession 
itself were given to the subject, communion with quacks and their fool- 
ish arts would naturally cease. As to the quacks, to notice them were 
to elevate them. Belonging strictly to the worst of 'the criminal 
classes, they are moved by no sentiments which the most acute criti- 
cisms could touch. A professed gambler may have sense of honor, a 
pickpocket may have skill, a professed burglar may have courage ; the 
professed quack has the sins of them all, the saving qualities of none. 
He is, because he is permitted, a forced necessity of morbid minds. 
One thing only would I note in his history as most wonderful, via : 
that the grand disseminators of human knowledge, the grand teachers 
of moral truths, the proprietors of the fourth estate allow him un- 
blushingly to deface their fair pages with his falsehood, his snares, his 
open loathsome sin. Day by day the press, in daring faultless lan- 
guage, and I sentiment, exposes vice and purifies the thought of the 
world ; day \)j day, in the greater number of its organs, it sells itself 
to the advertisement of immoralities worse than the worst it endeavors 
to remove. — From Dr. Richardson!^ address to the St. Andrews Med- 
ical Oraduates^ Association. 



EDITORIAL and MEDICAL NEWS. 



Our contributors have been so generous that but little space is 
left for any words from the editor. 

We are sure that our readers will readily judge this the best number 
of the Western Journal op Medicine ever issued. And we trust that 
the future numbers of the Journal shall be equally good, if not still 
better. Next month Dr. Woodworth of Fort Wayne, whom many of 
our readers know as one of the ablest and most scholarly physicians 



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EDITORIAL AND MEDICAL NEWS. 59 

IB the State, promises an artiele on Tuherculons; we LaTe already re- 
eeiyed an elaborate essay on Hospital Gangrene by Dr. Hudson of 
CiDciDnalP, and a report of Case of Injury to the Mead by Dr. Hay- 
mond of Monticello, and a very able paper upon Effusions into the Pleu* 
ral SaCj and their Treatment hy ParacentesiSy by Prof. Coleman Rogers 
of Louisrille, Kent^icky. Such is part of the bill of fare for Febru- 

Now may we ask our subscribers to do a few things in behalf of 
the JOUBNAL? 

Ftrst — Let them not be content with being subscribers, but contrib- 
utors as well. Every one can add something to the stock of medical 
knowledge. Let us have reports of cases, brief abstracts of the pro- 
ceedings of medical societies, discussions of medical opinions, criticisms 
of medical books, et cetera. 

&amd — Be not only subscribers and contributors, but induce your 
professional friends to follow your example. An increased subscrip- 
tion list will make the Joitbnal more valuable to every reader. A 
little exertion wouM give us within a month five or six hundred more 
subseribeTs; and we most earnestly request this exertion on the part 
of our friendB. 

Third — Prompt payment of subscriptions wonderfully facilitates 
the prompt issuing of the Joitrnal. Where gentlemen can not pay 
until the end of the year, or even then — ^and we know some such in- 
stances — ^we cheerfully furnish the Journal without any reference to 
the time of pecuniary compensation. 

And now, let us assure our friends if they are true to their part, 
the Editor will not fail in his. Annoyances, trials, cavilling criticism, 
springing from ignorance or personal malevolence, serious pecuniary 
losses — these are among the thorns that have been thick-set in our path- 
way. But on the other hand, the generous commendations of other 
jonmals, the numerous letters of praise that we have received from dis- 
tinguished as well as from obscure members of the profession, from 
medieal teachers, as well as from country practitioners remote from the 
great medical centers, from medical men in various parts of the land — 
to all such we desire to give our heartiest thanks — these give us 
strength and hope. We believe that the Western Journal of Medi- 
<3Jf£ has a mission — a work to perform in the profession, and that each 
Tear will witness its attaining a larger fame and a wider use^lness. 
Knowledge, truth, right and philanthrophy — these are immortal, while 
•nry, jealousy, ignorance, misrepresentation and slander, must sooner 
or later perish in ignominy. 



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60 WESTERN JOURNAL OF MEDICINE. 

Pbofessob Gobreght's introductory to his winter coarse of lee- 
tares at tke Medieal College of Ohio, contained an interesting narrra- 
tire of fais recent Atlantic trip, and also somewliat of his Ifendon ex- 
periences, especially of his meeting with Mr. Wilson and some other 
London celebrities. Prof. G. thus spoke of sea-sickness: 

This brings me to speak of sea-sickness. What is it? I can not 
fally accord with Darwin that it is ^^ a disturbance of brain consequent 
apon the unusual impression produced upon the vision^ by the motions 
of the vessel.'' This may, in some instances, be the case, but from an 
experience of four crossings of the Atlantic, I am of opinion that the 
nausea precedes the dizziness and is noi a consequence thereof. As an 
early friend of mine (C. S. Band) who had seen much of ocean, once 
said, "The stomach ought to be hung on gimbals," like a mariner^s 
compass, you know, so that it always preserves its horizontal and per- 
pendicular . Doubtless he was correct, as far as he went, but he should 
have included the liver, Some persons are never sea-sick. Here dis- 
turbed vision is of no account. Others, no matter how often they have 
been at sea, are invariably sea-sick, unless the liver is first cleared, 
when they escape. Constipation, from torpid liver, followed by re- 
versed peristaltic action, throwing the bile into the stomach, will pro- 
duce nausea and vomiting, whilst the heavily involved sympathetic sys- 
tem, by its connection with the cerebro.spinal, induces the dizziness : 

All for want of gimbals. So called sea-legs are gimbals. 

First — The antero-posterior motion is made at both hip-joints, 
aided by the knees. 

Second — The lateral motions, by a compound movement of a single 
entire limb. 

When these movements alternate or are combined, we have sea-legs 
or ginubals. 

The remedies for sea -sickness must, then, be mainly preventive, viz: 
oholagogue cathartics and the rapid attainment of sea-legs. And, 
should the stomach be obstinately irritable, demulcents, with chloric 
ether '^by the stomach to produce local ansasthesia of the terminal 
branches of the gasiaric nerves, whether sympathetic or cerebro-spinal. 

Prof. Or. concluded his lecture as follows : 

Gentlemen, do not forget to be courteous, like these noble English- 
men, to all true professional men wherever you find them; for we are 
all knights of a professional Round Table, not unlike that of King 
Arthur; for when the order was founded, "Then rose the king and 
spake to all the Table Bound, and charged them to be ever true and 
noble knights — to do neither outrage nor murder, nor any unjttst vio- 



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KNTO&IAL AND HJPICAIr NEWS. 61 

lenee, and always to flee ireason. Also, by bo means ever to be erne), 
bat give mercy unto Kim that asked for mercy, upon pain of forfeiting 
the liberty of bis court forevermore. Moreover, at all times, on pain 
of death, to give all succor unto ladies and young damsels ; and lastly, 
sever to take part in any wrongful quarrel for reward or payment." 
And to all this he swore them knight by knight. 

Then he ordained that every year, at Pentecost, they should all 
come before him wheresoever he might appoint the place, and give 
account of all their doings and adventures of the past twelvemonth. 

And so, with prayer and blessing, and high words of cheer, he in- 
stitated the most noble order of the Bound Table, whereto the best 
isd bravest knights in all the world sought afterwards to find admis- 
sion." 

And now, gentlemen, let me draw my good sword ExcalihuTf from 
the hand of the unseen servitor of the Lady of the Lake, (for us the 
goddess of health, Hygiea), and with it deal such blows against igQor- 
tDceand pretension as may rival those of King Arthur with his, against 
horrid giants, who slew other knights, but prevailed not against him 
and his charmed steel. ^ 

And when the gift in return for the presentation of the sword comes 
to be asked on her behalf by you, may each of you be armed, and 
ready to claim, not a favor, but a right, and to make good his claim by 
sack actions in the joustings of the final tournament, that he shall go 
forth knighted, with a towering crest, a spotless shield, a lance well set 
in rest, ready to do battle for humanity distressed— ever ready to lay 
WW trophies before the knights of the Hound Table of our noble pro- 
ieasioo, which I hope the most of you will soon be called to join. 

I^R. W. J. ElstuN, has been appointed Second-Assistant Physician 
of the Indiana Hospital for the Insane — a most worthy selection. With 
Br. Everts as Superintendent, and Drs. Hester and Elstun as Assist- 
tnts, the Hospital could not be under better medical care. 

Mrs. Sutton, wife of Dr. George Sutton, of Aurora, Indiana, died 
00 the 11th of last month. The sympathies of Dr. Sutton's numer- 
ous professional friends are with him in this sad affliction. 

HxBEDiTABT ToNGUB-TiE. — ^M. Mignot, of the H6pital de Chan- 
telle, observes that hereditary influence may be observed in small de- 
tails as well as in the general disposition of organs. It has not been 
remarked upon by authors in relation to the duplication of the mucous 



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62 WS8TEBN JOU&NAL OF IfEDIdMS 

membrane tenned the fradnum linguie, which, existing only in a rudi- 
mentary state in some children, is considerably deyeloped in others. 
He met with a lad fourteen years of age, who was a distinguished pupil 
at one of the lyceos, and spoke without difficulty. Having occasion to 
examine his mouth, he found the tongue kept down to the buccal floor 
of the mouth in consequence of the short and thick frsenum which 
extended to its point. Unable to pass the alveolar arch, the tougue 
had, by its constant pressure, pushed this forwards so that the incis- 
ors were projected externally, becoming also somewhat slanting, and 
separated from each other by a considerable interval. When he tried 
to put the tongue out it curved backwards, striking against them. The 
lad's mother had precisely the same defect, producing with her some 
difficulty of speech. Out of four of her children, three were born with 
. die same state of the fr»num. — Gazette Hehd., November 6. 

Bromidb op PoTASsniM IN THB NuRSERT. — Scarcely any modern 
remedy has enjoyed such favor among practitioners, and been the sub- 
ject of such extensive research, as bromide of potassium. Its effects 
have been vaunted in a considerable number of maladies where it is 
necessary to exert a sedative action upon the nervous system — ^for in- 
stance, epilepsy, croup, headache, &c. M. Moutard-Martin, a nosoco- 
mial physician of Paris, now informs us that it has proved a most useful 
remedy ia his hands for combating certain infantile diseases, and has 
been of especial service in producing a condition of tranquility in 
children who are much agitated by disease, and in procuring rest to 
infants who are deprived of sleep. The suffering which some children 
undergo from want of sleep, even when not otherwise ill, and the dis- 
tress to which they put their nurses or parents, are so great that any 
remedy having, like the one in question, the property of inducing need- 
ful repose, must be most welcome both to practitioners and parents. 
M. Moutard-Martin states that when every other remedy — such as the 
warm bath, orange-flower water, and the infusion of cherry — has failed 
in such cases, the bromide of potassium has siven the most remarka- 
ble results. There are also other cases in which its employment is very 
valuable in infantile therapeutics. The nervous erythism which at- 
tends dentition, and which manifests itself by a condition of excite- 
ment, cough and sleeplessness, is often abated by the employment of 
the medicament; and M. Moutard-Martin is conndent that its timely 
and proper use may even ward off attacks of convulsions. In many 
cases its action is very prompt and decisive. It should be admistered 
to very young children in weak doses of from five to twenty centigram- 
mes, and should be withheld in cases of diarrhoea. — Lancet, Dec, 12ih, 
1868. 

We have so often occasion to refer to the proceeding of the 
Academic de M6decine that our readers may like to know a little more 
of its exact constitution. The Societe Eoyale de Medecine and the 
famous Academic de Chirugie having disappeared during the storm of 
the Revolution, and the want of a learned Medical body being felt at 
the Bestoration, the present Academy was instituted by royal charter in 



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SDITOBIAL AND MEDICAL NEWS. 63 

0, though not fonnally opened until 1824. Of the one hundred 
tfld fifty one original foundation members, part nominated by the 
erown and part chosen by the Academy, only four now survive. The 
Academy now consists of one hundred titular members, distributed 
ijito eleven sections — ^viz., Anatomy and Physiology, ten members; 
Medical Pathology, thirteen; Surgical Pathology, ten; Therapeutics 
and Medical Natural History, ten; Operative Medicine, seven; Patho^ 
logical Anatomy, seven; Obstetrics, seven; Public Hygiene, Legal 
Medicine, and Medical Police, ten; Veterinary Medicine, six; Medical 
PhjBics and Chemistry, ten; Pharmacy, ten. There are also nine '^£ree 
associates," twelve " national associates," and fourteen ^'foreign asso- 
ciates;" each of these may be increased to twenty members. More- 
OTer, there are one hundred and twenty "national correspodents " to 
be reduced to one hundred and sixty-one "foreign correspondents," to 
be reduced to fifty j — THmes and Gazette. 

Entire removal of the tongue for Epithelioma of that organ was 
performed by Dr. Fenwick, on Friday, the twentieth November, at the 
Moatzeal General Hospital. The patient was a gentleman from Canada 
West, who came to Montreal to seek advice touching a disease of the 
tongue, which had been pronounced to be Epithelioma. The operation 
as performed was speedy and bloodless, being that described by Mr. Nun- 
neley of Leeds. An incision was made in the median line between the 
chin and hyoid bone, and the genio hyoid muscles separated. A long 
carved needle, to which was attached the chain of an ecraseur was then 
introduced into the mouth, through its floor, and close to base of the 
tongue; this was pushed over the tongue as far back as possible, the 
tongue being forcibly drawn out of the mouth by a piece of strong 
^mMd which transfixed its substance. After applying the chain and 
strangulating the organ, the operator proceeded to ablate, and the organ 
was severed in nine minutes and a half. The case has progressed most 
favorably, the patient returning home, a distance of one hundred and 
nioety miles, on the twelfth day after the operation. — Canada Medical 
Journal, December, 1868. 

Chinoyig Acid. — This is a resinous acid contained in all cinchona 
barks. Its physiological effects have been partially examined by Dr. 
€r. Kerner, in a paper treating mainly of its therapeutic value ( Wiener 
Med. Wochensch., 43; and Practitioner, No. 2, 1868, p. 127). He finds 
that it adds greatly to the tonic effects of bark, and that it is not lia- 
ble, like quinia, to cause "cerebral congestion." — Journal of Anatomif 
and Ph^ftioUxfy, November, 1868. 

Digitalis. — Dr. Constantin Paul, the able editor of the last edi- 
tion of Trousseau's Traite de Therapeutique, has published a research 
on the influence of digitalis on the pulse {Bulletin General de Thera- 
peiUique, Tome LXXIV, 1868, p. 193), in which his principal results 
were obtained by the use of sphygmograph. He thus states his con- 
clusions: Digitalis, in small doses, generally diminishes the frequency « 
of the pulse; in large doses, it increases it. When digitalis is exhib- 



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64 WESTERN JOURNAL OF MEDICINE. 

ited in such doses as to produce its hyposthenic effects, it lowers tlie 
arterial tension ; and tlie contrary effect may, possibly, be produced by 
Tery small doses, as some investigators have asserted. Finally, it is 
probable that digitalis raises tbe arterial tension wben it diminishes the 
frequency of the pulse, and that it lowers this tension when it increases 
the number of the pulsations.-^i%u2. 

Om TriJcinemas naturliga forekommande^ af Axel Key, Professor i 
Pathol. Anat. vid Karolinska Institutet. Prof. Key contributes a paper 
on the natural occurrence of TncMruB^ his object being, by pointing out 
the mode in which the pig becomes affected, to facilitate the prevention 
of the diffusion of the disease. 

It would appear that the trichina spiralis never occurs in birds, 
fishes, amphibious or invertebrate animals, and that these can not even 
be experimentally infected. On the other hand, all the mammalia are, 
with more or less difficulty, capable of being infected. Nevertheless, 
trichinffi are fortunately not so widely diffused in nature as might be 
expected from this fact, many animals being protected from trichinosis, 
not only by the difficulty of infecting them, but also by the nature of 
their food. It is quite certain that trichinss are not conveyed to ani- 
mals in any kind of vegetable food. In addition to men and swine, 
the animals which have been found spontaneoudy affected with trichinae, 
are rats, cats, foxes, polecats, martens and hedgehogs. There is ne 
doubt, however, these dangerous parasites occur also in other carnivo- 
rous animals not yet fully examined. The ruminants seem to be scarcely 
susceptible of trichinous infection. Prof. Sjostedt succeeded, never- 
theless, in infecting a goat and a sheep. He thinks it important that 
to these animals the infected food should be given in a fluid form, or 
cut up in small portions in water, so as to prevent rumination, which 
probably prevents infection. The author believes that the chief 
source of the infection of the pig is the rat, in which latter animal the 
trichina is very common. He says it is ascertained that pigs eat rats, 
whether they find them dead or catch them living, and he shows that 
it is precisely the animal infected with and lamed by the disease, that 
will most easily be caught. Hence he infers that the extirpation of 
the rat, and its exclusion from the pig-sty, will be the most efficacious 
prophlylactic means. — Ibid. 

A LAB who was dying from exhaustion after an operation performed 
at the Palermo Hospital, is said to have been saved by transfusion 6f 
blood from the veins of two students. 

PoiaoNiNO BY Nicotine. — M. Tardieu has remarked the curious 
fact that animals killed by this poison always fall on the right side. — 



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THE WESTERN JOURNAL OF MEDICINE, 

(Formerly, "Cikcin^iati Jottrkal or Mbdioinb.") 



fhna H will be seen that if man has pawiottfl which impel him to the deetrnctlon of man, if 
ke be the only animal who, deepiaing hie natural means of attack and deiinoe, hie derieed new 
Mau of deetmctiMi, he !• also the only animal who has the desire, or the power, to rdieve the 
nferiags of his fellow citixens, and In Whom the eo-existenoe of reason and benoTolence attests 
aaoralas well as an inteUecCnal stipeiiorlty.— Obavh* OumoAL Msnicm. 



Vol IV. INDIANAPOLIS, FEBRUARY, 1869. No. II. 



EFFUSIONS INTO THE PLEURAL SAC, AND THEIR TREAT- 
MENT BY PARACENTESIS. 



BT COLEMAN EOOERS, M. P., 

tLijmd Lecturer on the Science and Practice of Medicine, TJnfretsity of LouistiUe, Loals- 

Tllle, Kentucky. 



Not long since, two oases of chronic pleurisy with effusion, were 
under mj care, in which it was thought advisable to perform the ope- 
ratioa of thoracentesis. In both cases there were unmistakable phys^ 
ical signs of a large pleuritic effusion, and though the urgent dyspnoea, 
so often present, was absent in these cases, the pallor, anaemia, and 
general debility, showed plainly that the vital function of hasmatosis 
was seriously interfered with. In both of them, constitutional reme- 
dies had been faithfully tried, but of i^o avail, and the operation was 
performed as a dernier resiort, with a view either to a permanent cure, 
or as a mere palliative measure. 

The first eaae operated upon waa that of a young unmarried lady, 
aged about twenty-five years. 'The chest was tapped on four separate 
occasions, at her own request. A large purulent collection was evacu- 
ated at each sitting, much to the mitigation of her symptoms. At the 
fourth tapping, the paracentetis of necesit^ had taken place, and I made 
a counter opening at the point recommended by Malgaigne. 

This patient calls in to see me occasionally, and although it has 

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66 WS8TS&N JOtrftRAL 01* MfiDICIKX. 

been^ nearly three years since the first tapping was performed on her, 
she still holds her own, with a fistulous opening in the mammary re- 
gion Qf the left side. I am satisfied that life has been prolonged and 
rendered comparatively comfortable in this case, by the performance 
of the operation. 

The other case operated upon, was that of a man aged twenty -eight 
years. A thick, glutinous, fibro purulent material was drawn through 
the canula, by Bowditch's suction apparatus, to the amount of nine 
pints by measurement. He expressed himself as feeling greatly re- 
lieved by the tapping. 

I have lost sight of this case entirely, but have no doubt that if 
the operation could not have efifected a radical cure, it certainly pro- 
longed and rendered life more comfortable. 

It is remarkable that in a number of subjects, the great pressure 
upon the lung, of a copious pleuritic eflfusion, does not produce more 
manifest dyspnoea. Be this as it may, it is a fair physiological infer- 
ence, that when the function of one lung is so largely compromised, 
healthy nutrition and sanguification must fall below par, so intimately 
dependent are they upon the proper performance of respiration. 

The operation of empyema, paracentesis thoracis, thoracentesis, 
or tapping the chest, lays just claim to being considered one of the 
oldest in surgery, performed as it has been, from the remotest days of 
antiquity. It owes its origin, it is said, to a mythological legend, which 
tells us that Jason, seeking death in the midst of battle, received a lance 
wound in the chest, and was thus artificially relieved of an empyema. 
Traced as it can be, certainly, from Hippocrates downwards, through all 
this long series of years, it has afforded a theme for animated discussion 
as to its merits and demerits, and as to the proper cases, and indica- 
tions for its performance. It would be a work of supererogation on 
my part, to even attempt giving .a resum^ of the opinions of the differ- 
y^nt authorities, during its earjier history, for it can be truly said tliat 
they differ widely on almost every point. The cases imperatively de- 
manding it as a means of saving life, those in whom it would only serve 
as a palliative, furthering other therapeutic agents brought to bear, 
the place of election, the mode of operating, dand the possible danger 
and consequences of air being admitted into the pleural cavity, have 
been subjects of angry discussion in days gone by. 

Of late years, however, its utility in many cases, has begun to at- 
tract the notice of observers, and accumul^ited experience attests the 
fact that it should no longer be regarded the anceps remedium, as 



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SFFU8ION8 INTO THE PLEURAL SAC. 67 

formierlj. A modem author has remarked that it is a meaBore which 
has frequently proved successful, and that too in a disease which is 
generally, if not always, beyond the influence of medicine, and too 
often beyond the power of nature to remove. When we reflect that it 
is a procedure at all times easy of execution, productive of little pain 
to &e patient, generally followed by immediate relief, and has in nu- 
merous instances been crowned with complete success, it is surprising 
to find the.great opposition it has met, and still continues to meet with. 
If any surgical operation had been found upon long and faithful trial 
to uniformly fail, we certainly would have just cause for regarding it 
with distrust, or for discarding it entirely; but when we reflect that 
this one, performed as it has been in a vast number of cases, since the 
• days of Hippocrates, with successful results, we ought, 'perforce^ to 
arrive at a far different conclusion. It numbers among its advocates 
the great names of Townsend, Hamilton Roe, and Hughes, and Laen- 
nee^ and as we approach our own times, those of Walshe, Yalleiz, Vi- 
dal de Cassis, Yelpeau, Trousseau, Flint and Bowditch, with a host 
of others, of nearly equal celebrity, as pains-taking and impartial ob- 
servers. 

In considering th^ subject, I have thought that the following divis- 
ion of it might be made : 

Firtt — Those cases in which the operation is imperatively demanded 
vith a view to saving life. • 

* Second — Those cases in which, though life is not immediately 
threatened, health is seriously impaired by the presence of the efFu- 
rion, and the operation is indicated, to further other therapeutic means, 
after faithful but unsuccessful efforts have been made to produce ab- 
soiption. 

Third — Those in which, firom other complications, such as tuber- 
enlosis and cancer of the lung, the operation may be performed, not 
with the object of effecting a permanent cure, but only for its tempo- 
nrQy beneficial influence. 

Fourth — Those cases in which the operation is contra-indicated. 

Under the first heading, I place cases of acute pleurisy with effu- 
sion. It is well known, that very often in this affection, death has 
oeeurred from a copious and rapid effusion, producing apnosa or suffo- 
cation, after all the most efficient therapeutic agents have been brought 
to bear, either to quell febrile excitement, or to favor absorption of the 
effined fluid. Indeed, in many instances, the stages of gleuritis follow 
BO rapidly upon each other, that the effusion seems to have taken place 

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68 wESTEitM JoxrOsAL or MBDICniE. 

almost at the very onset of the attack, and the life of the patient 
placed in extreme jeopardy thereby. To wait noto for the effects of 
mercurialization, blood-letting, and other so-called antiphlogistics, to 
trust to the actions, uncertain as they sometimes are, of digitalis, 
squills, salines, and other drugs of the diuretic and purgative class, and 
to annoy him with sinapisms, blisters, &c., while he is in the very jaws 
of death by suffocation, when a simple puncture of the chest would not 
only palliate the distressing symptoms* and prolong life, but may effect 
a permanent cure, seems to me opposed to the dictates of common 
sense and extremely unphilosophical. Such cases as these haV^ been 
operated upon, immediate relief has followed, and yet we have the 
question asked: Would they not have recovered without it? Can we 
not as reasonably make the inquiry: Would they not have died with- • 
out it ? Addison was a staunch opponent of the operation upder all 
circumstances, and it seems to me that all his opposition was derived 
from the observation of a single case. Being called in consultation to 
see a case of acute pleurisy, with all the rational and physical signs of 
a copious effusion, and the subject seeming in imminent danger from 
suffocation, thoracentesis was proposed as a means of relief. Addison 
opposed it vehemently, and persisted in the use <^ the ordinary means 
to procure absorption. The case, it seems, ultimately recovered. Cer- 
tainly this isolated instance should not militate against the procedure, 
for where we meet with one such favorable termination, many others 
will terminate unfavorably. Even if this were not so, what harm could 
have arisen from early puncture, so soon as the signs of suffocation 
were developed? It may be answered that the introduction of air into 
the cavity of the pleura, would prove a source of danger, by the con- 
version of a serous into a pyogenic membrane. That this danger is 
more imaginary than real, will be mentioned farther on. But even 
granting that the serous effusion is thereby converted into a purulent 
one, statistics prove that the immediate danger to life is not at all aug- 
mented thereby. Cases are relieved as promptly, and life prolonged 
as certainly, in patients whose chests have been tapped, and pus re- 
moved at the first sitting, though ultimate recovery is not as certain aa 
in those cases in which pure serum is evacuated ; for the corpuscular ele- 
ment of inflammation, its unfitness for a high state of organization and 
repair, together with the impoverished condition of the subject's gen- 
eral health, preclude the possibility of ultimate restoration to health. 
Trousseau, hoprever, remarks that the per centage of recoveries is 



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SFFU8ION8 INTO THB PLSU&AL SAG. 69 

nearly as gre&t in those cases in which pus has been evacuated, as in 
those in which clear serum is withdrawn. 

That pure, uncomplicated pleurisy with effusion, does, in the great 
majority of cases, progress favorably, or tend to recovery under ordi- 
nary treatment, is undoubted, but it is none the less true that a vast 
number of the chronic cases, where the effusion persists, and lung is 
enveloped and bound down by fine adhesions, so as to be incapable of 
expansion, are the results of too much temporizing, and too long defer- 
ring the operation of tapping. 

Space will not allow me to quote authority on the points above con- ^ 
sidered. Numerous are the advocates of this procedure in the cases 
under consideration. Yalleix, Trousseau, Sedillot, Stokes, Flint, Bow- 
ditch and others, give us the weight of their authority in favor of it; 
not upon theoretical grounds solely, but bringing to bear upon the sub- 
ject, the stubbornness of facts and statistics. The language of Flint is 
emphatic, while Bowditch may be regarded as its boldest and most en- 
thusiastic advocate. The tabulated statements of other authors might 
be quoted, all tending to prove the gratifying results following the 
o))eration in acute pleurisy, but space will not permit it. Reference is 
simply made to Hamilton Roe, Trousseau, Yalleix, Archambault and 
Beau. From these, it appears that the operation has been performed 
in acute pleuritis at all ages, with successful results. In almost every 
instance when it was performed at an early stage of empyema, or in- 
flammatory hydrothorax, it was successful, and failed to cure in those 
only in which it had been too long deferred. Many of these cases, 
indeed, attest the fact that the success of the operation is directly in 
proportion to the shortness of the time which intervened^ between the » 
accumulation of the fluid and the time of its performance, and that 
the chief cause of its failure was its being postponed until too late a 
period. 

The columns of medical journals have been in days past, and at the 
present time are, filled with reports of successful results following this 
operation of thoracentesis in acute pleurisy with effusion. Isolated 
cases are thus noted and statistics accumulated from the hospital and 
private practice of American, English and continental observers, brought 
forward. These, to my mind at least, conclusively establish the fact 
that in acute pleuritis with copious and rapid effusion, threatening 
death by apncsa, when ordinary remedies have failed to procure re- 
moval of the effused fluid, paracentesis should be resorted to either as a 
means of saving or prolonging life. It should be regarded, indeed, 

L^iuiiiz.cu uy -^.^J -v^ v_y -It Iv, 



70 WESTERN JOURNAL OF MEDICINE. 

as one of the most powerful weapons that conservative medicine can 
wield against an affection, at times, so fatal and so rebellious to treat- 
ment. 

Under the second heading are placed cases of chronic pleurisy with 
effusion — those either essentially or originally chronic, or those which 
result from an acute attack. It may be remarked en passant, that 
acute and chronic pleurisy often merge so insensibly into each other, 
that it is frequently difficult to mark the boundary line between them ; 
for in many instances, the mere question of time will not solve the dif- 
ficulty. In one instance, the pain, dyspnoea, and febrile excitement, 
will last for weeks before the subsidence of urgent symptoms. In an- 
other, the effusion, though still remaining, will give rise to only occa- 
sional pain, with dyspnoea on exertion, and slight febrile exacerbations. ' 
In still another form, the effusion will be ascertained by physical ex- 
ploration only, the pain, dyspnoea, &c., as a rule, being absent. All of 
these forms, however, have one distinguishing mark in common, and 
that is, that the disorder of the general health proceeds pari passu with 
the interference with the vital functions of circulation and -respiration 
caused by the effusion. The two latter forms are properly denomintf- 
ated sub-acute and chronic pleurisy. The sub-acute when unattended 
to, or uninfluenced by remedies, often merges into the chronic form. 
Empyema, pyo-thorax, or suppurative pleurits, are included under this 
heading, as one of the varieties of the chronic affection. 

In the treatment of chronic pleuritis, we should be guided by two 
important indications, viz: First — To make use of those therapeutic 
means which experience tells us are beneficial in favoring absorption of 
, effused products. Second — To sustain and invigorate the powers of 
tbe system. In fact, we should adopt just the line of treatment that 
we do ifi acute pleurisy, though in a modified form and degree. 

To satisfy the first indication, vesicants and iodic applications to 
the chest, wrth salines, diuretics and alteratives may be used. Blood- 
letting and mercurials, should never be resorted to igi this affection on 
account of the anaemia and general cachexia, which are so generally 
present. 

The second object is best fulfilled by paying proper attention to the 
general health and the conservative functions of assimilation and of 
nutritrion. Ear these objects, tonics, vegetable and mineral, exercise 
in the open air, with avoidance of exposure, and the action of cold, and 
the proper observance of all other hygienic regulations. As Flint has 
remarked, cases which show but little improvement, either as regards 



SFFU8I0KS INTO THE PLXUBAL flAC. 71 

dieir general conditioii or physical sigDS, when too much dependence 
18 placed on absorbent remedies alone, immediately begin to change 
for the better on a tonic and supporting regimen. Absorbent reme- 
dies long eontinned, are apt to debilitate. The second object must not, 
therefore, be lost sight of, in our desire to affect disappearance of the 
efliision by sorbefacients. 

But both tonics and sorbefacients often fail of their object, and at 
this juncture, paracentesis becomes our only resort. 

I believe I am correct in stating that the opinion of the ablest au- 
chorities is almost undivided on the propriety, indeed, the necessity of 
this operation, after other measures have failed to procure absorption, 
and when urgent symptoms due to pressure arise. As it has the sane- 
lion of many of the great names before mentioned, in acute pleurisy, 
80 has it in the affection we are now considering. It is in these cases 
particularly, that Flint and Bowditch speak in terms so encouraging. 

Hitherto, the operation, in the opinion of many, was thought to be 
indicated only when dyspnoea is either constant or recurrent, when, 
after the prolonged use of sorbefacient and other remedies, the effusion, 
together with the exhaustion, anaemia and general depressfon of the 
vital powers still remained — when the effusion, in other words, is plainly 
beyond the influence of remedies. Then the procedure is advised, on 
the principle inculcated by the trite observation of Willis — dummodo 
tires constabuuty prcettat remedium anceps experiri quam nullum. 

Flint and Bowditch have, however, by their teachings, greatly ex- 
teaded the sphere of its beneficial influence. These observers, reflect- 
ing that this disease is very often beyond the power of medicine to re- 
lieve, and that the continuance with use of therapeutic agents, which 
experience has found to be of no avail, having a tendency only to di- 
minish the ultimate chance of success, until the effusion becomes so 
excessive and the patient's strength so undermined by drugs as to re- 
tard or prevent the possibility of a cure, are of the opinion that thora- 
centesis should not be brought into requistion as a dernier reuort simply, 
bat be performed in many cases where the effusion still persists, 
though there be no marked interference with respiration and derange- 
Jnent of the general health. 

To quote the language of Flint, " It is a question which has of late 
been much discussed, whether it be not advisable to puncture in oases 
in which the chest is dilated with liquid, although the patient be not 
in great distress or danger. It is clearly an object to get rid of the 
liquid, and the point to be decided is, whether it is better to effect 

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72 WXSTXRN JOURNAL 01* MXl^IOINB 

that object indirectly by purgatives, diuretics, &o., or to resort to di- 
rect means, that is, to puncture and withdraw it. I can testify from a 
limited experience, to the innocuousness of the operation, after the 
plan introduced by Drs. Wyman and Bowditch, the relief which it 
affords, and its value as a means of rescuing patients from a condi- 
tion of imminent danger to life. And the conclusions of Dr. Bow- 
ditch are not only sustained by his large experience, but are consonant 
with common sense. If, by an operation trivial with respect to pain, 
or any evil effect, and easily performed, the liquid effusion may be 
withdrawn at pleasure, it is certainly to be preferred to measures which 
are indirect, not very reliable, requiring considerable time, and produ- 
cing more or less disturbance of the system and debility.^' 

Br. Henry J. Bowditch, in an article published in the American 
Journal of the Medical Sciences, January, 1863, says : ^^ I have performed 
thoracentesis one hundred and fifty times oi^ seventy -five persons, dur- 
ing the past twelve years, besides being witness to ten other cases. I now 
give a brief resume of my experience. I have never seen the least 
permanent evil ensue from any of the operations, and but slight tem- 
porary diteculy as pain, dyspnoea, stricture, cough, &c. This, I think, 
sufficiently proves the innocuousness of the operation, by means of 
the exploring trocar, and suction pump, as suggested by Br. Wyman^ 
of Cambridge, Mass. I was once compelled to tap a patient, himself 
a physician, eight times in six weeks, and to operate on a lady nine 
times during eight and a half months, the first being to save her from 
death from orthopnoBa, when she was four months pregnant. But of the 
whole seventy-five patients, twenty-nine recovered completely, and ap- 
parently in consequence of the operation. In all these cases, the tap- 
ping seemed the first step towards recovery. I do not pretend that 
the operation will cure every case in which it is employed, b»t feel 
confident that, in my hands, it has been the means of saving many 
lives; and I believe that several patients within my knowledge, who 
have died whilst under the care of other physicians, might have recov- 
ered, had it been resorted to. I consider the operation so simple, that 
I would as soon perform it as draw a tooth or vaccinate a child." 

Br. B., in a later paper, advocates the procedure, even when the 
dyspncsa is not very urgent, or the general health not much impaired. 
In a letter written to me on this subject, I find that he has, at present, 
increased the number of his operations to two hundred, with the same 
ratio of success. 

Br. Hughes, in Guy's Hospital Reports, series ii, vol. ii^ states that 



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SFFC8I0N8 INTO THS PLSUIIAL BAC. 73 

<* Uie operation was performed in twenty-five cases, in some once, in 
others seyeral times ; of these cases, tliirteen may be fairly stated to 
liaye recovered, so far as regarded the effusion into the pleural cavity; 
two may be justly mentioned as having at least partially recovered ; ten 
bave ultimately died of other diseases, generally connected with that, 
for which the operation was performed, but entirely independent of 
its performance/' 

Dr. Brady, in an article upon this subject, published in the New 
York Medical Journal for March, 1856, reports the results of one hun- 
dred and thirty-two operations, collected from various sources. They 
are thus stated : 

Recovery complete in twenty-nine cases. 

Relief obtained in fourteen cases. 

Death in thirty-seven cases, (not the result of the operation.) 

Efiects null in one case. 

Result not known in one case. 

It must certainly be admitted that language is hardly strong enough 
to establish the benefits of this operation in the cases under considera- 
ti<m, i£ statistics do not greatly err. 

Under the third heading are placed oases of empyema, complica- 
ted with, or having for their cause tubercular or cancerous disease of the 
lungs, or with organic heterologous changes in the pleural membrane. 
Though under such circumstances permanent relief can not be expec- 
ted from the operation, on account of the great underlying morbid 
conditionB, palliation of distressing symptoms and prolongation of 
life, may be effected by it. In the promotion of euthanasia it is there- 
fore useful. If, however, we are disposed to agree with Bennett and 
others, in the opinion that pulmonary tuberculosis is by no means an 
incurable affection, the operation may even here prove to be something 
Bore than a mere palliative measure — may be even followed by a cure. 
Laennec was of the opinion that we should not abandon all hope of 
cure, even when there exists so serious a complication as tuberculosis ; 
provided there be no evidence of cavities in t}ie opposite lung. 

In mechanical hydro-thorax, the result of organic disease of the 
kidneys, liver, or heart, the operation holds out but little prospect of 
permanent relief, on account of the progressively fatal tendencies of 
its anterior and causative morbid conditions, 'though distressing symp- 
toms may be temporarily mitigated and Kfe prolonged by it. Thia 
form of effusion is, however, seldom so copious as to give rise to symp- 



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74 WXSTEBN JOUBNAL OF MEDICINE. 

ioms demanding thoracentesis, and is generally amenable to other 
treatment. 

Under the fourth heading, bloody effusions following gun-shot 
wounds of the pleura or lung are properly placed. The idea was first 
suggested by Baron Larrey, the elder, that extravasation of blood into 
the thoracic cayity, would of itself serve as nature's plug, and prevent 
further hemorrhage with its attendant syncope and exhaustion. Para- 
centesis is, therefore, contra-indicated here, until the hemorrhage has 
ceased, and all danger from its effects passed by. Larrey states this 
period to be at about the tenth or fourteenth day. 

From what I can glean from authorities, it seems that the age of 
the patient bears no direct relation to the result of the operation, in- 
fancy and old age being attended with as encouraging success as adult 
life. It would seem that more success attends its performance, when 
the conservative functions of digestion and nutrition are well performed, 
when the patient is of fair constitution, and the effusion moderate in 
quantity and recently formed. On the contrary, the prospect of suc- 
cess diminishes when the effusion is of long standing and accompanied 
by deteriorated general health. 

In respect to quantity of the effusion, though if very large, it 
diminishes the chance of ultimate cure, it does not seem, in many in- 
stances, to have precluded success, for recovery has followed the evac- 
uation of several quarts. Larrey was success^l after withdrawing fif- 
teen pints. In another successful operation performed by Dr. Archer, 
eleven pints were drawn off at the first tapping. 

The length of time which the effusion has existed, has an import- 
ant bearing on the success or failure of tapping. When it has existed 
for a long period, and the lung is rendered incapable of expansion, 
after the removal of the superincumbent fluid, on account of being 
plastered over with fibrinous deposit, and bound down by dense, tough, 
leathery adhesions, thoracentesis, although it may serve as a palliative 
by removing pressure through the mediastinum upon the opposite 
healthy side, can not, in the very nature of things, be followed by 
complete recovery. This state of things results frequently from too 
long deferring the operation, and it may be stated that it is just 
the condition which has given rise, to so much opposition to the pro- 
cedure, from many writers. 

Reasoning analogically, we may inquire as to whether the opera- 
tion for strangulated hernia, is not generally regarded as a safd one, 
and attended with enough success to justify its performanoe in all cases 



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EFFUSIONS INTO THE PLEtBAL SAC. 75 

Rqniring it. But suppose we temporise and defer it until sphacelation 
of the gut ensues, must we then, in the future, ignore it entirely, and 
regard it as an opprobrium of the surgical art, because in these des- 
perate cases it happens to be unsuccessful? 

As to the nature of the fluid withdrawn, and its bearing on the 
Rsult of paracentesis, something might be said, though I can glean 
nothing definite on this subject. The observations and statistics of 
Bowditch, contained in his one hundred and fifty cases, are, however, 
of some value. He states that " out of the seventy-five, the fluid ob- 
tained at the first operation was serum, in twenty-six of which, twenty- 
one made good recoveries. If afterwards the fluid became purulent, 
I have noticed an almost certain fatality to attend the change. Pus 
lowed at first in fourteen cases — seven of these recovered and seven 
died. A sanguinolent fluid at the first puncture, thin and of a dark 
red color, not coagulating, I consider almost certainly fatal. But when 
the fluid becomes of this color, only at the second or any subsequent 
puncture, I deem it of comparatively little importance. A mixture of 
bloody, purulent fluid, at the first operation, is usually fatal. A fetid 
gangrenous fluid is very rare.*' In cases where no fluid was obtained, 
Dr. B. says : " In seven cases I got no fluid whatever. The failure was 
probably due to the cautious and slow manner in which I plunged the 
trochar between the ribs, carrying thus the false membrane of the pleura 
eostalis before the instrument, instead of piercing it, so that it really 
aever entered the fluid." Dr. B. also states that other times, he has no 
doubt but that an error in diagnosis was made, when there was simply 
an uncxpand|3d lung, covered by thick, false membranes, causing as 
nueh flatness on percussion as if there was fluid present. 

The danger of the introduction of air into the cavity of the pleura, 
daring paracentesis, has long occupied the attention of medical men, 
and given rise to not a little discussion. The opinion of the great 
majority at the present day, is that, though the long continued and oft 
repeated contact of air with the pleura, may cause increased irritation, 
and possibly putridity of its contents, the transient introduction of it 
is innocuous, so far as these effiects are concerned, but that it may be 
detrimental, and as little as possible should be allowed to enter, on^ic- 
connt of its aflfording an obstacle to the rapid and free expansion of 
the Inng, after the removal of the effusion. Cases are on record, in 
which immediately after the operation the signs of pneumo-thorax were 
developed, showing that air was certainly introduced, and yet they 
were followed by complete recovery. The experiments of Nysten and 



76 WESTEBN JOURNAL OF ITEDIOINK. 

Speiss, clearly indicate that air transiently applied, exerts no delete- 
rious influence on the contents of the chest, and that its removal may 
be entrusted to the agency of the absorbents. 

If the fear of the introduction of air in small amount into the chest, 
is to deter us from operating in certain cases, we should never resort 
to the procedure at all, for there is no expedient that has, or can be 
devised, to altogether prevent it. Air must, and always docs, enter 
the chest during paracentesis. It can not be prevented by any means. 
If air did not enter, or we could possibly prevent its entrance, none of 
the effusion would, flow outwards, and our main object, relief from pres- 
sure and distension, would be defeated. The flowing in of air, is an 
indispensable condition for the flowing out of the fluid. 

Shall the opening of paracentesis be closed or left open? No rule 
which will apply to all cases, can be laid down on this point. In cases 
of acute pleuritic effusions, or in those chronic ones, where the fluid is 
found to be serous, and when we hope to relieve by the single tapping, 
the opening should be closed and hermetically sealed. In cases where 
purulent material h discharged, and we are satisfied that re-accumula- 
tions will take |flace from time to time (as is the rule) after the opera- 
tion, requiring several tappings, the wound should be left open, kept 
open and not allowed to heal. This is to be advised for very good 
reasons. The opening thus left, by establishing drainage, will prevent 
a re-accumulation, and allow the lung to become unfolded. If the 
opening is closed, operations at different points will have to be per- 
formed at each fresh accumulation. Air, of course, will then enter in 
large quantities. If the opening is closed upon this air, it is left free 
to prevent expansion of the lung, to set up its irritations with conse- 
quent putridity and offensive accumulations, without a vent. In short, 
if air must pass in, give it and its consequent offensive materials, chance 
to pass out. 

To effect this object perfectly and neatly, the drainage system sug- 
gested by Chassaignac, and so concisely described by Mr. Poland in 
Holmes' System of Surgery, will be found very convenient and avail- 
able. 

^he question has been discussed, as to whether all the fluid should 
be evacuated at one sitting, or removed at successive intervals. Town- 
send, Laennec, Stokes, Todd Thompson and others, decide in favor 
of the latter procedure, whilst Bowditch and Flint advise, except 
under peculiar circumstances, that as much fluid should be removed as 
flows freely and uninterruptedly through the canula. What adran- 

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SCTUBIOlfB INTO THS PLEUAAL SAC. 77 

tages accrue from muUCple evacutions, in ail cases, instead of OTie com- 
plete one, does not appear clear to my mind. In some cases, howeyer, ^ 
when from the great debility of the subject, it is found that a large and 
radden evacuation, by remoYing a long accustomed support of the tho- 
racic yiscera, might cause syncope with quite serious shock and depres- 
sion, the removal of small portions of the fluid at intervals, in suffi- 
cient quantities to palliate urgent symptoms, would certainly be the 
more prudent procedure. 

When from the long contact of air with the pleural cavity, or from 
other causes, the discharges become putrescent and offensive, or with 
the idea that a new diseased action can be established in the chronic - 
tllj inflamed and pyogenic membrane, authorities are for the most part 
agreed, that simple and medicated injections are not only innocuous, 
hat of great utility. They may consist, either of simple warm water, 
or water holding in solution, drugs of the alterative and detergent class, 
B«eh as chlorine, bromine, iodine,"chloride of zinc, permanganate of pot- 
ash, &c. The researches of Pasteur, utilized by Lister, as to the uses of 
carbolic acid, in surgery, point to that agent as being the most effec- 
tive we could use in this class of affections — ^as an injection to be used 
in aqueous solution, or suspended in oil or glycerine. The opening of 
the operation might be covered over with a paste of the same, made 
with glycerine and whiting. 

For performing the operation, cauterization, the simple incision, 
and the incision with the trochar and canula, have been recommended 
and used. 

Cauterization has justly become almost obsolete, and repudiated by 
Bodern surgeons. Besides possessing no advantages over the simple 
and less tedious methods of operating, it is much more painful and 
haniaing to the patient. As recommended by Walshe, however, in 
cases where the collection points externally, and patients are possessed 
wi& a dread of cutting instruments, the caustics may be made use of. 

The simple incision is now but little used, on account of its afford- 
lag 80 incomplete an exit to the passage of the fluid, and at the present 
day, the incision with the trochar and canula are in general use. Wy- 
nan's saction pump apparatus, so much used and so highly recom- 
neaded by Dr. Bowditch, is a most ingenious contrivance. By its use, 
we allow but a very small amount of air to enter the chesty and by its 
great snction power we are enabled to draw out again what little air 
My enter. We are, also, enabled by it to draw out thick, consistent, 
itringj collections which would with difficulty flow through the ordi- 

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/ 



78 WESTERN JOURNAL OF MBDiaNX. 

nary unassisted canula, Authorities, generally, make division for the 
exit of the fluid into the pierce or empyema of neceisity, and the place 
of election^ according as the collection points externally by perforation 
of a costal lamina, nature's method ; or where the surgeon is at libcfrtj 
to select a point, for the introduction of instruments in puncture. 

As soon as the external tumor becomes well defined, it is adyised 
by most obseryers to puncture and eyacuate the collection at its most 
dependent part, in order to avoid the possible danger of caries of the 
rib, together with burrowing of the fluid in the formation of long and 
intricate sinuous passages. But when auscultation elicits the fact that 
the collection is not confined by adhesions, and that there can be no 
danger of wounding the lung, a counter opening may be made. A 
valuable suggestion is offered by Prof. Flint on this point ; he says : 
^' If a perforation be at a point so far above the bottom of the sac that 
only a portion of the fluid is evacuated, more or less constantly re- 
maining below the point of perforation, a counter opening should be 
made." 

Authorities differ as to the place of electianj or the point to be 
chosen for the introduction of the trochar, in cases where we have that 
choice. Laennec, having in view the possible danger of transfixing 
the diaphragm, or wounding the liver, spleen and other important ab- 
dominal viscera, and from the fact that in his own observation, "the 
upper lobe adheres to the ribs more frequently than any other part of 
the lung, and that the lower lobe is frequently attached to the dia- 
phragm, while adhesions seldom exist at the central part of the chest," 
prefers the space between the fifth and sixth ribs. This can be made 
the most dependent part, by inclining the patient towards the affected 
side. 

Stokes advises that the operation be performed higher up than is 
usually recommended, for the following reasons: "The lower situation 
is not better for facilitating the flow of fluid, for it^can, and has taken 
place from different parts of the chest." He argues that in most 
case where the empyema of necemty o<fcurs, the tumor forms in the 
third or fourth inter-space, near the sternum and clavicle, and in the 
axilla.' He draws a fair analogical conclusion from this, inasmuch as 
nature seems to indicate a high operation. 

Townsend and Walshe favor the views of Stokes. French authori- 
ties, as a rule, headed by Yelpeau, prefer the third intercostal space 
for the lefl, and the fourth for the right side, assigning nearly the 
same reasons for the selection that Stokes and others do. Malgaigne 

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xmsHsiyc FBAortnu of ths skull. 79 

ftdrues vs, in order to avoid the arteries and the diaphragm, to select 
the middle third of the contour of the chest, at the third or fourth inter- 
space, counting ft'om below upwards. In fat and well developed per- 
SOBS, as regards the exact point to be selected, he remarks that, *^as a 
proximate guide it will be found about six fingers breadth below the 
inferior angle of the scapula." 

^owditch prefers, as the most appropriate spot for puncture, "the 
space between the ninth and tenth ribs, on a line let fall from the angle 
of the scapula." He states, also, that in selecting an inter-costal space 
OD the postero-lateral portion of the chest, he chooses one " on a level 
with the lowest point at which the respiratory murmur can be heard in 
the healthy lung of the opposite pleural cavity." 

Whenever and wherever\we operate, two things should always be 
borne in mind, viz : To avoid wounding the diaphragm and the inter- 
costal artery, and to select that point which will give complete and 
free aecess to the flow of fluid. 



CASE OP EXTENSIVE FRACTURE OF THE SKULL— RECOV- 
ERY. 

BT W. 8. HAYMOND, M. D., MOMTICELLO, IIIDIANA. 



The patient, Benjamin J. Peterson, aged thirty years, was injured 
in the following manner: On the 27th day of last August, while 
reaching over the tumbling shaft of a threshing machine, in the act of 
oiling some part of the machinery, the clothing of his right arm was 
caught by the shaft, dragging him upon it, and causing him to revolve 
with it. His forehead was drawn down upon the upper knuckle of 
the shaft, near tne cylinder, and carried around in its revolutions 
through the narrow space which separates it from the body of the ma- 
chine, a distance not greater than the shortest diameter of an average 
adult head. A bolt of iron about three-fourths of an inch in diameter, 
passed through the knuckle, one end of which projected an inch be- 
yond its surface. The projecting end of this bolt, in its rapid revolu- 
tions, was brought to play directly upon his forehead, while he was 
revolving with the shaft. 

The accident occurred at ten o'clock A. M., and his injuries re- 
mained undressed until my arrival, four hours later. All the scalp of 

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80 WSSTXaN JOUENAL OF MEBIGINS. 

the right side of the os frontis, with a portion from the temporal bone 
was separated from the skull, and hung in bruised and torn fragments 
upon his right cheek, revealing the existence of a large fissure occa- 
sioned by the removal of osseous structures. The lower line of the 
fracture extended from a point in the median line of the os frontis, to 
a point a few lines beyond the temporal ridge, on the right side, run- 
ning with the supercilliary ridge, and nearly parallel with the orKtal 
arch. From the commencing point in the median line, the fracture 
extended almost directly upwards the distance of an inch, thence paral- 
lel with the lower line to the temporal ridge. The fracture on the 
fourth side was about an inch in length, and chiefly to the right of the 
temporal ridge. 

Here, then, was a portion of the skull, nearly rectangular in shape, 
about three inches in length, and an inch or more in 'average width, 
broken into fragments, some of which were carried away by the bolt 
of iron, but a larger number by some peculiar action of the me- 
chanical force, were turned edgewise and buried in the brain to a depth 
of from half to three-fourths of an inch. Some of these fragments 
were set in perpendicularly and others obliquely, and all com- 
pletely separated. The membranes, within the space occupied by the 
fracture, were torn to pieces and almost entirely destroyed, leaving the 
lacerated brain naked. 

In removing the fragments of bone a spiall quantity of brain, 
amounting to about a teaspoonful, escaped. It is not improbable that 
some of the brain was lost at the machine, which corresponds with the 
statements made by some of the bystanders. But this quantity, if any, 
was undoubtedly not great. In addition to the severe injury of the 
head, the patient's right arm was fractured in the middle of the os 
humerus, and severly bruised around the fractured region. 

Notwithstanding the extent of the fracture of the skull and its 
complications, the patient did not, at the time the%ccident occurred, 
manifest the slightest mental disturbance, nor has he since. As soon 
as he was cut loose from the shafl, he remarked that his " right arm was 
broken," and was able to walk to the house, a distance of about sixty 
yards. 

Treatment in the first place — a careful removal of the fragments 
of bone. These, as before stated, were all buried in the substance 
of the brain. They were discovered by exploring with the finger, 
and, when found, removed wiQi the forceps. During this some- 
what painful process, the patient, (who is by nature a merry fellow,) 



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KZTKNSiyS FftACTU&B OV THX SKXTLL. 81 

continned to talk in his usual pleasant and witty manner, and without 
appearing to manifest serious concern about bis dangerous condition. 
He declared "it was tbe worst scrape be ever got into; " but bis cbief 
uieasiness was about bis arm. He was very desirous of baving it 
(« fixed up rigbt," so be could work again. 

After removing tbe broken pieces of skull from tbe brain, and 
clots of blood, tbe li&cerated scalp was drawn over tbe cbasm, and 
tke edges closed by sutures and adbesive strips. A dressing of cbarpie 
VIS applied, wbicb was retained in place by compress and bandage. 
Poise sixty per minute. Ordered bis bead to be kept cold, and sulpb. 
magnesia Sas, to be given. Applied splints to bis arm. 

August 30. — Patient quite comfortable, tbougb complaining some 
of bis arm. Pulse eigbty-four. Rested well tbrougb tbe nigbt witbout 
anodynes. Has manifested no signs of mental disturbance. Bowels 
unmoved. Ordered sul. mag. 3j to be given; cut bis bair off close to 
tbe scalp, and applied ice contained in a bladder to bis bead. 

August 31. — ^Patient in fine spirits, and bis mind clear and undis- 
turbed. Right eye closed by swelling from inflammation of tbe injured 
parts. Pulse ninety-six per minute. Catbartic operated efficiently. 
Freacribed ant. et potas. tartras j^tb grain., every four bours, with tinct. 
Tirat viride gtts. viij., calomel and jalap aa grains viij., to be taken at 
the hour of bedtime. Continue ice to bis bead. 

September 1. — ^Patient cheerful. Pulse eighty. Removed dressings 
from the head, wbicb was followed by a copious discbarge of purulent 
matter. Applied dressing of oiled lint. Continue the antimony and 
veratrum. 

September 2. — ^Pulse sixty-six. Removed several sutures. Pus 
escaping freely from several places. Patient in his usual cbeerAil mood, 
and very bopefiil. 

September 3, 4 and 6. — ^Patient continues doing well. Pulse has 
ranged from seventy-six to sixty-eight. Treatment continued. 

September 6. — ^Patient doing remarkably well. Discontinue all in- 
ternal treatment except cathartics. Pulse sixty-six. 

September 8. — Patient improving. Pulse sixty-six. Bowels costive. 
PreEcribed mercurial cathartic, to be followed, if necessary, with sulpb. 
m^. The scalp is healing slowly in several places. Owing to the 
extent and nature of the injuries received by the soft structures, it 
was impossible to obtain enough to cover all parts of tbe skull from 
wbicb they were removed ; but with some difficulty tbe fragments were 
joined so as to afford a covering to the exposed brain. A portion of 

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82 WS8TX&N JOTJBNAL OF H£DtCIN|!. 

denuded skull about an inch square, above the fractured region, wasr 
left uncovered. 

September 9. — ^Patient in fine spiri^, and telling anecdotes for the 
amusement of his friends. Pulse sixty-six. 

September 11. — ^Pulse sixty-six. Pus discharging freely through 
the orifices in the scalp. No union yet among the fragments of the 
scalp. 

September 13. — Considerable quantity of thin pus escaping from a 
small circular opening at the lower border of the fracture. Union 
slowly taking place in several points of the scalp. Stimulating appli^ 
cations applied to edges of the scalp, to encourage the growth of gran- 
ulations. Ice intermittingly continued to the head. Pulse sixty-five. 

September 15. — ^Pulse sixty-six. Scalp united in all places over 
the fracture, except the round opening at the lower border. Granula- 
tions advancing very slowly in the margin of scalp surrounding the 
denuded skull. Applied to it with a camel hair pencil a mixture of 
equal parts of cantharidal lotion and oil of turpentine. Patient re- 
mains totally free from pain about the head-^has had no headache 
since he was hurt — ^is cheerful and comfortable, and in the full enjoy- 
ment of his mental faculties. 

September 17. — Pulse sixty-eight. Patient improving rapidly. 
Bowels well purged from cathartic of sulph. mag., taken yesterday. 
Granulations springing up from the pericranium in the center of denu- 
ded bone and the margin of surrounding scalp. 

September 20. — ^Pulse seventy-two. Healing process advancing 
more rapidly. Patient able to walk about his room — was carried to- 
day on a sofa, to another house about half a mile from the cabin 
where he has been confined. 

September 23. — ^Patient sanguine of recovery; in fact, has never 
entertained any other opinion. Pulse seventy-five. Some improve- 
ment manifest. 

September 26. — Rapid improvement. Pulse normal. Appetite 
good. Edges of scalp covered with healthy granulations, and those 
^on the skull increasng. Slight discharge of healthy pus from the 
small opening at lower edge of fracture. Union of the fractured hu- 
merus has not taken place, though the arm has ceased to be painful. 

October 1. — ^Patient was removed home, to-day, in a carriage, a dis- 
tatwe of eight miles, and continues to do well. Is able to go about. 

November 2. — Saw the patient to-day — had a slight chill yesterday, 
which has no connection with his injuries — ^feols well enough to-day. 

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LITHOTOHT OF THX OALL-BLADBBR. 83 

Diflcliarges of pas from the fracture ceased entirely about three weeks 
and bead healed up in every place. Imperfect or delayed union in* 
the fractured arm. Ordered splints to be removed daily, the arm to 
be gently rubbed, and tincture of iodine to be applied about the frac- 
tured region. . Prescribed mur. tinct. Ferri, gtt. xx, to be taken three 
times a day. 

December 10. — Patient called at my office to-day, after a ride of 
t€D miles in a wagon. Head entirely well — arm firmly united, and re- 
wrery complete in all respects, except that he has not yet obtained 
perfect use of his arm, but undoubtedly will in a reasonable time. 

The fortunate result in this case was, perhaps, greatly due to the 
opeaing at the lower part of the fracture, which afforded a free outlet 
from the floor of the brain for the discharge of the products of in- 
flamination. There have probably been many cases of recovery where a 
larger quantity of skull was lost thatt in this case ; but perhaps few where 
fracture to such extent was associated with severe lesions of the brain 
and its membranes, without the occurrence of any mental disturbance 
▼batever. The patient is now in excellent health'and experiences no 
ill effects from the injuries to the head, except a slight sensation of 
uneasiness when stooping, caused by the brain pressing against the iB>- 
teguments. 



ON LITHOTOMY OF THE GALL-BLABDEK. 



BY GEO. 0. BLACKMAN, M. D., 

fnkmat <tt Scrg^rj in the Mtdical College of Ohio; Snrgeon to the SanMrltan Hoepital,. Oin* 
elnnatl, Ohio, etc., etc. 



Some ten years since, with Prof. Comegys, we had an opportunity 
of examining a female patient, who was passing through a spontaneous 
opening in the abdominal walls biliary calculi, of various forms and 
dimensions. Puring a period of a few months, not less than ninety- 
ax were thus discharged, after which the fistulous opening-closed, and 
tie patient has ever since enjoyed excellent health. The above case, 
in connection with one reported by Dr. J. S. Bobbs of Indianapolis, 
f TVajif. Ind. State Med. Soc, 1868,) in which he opened a tumor pre- 
lentbg "just inside the right iliac bone," and removed a number of 
biliary calculi, has induced us to collect such cases as we could find 

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84 WK8TEBN JOURNAL OF MIDICINB. 

scattered in yarions writings, as well as to trace the history of the earli- 
tist proposition to resort to the knife. 

In the first volume of J. L. Petit's Traite des Mal^adieM Chirur- 
fficalesj Paris Ed., 1790,^ at p. 293, we find a chapter entitled, Parallel 
between Retention of Bile, and Calculi in the Gall-Bladder and B.e- 
tention of Urine and Stone in the Bladder, {Parallele de la reteniion 
de la hile etdespierres de la vesicule dujiel, avec la retention^ d' urine et 
Us pierrei de la vesiie,) He remarks that by means of this analogy 
we emancipate ourselves (noia nous emancipons) so to speak, to per- 
form what has not before been attempted. He refers to three cases 
contained in his Memoire n^on this subject read to the " oMemblee pub- 
Uque^* in 1733, (vid, Mem, de I. Acad. Roy. de Chirurgte, 1733), in 
which a distended gall-bladder, having been mistaken for an abscess, 
was opened either by puncture or incision, causing the death of two of 
the patients, as he belived from the extravasation of bile, and the effect 
of this substance upon the viscera (Taction de cette liqueur mr tout les 
viBceres.) These cases, he remarks, are sufficient to show the zeal of 
young surgeons who are always ready to use the knife, even when 
adhesions have not formed between the distended gall-bladder and the 
abdominal parietes. But as one of the three did escape with life, he 
insists that the fatal results in the other two should not render us too 
timid in resorting to this proceeding in which the result was more for* 
tunate in consequence of the adhesions which had formed and which 
were sufficient to guard against the extravasation of the bile. He 
states that when the patient has had frequent and severe attacks with 
inflammation over the seat of the tumor, we have a right to infer that 
adhesions have formed. In such cases, if the retention of bile is likely 
to cause the death of the patient, he would advise the puncture of the 
tumor with a trocar, as his colleague, M. Mery, had often done in cases 
of retention of urine. In proposing to enrich surgery with the new 
operation of lithotomy of the gall-bladder, he admits that so far as 
the parallel, in detecting with the sound biliary calculi in the urinary 
• bladder, must frequently fail, nevertheless, when biliary calculi are 
known to be present, and adhesions have formed, then lithotomy may 
be performed without danger. It is in these cases, he remarks, that 
the skillful surgeon may show his genius, (peut montre son genie,) If 
the tumor has been punctured through the same opening, a proper 
sound may be introduced, the calculi detected, and in the following 
manner extracted : The puncture having been made with a trocar and 

''Tho flrit edition WM pQbllih«d in 1774. Thti iMt edition wm luperTlMd by M. Leeno. 

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LITHOTOMT OF THE QALL-BLADDSR. 86 

cftDuU, the former is withdrawn and a portion of the fluid allowed to 
escape. A long button-pointed probe, suf&cientlj flexible to be brought 
in eoDtact with yarious portions of the gall-bladder, is then introduced 
through the canula, and if the stone be detected, it is withdrawn, and 
without remoying the canula, which serres as a guide, with a sharp 
bistoary both the integuments and the gall-bladder are divided to the 
extent deemed necessary. The forefinger of the left hand is now intro- 
duced into the cayity of the gall-bladder, the calculi felt and with 
siitable forceps extracted. Petit adds that the above is sufficient to 
piewnt the reader with his idea of this new operation — "do I say new? 
It is aot new, for Madame Fibergeau submitted to two operations after 
aa interval of several months. She suffered from retention of bile in 
the gall-bladder. Believing it to be an abscess, it was opened, and the 
vonnd remained fistulous. Several months after the puncture, she 
snbmitted to an operation to close the fistula. A stone the size of a 
pigeon's egg was found at the bottom of the fistula — that is to say, in 
the gall bladder — ^which was withdrawn with the forceps. Was this not 
an operation for the extraction of a stone, and done "en deux temp$f^^ 
as scTeral other surgeons have performed lithotomy for the removal of 
urinary calculi? How many patients have perished because the nature 
of their disease has not been detected, or if detected, because the sur- 
geon has been too timid to attempt their rescue by the measure I have 
proposed?** He then gives us in full detail such cases as he has been 
able to find recorded, where the autopsy demonstrated that the opera- 
tion might hare been performed. 

The first case was in the practice of M. Leaute : A man ast. 45, who 
for a long time had been suffering from hepatic derangement, with 
interrals, however, of good health, at length gradually wasted away 
and died. A tumor formed by the gall-bladder, filled the right hypo- 
ehondrium, having the form of a large cucumber. It pressed the liver, 
stomach, omentum and colon, against the diaphragm, and the thick- 
M» of the liver was diminished. The distended gall-bladder was 
adherent to that portion of the liver which covered it, whilst the ante- 
rior part was firmly attached to the peritoneal lining of the abdominal 
parietes. Leaute opened it, when a large quantity of a very limpid 
hid, but viscous and bitter, escaped, after which he extracted sixty 
ealenli of various forms and dimensions. 

The next case occurred to M. Dargeat: A female set. 66, for sev- 
^1 years had been subject to hepatic colie, and mouvements de vapeursy 
^9F*>condriaqueSy when a hard tumor appeared on the right side of the 

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86 WESTERN JOURNAL OF MEDICINE. 

abdomen, and increasing, extended toward the anterior and superior 
spines of the ilium. The tumor presented itself during a period when 
the patient seemed to be enjoying excellent health. Neglecting her- 
self, however, she had a relapse of her former troubles, and sought 
medical aid. The symptoms — violent colic, nausea, fever and wake- 
fulness — wore not supposed to have any connection with the abdominal 
tumor, which to the touch seemed to involve only the integuments, or 
the abdominal parietes. The patient was bled, and other measures 
adopted which gave her temporary relief; but for nearly three years 
she suffered from a renewal of these troubles. At length, the abdom- 
inal tumor began for the £rst time to become painfuL Poultices were 
applied for two months, when a spontaneous opening occurred. 

After discharging for several months, and causing the almost total 
disappearance of the tumor, the fistula became closed. For a long 
time it alternately opened and closed, until, at last, the patient, with 
her old attack of pain recurring so frequently, became exceedingly 
emaciated and died. A probe passed into the fistulous orifice — to 
which the patient, while living, would not consent — ^penetrated more 
than five inches, passing obliquely toward the gall-bladder, which was 
not of its ordinary form, but divided into three well marked cul-de- 
sacs, in which calculi were lodged. An elongated band connected the 
gall-bladder with the abdominal parietes. It was in the form of a 
cord, and a fistula extended through it from the gall-bladder to the 
external orifice. 

A third case was in the practice of M. de la Peyronie, which pre- 
sented many features in common with those already reported. Through 
an opening spontaneously formed, large quantities of bile and numer- 
ous calculi were discharged. The fistula having become obstructed, 
a sound was introduced into the gall-bladder, when another stone 
escaped with the bile. Two years afterwards, although the fistula 
remained open, the patient was in the enjoyment of excellent health. 

From the above facta Petit concludes that in similar cases, should 
the symptoms return, caused by calculi retained in the gall-bladder, 
the fistula should be dilated by means of prepared sponge or other 
means, and the calculi withdrawn, as had ^Ir^ady been done by skillftil 
practitioners. That if the symptoms should depend upon inspissated 
bile retained in the gall-bladder, the latter should be washed out with 
appropriate injections. 

He next quotes the case reported by M. Saurau. In this the pa- 
tient suffered for a long time from biliary trouble ; an abscess finally 

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STILLINOU. IN SYPHILIS. • 87 

gave exit to the contents of a tumor, formed by a distended gall-blad- 
der. Wbile tbe fistula remained open, the patient would be comfort- 
able; but when closed, her sufferings were severe. Saurau, with a 
soood, detected a hard body, which appeared to be situated over the mus- 
cles of the abdomen. He made an incision which enabled him to lay 
liold of this foreign body, which he found adherent, but which was 
finally detached and extracted. It proved to be a biliary calculus four 
inches in length and three in circumference. Having completed this 
operation, he discovered another canal leading to the opposite side, ex- 
tending beyond the linea alba to the left hypochondrium, but giving 
rise to no appearance of a tumor. He introduced a sound some three 
inches, and found a second calculus, which was reached after making 
the proper incisions, and withdrawn. Through the opening in the 
right hypochondrium, for some days, bile mixed with pus escaped ; but 
the progress of the case was favorable, and in about two months the 
patient was perfectly cured. 

(To h€ anUinued,) 



STILLINGIA IN SYPHILIS. 



BY DE. J. 0. m'mECHAN, CINCINNATI, OHIO. 



In the American Medical Recorder for April, 1828, (vol. ziii, page 
312.) Dr. Simons recommended the use of stillingia in secondary syph- 
ilis, in place of mercury. This article, at the time, attracted consid- 
erable notice, and the drug came into popular use. Doctors Lopez 
and Frost also wrote in favor of its use and confirmed the views of 
SunoDs in regard to its efficacy in syphilis. 

For the past few years, owing to some unaccountable reason, it has 
heen seldom prescribed. 

We have used the drug in a certain form of syphilis, and with the 
finest results, and have seen Dr. Dawson, Surgeon to the Cincinnati 
Hospital, prescribe it frequently, with the most marked effect, when 
other remedies had failed. 

The form of syphilis in which It is most useful, is secondary, where 
the symptoms of tertiary are just beginnii^ to manifest themselves, but 
it is also useful later in the tertiary form, in combination with iodide 
^ potassium. 



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88 ' WXSTIBN JOURNAL OF MXDICINX. 

In secondary syphilis, in broken down subjects, mercury is, of 
course, objectionable, and if administered, can not be carried to the 
point where it wonld have a marked effect upon the syphilitic eruption. 
If mercury can not be administered, there are but few remedies left to 
prescribe, and the principal ones, perhaps, are sarsaparilla, and iodide of 
potassium. The latter remedy is very good in the tertiary {brm, but 
in the secondary, it has been found almost inert, having but very little, 
if any, effect upon the eruption. SarsaparilU, at one time, had quite a 
reputation, and it was next to impossible for a patient to recover with- 
out its administration. It is now seldom administered, except for its 
moral effect, unless outside of the regular profession. Now, in primary , 
we have iodide of mercury, (and in healthy subjects it is the proper 
remedy in secondary), and in tertiary, the iodide of potassium. But 
here is a vacancy, what is the remedy in secondary when the patient is 
broken down in health or when mercury has been used without effect? 
There is but one remedy in the materia medica that can fill the vacancy 
properly, and that one is stillingia. For broken down patients, with 
the syphilitic eruption, to patients on whom mercury has had no effect, 
and to patients in whom the bones have become affected and the sec- 
ondary manifestations still continue, let this remedy be given : 

Case I — Jno. L , laborer, aged twenty-five, came under our 

care August 10th; had primary disease eighteen months previous to 
this time; suffered greatly from the eruption; general health very 
poor. Put upon tonics, and in conjunction with them, stillingia. In 
one month, the eruption almost disappeared. 

Case II — Ferdinand G , aged twenty-two, applied for relief 

July 25th ; had the eruption in various parts of the body, and bon^s 
of the nose were necrosed; the parietal bone of the right side was alBo 
undergoing necrosis. For the eruption, prescribed stillingia, and for 
the tertiary symptoms, iodide of potassium; he also took supporting 
and tonic remedies, and a little surgical interference was necessary in 
regard to the dead bones. In a few weeks he was much better, and he 
is still improving in his general health. At present, the eruption has 
entirely disappeared. 

The best preparation of the drug is the stillingin, and of this, two 
grains can be given three times a day. Of course the drug is not to 
be relied on to the exclusion of other remedies, such as tonics, iron 
and supporting remedies, but is to be used in conjunction with them. 



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BELLADONNA IN HOOPING-COUGH. 



BT B&. B. 8. WOODWORTH, FOBT WATNB. 



I heard Brown-Seqaard say, in a speeoh or lecture before the Amer- 
lean Medical Asaociation, at Baltimore, a few years ago^ that hooping- 
eovgh could be cured in three days by belladonna. But that in order 
to do this, it would be necessary that the physician should stay in the 
house of the patient and watch the effects of the medicine. I took 
notes of this lecture at the time, and on the first opportunity, I pre- 
seribed belladonna in doses that I had not previously dared to do. I 
became conrinced, howeyer, that this drug was signally efficacious in 
hooping-cough, and I have never failed since that time, to give the 
BMdieine, not only in hooping-cough, but in many cases^ of cough 
among adults, that seemed to depend principally upon nervous de- 
rangements. A recent epidemic of hooping-cough in this city has 
given me an opportunity to witness the effects of belladonna in a lar- 
ger number of cases than I have previously witnessed it; and I have 
no more dotibt of the specific influence of it than I have of that of 
quinine in intermittent, or of ergot in producing contractions of the 
uterine muscles. By the way, although some have denied that the 
specific effects of the latter are certainly to be relied upon, I must truly 
say that I never, after a practice of thirty years, knew it to fail. ^ 

In the present epidemic I have treated about fifty cases — all but 
one were uncomplicated with other diseases. The exceptional case, a 
child four years old, had capillary bronchitis, and possibly very cir- 
cunseribed pneumonia, and for several days death seemed imminent, 
hot recovery took place. Most of the cases had had the usual symp- 
toms of bronchitis for several days before I prescribed for them — ^in 
short, the disease was fully developed. I began by prescribing the 
extract in as large doses as I thought the patient would bear, and in- 
creasing it at every successive dose until the pupils were fully dilated, 
and then kept them dilated, being careful to tell the friends to watch 
the effect and omit the medicine in ease any dangerous symptom su- 
pervened. I have never seen any ill effects from it. In a majority of 
the cases that characteristic scarlet flush or efflorescence appeared, and 
with it an abatement of the cough, or of its spasmodic character. In 
a few cases I gave opium with the belladonna, or alternately. In that 
ease the diktion of the pupils will not be witnessed, if they be given 

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^0 WESTERN JOURNAL OP MEDICINE. 

in about the medium dose of each — they balancing (not neutralizing) 
«aoh other. I believe it is now generally conceded, that those nar- 
cotis, which we call mydriatics, are antidotes (or nearly so) to those 
that produce contraction of the pupil, and vice versa. But, perhaps, 
more experiments, or experience* are wanting to verify this. I, how- 
ever, think it probable that wc may find it advantageous to prescribe 
the two together sometimes, thus avoiding the bad effects of either, 
while the g^od are obtained. This is no new principle in medicine, I 
am aware, and for a long time I have acted on that principle in refer- 
ence to quinine and opium — considering one an anti-congestive, while 
the other is congestive in its effect. 

Now, although I have not proved that Brown-Sequard's saying that 
hooping-cough can be cured in three days, I verily believe it can be 
greatly cut short, and that there is no more need of hooping-cough 
continuing for months, than there is for ague continuing an indefinite 
length of time, when plenty of quinine can be found. 



HOSPITAL GANGRENE, AS IT APPEARED AT- THE CLAY 
AND CRITTENDEN U. S. A. GENERAL HOSPITALS, AT 
LOUISVILLE, KENTUCKY. 



BT J. Q. A. HUDSON, M. D., CINCINNATI, OHIO. 



From the latter part of the month of September, 1864, to the lat- 
ter part of January, 1865, the writer, as Acting Assistant Surgeon U. 
S. A., had charge of t^e gangrene wards of the Clay General Hospital 
till the middle of November, 1864, and of the Crittenden General Hos- 
pital the remainder of the period, at Louisville, Kentucky. « 

About the middle of November, 1864, the occupants of the Clay 
Hospital were removed to the Crittenden, the former being abandoned 
by the Government for hospital purposes. 

The latter was built by the government upon the most approved 
plan for convenience, cleanliness, ventilation, water and light. There 
was nothing peculiar or unusual in the weather at this station, during the 
period above mentioned. The summer and fall of 1864 were remark- 
Ably pleasant, the atmosphere dry and the temperature equable and reg- 
ular. The city physicians reported the health of the city unusually 
good. 

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H06FITAL GANOBEIVC. 91 

Hospital gangrene had been prevailing for some time previous to 
my connection with these hospitals, principally at the Totten General 
Hospital, the Clay Geneitil Hospital, and at the Jeffersonville General 
Hospital, at Jeffersonville, Indiana, opposite Louisville, but it was 
nrely seen at the other hospitals at this point, or in the vicinity of 
Louisville, probably from the fact that at these hospitals there were 
fever wounded in proportion to the whole number under treatment, 
than at the hospitals named. The hygienic condition and management 
of the Clay and Crittenden Hospitals, were excellent. Everything 
necessary for the welfare and confort of the sick and wounded, in the 
way of food, medical supplies, and attendance, clothing, &o., was fur- 
nished in abundance. 

In order to secure a plentiful supply of pure air and free ventila- 
tion, the gangrene cases of the Clay Hospital were located in tents a 
tew rods east of the hospital building. 

There were six ward buildings at the Crittenden, ranging east and 
west, and the most easterly was selected for the gangrene ward. This 
iras done to secure the favorable influence of the prevailing winter 
winds from the west and north-west, to keep the deleterious action of 
the gangrene poison from the other wards. 

In order to prevent the diffusion of the poison, the bandages, lint, 
and all material used in dressing, were carefully collected and de- 
stroyed. No instrument or vessel used in the gangrene wards, was 
allowed to be used in other wards or for other patients. 

No variety of wound, mild or severe, was exempt from the disease. 

The same was true as to individuals. It attacked the old as well 
«8 the young soldier, the robust as well as the debilitated — no condi- 
tion of age, temperament or health, was exempt among the wounded. 
Many there were among the wounded that were not affected ; but the 
disease seemed to have no preference for any particular class or condi- 
tion of persons. 

Nearly all the cases of hospital gangrene, were in wounds of the 
lower extremities. This fact has been noticed by several writers on 
this disease. As far as the Clay and Crittenden Hospitals are con- 
cerned, this circumstance may be explained. A large proportion of 
aU the wounds were of the lower extremity. I am inclined to believe 
that this statement is true of all military hospitals. 

Stmptoms and Course. — In the majority of cases the commencement 
of the attack was indicated by a change in the state of the wound. 
The usual bright red color of a healthy granulating surface, assumed 

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92 WISTSBN JOUENAL OF MEDICINS. 

a pale hue. The surface became comparatively dry. The discharge 
diminished in quantity and became thinner and sanions in quality. 

Inflammation and tumefaction of the margin of the wound and of 
the parts in its vicinity, accompanied with some pain in the swollen 
parts, especially on the least movement of the limb, occurred. 

The tumefaction is sometimes very great and extending some dis- 
tance from the wound — ^very much resembling oedema. 

The skin at the margin of the sore is hard and everted, and a red- 
dish blush frequently extends a short distance from that margin, espe- 
cially if the inflammation is excessive. If the inflammatory action 
continues, the red margin becomes dark, and finally, black like ordi- 
nary gangrene. 

Besides the pain that accompanies the swelling and inflammation, 
there is generally a stinging pain on the surface of the wound itself, 
which is said to be peculiar to this disease. This last symptom is not 
always present, but is generally so in the inflammatory cases. Concur- 
rent with or soon after the development of the foregoing symptoms, the 
wound takes on those peculiarities which constitute the disease — ^hos- 
pital gangrene. In some cases, the entire wounded surface becomes of 
a whitish gray or ashen color, appearing very much as though a false 
membrane covered it. In other cases, this change commences at one, 
two or more points, on the surface of the wound, the morbid action 
extending from these points till the entire sore is completely covered. 

The color of this coating is not always the same. In most of the 
cases that I saw, it was of a dirty ashen hue — it may be yellowish 
white. In cases where there is great vital depression, both general 
and local, the coating may be quite dark. When this coating is formed, 
any part of the surface of the^wound can be touched without sensation 
or pain. This dead structure is intimately adherent to the living parts 
below. It can be swayed to and fro by catching it up with the for- 
ceps ; but it can not be detached, at least at the onset of the attack, or 
until nature begins to separate the dead from the living tissue, and the 
former is slowly detached in the form of a slough. 

The wound now emits a peculiar disagreeable fetor, which is said 
to be 8ui generis^ and is one of the .characteristics of the disease. 

'ike larger number of cases were ushered in with the local inflamma- 
tory action above described, yet in a few instances this was absent, and 
neither general nor local disturbance indicated diseased action. 

The surgeon, in dressing the wound, finds a healthy granulating 
surface giving off laudable pus. A few hours subsequently, possibly 



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HOfPnAL OANORENS. 93 

• 
tt the next dreBsing, he finds the gangrene over a part or the whole of 

the sore. At the same time the patient ezperienoes nothing unnsaal 
in tke part, and the general system may be apparently in good condi- 
tion, all the fiinctions of assimilation, secretion and innervation nat- 
urally performed. Inflammation may supervene upon this local change, 
jet in some instances there is hardly any, if any, increased action in 
or around the wound. 

Where the disease makes rapid progress, and especially in exten- 
nve wounds, with high inflammatory action, the discharges are mixed 
with dark bloody matter, and the slough is darker, frequently resem- 
bling ordinary gangrene. This condition of the wound is generally 
iccompanied with a low state of the system, and depressed local vital- 
ity, and often has a fatal termination. This disease seems to have a 
strong affinity, so to speak, for the cellular or areolar tissue. It at- 
tseks this structure and destroys it in every direction, taking the 
Yound as the starting point, undermining the integument, separating 
tke muscles and destroying the sheaths of vessels and nerves. In a 
aegleeted case, or in one that is inveterate and does not yield readily 
to tke action of remedies, the surgeon will find that the skin (although 
of a natural healthy color, except near the margin of the wound,) is 
leparated from the parts beneath by the destruction of the superficial 
&8cia, and the probe can be slid under it for §ome distance from the 
border of the wound. In nearly every case the separation extends six 
to twelve lines, and I have seen it extend several inches. In one case 
tlie entire skin of the lower half of the leg was disconnected from the 
parts beneath. In another case the areolar tissue of the leg seemed 
to be completely destroyed from the knee to the ankle, separating the 
ikiii and muscle. The vascular tissue does not seem to be very liable 
to be affected by it, though instances are on record in which fatal hem- 
orrkage has occurred from the sloughing of large vessels in hospital 
gangrene. I am inclined to think that the death of the vascular tis- 
sue arises rather from the destruction of the areolar or connective tis- 
sue of the vessels, cutting off their vascular and nervous supply, rather 
tban from the direct action of the gangrene upon the vessels them- 
selves. 

I believe the same is true of the integument. The skin does not 
seem to be much affected, at the margin of the wound. When, how- 
erer, the fascia beneath the skin is extensively destroyed, it will die, 
bat its death is more like ordinary sphacelus or mortification, than like 
hospital gangrene. The areolar and muscular tissues are the structures 

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94 WESTERN JOURNAL OF MEDICINE. 

upon whioh this disease principally acts, and its action upon other tis- 
sues directly is, in my opinion, a matter of some question. Unless the 
surgeon examines the wound carefully with the probe and forceps, he 
will not be aware of the extensive ravages of the disease. The gan- 
grene will appear to be confined to the wounded surface alone; but, 
upon using the probe cautiously and carefoUy, it may be found that 
the areolar tissue is destroyed for some distance beneath the integu- 
ment, between the muscles, and in the course of the vessels and 
nerves. 

The local symptoms in very extensive and serious wounds, as in gun- 
shot fractures, are generally different in some particulars from the 
foregoing. 

After the battles at Franklin and Nashville, Tennesee, during the 
winter of 1864-'5, a great many of the wounded of those engagements 
were sent north by railroad to- Louisville and Jefferson ville. It seems 
strange to write it, but it is nevertheless true, that a number of sol- 
diers with comminuted gun-shot fracture of the femur or tibia, were 
sent to Louisville during the coldest weather of that winter, over a 
rough railroad. They had the pleasure of riding in box-cars, without 
stoves or other means of warmth save the blankets and bedding sent 
with them. The Crittenden Hospital received a number of these poor 
fellows. Some of them had hospital gangrene when they arrived, and 
others were afterwards attacked. I need hardly say that many of 
them died. 

In these cases there was a profuse discharge of dark and bloody 
matter from the wound. Portions of the surface were dark and bloody, 
and offensive grumous matter was constantly oozing from it. 

There was great general and local depression — the vitality of the 
wounded part seemed partially destroyed, and extensive sloughs oc- 
curred from sphacelus and hospital gangrene combined, and the pa- 
tient died either Arom exhaustion or from the supervention of some 
low form of fever. 

In regard to general symptoms, or those arising from a disturbance 
of the general system, it may be said that there was no uniformity. 
In many cases the system did not seem to be in the least affected by 
the existence of gangrene, and during the whole course of the disease 
all the bodily functions were in perfect action — the pulse, respiration, 
sleep, appetite, secretion and excretion, all natural and healthy. 

In the majority of cases, however, there was greater or less general 
disturbance, sometimes preceding, sometimes cotemporaneous with, 



SfMBPBTAL^ QANOSEin. M 

aid in other eases following the local disease. The general symp- 
toms were in some cases slight, consisting of headache, acceleration of 
pulse, loss of appetite, &o., &c., which soon passed away if the local 
disease was subdued. When these milder symptoms prevailed, the 
disease was generally amenable to treatment. 

In other cases the general symptoms were severe and marked, 
especially in the severe and obstinate cases. Pulse permanently fre- 
qneDt— one hundred or more per minute, tongue coated with a whitish 
or yellowish fur, headache, fever, bowels either sluggish or too loose, 
perhaps diarrhea, occasional or constant delirium — in short, all the 
general symptom that indicate a poisoned condition of the blood. 
This febrile state often resembled, in every particular save the local 
deposits of pus, the ^disease described by surgical writers as pyaomia, 
and was probably caused by absorption of the poisonous matter irom 
the local diseased part. Where the constitution was thus seriously 
tiected, it was observed that the local disease was difficult to eradi- 
cate, and it seldom yielded till there was an amelioration of the gen- 
eral ijmptoms. 

There seemed to be no regular correspondence between the local 
and general symptoms. I have observed severe general symptoms in 
slight local disease, and again, slight constitutional disturbance, with 
ficrere local gangrene. In most instances I think that the severity or 
Dildness of the constitutional affection depends upon the state of the 
sjitem at the time of the attack. Those who were weak or debilita- 
ted firom any cause, scorbutic, or affected with diarrhea, were more apt 
to liave serious general symptoms, and vice versa. 

Other conditions being the same, that is the condition of health, 
strength and power of resistance, the general symptoms corresponded 
generally (not uniformly) with the extent of the local disease. 

In those cases which terminated fatally, a low form of fever usually 
existed for some days previous to death, in many instances, as before 
stated, resembling pyaemia. The pulse ranged at or above one hun- 
dred per minute, with hardly an appreciable variation during the 
twenty-four hours. 

The tongue was covered with a thick yellowish coat, inclining to be- 
come dark and dry, sordes accumulated upon the teeth and gums. 
The mind sympathised with the low state of the system. The patient 
seemed to have no concern as to the results — was stupid and apathetic, 
and a low form of delirium was often present. Diarrhea often existed, 



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96 wsnnaui jourk al w MDicnnB 

and in extreme cmees, there were inyoluntary evaonations of the nrina 
and feces. 

The 8)cin and oonjnnctiTiB became jaundiced. This latter sjinp* 
torn I saw in but two cases, both of which were fatal. 

Before leaving the subject of symptoms, it wonld be well to notice 
that the disease is apt toTecnr in certain constitutions. This peculiarity 
has been repeatedly observed by surgical writers. We had a number 
of cases who were returned to the gangrene ward ftom two to six times, 
after being each time fk^ed from the disease. 

In some of them the disease was very obstinate and difficult to sab- 
due— the treatment extending through several weeks. None of these 
cases were fatal; and there was very little or no general systematic 
disturbance, and the disease seemed to be wholly local, but ef an in- 
veterate character. 

These recurring cases were mostly in individuals of the phlegmatic 
temperament. I should judge that at least one-sixth of our oases 
were attacked more than once. 

Gausbs and Nature. — The cause of this disease is stiU involved 
in obscurity. There is no doubt in regard to its contagious nature 
when once developed; but whether every case originates thus it is dif- 
ficult if not impossible to decide. Hy own opinion is that the disease 
may be produced under a certain combination of circumstances not 
perfectly understood, and when once developed it may be propagated 
by contagion, and when the morbid principle is strong, and circum- 
stances and conditions exist favorable for its concentrated action, it 
may be propagated by infection or through the medium of the atmos- 
phere. 

We know that gonorrhea may originate de novo, and afterwards be 
communicated by contact ; and it is not impossible that hospital gan- 
grene, (and possibly many other contagious and infectious diseases), 
may in like manner originate by the existence of conditions favorable 
for it, aad without the previous existence of the gangrene poison. 

It has existea as an epidemic both in military and civil hospitals.^ 

The local morbid action is essentially a molecular death of the part 
affected. 

The tissue dies not en maue, but littie by little, particle by parti- 
cle, extending indefinitely, unless checked by nature or the skill of the 
surgeon. 

*8m Am, Jmt. Med. BeL, toI. z, 188S, p. 47, vt Seq.; «Uo, Lmtd» U^d, CMt, Afv., Aug., ISSS, 
p. 871, •( Seq. 



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HOfflTAL GAHOBSraS. 97 

h the disease a local disease, or are ftlie loeal phenomeiia merely 
maiiifestotioiis of eoii8titatt(»ial action? 

AvUiorities are still divided on this point, and many of our best 
vriters (among them S. D, Gross) consider the disease constitutional. 

How are these eases to be explained in which there is an entire 
ibflenee of constitutional trouble? 

Hennen, who believed the disease a constitutional one, and relied 
ilnost whoUy upon general remedies in its treatment, even to the ex- 
ehsioD of a valuable local remedy that was introduced by one of his 
brother army surgeons,* (I allude to the use of arsenic,) says, '*In 
this distressing state of our hospital, some few constitutionB resisted 
the febrile action altogether; some had exiendve local diiea$e toithaut 
oj^ general affection,'* ^ 

We may reasonably suppose that when this disease originates wholly 
by infection, and witkotU the existence of a previous wound on the per'- 
iM icAo receives the infection, that the general system would be first 
t&cted. 

If the disease occur as an epidemic, as it undoubtedly has done, 
ve msj have those differential peculiarities, in the different epidemics, 
jut as is obeerred in other epidemic diseases. 

In some epidemics of hospital gangrene, the system may be always 
uq^Iicated, while in another there may be very little constitutional 
trouble, or the system may be affected in a limited number of cases. 
With the knowledge we now have of hospital gangrene, as it has occur- 
^ &om time to time during the present century, it seems to me to be 
the hight of absurdity to affirm that this disease is essentially consHtu- 
tioMi. 

A pathological principle, or even an hypothesis by which it is pro- 
posed to explain a particular disease, is unworthy of the regard of 
MBsible men if it does not embrace all cases of the particular disease 
it is designed to explain. 

Ib regard to the character of the constitutional disturbance, when 
it exists, it may be said that the tendency was to a low form of fever, 
dynamic in character. This has been generally observed by writers 
oa this disease; yet it is not always the case. Hennqji states that 
tovards the close of the epidemic which he observed, the fever became 
■Bttked and open, pulse strong and hard, severe inflammation in and 
>niand the wound. The synochal character of the disease was so evi- 
dent^ that blood-letting was employed with successful results. The 

•mOarf Swvt Xdinbnrgb Kd.. 1818, p. 238. 

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98 WESTEBK JOimirAL OF HBmoINS. 

lancet wounds did not take on diseased action.^ Would we not antici- 
pate gangrene in the lancet wounds, if the disease was constitutional? 

In 90 far as the hospital gan^ene at the Clay and Crittenden Hm- 
pital is concerned, I am of the opinion that it was a local disease, from 
the following reasons : 

First — The entire absence of general symptoms in many cases. 

Second — ^The want of correspondence between the general and local 
symptoms, when both existed. In some cases, there was serious con- 
stitutional disturbance, with slight local disease,' in some other in- 
stances, vice versa. 

Third — The existence of gangrene in one wound, while another 
wound in its immediate vicinity would be unaffected by it. 

Fourth — The greater success resulting from the use of local, as 
compared with general remedies, even in cases where there were serious 
general symptoms. 

Diagnosis. — But little need be said on this point. Writers are 
disposed to be particular to point out the difference between the slouch < 
ing scorbutic ulcer and hospital gangrene. The difference is so wide 
and mai^ked, that the labor is lost. We might as well be careful to 
note the particular symptoms that distinguish epilepsy from gonor- 
rhosa. 

Some recent writcBS in our medical journals, have fabricated two 
kinds of hospital gangrene — ^the false and the true, the former said 
to occur in depraved, scorbutic subjects. The disease may occur in 
scorbutic or scrofulous, or in syphilitic subjects ; but in so far as its 
real nature is concerned, and in all that relates to its local treatment, 
it is true, genuine hospital gangrene. This division into two kinds, 
false and true, is a distinction without a difference. The greyish, yel- 
lowish white, or brown slough attached to the wounded surface, not 
formed by any local application of the surgeon, will sufficiently indi- 
cate the malady, and may be considered the diagnostic symptom. 

Prognosis. — Since a vigorous local treatment has been generally 
practiced in hospital gangrene, it has been much less fatal than for- 
merly. 

When there is serious constitutional trouble, particularly of the 
nervous and circulating systems, the prognosis is not favorable. This 
• state is noted by stupor or delirium, and a persistently frequent and 
quick pulse, at or above one hundred per minute. 

If, in conjunction with serious general symptoms, such as stupor or 

♦Hennen't MU, awrg., pp. 246 and 2i6w 

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yiSSSLS AND NKEYI8 OV FIBROUS gTRUOTURES. 99 

delirium, frequent pulse, dry, coated tongae, &c., there is a bad state of 
the wound— extreme slongbing and destruction of tissue, and espe- 
cially if local remedies Lave little or no power to check the progress 
of the gangrene, the prognosis is very unfavorable and the termination 
will probably be fatal. 

The old, debilitated soldier, those debilitated from any cause, such 
as loss of blood, diarrhoea, are bad subjects for this disease. 

The co-existence of a scorbutic, a scrofulous, or a syphilitic taint, 
especially the first, is an unfiArorable complication. 

It may be stated as a rule, that there will be little abatement of the 
local disease while the constitutional symptoms are strongly marked. 

In some instances, these depend upon the local irritation and in- 
flammation, and speedily subside when they are removed. The young, 
the robust, those not affected by other maladies, of course resist the 
diseased action more strongly, and in these the prognosis is more 
favorable. 

When the constitutional trouble is slight, we may anticipate a favor- 
able termination. Even in quite extensive wounds, if there be mild 
general symptoms, and if the disease seems readily to yield to local 
remedies, we may have strong hope of a favorable result. 

(Treatxsnt in the next number.) 



THE VESSELS AND NERVES OF FIBROUS ANI> FIBRO- 
CARTILAGINOUS STRUCTURES. 



[Thit, though some two or three jean old, we suspect has escaped general pro- 
t atteotion, and therefore we re-pnblish it. T. P.] 

M. Sappey has communicated to the Academy of Sciences the re- 
solts of his investigations on the vascular and nervous supply of artic- 
ular fibro-cartilages, tendons, and aponeuroses. 

1. Articular Fibro-cartilages. Authors state that these structures 
possess neither vessels nor nerves. M. Sappey, however, says that he 
has been able to ascertain the presence of both. Among the articular 
fibro-cartilages, those of the knee are the most vascular. The vessels 
at first proceed parallel to the bundles of connective tissue, giving off 
s large number of branches at various angles, which anastomose and 
form a network. The vessels reach the middle part of the cartilage, 
sometimes even the vicinity of the edge. The arteries have at first 
theb three coats; their ultimate ramifications end in loops which spread 
over the two surfaces of the fibro-cartilage, and are arranged in the 
most elegant and varied manner. The veins follow the course of the 

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100 WESTERN JOURNAL OF MEDICINX. 

arteries. In the fibro-cartilages of the other parts, the vessels pass 
from the circumference towards the centre to a depth of about one- 
tenth of an inch, and end in arches surrounding the centre, which is 
entirely destitute of blood-vessels. The periarticular fibro-cartilages 
are much more vascular, and do not in this respect differ from perios- 
teum, of which they may be considered as an offset. The vessels are 
arranged in the same way as those of the inter-articular fibro-carti- 
lages. The fibro-cartilages receive nerves, part of which accompany 
the vessels, while part follow a separate course. Those which follow 
the vessels are frequently separated from them, and sometimes cross 
them at a right or acute angle. At some points, the nerves are larger 
than the vessels. They anastomose, and form plexuses with unequal, 
often very fine, meshes. 

2. Ligaments. Vessels enter the ligaments in very large numbers. 
They lie in the interstices of the fasciculi, which they surround with 
anastomoses,. They gradually subdivide until they reach the surface, 
covered by synovial membrane, where they form an extremely rich net- 
work. In the capsular and some other peripheric ligaments, the deep- 
est layers, hitherto considered by many as almost completely destitute 
of vessels, are, on the contrary, very vascular, the vessels being dis- 
tributed almost as in the skin. All the ligaments receive a large sup- 
ply of nerves ; some even more than the skin of the trunk and limbs, 
their supply being rather comparable to that of the fingers and toes. 
In their course, the neryes send off a number of branches and minute 
twigs, forming plexuses, which most generally accompany the vascular 
plexuses, but are sometimes isolated. The nerves become subdivided 
until they are reduced to one or two tubules, so that they seem to end 
in free extremities. M. Sappey does not assert they do so ; he can 
not say that the isolated tubercles do not become united with others. 

3. Tendons. Vessels and nerves are a little less numerous in ten- 
dons than in ligaments, but are arranged in the same manner. 

4. Aponeuroses. In all the fibrous envelopes of the muscles there 
are ramifications of arteries and veins, accompanied by nervous fila- 
ments; the latter being sometimes larger than the vessels. Two or- 
ders of nerves are met with in the aponeuroses. Some, having run a 
longer or shorter course in the fascia, leave it and end in the subapo- 
neurotic structures; while others, especially destined for the fascia, 
form frequent anastomoses, as in the ligaments and tendons. — Gaz. 
Med. de Paris, 2 June, 1866. 



TREATMENT OF EPILEPSY. 



Br. Hermann Beigel, in concluding some papers on the Pathology 
and Treatment of Epilepsy, (^Lancet, December 28th,) speaks as fol- 
lows : 

There is, perhaps, no other disease in which the physician can do 

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TREATMSNT OF XPILXP8T. 101 

more good to his patient than in epilepsy. In many cases he is able 
to effect a curcy by which term I mean the patient's not having fits for 
jears. K we see cures of epilepsy every week published in the jour- 
nals, and see farther that some writers fancy the patients to be cured 
because the fits do not make their appearance for several weeks, then 
we may rest assured that such an author has other motives in publish* 
ing his case than that of advancing science and serving the truth. 

In the majority of oases, the physician is able to improve the 
patient's condition, in a great measure, by turning very long fits into 
slight ones, or by causing the interparozysmal time to be much longer. 
Mr. Barry, late house-surgeon to the Metropolitan Free Hospital, 
has watched a case with me, which was of very great interest in a the- 
rapeutical point of view. The patient was a woman aged forty-eight. 
Six years ago she had been attacked with fits, and had ^^ scores " of them 
eTcry day — ^at least twenty in twenty-four hours. During the whole 
six years she was only once free of them for four days. She must, 
therefore, have had six thousand fits altogether. When I first saw 
her, she had an attack in my consulting room, and I confess it was the 
most terrible attack I have ever witnessed. She was treated by means 
of hypodermic injections of morphia, and in the week after the injec- 
tions, she had only one attack. The injections were repeated twice a 
week, and when the attacks were turned into "faintings," as the patient 
called them, which recurred about three or four times a week, and did 
not cause her to fall, she did not return to the hospital any more. 

Of the whole number of my patients, forty-six remained sufilciently 
long under treatment to warrant an opinion of the efficacy of the drugs 
applied. Of the number just mentioned, fourteen were cured, twenty- 
six have improved, while in six the treatment had no effect. A case 
which I am inclined to look upon as cured is the following: The 
patient was twenty-one years old, a shoemaker by trade. The grand- 
&ther had several fits, but the patient was in good health until three 
years before he came under my care. At that time he came up from 
t&e country, in order to see an execution at Newgate, which made such 
an impression on him as to bring on epileptic fits after a few hours. 
In these fits he lost consciousness, and was very much convulsed. For 
two years he was sometimes free from paroxysms for several months, 
and then again he had several attacks in the course of a day; six 
months, however, before he was admitted an out-patient to the hos- • 
pital, he was seized several times every day. He was likewise treated 
by means of hypodermic injections of morphia, which were continued 
for a long time. After having been free from attacks for about twelve 
months, he requested me, in 1865, to discharge him, in order that he 
might go in search of employment. A few months ago his father came 
to the hospital, and from him I learned that his son, who is now in 
the country following his trade, had never had a fit since he left the 
hespital. 

As to the remedies used by me for the treatment of epilepsy, I 
kave tried nearly all drugs which have been recommended by different 
authors, including urari or the arrow poison of the Indians, so strongly 

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102 WE8TEBK JOUBNAL OF XSDICINE 

recommended by a few continental physicians, which, however, has 
failed in my hands. 

But there are two drugs in which confidence may be placed, viz : 
bromide of potassium and hypodermic injection of morphia. It is now 
a well-known fact, that the former, when used in very large doses, has 
the power of postponing the paroxysms, and, in some instances, to 
make them disappear altogether. Hypodermic injections have the 
power of producing the same result in a much shorter time. It is 
very difficult to. explain why the action of morphia is different when 
given internally and when applied hypodermically, but that such is the 
case has been confirmed by reliable observers. 



ON MARKINGS OR FURROWS ON THE NAILS AS THE RE- 
SULT OF ILLNESS. 

BY SAMUEL WILKS, M. D., 
Phyiicbtn to Ouy*s Hotpital. 



The fact that the traces of a past illness may be found on the nails 
is probably known to many in the profession, as it is one with which I 
have been well acquainted for many jrears. Constantly meeting, how- 
ever, with medical men to whom it is unknown, I take the liberty of 
bringing the subject before their attention, hoping that the experienced 
will pardon the intrusion for the sake of those to whom the fact is un- 
known. I can not at present lay my hands on works of reference, but 
I believe ihe subject has been alluded to by English and foreign au- 
thors. On taking up the book on "Skin Diseases," by the late la- 
mented Dr. Hillier, I find the following casual allusion to it: — ^' Cross 
furrows are often seen on the nails. It has been suggested that these 
are due to an irregular growth of the nail from disturbances of health, 
the thinner portion being formed when the patient is out of health, 
and the thicker parts in the interval." My own distinct knowledge 
. of the fact that the nails become altered in disease was obtained many 
years ago, when a non-professional gentleman observed the circumstance 
for himself, and was so much interested in it that he referred the mat- 
ter to a distinguished natural philosopher. It was after a severe at- 
tack of diarrhoea, which caused almost as much prostration as Asiatic 
cholera, that he discovered a white line or depression at the roots of 
the nails. Having formed a pretty accurate idea of their rate of 
growth, he was convinced that the markings corresponded with the 
date of the illness. I may state that these marks are caused by a 
slight furrow, which is found more especially on the middle of the 
nail, and more distinct on that of the thumb. They point, no doubt, 
to a sudden arrest of the nutritive process during the time of the ill- 
ness, and herein lies the interest of the observation. In cases of fever 

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PROCSSSINQB OF MEDICAL 60CIBTIES. 103 

we know that the most profound changes take place in all the tissues 
of the body. In scarlet fever, for instance, the whole of the epithe- 
lial surface within and without the body is affected, and, as a result, 
we may witness a desquamation of the cuticle, falling of the hair, and 
fleparatien of the nails. When the fever is at its height, we can haye 
dien little doubt of the changes taking place in the tissues, and can 
feel no surprise that the nails show evidence of the former conflagra- 
tion. As the patient recovers, and a new cuticle forms, and the hair 
b^ins to grow, the nail proceeds to shoot forward afresh, and it is not 
leng before the latter exhibits a transverse furrow, indicative of the 
previous illness. It is possible, therefore, to ascertain the date of the 
attack. Physiologists say that the thumb-nail grows its whole length 
twice in a year, and thus it follows that if the furrow be found in the 
middle of the nail, the illness occurred three months before. This 
&ct may then serve for a limited period, like *' foot-prints on the sands 
of time," as some additional proof of a previous serious illness. For 
instance, a patient with a cardiac disorder stated that he had had an 
Olness three months before, and on his nails som^ transverse mark- 
ings were found; also another suffering from phthisis, said that his 
Olnefis resulted from an inflammation of the lungs, occurring a few 
weeks previously, and on his nails, also, some distinct lines were dis- 
covered. That a severe diarrhoea could produce such a cessation of 
the natritive process as to exhibit its effects on the nails is a fact for 
which I should have been unprepared had it not been apparent to the 
eyes. It is one, however, of extreme interest. I have never made the 
abject one of accurate clinical observation; but if I can induce my 
clinical clerks to record a few cases, the readers of The Lancet shall 
be furnished with the result. — Lancet^ January 2d. 



PROCEEDINGS OF MEDICAL SOCIETIES. 



PROCEEDINGS OF THE GRANT COUNTY MEDICAL SOCI- 
ETY. 

This society met pursuant to previous adjournment, in the office of 
Dts. W. k G. Lomax, in Marion, on Tuesday, November 24th, 1868. 
The President being absent, Dr. Shi^ely was elected President jpro tern. 
A quorum being present, the minutes of the previous meeting were 
read and approved for record. 

The name of Thomas C. Kimball, M. D., of Xenia, Miami county, 
was presented as a candidate for membership. Having the credentials 
reqinired by the constitution, he was unanimously elected; when he 



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104 WESTERN JOTTBITAL OT KBDICINE. 

signed the constitution, paid the assessment and was declared a mem- 
ber of the Society. 

Easiness requiring early consideration being in order, 

Dr. Kimball asked and obtained leare to bring before the meeting 
for examination and opinions of the members, a case of enlarged parotid 
gland in an athletic, robust man, aged about forty, and a farmer by 
occupation, who gave the following history of the case : 

Some twelve years ago a small tumor the size of a hazel-nut, was 
observed posterior to the angle of the lower jaw. It was hard, pain- 
less and movable, giving no suffering of any kind. It gradually and 
almost imperceptibly increased until it has attained nearly the size of 
a turkey's egg, causing some inconvenience to the free use of the jaw, 
and to opening the mouth widely; attended at times, and especially on 
taking cold, with a dull uneasiness in the tumor. It is quite protu- 
berant, irregularly nodulated ; the point first noticed as a small tunoior, 
stands out as if an outgrowth from the body of the disease. The whole 
mass is hard, heavy and movable beneath the skin and upon the sub- 
jacent parts. The progress of growth, he thinks, has been increasing 
for some time past. The health has generally been good, excepting 
that for the last four years he has been subject to attacks and relapses 
of ague, from which he says he is considerably reduced in flesh, and 
has recently observed a more dingy sallowness of the countenance 
than in good health. Has never heard of any cancer in any of bis 
family relations. The case has never been submitted to treatment. 

Having gone through with the examination, opinions were given as 
follows: 

Dr. Charles — From the length of time this tumor has existed, its 
slow growth, having only attained the dimensions of two inches in 
length and about one and one-half inches in its transverse diameter, in 
a progress of twelve years, its entire freedom from pain or adhesion to 
the integuments, the general good health of the subject, and absence 
of ancestral proclivities to malignant disease, would lead to the con- 
clusion that this was a benign tumor. As to its precise nature, he was 
not prepared to give a very definite opinion. It was, probably, an 
encysted tumor, not cheesy in texture he would think from its feel^ 
but possibly fibrous, which might degenerate into a malignant disease. 
Upon his first examination he thought the tubercle occupying the OLost 
prominent point of the tumor was merely an enlarged lymphatic gland 
which had become involved, or, perhaps, the first to take on disease. 
But on a more careful examination, he found it firmly adherent and 

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FBOdKMMaft or MKDIOAL 80CIBn£& I0& 

^Ting the appearance of a real outgrowth from the main body of the 
disease. 

As to the treatment, he should not have confidence in anything 
Imi the knife. And this might be attended with more or less danger. 
He could not determine by his examination, whether it had formed 
idhesions to the parts on which it rested or not. But from its adja- 
cency to the carotid artery and jugular vein, would fear those vessels 
ught be iuTolyed, which would seriously complicate an operation for 
ilB lemoTaL In view of the difficulties and haaards of the operation 
on the one hand, and the slight inconyenience to the patient, and the 
liov growth of the disease on the other, would advise non-interference 
for the present; but a careful watching of its condition and progress^ 
•0 that should it assume a decidedly threatening appearance, it might 
be remoyed at once, and before the difficulties of the operation should 
be materially increased. 

Dr. Kimball said this man had called upon him to treat the tumor, 
a few days since; but having consulted many different physicians, and 
receiTed a great variety, as well as discrepancy of opinions, he had 
eooelnded to bring him before the Society and hear the opinions of 
tke members, before making out a prescription. It was his diagnosis 
that the disease consisted in an enlargement of the parotid gland, and 
vtnid be difficult to remove by absorption or a surgical operation 
either. But he was thinking of first trying a course of discutient 
treatment for its reduction, and when this was thoroughly tested, 
should it fail to arrest the growth, would then resort to the knife. 

I>r. C. Lomax — ^After a carefizl examination, had no doubt of the « 
disease consisting of a morbid growth developed in the structure of 
the parotid gland. As to the real character of the growth he was not 
veil satisfied. While the general good health of the subject, the 
ftbeence of pain in the tumor, (it being neither tender nor sensitive 
mder pressure,) would^ indicate that it was one of a benign character, 
KTofulous perhaps; but its slow growth, nodulated surface, heavy, 
hidnrated feel, and the known tendency of diseases of this form to take 
on malignancy, would lead him to suspect this to be the true nature of 
tbe present disease. As long as it remains dormant, would advise that 
it be let alone. Would do nothing which might light up active inflam- 
mation. Avoid handling or examining it, and everything which would 
^d to develop active disease. Should this occur, however, and the 
general health suffer from the force of pain and enlargement of the 
^Uor, would then resort to extirpation* 

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106 WESTERN jomoTAL OF mwDfcm^ 

Dr. H*e88 — Thinks this is an enlargement of the pai^tid gland of 
malignant character. That little tumor on it is a diseased lymphatic ; 
would have no confidence in any attempt to discnss it; would do 
nothing unless it became painful, or should grow rapidly, when he 
would remove it with the knife; thinks it is external to the large 
blood-vessels, and may be removed readily and safely. 

Dr. Williams — Said this is a case to which we should, for several 
eonsiderations, attach more than ordinary importance. In the first 
place, we have a useful man and a most worthy citizen, who can illy 
be spared in the community where he lives. While we should ever 
feel under moral and professional obligations to render the best aid our 
science can furnish in every case entrusted to our care, there are some 
in which the moral and social bearings of the patient are calculated to 
awaken the most lively interest in his behalf, and this case seems to be 
one of that character. There is another consideration which imposes 
no small weight of responsibility upon the medical adviser, growing 
<mt of the peculiar nature of the case and the special stage presented. 
The locality of the tumor shows it to be an enlarged parotid gland, 
while the history of its development, the slow growth, the hard and 
lobulated feel, and the tissues involved, preclude the shadow of a doubt 
of its ms^lignant character. The dusky, dingy countenance, the loss of 
flesh amounting to fifteen or twenty pounds below his ordinary weight, 
the uneasiness complained of when the tumor overlaps the angle of 
the jaw, and in mastication and forcibly opening the mouth, all go to 
confirm the opinion given as to the nature of the case, as well as to 
foreshadow the fearful condition at no great distance in the future. 
He concurs in the opinion generally expressed, that the only rational 
hope of relief is in extirpation with the knife. But most of the gen- 
tlemen propose pos^oning the operation to a period when the suffer- 
ing of the patieut and failing health may demand it as a measure of 
relief. He would ask why should the physician advise delay when 
everything in the case teaches him that the issues of life and death 
may turn upon an early operation? The adhesions and complications 
are now so limited as to present comparatively but trifling embarrass- 
ment to its removal. And the operation would not only be more easily 
performed, but with less risk to the patient and much greater promise 
of security against a fixture return of the disease. Should it be per- 
mitted to run on, with all the depressing influences which the dread of 
mind accompanying its progress will unavoidably produce, until it has 
involved the neighboring parts, the difficulty and danger of the oper*- 

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PROCEEDINGS OF MEDICAL SOCIETIES. 107 

don will hare been greatly augmented, while the chances for an ulti- 
mate recovery and a permanent cure will be correspondingly dimili- 
iflhed. Should the patient liye for any length of time, the operation 
will finally have to be performed. With these views of the case, he 
Bhould feel it an imperative professional duty to advise the patient to 
nibmit at once to the operation, at the same time, giving him as full 
and fair a statement of the probable course and termination of the 
etse as possible, leaving the responsibility of a final decision of the 
matter with the patient himself. 

Br. Pugh — Thinks there is no doubt of the, tumor consisting of an 
enlarged parotid gland, and also, that it is of malignant character; 
woold expect an operation for its removal would be a difficult one, but 
would have no faith in any other remedy. 

Br. Corey — Has nothing to add in relation to the part involved, or 
the real character of the disease. Thinks, however, the. dusky hue to 
which reference has been made, may have been the result of bilious 
derangement, as the man states he has been subject to the ague for the 
last four years. He should certainly not attribute it to the ravages of 
a cancerous diathesis upon the constitution. As to treatment, should 
ftgree in opinions already given. But with regard to the time, would 
feel inclined to wait until evident inroads upon the general health or 
the rapid growth of the tumor, should demand it. The progress of 
the disease has been slow so far, and there has yet been no decidedly 
marked increase in its rate of development, and there is comparative 
freedom from pain, without special inconvenience from its size, and the 
operation required to remove it, even in its present condition, being a 
serious one, as important parts are necessarily involved, would lead him 
to adopt a compromising course, and let it alone' as long as it should 
eonfine itself to anything near its present condition. And he would 
advise whoever should attempt its removal, to prepare for a big opera- 
tion. ' 

Br. Shively said, the disease is located in the parotid gland. The 
dusky skin, the slow growth and lobulated condition of the tumor, 
the firm texture and uneven surface were stifficient reasons to his mind 
for the conclusion that the disease was malignant. Indeed, he could 
have no doubt of it. His only hope would be in an operation ; and 
the sooner the better. Should it be performed early, and the patient 
he restricted to the Twitchell regimen, he might live many years. But 
if delayed until the health runs down, all the difficulties and dangers 
win be increased, and the operation a failure. We all have witnessed 



108 WESTERN JOURNAL OF MEDICINE 

the fatal consequenoes of delay in similar cases; and also the happy 
results of timely operations. From all of these considerations, he 
would urge an early removal of the tumor by an operation. 

Dr. W. Lomaz said, he agreed with gentlemen as to the nature of 
the disease, the parts affected, and also as to the only treatment which 
promises any permanent advantage. Yet as to the propriety of an 
immediate operation, he could not feel so clear. There can be no 
question that an early operation would be more favorable to a complete 
and permanent cure, than one deferred until the disease had assumed 
an active and progressive condition. At present it appears to be in a 
quiescent or dormant state. The outlines are well defined; and the 
whole of the diseased mass could, probably, be readily removed, and 
that with but little sacrifice of sound tissues. The prospect, too, for 
a permanent cure is good, infinitely better than where the disease is 
active and spreading. For a mere surgical exploit, the conditions are 
peculiarly propitious. There will never be another period in the prog- 
ress of the case as much so. But there is another standpoint from 
which the case may be surveyed. It traverses the balance-sheet of ad- 
vantages and disadvantages, and casts its verdict with the prepondera- 
ting scale. Some of the issues appropriate to this calculation are pos- 
itive and fixed, and the others are hypothetical, and of value propor- 
tioned to the probabilities with which they are invested. Of the 
former class may be considered the paralysis of the eye-lids and side 
of the face, corresponding to the operation, which would inevitably 
result. Although the disability might have no tendency to shorten 
the natural duration of life, it would entail an inconvenience far more, 
gr^vious than anything yet suffered from the disease itself. The re- 
lief which a confidence in security against dying of cancer will bring 
to the mind of the patient, will depend upon the constancy with which, 
in after life, he may continue to believe himself once the devoted prey 
of that fearful malady. Whatever that might be should go to oflbet 
any unpleasant consequences resulting from the operation. But it was 
his observation that real or fancied injuries, professionally received, 
were more indelibly fixed in the memory of our patients than any im- 
munity from suffering which is strictly prospective, however well- 
grounded in rational and scientific faith it may be. And, however 
successful the operation, it will be almost certain, ultimately, to bring 
the censures of the patient upon the physician who performs it. This 
is one of the small persecutions inseparable from our profession, and 
should not enter largely into the motives of the conscientious physi- 



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FBOCSXDINGS OF MXDIGAL S0CIITIZ8. 109 

eian in settling a question of this magnitude. He was not sure b^t 
that tHe signs of active, malignant degeneration had been oyerrated by 
gentlemen who thought thej saw an urgent demand for an immediate 
operation. The dingy complexion and loss of flesh, to which so much 
importance had been given, might depend, as Dr. Corey supposed, 
upon the ague to which, during the last few years, he has been sub- 
ject Were it the result of cancerous cachexeia, lighted up by this 
local trouble, he should expect greater suffering in the tumor itself 
than has ever been experienced. There having never been any pain 
or tenderness of account, nor manifest increase in the rate of growth, 
would lead him to hope the disease might remain dormant for years to 
eome, and possibly until the patient might be carried off by some other 
malady. The inconvenience of his present condition is nothiDg com- 
pared to those which the most successful operation would inevitably 
produce. He would, therefore, recommend that it be let alone as long 
IS it remains in a passive state. Should it become painful, and assume 
an active development, he would advise its prompt removal And, as 
is common in such cases, many professional opinions have been sought 
and a great diversity given, he would specially caution him, when he 
submits to the operation, not to intrust himself to the skill of those 
expert doctors who have declared it to be as simple, as speedy, and as 
ttfe as the emasculation of a pig. 

Dr. Drayer was not satisfied whether the tumor was malignant or 
not From its slow and gradual growth, he would be inclined to think 
it is not. But it might be liable to degenerate into malignancy at any 
time — does not know what is the cause of it. Should it grow no faster 
is the future than it has done in the past, the subject would have to 
be an old man before serious inconvenience would be suffered. He 
vould, therefore, advise that it be let alone, unless more grave symp- 
toms should arise, when it could be treated accordingly. 

Dr. C. Lomax wished to inquire at what stage of cancerous affec- 
tions the dusky hue of the skin made its appearance, and what caused it. 

Dr. Williams replied, that it was when the constitution itself yields 
to the force of the disease. The cancerous poison destroys, to some 
extent, the red corpuscles of the blood; the tissues, in consequence, 
become reduced and shriveled; and both tissues and blood are defi- 
cient in vital force and activity. 

Dr. Kimball stated that the patient was desirous to have his case 
treated, and requested to hear the opinions concerning it. 
^ The president suggested that he be allowed to come before the 

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110 WX8TBEN JOUBITAL OF MEDICINX. 

meeting, and that the secretary give a brief summary of opinions as 
expressed in this discussion, which was done. 

Dr. Williams, firom the committee on the subject, reported that iHe 
case and drawers for preserving the books, papers and other property 
of the Society, had been contracted for and would soon be finished, 
and ready for use. 

The treasurer reported a balance in the treasury of $370.70, which 
report was received and approved. 

Dr. Shively reported a case of a large abdominal tumor, resulting; 
in death. It was removed in a post mortem examination, and weighed 
forty-seven and a half pounds. 

On motion, the secretary was ordered to furnish the proceedings oF 
this meeting for publication in The We$tem Journal of Medicine. 

The meeting adjourned, to meet again on the third Tuesday of 
January, 1869. Wm. Lomax, Secretary. 



CORRESPONDENCE. 



Fort Wallace, Kansas, Degembbr 31, 1868. 

Deab "Western Journal: " A fac-simile of your pleasant self for 
December, has been received, and, as usual, examined with the satis- 
faction it invariably brings. I will say that, next to The Amert- 
can Journal of the Medical Sciences^ The Half- Yearly Abstract^ and 
BraithujaitCj it ranks with them, and is quite the peer of the Lancet^ 
and the Medical Record^ The Medical New$ and Library^ and The Med- 
ical and Surgical Reporter^ all these several periodicals being finished 
by the Medical Department of the United States Army. 

For months past, in fact since last August, when the Indian war for 
1868 began, it has been my thought to give you, monthly, items con- 
cerning gun-shot and arrow wounds, many of these having had my 
supervisiou. Kegret that this duty was left undone is, however, all 
the apology I may offer, excepting the present mention of some of 
them, as follows: 

Duty with various scouting detachments, out ft-om this fort, during 
September and October, gave me rftre opportunities to witness not only 
the strange and exciting warfare with our wild red brothers, but also 
the variom character of wounds incident to* such warfare. 



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C6Bai8901V9IlVCB: 111 

It mfi mj pleaswe in September last, to bare been one among the 
fast to the relief of ike party of Brevet-Colonel (now Brevet-Briga* 
£er Oeneral) €K A. Forsyth, United States Army, that was attacked 
by oyevwhelming numbers of the savages, on the Arikare fork of ike- 
Bepabliean river, distant noYth north-west from this fort one hundred 
aad thirty miles. Ivthe bravevy of desperation, the assaults of the* 
nd-skins were repelled with deadly loes to them, whilethe GolonePs party 
Bsfersd severely. The cinmnistanceB surroundings these brave fellows 
diet the fight, were of such' nature as to have materially influenced 
t^ charaeter and results of the* wounds, and are of sufficient impor- 
tiooe to rehearse. On the day of the fight (the 17th of September), 
tbe svbeistence stores taken out by the Coloners party, were all* ex- 
hausted and beleaguered by the savages. For three days they wese 
foieed to IWe on the flesh of their dead horses and mules, all of which 
hkd been killed in the first day's fight. After the [third day, for five 
more weary, interminable days, waiting for relief, their only food was 
the pvtrid flesh of these animals, and a few joints of the wild cactus, 
to he found near by. So great was their loathing of the spoiled food, 
that they made efforts to shoot the prowling wolves at night for suste- 
nance instead. They, however, killed but one of these, which scarcely 
made* a taste around for* the famished men. Beside all this, they were 
kept inconstant vigil bytheproximity of the savages, and were exposed Ur 
seveial chill and rainy nights. Tfe reached them September 25th, and 
their altered appearance anu hollow voices betokened their peril ftrom 
&Bine. 

Of this- party four were killed outright or survived but a few hours ;- 
another one died the evening of our arrival, after amputation at junc- 
tion of middle and lower third of femur, for extensive destruction of 
its extremity, and the knee-joint; and one other died within two 
months after arrival at this post, from a wound involving the knee-joint. 
Of the fourteen- others wounded, eight of them are yet invalids, or 
eripples for life; while in* several diffuse abscesses and tendencies to* 
septicemia were present. In all of them, excepting three very slightly 
wounded, recovery is very tedious. Colonel Forsyth himself suffered^ 
vith the rest, and remains at this pest, bed-ridden, by a fractured ti* 
Ina, parts of which have necrosed^, and been removed, while the solu- 
tion of continuity still exists. 

During this fight an arrow struck a- man on the left frontal protu- 
berance, and could not be removed by a stout comrade. A moment 
afterwards, however, a pistol-ball- grooved the scalp adjacent, and car- 

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112 WE8TEBN JOUBXAL OF HEDICINS. 

ried the arrow several paces distant. This was one of the slight wounds 
mentioned — the man recovering in a few weeks time. 

In the month of November, another party oat from this point had 
a fight, in which our loss was four wounded, three severe arrow wounds, 
and one gun-shot wound, of the breast, all of which speedily recov- 
ered, while five Indians were killed and several wounded. 

Aside from the above, quite a number of interesting cases from 
civil (?) life, as the result of whisky, or of accident, have been treated 
hereabouts ; and the generally good results of all must be attributed 
to the salubrious climate of this region. Apropos of this I must men* 
tion a ccue occurring in November last, vii : 

Was called to Sheridan, (railroad terminus, fourteen miles distant,) 
by telegram, November 23d ; patient, a Magdalen Lizzie, »t. nineteen 
years i wounded in a drunken row, by a '* border " ruffian; found a com- 
minuted fracture of neck and head of left humerus; saw the necessity 
of and made an exsection, removing head of humerus and fragments, 
altogether three inches in length; improvising my assistants ftom the 
pistol-girded roughs at hand ; was forty minutes from beginning the 
exhibition of chloroform; some ooiing of blood, but no active hem- 
orrhage; lips of incision approximated by interrupted sutures. Was 
hastily called (all this at night) an hour and a half afterwards, when 
I found that a dangerous hemorrhage had occurred. Patient almost 
exsanguine; removed sutures at once, and found the ooze deep down 
in the bullet's track ; the anterior circumflex had been carried away by 
the missile ; my efforts to secure it were in vain, when I resorted to the 
only means at hand and cramTned the chasm full of old muslin torn 
into shreds ; over this a compress and roller bandage ; exhibited morph. 
sulph. grs. M, and remained until towards morning, when I secured 
some rest. 

November 24, 7 A. M. — ^Patient resting well, with no bleeding, 
but with an almost imperceptible pulse; sent to Fort for liq. ferri. 
persulph ; it came at four o'clock p. m., when I removed compress and 
stuffing, and saturating a good piece of sponge with the styptic, I re- 
peatedly mopped out the wound, filling up afterward with fine charpie, 
and applied roller from the hand up ; left morphine to be taken for pain 
or sleeplessness, but thought she would die that night. 

Saw her November 26th; doing well; pulse good, but weak; appe- 
tite also good; replaced soiled charpie with new, and reapplied roller, 
leaving more morphine, with directions as to diet, &c, 

November 28. — Wound in splendid condition, and patient rap- 



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<X>RBX890in>16NCX« 113 

idly improTi)ig; removed charpie, washed onfc the wound) and brought 
the edges together with one suture and adhesive strips; applied simple 
water dressings, and gave tr. ferr. chlor., gtt. xii, thrice daily. 

December 2. — Getting well rapidly; brought the edges of wound 
still more closely together, and applied simple dressing as before. 

December 10. — She is up and about; wound healed and well united, 
excepting a small depending wound, from which comes a slight dis- 
charge of healthy pus, and she has already resumed her former voca- 
cation, on the sixteenth day of her injury. 

December 25.— Is well recovered, and plying her vocation quite as 
formerly, (I am told,) and it is said that she is quite in demand and 
popular, by reason of her injury and abstinence during recovery. 
With this, I am, very truly yours, 

J. W. FiTZGBBALIS U. S. A. 



THE NEW MEDICAL LAW OF OHIO. 



Editor Western Journal of Medicine — Dear Sir: As our last ^ 
L^slature was pleased to adopt seme measures looking to the eleva* 
tion of the standard of the profession of medicine and the protection of 
the citizens of Ohio from empiricism ; and, although, probably, recog- 
nizing that such interests rest in the hands of regular medical colleges, 
still, for the encouragement of worthy persons whose circumstances 
have, thus far, prevented their graduation, they have reposed a trust 
in the country medical societies throughout the State, which it is pre- 
Buned they will not abuse, please permit me to give jou a synopsis of 
the action taken by the Scioto County Medical Society, 

A committee of three, with one alternate, was aj>pointed as a 
board of examiners, and instructed to grant certificates to those only 
who practiced medicine in accordance with the code of ethics as laid 
down in the constitution of the American Medical Association, and are, 
tfter a rigid examination, found duly qualified to practice medicine, 
Eorgery and obstetrics, and urge that the interests of the profession 
demand their graduation in some regular medical college, at their 
earliest convenience ; and also, that they shall grant "^certificates of 
limitation," in proportion to the correctness of the answers given to 
the questions asked, and n^ certificate given for a longer period than 
that of two years* 

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114 W£STKSN JOUKNAt OF MEDIcmB. 

Such a course, it is deemed, will effectually carry out tie objects of 
the law, by compelling the ignorant pretender to renounce his practice, 
and act as a constant incentiye to the worthy, but poor practitioner, for 
his earliest graduation. Respectfully yours, 

M. S. PiXLBT, Secretary. 

Portsmouth, Ohio, January 6, 1869. 



Cincinnati, January 7, 1869. 

Editor Western Journal: Laua Deo! Cincinnati has at last a 
hospital worthy of the city and the times, and will soon have forgotten 
the "old Commercial," and the temporary occupation of "St. Johns" 
and the " Orphan Asylum." As you know, it was intended to hare liad 
a part of the new building ready for use by the first of October last ; 
but there was delay in the completion of the Ann Street Sewer, and the 
finishing up of the thousand and one "last things " that had to be done 
before patients could be admitted^ so that the dedication was defer- 
red from time to time. But to-day the house was formally transferred 
by the Hospital Commission to the Board of Trustees, and to-morrow 
night will find the sick comfortably located in their new quarters. 

As seyen hundred and fifty thousand dollars of the city funds have 
been expended upon this noble charity, it was very properly concluded 
that the public at large ought to have an opportunity of seeing the 
result of such liberal expenditure, so the doors were thrown open at 
eleven A. M., and for hours a steady stream of men, women and ckild- 
ren poured through the wards and passages. Mere curiosity took most 
of them there, but to some, doubtless, it was a visit to the place that 
would receive them when next they were sick. The formal exercises 
were held at two P. M., in the amphitheater, which was densely crowded 
with representatives of all classes in the community. After the open- 
ing "Gloria in Excelsis," Mayor Wilstach, on behalf the Hospital 
Commission, transferred the keys of the building to the Board of 
Trustees, appropriately remarking upon the just pride that the city felt 
in her new hospital, and concluding as follows : 

"I have the honor, by virtue of my position as Mayor of the city and 
President of the Hospital Commission, to transfer to your hands, as Trustees 
of the Cincinnati Hospital, this building and its appurtenances, trusting 
that yon will so guide its destinies, that in the future all the people majr 
truthfully say: 'Well done, good and faithful servants.'" 

Pr. David Judkins, as representative of the Board of Trustees, 

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CORRESPONDENCE. 115 

received the keys, and gave a brief history of the hospital from its 
establishmeni in 1864, to the present time, showing how and when 
from the "old Commercial," that forty-seven years ago was, "by law, 
hospital, poor-house and insane asylum," there had grown out the 
Infirmary, Longview Asylum, and the present six hundred-bed Hos- 
pital, and- showing further the necessity of ample accommodations for 
the sick. 

''There are, at this time, in oar city, somewhere between eleven and thir- 
teen thousand men and women, mechanics, clerks, shopmen, &o., without fam-' 
iJiea, whose homes are in boarding-houses, and who, while health is afforded 
can manage to live with comparative comfort; but when sickness seizes 
them^ they suffer for thorough means of relief, occupying, perhaps, a small 
room in a cheap boarding-house, the mistress of which has not tne time to 
spare from her toil to pay them such attention as is essential to their relief 
and care — no time to watch at the bed-side, none to devote in preparation of 
proper food, ventilation of rooms and their proper cleanliness can not be 
attended to. In short, thev do not and can not receive such attention as will 
promote prompt relief and speedy cure. Here is a home for this class of 
persons where all these things can be found, and at the same time secure the 
ablest medical skill in the treatment of their maladies, and not as paupers 
either, for we shall be prepared with proper wards and apartments tor such 
u are able to pay their expenses." 

As the hospital was now in the hands of its proper Governors, and 
ready for its legitimate use, there was an especial appropriation in the 
invoking, at this stage of the exercises, the protection and blessing of 
Ac Great Physician, in prayer by Bishop Mcllvaine. 

Br. John A. Murphy, on behalf of the Medical Staff, followed in 
an able address, reviewing the history of the hospital, the efforts made 
from time to time to secure proper and ample accommodations for the 
aek, and the obstacles that had so often been thrown in the way of 
those who had endeavored to get rid of the old and unfit building ; in 
conclusion, assuring the gentlemen of the Board that "your medical 
staff who has sympathized with you, supported and assisted you to the 
be«t of its abilities, in your labors, again thank you, and pledges itself 
here to-day, to be with you in the future in carrying out in this home 
the wishes of all good citizens — the relief of the sick and the comfort- 
ing of the wretched." 

As the oldest member of the Staff, and one long associated with 
medical teaching and practice in the city. Dr. M. B. Wright spoke for 
the profession ; referring to the history of the hospital and those prom- 
inently connected with it in the past; showing the necessity and pro- 
priety of the erection of this "magnificent temple to the cause of 
humanity," pointing out the class of persons that would be benefitted, 
by its provisions, and indicating the* "delicate, yet stern responsibili- 



116 WESTERN JOURNAL OF MEDICINE 

ties reBting upon '* those connected with its administration. "Among 
these is the selection and continuation of a conscientious and compe- 
tent Medical Staff. In an address delivered by an honorable citizen at 
the laying of the corner stone of this edifice, is the following sentence : 
^ Let there be here the expression of the purest philanthrophy, embit- 
tered by no sectarian prejudices, controlled by no narrow code of med- 
ical ethics, but exhibiting to the world the daily manifestation of the 
truth that diversity of opinion may be tolerated with safety if the mind 
is left free to combat error, no matter where it exists — by whom it may 
be promulgated.' To these sentiments I yield my unqualified assent, 
and I am rejoiced to know that the motives and efforts of the profes- 
sion are controlled only by human suffering. It is no band of gipsies 
pitching tents here and there for personal gains. It walks the earth, 
scattering blessings everywhere and to everybody, and is covered by 
nothing less than the great dome of heaven. It guarantees the widest 
latitude of opinion, and imposes no restriction on practice. ' There is 
no narrow code of medical ethics * requiring the administration of any 
particular medicine or amount of dose. On the contrary, all are left 
free, in the exercise of a calm, enlightened judgment. There is in- 
scribed on the banner of the profession in living light, * Progress/" 

With the conclusion of Prof. Wright's address, the exercises were 
over, but during the remainder of the afternoon, a crowd still lingered 
about the building, inspecting and admiring. The completed portions 
of the hospital, (the administration buildings and western pavilions,) 
will be occupied to-morrow, affording accommodations for about three 
hundred patients. The eastern pavilions will not probably be ready 
for occupation before the first of May next. * 



DISCUSSION ON DIPHTHERIA, BY THE CINCINNATI ACAD- 
EMY OF MEDICINE. 

I have read the discussions by the Academy upon several subjects, 
as jpublished in the Lancet and Observer^ with great interest, and espe- 
cially that upon diphtheria. ^ 

It is the sum of individual observations, carefully made and com- 
pared, that gives us any safe basis for progress in our profession. 

No matter how humble or exalted the member who may be devoted 
to medical science, if he learns one new fact, and gives it to the world « 
every true-hearted physician receives it gratefully. ,<^ , 

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OORR£SPONDSNCE. 117 

Oar noble science is progressiTe. There is no place in our profes- 
sion where we can stop and say that our knowledge of this disease or 
tiiat, either in cause, pathology or treatment, is finished ; that we know 
all there is to be learned about any given disease. 

The great medical theories that have attracted the attention, and 
fonned the faith of so many medical men in the past, have culminated; 
one after another, and the popular furor that emblazoned them is ex- 
tinguished, and not a devotee is left to reverence their antiquity or 
former notoriety. 

It is well that we are settling down into a practical age, where we 
are to inquire for facts; no theory, no eminent authors, no assertions 
of this system or that, will answer in this age, unless founded upon 
incontrovertible facts. 

Bat to our subject. Our friends in the Cincinnati Academy of Med- 
icine have proved all I have said beyond a doubt. No one who reads 
care^Uy their discussion upon diphtheria, able, interesting and valua- 
ble as it is, can doubt one thing, that the medical profession have not 
yet settled the cause, pathology, diagnosis, prognosis or treatment of 
diphtheria. 

The learned and able disputants have given us many interesting 
fiicts and opinions, not only of their own, but of many eminent authors; 
yet they leave all the main questions and points- discussed still unset- 
tled, and some that they have settled, are not so clear to my mind as I 
would like to have them. 

It would be a great gratification to know the relation between diph- 
theria and scarlatina. Are they brothers or cousins? 

I>r. Murphy tells us " he has known diphtheria to come on directly 
after scarlatina, but does not believe that the two diseases could exist 
together." * 

Now if this opinion from a learned man, does not finish the whole 
question, I would like to give a few facts upon the point. 

In 1860 diphtheria began to prevail in this vicinity as an epidemic. 
It soon spread throughout the entire town and country. It prevailed in 
its epidemic form for some eight months, since which time it has appar- 
rcntly become one of the common diseases of the country. Among 
the great variety of cases was a family of five children, living three 
miles north of town, all sick at the same time. Two had ordinary 
diphtheria, one with the entire nasal passages, as well as tonsils, cov- 
ered with the diphtheric membranes as in the throat, as much so as I 



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118 WESTERN JOURNAL OF MEDICINE 

ever saw, witb full and perfect scarlatina. One of these cases died and 
one recovered. 

A German family, in town, had three children sick at the same 
time ] two of the cases had a perfect diphtheric deposit on the tonsils, 
with violent scarlatina at the same time. 

I was called recently to see a little daughter of Mr. Curls, aged 
eight years ; found her with diphtheric membranes fully developed. 
The second day a scarlet eruption came out over her entire body. Dr. 
Bowers visited the case with me, and said there was no doubt about 
the case. The double disease yielded readily to quinine,, iron and 
chlorate of potash. On the tenth day she had an attack of general 
anasarca, with an excess of albumen in the urine, which yielded readily 
to diuretics and tonics. I noticed a number of cases where children 
of the same family were sick at the same time, some with scarlatina and 
some with diphtheria. 

These facts, with many others, have convinced me that diphtheria 
and scarlatina do occasionally exist at the same time in the same indi- 
vidual. 

It was a matter of great surprise to see the wide difference in the 
treatment of diphtheria by the learned Academy, and especially to see 
the wonderful extremes in their mode of practice. The most venera- 
ble Dr. Carroll tells us ^Hhat all the varieties of throat-diseases zymo- 
tic in character, were caused by some blood-poison ; that when mild they 
will run a fixed course, endure a certain time, whatever the treatment 
may be. That we should not deplete unless there is exudation; but 
upon its appearance we should bleed, leech, vomit, purge, and apply 
cold externally." 

We are to understand by this, that in certain forms of zymotic dis- 
ease we are to do nothing ; that must be a great relief to the labors of 
the profession. In other and more violent forms, where there is exuda- 
tion, we are to attack our patient with the most heroic treatment ever 
known in the palmiest days of the great antiphlogistic theory of treat- 
ment. 

I love antiquity, and have often wished I could visit the tomb of 
Hippocrates; but I would' not like to bring from the tomb of any an- 
tiquated medical father, either the old notions of doing nothing for 
our patients, or doing too much. 

It seems to me a very singular idea that we should leave one-half 
of our patients to take the chances of getting well or dying without 
anything, and the other half a still greater chance to die by the rash- 



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GOEEBSFONDSNCS. 119 

ness «f our practioe. Dr. Murphy tells as " that when called to cases 
of membraoous exudations presenting intense toxic effects, he at once 
gives remedies that will liberate quantities of oxygen in the system, 
5Qch as quinine, tr. chlor. iron, chlorate of potassa, stimulants and 
food/' 

Here, in my humble judgment, is as much valuable advice in a few 
words, upon the treatment of zymotic diseases as ever came from any 
zun. 

Yet, what extremes these two men represent; the one rehearsing 
Ihe exploded notions of more than a quarter of a oentury ; the other, 
on the advance .guard of the great modern improvement. 

Mr. Editor, I have written this short article, not to criticise the 
proceedings of the Academy, but to raise a few questions that I would 
like to have answered : 

First — ^What is the relation between diphtheria, scarlatina, erysipe- 
Im and typhoid fever? 

Second — ^Are they not all lymphatic diseases? Or, is not their 
pathology located in the lymphatic system? 

Third — Do they not originate first in lymph-poison, instead of 
blood-poison? Wayne Griswold, M. D. 

CiscLsviLLE, Ohio. 



^ DEATH FROM CHLOROFORM." 



Ml. Editor : I read with the greatest interest the clinical lecture, 
11 jour last number, upon a fatal case of chloroform-inhalation, by 
Dr. Billroth, the eminent professor of Surgery in the University of Vi- 
enna. The high position of this gentleman, and his well-known ability, 
give unusual weight to any doctrines he may advocate ; yet, in science, 
no single authority can be considered so high as to allow statements to 
be received without question, or to permit error to pass unchallenged. 
It is not my purpose to examine at any length the views presented in 
^t lecture, but I can not abstain from calling attention to two points, 
in which, I think, the eminent professor is not sustained by facts. 

The first is the attempted explanation of death under chloroform, 
by claiming idiosyncrasy for the patient. Now the record of fatal 
^ases shows several instances in which the patient had inhaled the 
*»«8thetic with safety within a few days, the day before, and, I be- 
Uev, in one instance, on the very same day the death took place* 

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120 WESTERK JOURNAL OP MEDICINE. 

Idiosyncrasy is a peculiarity of oonstitntion, and does not change 
thus rapidly. If it did, with how much reliance could we adminis- 
ter any medicines, since the accepted doctrine of idiosyncrasies as to 
opium, mercury and other articles, is well sustained? How could wo 
ever be sure that the patient who took one of these kindly last week, 
would not be poisoned by an ordinary dose to-day? It seems strange 
that so eminent a man should haye overlooked the facts above alluded 
to, and their bearing upon the question of idiosyncrasy as an explana- 
tion of death from chloroform. 

The second error is in the following sentence: "The singular idea 
that a mixture of chloroform and ether is less dangerous than either 
of these substances used separately, has been abandoned." This may 
be true of Germany — it certainly is not true of England and other 
parts of the world. Moreover, there is a vast amount of evidence to 
show that this idea is sound ; almost universally, death under chloro- 
form is sudden — the patient has been overwhelmed, struck down in a 
moment by a powerful agent. Is it not reasonable to believe, then, that 
the more this agent is diluted, whether by atmospheric air, by ether, 
or by the vapor of alcohol, the lees probability there will be of death 
in this manner? Experience has sustained theory in this, or rather the 
theory has grown out of observation of the facts, and I believe that the 
use of a mixture of anaesthetic vapors is increasing instead of dimin- 
ishing. Yours truly, J. C. Reeve. 

Dayton, Ohio. 



BIBLIOGRAPHY. 



CONSTIPATION OF THE BOWELS; THE VARIOUS CAUSES, 
AND THE DIFFERENT MEANS OF CURE. 



BT S. B. BIRCH, M. D., 

Member of tbe Soynl College of Physicians, London ; Corresponding Member Salopian Madico- 

Btbical Society^ etc., etc. From the third London edition. Philadelphia: 

Lindsay A Blakiston, 1868. Pp. 181. 



Constipation of the bowels is a yery troublesome condition of no 
insignificant proportion of the human family, found among people of 
all ages and stations. We are of the opinion, too, that the dijficulty 

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BIBLIOGRAPHT. 121 

i» freqoentlj very imperfectly understood, and quite evroneously 
tr»ied. 

Dr. Birch sets out with a declaration of similar opinions, and then 
proceeds to consider the whole subject in a philosophical and practical 
sort of way. He regards improper regimen and badly regulated hab- 
its as the prime cause in a vast majority of constipated bowels, and he 
tiiisks the use of purgative medicines to oyercome this irregularity, 
Yilkottt an attempt to correct the cause, is not infrequently the means 
•f establishing permanent ill-health. 

The book has sound and judioievs theories, and well-considered 
pnetical recommendations. All medical men may find something in 
it pleasant and usefuJ. Its author, however, is something of a pedani, 
and given to verbosity; the essential matesial of the little volume 
lught have been presented in less than half its pages. J. F. H. 



LECTURES ON THE STUDY OF FEVER. 



BY ALFRED HUDSON, M. D., M. R. I. A., 

.n^lciaa to tha UMth Hoepltal. Philadelphia: Henry C. L«>a, 1869. Pp. 316. For sale by C« 
P. Wilder, Indianapolle : Robert Clarke 4k Co., Cincinnati. 



These fifteen admirable lectures, diadaetio in characrter, are to be 
MDfiidered as complimentary to the lecturer's clinical course in the 
hospital. 

Clinical lectuies pxopef , based upon the obseryation of the yarious 
patients as they are met with, have a kind of desultory, individual, or 
disconnected character, and Dr. Hudson yery properly came to the con* 
eluiMi that in so important a form of disease a&feyer, the students 
would the more con^pletely appreciate that importance, and the more 
hllj comprehend the whole subject in its true bearings, if, in addition 
to these bedside teachings, they should haye added a scientific yiew of 
ieTer, in a connected secies of lectures covering the entire ground, the 
practical points being illustrated and enforced by frequent reference ta 
iadiyidual eases examined in the wards of the hospital. This idea 
Dr. H. has carried out in a yery comprehensiye, entertaining and in-^ 
stnictive manner; beginning with the nature of feyer, and running 
dirongh the cause, symptoms, complications, termination, prophylaxis^ 
lad treatment;, and all this in a yer.y full and satisfactory manner, with^ 
out being tedious or prolix. 

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122 WC8TE&N jrOUBNAL OF MEDIGIinB. 

The immediate practical obserrations are confined to typlms, ty- 
phoid and relapsing synocha ; but the philosophical teachings compass 
the whole affair of febrile disturbances. The readers of the Medical 
New9 and Library will recognize this volume as that which has just 
been completed in the Library department of that journal. 

Nothing in this work, as presented to us, directly indicates whether 
it is a reprint of a foreign book, or an original American one. The 
preface is without date, and has no mark to signify where it was writ- 
ten. In the title page the author is styled a '^Physician to the Meath 
Hospital;" but where is the Meath Hospital? in Philadelphia, Copen- 
hagen or Dublin? If any one finds out that it is located in the last 
named place, he will derive his information from other sources than 
the pages of the book under notice. The lecturer, beside being aa 
M. D., is styled a M. R. I. A., whatever that means. One may guess 
at the interpretation of these mystical letters, but certainly no com- 
mon American student will be able to tell where the author is, or 
what he is, from this affix to his name. 

We think the publisher does himself a moral wrong, and injustice 
to the author of these excellent lectures, to say nothing of his lack of 
candor and fullness to his American readers, by the parsimony of his 
information in the opening pages of the book. J. F. H. 



A THEORETICAL AND PRACTICAL TREATISE ON MID- 
WIFERY, INCLUDING THE DISEASES OF PREGNANCY 
AND PARTURITION. 



BT P. CAZEAUX, 

Manber of th« Imperial Academy of Medicine, Ac, Ac. Rerleed and Annotated by S. Tarnler, 

Adjunct ProfoMor in the Faculty of Medicine of Paris, Ac, Ac Fiftli American ttom 

the SoTenth French Edition. By Wm. R. Ballocic, M. D. Published by 

Lindsy A Blakiston, PhiladelphU. For sale by 0. P. Wilder, 

Indianapolii; Bobert Clarice A Oo., Cincinnati. 



About twenty years siQce, when asking our preceptor, Dr. John 
Neill, what work to get on midwifery, the reply giyen was ^-Cazoaax." 
This was the first work upon this subject we read, and in the years of 
active practice, it is that to which we ofbenest refer. Both at home 
and abroad, as the numerous editions testify, '^Cazeaux'* stands unex- 
celled by any, unequaled by any. Prof. Tarnier, who, in consequence 
of the lamented death of the author of the book, edits this edition, 
concludes his preface thus : 



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BIBLIOOBAFHT. 123 

' ''It wonld be impossible to point out all the additions which are 
geaitered through the work, but they are very many. Everywhere 
have I accorded to the views of Prof. Depaul and Pajot, as also to the 
Tiews of all cotemporaneous authors, the prominence which they de- 
serve. I hope, therefore, that this book, which is, so to speak, a new 
one, will be found to represent all the most important knowledge which 
ve possess pertaining to the obstetric art." This hope, let us add, in 
conclusion, will l^e completely realized by any one who carefully con- 
salts these pages.- No one engaged in obstetrical practice, should deny 
kimself the right and privilege of possessing this book. T. P. 



THE MEDICAL FORMULABY; BEING A COLLECTION OF 
PBESCBIPTIONS, DEBITED FBOM THE WBITINGS AND 
PBACTICE OF MANY OF THE MOST EMINENT PHYSI- 
CIANS IN AMEBICA AND EUBOPE, TOGETHEB WITH 
THE USUAL DIETETIC PBEPABATIONS AND ANTI- 
DOTES FOB POISONS. TO WHICH* IS ADDED AN APEN- 
DIX ON THE ENDEBMIC USE OF MEDICINES, AND ON 
THE USE OF ETHEB AND CHLOBOFOBM. THE WHOLE 
ACCOMPANIED WITH A FEW BBIEF PHABMACEUTIC- 
AL AND MEDICAL OBSEBVATIONS. 



BT BENJAMIN ELLIS, M. D., 
Uto ProfoMr, Ac. Twelfth editiont curelully reTiied and much improred, by Albert H. Smith, 
K. P., F. 0. P., Phil. Lecturer on Obftetrics, Ac. Philadelphia. 
H. C. Lea, 1868. Pp.374. 



This huge title recites nearly all that need be said of ^^ Ellis* For- 
mulary," now attained to its twelfth edition. Dr. Smith has omitted 
some formulas that had become superanuated, and added some new 
ones. Many practitioners, in years gone by, have found great comfort 
in this book, and many more may do so in the present edition. 

Hypodermic injection, and inhalation of atomized liquids are suit- 
ably presented among the new appliances in therapeutics, but we find 
BO mention of Eichardson's method of producing local ansssthesia, 
vhich has great value in many minor surgical operations, and was 
worthy of being called to the attention of those physicians who will 
consult the "Formulary." J. F. H. 



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124 WESTERN JOURNAL OF MEDICINE. 

ATLAS OF VENEREAL DISEASES. 



BT A. CULLERIER. 

Translated from the French, wfth Notes and Additions, bj Freenan J. Bumstead, M. D., Profes- 
sor of Venereal Diseases in the College of Physicians and 8nit;«ons, New York, Ac. 
Published by Henry C. Lea, Philadelphia. For sale by C. P. Wilder, 
Indianapolis; Robert Clarke A Co., Cincinnati. Part t. 



We have already noticed the previous numbers of this magnificent 
work as they were issued ; the present fasciculus completes the volume. 
It is hardly necessary for us to reiterate what we have previously said 
in commendation of this work. The plates, so admirably executed, are 
themselves almost worth the entire price of the volume ; but besides, 
we have the fruit of the rich experience and learning in this depart- 
ment of disease; of one of the ablest and most celebrated of French 
surgeons, rendered still more valuable by the ■ excellent notes and 
additions of the American editor who, probably, more than any one 
else in the United States, is qualified to speak ex cathedra in all that 
pertains to venereal diseases. T. P. 



THESE DE PHARMACIE, PRESENTEE ET SOUTENNE A 
L'ECOLE SUPERIEUEE DE PHARMACIE. 

PAR ARMAUD FUMOUZE, 

Doctear en Medecino— Pharmaclen de premiere classe. Member de la Societe Entomologique 

de Franco, et de la Societe Chmiqno de Paris. DE LA CANTHARIDS OFFICI- 

NALE: Paris, choB Ocrmer Bailliere, Llbrairo*Editeur, 

1867. From B. Foagera, New Yerk. 



OFFICINAL CANTHARIS; A THESIS PRESENTED TO THE 
SUPERIOR SCHOOL, PARIS. 

BY AMAND FUMOMZE, ETC. 



This thesis of fifty-three quarto pages is divided into four chapters. 
The first is devoted to the natural history of the officinal cantharis. 
The second to the chemical history of the same. The third to the 
causes which alter or diminish the peculiar properties of cantharides; 
and the fourth, to the various insects to be met with in cantharides. 

These chapters furnish full and satisfactory information in relation 
to the subjects of which they treat. Many experiments are reported 
in detail. These will render this brochure attractive to the pharma- 
ceutist, for whom it will have more interest than for the physician. 
Two handsome plates, containing many figures, are attached. 

J. R. W. 



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BIBUOORAPHT. 125 

UTEBINE CATARRH, FREQUENTLY THE CAUSE OF STER- 
ILITT— NEW TREATMENT. 



BT H. B. GANTILLON, M. D. 
From th« Author. 



Here we have a monograph of nearly ninety pages, printed in Eng* 
Ml at Piiifi. Its author once resided in this country, but is now set- 
tled in Paris, and is preparing a work on disecue* of women^ this hro' 
cktft constituting a part of the proposed volume. 

We suspect that were it devoted to a method of causing instead of cuv" 
1)1^ sterility, it would have a great " run" in some circles of American 
wciety; such knowledge would be eagerly sought for, by not a few of 
tke female sex, who cheerfully sacrifice the pleasures and the duties of 
maternity upon the altar of insane and unholy fashion, or else shrink 
from the perils and the responsibilities of a condition which is the law 
of married life, for woman's lot is " to bear, to rear, to love, to lose," 
the fint and second quite as much as the third, and still more than the 
fonrth, of this quartette of duties, as sung b^one of the best poetesses 
of the day. 

Bnt to the book. The following are the topics discussed : Ana- 
tomical and Physiological Reflections on the Uterine Cavities, Causes 
of Uterine Catarrh, Symptoms of Uterine Catarrh, Diagnosis of Uterine 
Catarrh, Prognosis of Uterine Cat&rrh, Treatment of Uterine Catarrh, 
then, the Method of Performing Intra-Uterine Injections, and finally, 
Cues. For the purpose of injecting the uterine cavity, a solution of. 
nitrate of silver is used. The author has invented an excellent syr- 
'^1 holding but a drachm, a tube attached to it, having a diameter 
less than that of the ordinary uterine sound, round and perforated at 
the extremity, ^' with holes directed backwards towards the operator, 
on the same principle as the urethral syringe of Dr. Langlebert." 

The author speaks quite positively of the efficiency of this method 
^ treatment, and also of its innocuousness. While we write we recall 
» case reported a few years since by one of the New York physicians, 
^' ^oeggerath, we believe, where the injection of a solution of nitrate 
^ Bilrcr into the uterine cavity was followed by a fatal peritonitis j 
Bor are we prepared to abandon the creed firmly established in our 
^ds after a somewhat diligent study of "Bernutz," of the ready 
passage, in some circumstances, of fluid by the oviducts from the ute- 
nne into the peritoneal cavity. Nevertheless, it may be possible that 

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126 WXSTE&N JOTTRNAL OF HEBICINX. 

Dr. Oantillon's instniment will secure the benefits of intra-aierlne 
injections without their great peril; indeed, we think it decidedly 
the best that has yet been invented. "We will say still farther, we 
fully believe, and our practice corresponds with the belief, that a per- 
sistent uterine catarrh as imperatively demands local treatment as a 
conjunctival catarrh, and that in each case nitrate of silver is the best 
agent. 

But, on the other hand, we can easily understand that rash and 
reckless resort to this agent, whether in substance or in solution, may 
kindle the flame of a slumbering endo -metritis which shall spread to 
the substance of the womb, or else by continuity of structure, travel 
an oviduct and very soon develope a local or a general peritonitis, 
rapidly hastening to a fatal issue. Let physicians, while appreciating 
the advantages, be warned against the perils of certain methods of local 
uterine therapeutics. 

We heartily thank Dr. Gantillon for his little book, and we believe 
that it adds materially to a general professional knowledge of a very 
frequent form of uterine disease and of. its successful treatment. 

T. P. 



EDITORIAL AND MEDICAL NEWS. 



Three bills, in which the medical profession are especially inter- 
ested, are now pending in the Indiana Legislature. The first is enti- 
tled "-4n Act to protect the citizens of Indiana from Enipiriciim, and 
elevate the standing of the Medical Profession^ This act has passed 
its second reading, and probably will become a law, so far as legisla- 
tive action is concerned, (though we hope not, unless some material 
alterations are made in it,) before this number of the Journal reaches 
its readers. It makes it "unlawful for any person who has not at- 
tended two full courses of instruction and graduated at some school 
of medicine, in the United States or some foreign country, or can not 
produce a certificate from a State or county medical society, and is not 
a person of good moral character, to practice medicine in any of its 
departments, for reward or compensation, for any sick person in the 
State of Indiana; provided, that in all cases where any person has 
been continuously engaged in the practice of medicine for a period of 



ten je^n m sore, he shall be considered to have complied with this 
tct, and that when persons have been in continuous practice of med- 
icine for five years or more, they shall be allowed two years in which 
to comply with such proyision." The second section of this act re- 
coants the penalties for its violation— not less than fifty dollars, nor 
■tore than one hundred dollars for the first transgression, and for the 
tecond, thirty days in jail besides the fine, and in no case can any fee 
for professional services, rendered by the offender, be collected, and 
eoodttdes by stating that dentists are exempt from the action of thi» 
law. 

It is hardly necessary to tell oar readers that the law is badly 
Torded ; but this is a comparatively trivial objection. '^ Two full courses 
of instruction and graduated at some dchool of medicine," &q. • Now 
what period must these ^/two full courses" occupy? Can they be con- 
densed into eight or nine months, or must they occupy portions of at 
least two years? 

Some reputable medieal schools in this country admit gentlemen 
to graduation who have been in practice five years, and attended one 
eoBTM of lectures; others confer honorary degrees without asking 
whether the recipient has ever attended a single full course of lectures. 
Now will the law go behind the diplomas these gentlemen may have, 
and insist upon their attending "lectures" a while longer? "Gradua- 
ted at some school of medicine." No matter whether by grace or 
merit. It is shamefolly true that men have diplomas without even a 
good English education. No matter what school — simply "some 
Khool" — ^it may be a school whose diplomas, signed and sealed, are 
peddled abroad in foreign countries, as was the case with those of" an 
eastern Eclectic school, until the foul wrong was exposed through the 
iaflaence of Dr. Corrigan. 

Bat again : State and county medical societies may license. Bui 
what medical societies? Eclectic, Homoeopathic, Hydropathic, any sort 
you please, just as well as those of the regular profession. But even 
if this power were specifically confined to the societies representing reg- 
ilar medicine-*~a measure that we should look upon as impolitic, to say 
the least — ^great abuses might result from giving it to so many different 
toorees. Every county in the State may have a county society — it may 
ha? e a doxen, all licensing doctors. But suppose no county society ex- 
ists, as is the case in several counties in this State, what is the appplioani 
for license to do? Or, suppose such society existing, it meets at distant 
intervals, rarely has a quorum, does not represent some of the best ele- 

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128 WWnSBlN JOUBKAti 09 MEDICim. 

tnento of the profession in its locality, is under the control t)f a eliqtie 
of selfish men, who can not brook any rivals for public patronage, or 
who would crush every one by foul means if not by fair, that was not 
of their ^^set," worshipping their golden calves, kissing their croco- 
diles, or becoming petrified like their ibssilsl We believe that the 
delegation of this power of licensing doctors should not be made to 
the society or the different societies of a county, for the reason that 
injustice might sometimes be done from prejudice, unscrupulous selfish- 
ness, or other cause, now and then. When there should be a hun- 
dred or more examining bodies in the State, what uniformity of exam- 
inations might be expected. One county society might license a doc- 
tor when he had been rejected by a dozen others. We believe all per- 
taining to State and county societies ought to be eliminated from the 
bill; and the power of licensing confined to -a board of three or five 
physicians, appointed by the Governor, (confirmed, if thought best, by 
the Senate), which shall hold semi-annual sessions at the Capital : each 
member of the board receiving from every applicant for examination, 
a fee of three or five dollars. 

One word more. We hope our friends are not expecting too much 
firom legislation. The passage of this or a dozen similar bills, but 
more stringent — however much good to the people and to the profes- 
sion they may accomplish-— is not going to bring the medical milleni- 
um. Our chief work to exalt Medicine to that sublime position which 
she ought to occupy, must be done in and with ourselves — in our own 
ever-growing attainments, in our own ever-enlarging philanthropy, in 
our own ever- vivid conscientiousness: every drop being pure and 
sparkling, shall not the entire fountain be clear as crystal? Every 
grain of gold being thoroughly purged from the dross, shall not the 
burnished shield fiash perpetual brightness on the pathway of man? 

The other two bills to which we refer, are one in reference to the 
establishment of a medical department of the State University, and 
the other for the registration of medical practitioners in each county 
auditor's office every year, a fee being paid by every one thus register- 
ing, (he at the same time specifying the school to which he belongs), 
these fees to be distributed to the different county medical societies. 
This last bill was prepared by our friend Dr. Hibberd, and we hope 
he will give in the next number of the Journal some details as to it. 

As to the bill for the establishment of a medical department, to 
be located at Indianapolis, of the State University, we have merely 
space to say, that the trustees of that institution propose, if the legis- 



.oogle 



htm Bboald gire the Uniyersity the ^'agrkultunj college graai/' to 
spend a part of the funds in that way, their design being to build wf 
a medical school upon a similar plan to that belonging to Michigan 
fJiiiTeraity. In a fdtore nninber we shall have sonetiiing more to say, 
ihonld this bill pass, upon the subject of a medical school in Indiana—^ 
enly bov saggesting that neither will snob an institntion make a medr 
leal miUeniom. 

Ik thb Philadelphia Medical and Sur^cxil Reporter^ January 2d, 
m find the following in reference to Priority in Ligature of the Fetno- 
nl Artery. We only wish to premise the extract by saying that the 
eredit of haying pointed out the priority of American surgery in this 
eperation, for such therapeutic purpose, is due Prof. BlaokmaB. 

'^Inacomnranicatian to the Britith Medieai Jawmaly in June laal^ 
Xr. C. F. Maunder, F. R. C. S., thus gracefully yielda a palm to Amer* 
kan surgery. All honor to Mr. Maunder ! 

"Twelye months ago I proposed the application of a ligature to 
ike superficial femoral artery^ to check acute inflammation of the limb 
following wound of the knee-joint. The operation was performed with 
immediate and continuous benefit, and the patient recoyered. I need 
iearoely say that at that time I belieyed the suggestion to be original^ 
sad kaye only now been undeceiyed by the perusal of a short paper 
upon the subject, in the American Journal of Medical Sciencet, of 
April, 1868. It there appears that the femoral artery was ligatured, 
ybif— for wound of the knee-joint, by H. U. Onderdonk, M. D.,. in the 
yesr 1813, and occasionally since that date also i^ Anaerica. It is a 
mrioQS fact that no surgeon has oyer informed me that my suggestion 
was not original ; and it is still more strange that the author of the 
Awmui Medicw, 1867, published in the Lancet, should haye spoken of 
the operation proposed by me 'as bold and novel, (italics aire ndne,) 
and withal auccessfy , surgical proceedings of the year, we may men* 
tioB the ligature of the femoral artery in a case of acute traumatie 
iniammation of the knee-joint, on the principle of diminishing the 
arterial supply of an inflamed part — a principle suggested by Mr. 
Maander, and now under much discussion.' Still, with the «yulenea 
before me, it is clear that I can not claim priority in the suggestioh; 
tal I haaten, by thus addressing you, to giye eradit to wliam oredil 
bdae." 

DsATH OF Db. F. Schusbmann. — At a meeting of the medical 
frefcssioB, held at the Dental College, Monday eyening, January llih, 
IttH, for the purpose of testifying their respect for the memory of ih% 
kte Dr. Fsmnois Sehuermann, Dr. Dawson «aai called to Ike efalury airf 
Aa foUowing resolutions were unanimoBsly adopted: , • 

"Wmotxia, Ck>d, in his allwiae proyidence, remoyed, after a liitgerUif 
oar friend and ooUeague, Dr. Fhuioia fidbuermaBa, one of dmt oldeal 



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Is^ wmiBii jeimKAL of mbdicins. 

teemben, who diad on lli« Itt of JtMUtaj, ftfter a lo9g life of piofeMioiiA] 
uefulneM, in thit cilj ; 

^Re9oltcd^ That we hsTe received the intelligeace of the death of Dr. F 
Behuermann, with the deepest lorrow. 

^'EeMolc€d, That wo doplore the loes whieb oar profeiaioo haa mol with 
throuirh hia deceaae. 

^^Sesolved, That these proceedings be published in the daily papera and 
Medical ioornala of this city, and that a copy of these resolutions bo sent to 
the family of the deceased." 

Dr. A. Rosenfeld, Dr. Wm, Carson, Dr. C. S. Muscroft, Dr. J. P. 
Walker, Dr. J. 8. Uniioker, Committee; F. Brunning, M. D., Socretarj. 

For Balk. — An order for an artificial limb. Will some one of 
our surgical friends take notice? - 

New SuBacaiBlBS caa be furnished with complete sets of the •/our- 
not from its oommencomftnt, January, 1866, to the psesent, the Feb- 
raary number for 1864 exoepted. By the Way, we still offer twenty- 
fire cents for each copy for that month. 

We hope our friends will not weary in their efforts to add to our 
subscfiption list, npr in our solicitations for such efforts. Even if eacli 
one of half our subaoribers added a new one-— a thing which any of 
them could easily do— we would be content. 

Pleabi kemehbea that subscriptions are expected in admanee^ 
when it is practicable for parties to remit. We hate to *^dun,** but 
we hate still worse to be in debt. By the way, we send receipts in the 
Journal^ not by letter. 

A niXND at MuBoiet, writes us that the post-master ihere ohargea 
twenty -four cents postage for the Western Journal of Medicine, This 
IS wrong; the charge shimid be but twelve cents, as we are informed 
by the post-office department here, and we hope the error will be 
promptly eeneoted. 

t Wl wfiB ta Mggast to those of our friends who have not their 
Ktos insured — and we believe physicians, above all other men, eught 
to have such insurance — that the Mutual Life Insurance Cohpant, 
09 New York, the advertisement of which we publish^ is one of the 
f #17 best eeiepanies iu the United States, and especially eharactedied 
\f its Rhefil aed honorable eeurse towards medical gentlemeii wlie 
may be in its employment; We speak that which wo know in tikis 
Vegardu- 



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THE WESTERN JOURNAL OF MEDICINE, 

(Former^fJ "Ginoinkati Journal of Mbdioinb.'') 



Thug it will be Been that If man has paasioni which impel him to the destruction of man, if 
Is be tbe only aaimal who, despising his natural means of attack and defence, has devised new 
aeus of destmetion, he Is also the only animal who has the desire, or the power, to teUere the 
nAriagi 4)f his fellow citizens, and in whom the bo-e&istonce of reason and benoTolence attosta 
ftiwnl is well as an intellectual superiority Gravbs^ CuincAL MsDrciKS. 



Vol IV. INDIANAPOLIS, MARCH, 1869. No. in. 



GUNSHOT WOUND OF THE SPINE— WOUND INVOLVING 
THE ATLAS AND AXIS. 



BT 8. 0. THOMAS, M. D., MILROY, IND. 
(Bssd befora the Bosh Oonlity Ifedieal Society, and pnhlished by request of th« Sodaty.) 



July 12^ 186S, 4 o'clock P. M. — I "Was sumttioned in haste to see 
Mrs, Ann B— — , who had been accidentally shot by her husband, with 
X rery small Yest-pocket pistol, with which was used conical ball-cart- 
»^ 

After examination, I found the ball had entered beneath the inferior 
Bixillary bone, two inches to the right of the symphysis mentis, rang^ 
iog apward and backward, entering the npper and right side of the 
&Qces, immediately behind the "velum pendulum palati.'' 

Hemorrhage was quite profuse firom the mouth and right nostril 
fer a Tery few minutes, after which it almost entirely ceased, and we 
M no further difficulty from that source until some thirty-six hours 
kfore death. 

When I first saw patient her mental condition was good. Nerrous 
sjBtem but little disturbed. No acceleration of the pulse. Respira- 
tioB normal. Articulation of sounds and deglutition attended with 
auek difficulty and |^ai«i« 
(10) 

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132. WSBTIRN JOURNAL OF MZDICINK 

Treatmunt. — Cold water dressings to chin and neck, and anodynes 
sufficient to control pain. 

July 13. — Seventeen hours after accident. I found patient feeling 
very uncomfortable, on account of augmented inflammation, and swell- 
ing of the chin and the right side of the fauces. Complains of pain 
in back portion of head and neek, aud also that sbe is incapable of 
otating the head. Kespiration and circulation but slightly changed. 
Deglutition less troublesome. Swallows fluids very well. Articula- 
tion of sounds much the same. 

Treatment — Continued, with the addition of the sulphate of mag- 
nesia to move the bowels. 

July 14' — Patient complains of increased pain in posterior portion 
of the head and neck, and also of extreme soreness at the junction of 
the spine and cranium. Slight photophobia. Inflammation and swell- 
ing increased, and suppuration set up in the right side of the fauces. 
Muscles of the right side of the neck very sensitive to the touch. 
Bowels not moved. Other symptoms much as they were before. 

Treatment. — Ordered sulphate magnesia to be repeated every 
three hours, until free catharsis shall be obtained. 

July IS, — Says she feels better, and that the pain in the posterior 
portion of the head and neck has subsided. Stiffness and soreness of 
the neck still continue. Bowels freely moved. 

Jukf IS, midnight — ^Patient grew suddenly worse. Pain in poste- 
rior portion of the head and neck greatly augmented. Excruciating 
pain in front portion of the head. Much intolerance of light. Had 
a very severe and protracted rigor, — lasted about three hours; after 
which complete reaction came up. The wound in the fauces ceased to 
uppurate for six hours, after which it threw off more than at any time 
previous. 

July 16, 9 A, M. — Pulse feeble and quick. Respiration labored 
and rapid. Deglutition again attended with pain. Severe pain in 
back portion of head and neck, with increased stiffness of the lat- 
ter. Increased soreness of the muscles of the right half of the cer- 
vical region. Profuse perspiration. A painful condition of the 
muscles throughout the whole system. Congestion of the conjunctivae ; 
but less intolerance of light than through the night. Increased swell- 
ing of the right and posterior fauces. Persistent nausea. Within 
twenty-four hours, four large and offensive' stools. Exhibits unusual 
anxiety. 

Treatment. — Wine, quinine, chlorate potash and sulph. morphine. 



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OUN-SHOT WOUND OF THE 8PINX. 133 

Jultf 16, 6 o'clock P, M, — Met Dr. M. Sexton, who was called to 
Tisii patient. We found patient better than in the morning. Has had 
four rigors since midnight; the last one only lasting some twenty min- 
utes. Circulation one hundred and twenty; respiration twenty -four. 
Heary, muddy coat upon the tongue. 

Swallows much better. Has taken solid food without anything to 
moisten it. Appetite better than at time of morning visit. 

Treatment — Continued. 

July 17, 9 A. M, — ^Respiration eighteen, and circulation one hun- 
dred per minute. Pain in the extremities has subsided. Pain and 
Eoreaess at the junction of the spine and the cranium unchanged. 
Less congestion of the conjunctivae, and, also, less photophobia than 
for three days. Secretion of pus large and very oflfensive ; it often 
excites vomiting as it passes through the mouth. In other respects 
patient much better. 

Treatment — Continued . 

Jv/jf 18, 9 A. M. — Circulation one hundred ; respiration increased 
in frequency, and attended with pain in upper portion of the chest. 
SwilWs well any kind of food. Less inflammation of the fauces; 
notwithstanding patient complains of pain in that region all of the time. 

Pain in the back portion of head and neck increased within twen- 
tj-fonr hours. Stiffness of the neck and shoulders is giving much 
distress. Does not breathe through the nostrils, but alone through the 
Bonth. Breathing loudly stertorous during sleep. During sleep the 
expired air leaves the mouth as if blown out, as in smoking. A te- 
tanic condition of all the muscles. A slight noise disturbs the patient 
mncli, although she is rational and conscious all of the time. 

Extremities covered with a cold, clammy sweat. Increased photo- 
phobia, and congestion of the conjunctivas. Sleeps with eyes nearly 
open. Takes but little food, and there is an increase of thirst. 

Treatment. — Ordered the bowels moved, and the other treatment 
c<^ntinued as before. 

July 19, 10 A, Jf. — Patient is feeble; but in every other respect 
dtt is much better/ 

Trsatmeht. — Increase the dose of tonics and stimulants. 

July 20,9 A, M, — Pain in back portion of head and neck very 
gnat through the night, but slightly better this morning. Complains 
of dimness of vision. Muscae volitantes, and roaring in the ears. 
Pliotophobia increased. More swelling of the right side of the fauces 
uid RvuU. Large secretion of pus by internal wound. Can swalloir 



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134 WXSTEBN JOURNAL OF MEBICINX. 

fluids well, but solids not at all. Increased thirst. Bowels very free 
in their action. A severe and protracted rigor during the night. 

Treatment — Continued, with the addition of an astringent for 
bowels. 

July 21^ 9 o'clock A. M, — Much improved in almost every respect. 
If it were not for stiffness of the neck, we would conclude that our 
patient was fast approaching cure ; for at every other point there has 
been a marked change for the better. 

July ^3, 10 A, M. — ^Rested badly during the night, notwithstand- 
ing she was doing quite well previous to that time. Had a severe rigor 
at two o'clock A. M.; and after reaction was set up, she had very high 
fever, which still continues. Bowels very active, and the stools large 
and offensive. No appetite for anything. Tongue covered with a 
heavy brown coating. Circulation feeble and frequent. External 
wound entirely healed, and swelling and inflammation of the fauces 
greatly reduced. 

Treatment. — Gave full doses of quinia, chlo. potash, per. sulph. 
iron, and wine. Anodynes, to be used as occasion may require. 

July 24^ 11 A. M, — Case unchanged since yesterday, except the 
diarrhoea, which is now somewhat controlled. 

Treatment — Continued. 

July 26^ 10 A. if. — ^Patient sleeps with eyes wide open, and the 
eyeballs continually in motion. Froth and mucus forced out of the 
mouth at every expiration during the most profound sleep. Other 
symptoms unchanged. 

Treatment — ^The same. 

July 26, 11 A, M. — ^Patient much better. Circulation eighty-five, 
and full. B.e8piration sixteen, and easy. Skin soft, moist and warm. 
Suffers no pain, except when she attempts to move the head. Swal- 
lows food without any trouble. Very little redness or swelling 
about the fauces. Suppuration profuse and offensive, and of a dark 
yellow color. Appetite improved. No thirst. Eyes less open, and 
no motion of the eyeballs during sleep. No^frothing, nor any other 
disturbance of the mouth during sleep. 

Treatment. — Supporting. 

July 27 and 28, — Improvement continues in every respect except 
the stiffness of the neck. Able to rise up and remain for a consider- 
able time without fatigue. 

July 29, 11 A, M. — Patient has been resting quietly since last seep. 
Circulation and respiration normal. Discharge of pus from fauces 



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OUN-SHOT WOUND OF THE SPINS. 135 

still large and offensive. Pain has entirely subsided, and but slight 
soreness remains in the cervical region. Bowels rather free. Appe- 
tite good. 

Trsatment. — Stimulants, tonics and astringents. 

July SO. — Patient still improving. 

Jubf SI. — Walked across the floor, and took her meals with family 
at the table, and does not suffer any inconvenience from any cause, ex- 
eept stiffness of the neck. 

From t&is time until August eighth, patient steadily improved in 
strength and ability to walk. Gould not rotate head, and when she 
sttempted it, increased soreness of the cervical muscles was the conse- 
queoee. After she was able to walk about, she would occasionally 
kave a rigor, (never lasting over a few minutes), whenever excited or 
fatigued from any cause. 

She performed manual labor of the lighter kinds for a few days, 
and did not seem to suffer any inconvenience from it. I am told that 
she spun or twisted yarn at the big wheel for a part of one day, and 
that it resalted in nothing more than slight fatigue. 

August 8y 8 o\lock A, M. — Patient feeling as well as she had for 
days, walking over the yard, and, without any apparent cause, fell, bat 
quickly got up again without any assistance. She stated that she 
knew no reason why she fell, except the sudden giving way of the 
muscles. 

At twelve o'clock m., she was seized with a severe lancinating pain 
beneath the right mammary gland, which continued gradually increas- 
ing until four o'clock P. M., when she coughed, and at the same time 
ielt something give way at the seat of pain. Complained that the 
ehest felt full and hot, and that the breathing was difficult; after 
which came profuse hemorrhage from the mouth. Judging from the 
general appearance, and the amount that could be collected, I think 
the patient lost one quart of blood. 

When I first saw patient, she was pale and apprehensive; cir- 
eolation one hundred and forty and feeble, respiration twenty-eight 
and labored. Examination of the chest revealed the fact that the 
bronchial tubes were filled with a fluid. Bronchial rales could be 
heard all over the chest. Pain in back portion of head and neck ex- 
eniciating. Increased thirst. Appetite gone. During the day she 
had three paroxysms of hemorrhage, but the amount of blood lost 
wassnudl. 

Treatment. — Stimulants, tonics and anodynes, to be given freely 



<,te 



136 WESTERN JOURNAL OP MEDICINE. 

Augutt 9j 9 A. M. — Patient more feeble. Portions of the Inngs 
not expanded this morning. Pain in bead and neck mucb the same as 
yesterday. Has occasional rigors, but tbey are not severe nor long. 

Treatment — ^Continued. 

Augicst 10. — ^One paroxysm of hemorrhage during the night. Rap- 
idly failed in strength, until death closed the scene, at eight o'clock 
A. M. 

Post mortem examination, held at two o'clock p. M., six hours after 
death. Drs. F. M. and P. M. Pollitt gave kindly and efficient assist- 
ance during the examination. 

Symptoms during life led to the examination of the lungs first. 
Lower and a portion of the upper lobes of the lung were largely 
congested. By cutting into the lung structure, we found isolated 
patches of miliary tubercles and the air-cells filled with extravasated 
blood, which fiowed freely as soon as the incision was made. The 
bronchial tubes were healthy, and the right were filled with blood. 
Being satisfied with our examination of the viscera of the chest, we 
next turned our attention to the wound. The wound, from the en- 
trance of the ball to the point where it passed into the fauces, seemed 
to be thoroughly healed, and almost all trace of it obliterated. 

The ball passed through the fauces, impinging heavily upon the 
anterior arch of the axis, in close proximity to its junction with the 
atlas, producing a radiated or comminuted fracture. The soft parts at 
and in the immediate vicinity of the injury were in a suppurative con- 
dition,' and had a dark and gangrenous appearance, emitting a very 
disagreeable and offensive odor. 

After careful examination of the wound, we discovered small pieces 
of bone, which were easily removed with the fingers. Notwithstand- 
ing we made strict and minute search, we were unable to find the ball. 
The anterior articulating surfaces, as well as the ligaments connecting 
the anterior portions of the axis and atlas, were entirely destroyed, 
and the odontoid process detached so that it could be easily removed. 

The theca vertebralis was in a softened and almost disorganized 
condition, so much so, indeed, that its continuity of structure was 
easily destroyed by our manipulations, in connection with our exami- 
nation of the parts. The medullary matter for an inch each way, in 
the spinal canal, from the opening in the spinal column, was largely 
mingled with dark, grumous blood. The connection between the axis 
and the atlas was so fragile that the weight of the head, when thrown 
backward, destroyed it. 

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FOUB CASES OF EPILEP8T. 137 

We were unable to say l^at the hemorrhage immediately preceding 
death came from the wound, because there were no important blood - 
yessels in the line of injury, and, also, in consideration of the fact that 
Aere was strong eyidence, before and after death, that it might have 
come from the lungs. 



EPILEPSY— A REPORT OF FOUR CASES, WITH TREAT- 
MENT, FROM MY NOTE-BOOK J ALSO, SOME REMARKS 
AND OPINIONS UPON THE PROGNOSIS, AND STUDY OF 
THIS SAD DISEASE. 

BT WATITE GRISWOLD, M. D., CIRCLEVILLE, OHIO. 



Case I. — J. D , boy five years old. First called to the case, 

February 4th, 1867. Well developed; nervo-bilious temperament; 
dark hair and eyes, but dull and downcast in look ; like most epilep- 
iiea, inclined to be silent, morose, petulant, and excitable ; occasionally 
complains of pain in back part of head; respiration and circulation 
nttaral; bowels regular; appetite good; inclines to run and play as 
Bsoal. 

Had enjoyed good health up to last July, when, after playing in 
the hot sun for some time, he went into the cellar kitchen and laid 
down upon the damp brick floor, fell into a sleep, took a congestive 
chill, followed by fever, producing a violent epileptic convulsion. 
Prom that time up to February 4th, the boy had a return of the par- 
oxysm every four to six weeks, usually in the night. 

The parents were deeply anxious about the chlid, and very solicit- 
om to know if he could be cured. I gave them to understand that I 
Bhonld have great hope, if they would follow a prescription for ten to 
fifteen months. I make it an invariable rule to make no prescription 
for a chronic case of epilepsy requiring medication, unless they will 
follow the directions from ten months to two years. Trousseau never 
ottered a greater truth than when he said, '^chronic diseases require 
chronic treatment,'' and it is particularly so in epilepsy. 

I could not discover any organic lesion in the case ; no hereditary 
taint; no trouble with teeth, worms, kidneys, bladder, sexual organs 
or bowels. My theory of the case was, that some congestion or irri- 
tation of the medulla oblongata had remained from the severe attack 



^iyiiiz.cu uy ■ 



"«3 



le 



138 WESTERN JOURNAL OF MEDICINE. 

in July, and that occasional excitement from deep sleep, prodnced sad- 
den contraction of the yaso-motor nerves of the encephalon and its 
meninges, followed by anemia of the brain, and the epileptie paroxysm. 
Prescription. — Good food, free exercise in the open air, with an 
ocasional warm bath. 

• B Potaasli Brom., ^iii. 

AqujB gir. M., Ji, ter. die. 
Also, rub the back of n^ck and spine with strong stimulating liniment. 

At the end of three weeks, I gaye the boy a half grain of yaleri- 
ante of zinc, three times per day, with the potassium. 

The boy had but one paroxysm after the treatment was fairly com- 
menced. This course was followed for nine months, without change, 
and then gradually slacked off. The bpy has been perfectly well ever 
since. 

Case II. — E. B , girl, aged five years; nervo -sanguine temper- 
ament; light hair and complexion; blue eyes; dull and downcast; 
mind weak; restless, excitable, petulant and easily irritated. About 
two years before, this child had a severe sickness. From that time she 
had epileptic fits, about one a week on an average, usually at night, 
followed by an involuntary discharge of urine. She had been under 
treatment by a quack all this time, and was constantly growing worse. 
I could not discover any local lesion in this case ; yet she was weak in 
body and mind and inclined to be anemic. 

Prescribed a generous diet; free exercise in the open air ; occasion- 
ally warm bathing ; keep her as cheerful as possible ; let her have a 
little whisky when there is much weakness or nervous excitement. 
Gave her five grain doses of bromide potassium at meal time, also half 
grain val. zinc three times a day. 

This treatment was followed for seven months, without change, and 
then gradually lessened. She had but three paroxysms after the treat- 
ment commenced, and has been free to date. 

Case III.— Called December 13th, 1867. A. C , girl, aged 

three years and six months; had hooping cough badly when one year 
old; soon after had spasms from worms and teething; when about two 
years old she took epileptic fits, generally in the night, occasionally in 
the day time; had from one to four every twenty-four hours. At 
present the child has from two to six every twenty -four hours ; she is 
very weak and irritable; staggers when she walks; often falls down; 



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rOUB CASES Ol^ SPILSP8T. 139 

seems to iiaye but partial control of muscles of the extremities; head 
inclined to lean forward; downcast look; eyes indicate great vacuity; 
mind weak; appetite tolerable ; respiration and circulation natural but 
weak; restless, uneasy and excitable; nervous temperament; seemed 
well nigh destroyed both in body and mind, from the frequent repeti- 
tioD of the paroxysms for the last year. 

While looking at the child, Und reflecting upon the cause and 
pathology of the case, I saw her pass her hand under her clothes up 
to her privates. I called the attention of the mother to the fact, and 
inquired whether she had seen her do that before. Said she had fre- 
quently; but did not know that there was any harm in it. Upon ex- 
amination, I found this child had fingered and pulled at the vulva, 
until the vagina, for some distance up, was enlarged enough to enter 
the end of a full grown thumb. 

I never investigate a case of epilepsy, that my suspicions are not 
torned to the generative organs for a most careful examination, no 
matter how young or old, unless a positive cause is known. It is aston- 
ishiDg how young children of both sexes are led to self-abuse ; and, of 
all the causes of epilepsy, as far as my observation goes, this is the 
greatest and worst. 

I prescribed for this case with little hope, simply because the 
mother, while she felt a deep interest for her child, was wholly defl- 
eient in the capacity and patient perseverance to manage and nurse 
the case. 

Prescription. — Keep her hands from the privates, never let her 
touch them, if they have to be tied for a year; free nourishing diet; 
warm bath and exercise in open air. 

B Belladon. Fid. Ext, gtts. xl. 
Potassii Brom., 3iii. 
Aquae, ^ir. M. 31 ter. die. 
Alao, a one grain pill of iron by hydro|^en, at meal time. 

Up to January, 1868, the child had about two paroxysms every 
^7; but had improved somewhat in strength. During January, she 
had only two each week. The mother had kept the child from self- 
abnse. In February, averaged three fits a week. March 1st, left out 
the belladonna, continued the bromide, also stopped the iron pills, and 
gave half grain val. zinc three times a day; child improved both men* 
tally and bodily. This course of medicine was continued, noting the 



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140 WESTERN JOURNAl^ 07 MEDICINE 

case carefully up to November, 1868, child baying from four to six 
paroxysms each mootb. From tbat date, tbe parents concluded to stop 
medicine, as they bad so far to come, and tbe weather became cold. 
January 1st, 1869, two months after, the child was still improving, and 
not more than one fit in a week. If this child was so situated that she 
could have constant care and medical attention for a year more, I 
should have little doubt of a permanent cure. 

Case IV.— Mrs. B . Called to see her November 11th, 1867. 

Married, aged thirty-two years; has had two children, one living aged 
seven ; light complexion and hair ; gray eyes ; spare, sharp features ; 
nervous temperament; excitable, restless, very loquacious ; respiration 
and circulation natural ; general health tolerably good ; works most of 
the time ; had epilepsy in childhood, and occasionally up to woman- 
hood. The day after the birth of her first child, she had nine severe 
convulsions, whether eclampsia or epileptic, I could not learn. Since, 
has had attacks every four or five months, coming on generally in tbe 
night while asleep, and occasionally, two or three paroxysms in a sin- 
gle month, generally severe, leaving the patient weak, sore, sometimes 
bruised, also pain in head, and giddiness. 

Prescribed quietude and good nourishment. 

B Hall's Sol. Strjchnia, f 3 iL 
Potassii Brom., giv. 
Aqua, giv. 

Tea-spoonful middle forenoon, middle afternoon, and bed time. 
Also, gave three grain pill of iron by hydrogen at meal time. This 
course was pursued carefully up to April, 1868. She had one fit March 
3d. On the 1st of May, the pill and strychnia were omitted, she hav- 
ing become pregnant. The potassium was continued in increased 
doses. She enjoyed good health up to November 11th, when she was 
delivered of a fine large boy — labour natural, and free from any con- 
vulsions. On the 22d, being somewhat exhausted with a ^bad breast, 
she had an epileptic fit, the second in a year and twelve days. From 
this time, I added the iron to the treatment. January Ist, 1869, feels 
quite well, is nursing her child, and continues treatment. 

There was a peculiarity in this case worthy of note. She has a 
shoulder which has been dislocated probably twenty times, by simply 
raising the arm and carrying it back ; and during the struggle of her 
last attack, she dislocated the shoulder. The original dislocation was 
probably produced by the same cause. 

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FOUR CASES OP EPILBPSY. 141 

I report these cases, not for the purpose of discussing the causes 
or pithology of epilepsy, or to urge any particular mode of treatment ; 
but to present the simple practical facts, hoping to awake a deeper 
interest in this sad disease, and to excite the profession to a more de- 
voted and careful study of the causes, pathology, prognosis and treat- 
ment of epilepsy. I am fully aware that authors are divided upon the 
prognosis of this disease ; that many eminent men consider epilepsy 
incnrahle. 

Trousseau tells us, '* That in past ages this disease was considered a 
Konrge sent from the Almighty, and that nothing hut Providential 
ioterference could cure it." "The progress of science," continues this 
ntkor, "has only slightly altered this state of things, and epilepsy is 
BOW a days, generally quite as incurable as formerly." 

Prof. Tardieu says : " There are few diseases so severe and so terri- 
ble IS epilepsy, and that it is nearly always incurable." 

M. Romberg expresses faith in the curability of many cases. 

M. Herpin of Geneva, in his premium essay from the French Insti- 
tute, reports fifty cases — one-half cured by medicine. 

Althaus, Chambers, Locock who was one of the first to call the 
attention of the profession to the use of bromide of potassium in epi- 
lepsy, and Reynolds, all give us a favorable prognosis, with a hope of 
enre in numerous cases. 

Watson, Barlow, Aitken, Tanner and Sieveking, give a doubtful. 

Brown-Sequard, Marshall Hall and Schroeder Van Der Kolk, who 
have thrown so much light upon the pathology of epilepsy, are san- 
guine of cures, under their peculiar principles of treatment. 

I quote opinions only to show that while we are advancing in these 
latter days, we have gathered only a few pebbles on the medical shore, 
wbile the great ocean lies beyond, and the study of epilepsy opens up 
a field for the medical student in the future, worthy of the highest 
effort in the cause of humanity and science. 

If the world should ever be reconstructed, and placed upon the 
platform of that Noble Humanity born at Bethlehem, the free-offer- 
ings of individuals and States, would supply the means to open epilep- 
tic hospitals in every part of the land. Then we might expect results 
just as favorable and happy as those which follow the treatment of the 
insane in our lunatic asylums. 



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142 WESTERN JOURNAL OF MEDICINE. 

HOSPITAL GANGRENE, AS IT APPEARED AT THE CLAY 
AND CRITTENDEN U. S. A. GENERAL HOSPITALS, AT 
LOUISVILLE, KENTUCKY. 



BY J. Q. A. HUDSON, M. D., CINCINNATI, OHIO. 



(CS9ii<MMi«d frcm (ki February Nnmher.) 

Treatment. — The methods of treatment of hospital gangrene, vary 
with different authors according to the views entertained as to its char- 
acter as a general or local disease. This is especially true of some of 
the older writers, particularly Hennen, who relied almost wholly upon 
general treatment. Most recent writers, however, whatever may be 
their pathological theory as to its nature, place great importance upon 
local remedies, and it may be laid down as a rule, that the success in 
treatment is commensurate with the use of energetic local remedies. 
Might not this fact tend to confirm the doctrine of its local nature? 

At Bilbao, during the Peninsular war, in the summer of 1813, 
where Hennen had his observation and experience in this disease, and 
who treated it almost entirely by use of general remedies, the fatality 
was very great. {Op, cit.) 

During the same summer, in the same campaign, at Passage, the 
disease was treated by Blackadder, (also a surgeon in the English 
army), by the local use of arsenic as a caustic, and with comparatively 
good success. 

Local treatment was considered of the first importance at the Claj 
and Crittenden Hospitals, and I think this is true of nearly all the 
military hospitals in the west and south-west where the disease pre- 
vailed. 

The principal local remedies used were, bromine, sol. permangan- 
ate of potassa, and nitric acid. The first two named were the agents 
mostly used; but our main remedy was bromine. 

It was first introduced as a remedy in the treatment of hospital 
gangrene and erysipelas, by M. Goldsmith, Surg. U. S. Y. It was used 
at first by reducing its strength, mixing it with water, by the aid of 
bromide of potassium. It was afterwards found that in hospital gan- 
grene, the pure bromine was much more effectual, and those who had 
used it both pure and diluted, preferred the former in most cases, espe- 
cially for the first application. It was used in the following manner. 
I shall give the details quite full, as many do not seem fully to under- 
stand the manner in which it was applied, notwithstanding the numer- 

.oogle 



^iyiiiz.cu uy ■ 



HOSPITAL OANORBNE. 143 

OOB articles in the medical journals relative to its use, since its intro- 
duction : 

If there is much extent of the gangrene, it is necessary to put the 
patient under the influence of chloroform. Then, by the aid of the 
forceps, carved scissors and scalpel, the dead gangrene is wholly re- 
moved, taking it all away down to the living part. The integument 
along the margin of the wound should be everted and the dead areo- 
lar tiBsae cut away. Sometimes it will be necessary to slit up the skin 
at one or more points, to have better access to the dead fascia beneath 
it Where there are extensive sinuses formed along the course of the 
araseles and vessels, it is generally not advisable to cut the skin and 
deep fascia, and expose the whole of the interior of the limb; but as 
much of the gangrene as can be reached, should be taken away, and 
the rest left to the action of the bromine. 

It may be advisable in sopie cases, to make quite extensive incis- 
ion, exposing the parts beneath. It is dif&cult to give rules for this, 
and much must be left to the judgment of the surgeon in each par- 
ticular case. 

After the removal of the gangrene, the bleeding should be stopped 
^j the application of cold water and the pressure of the sponge. In 
order that the bromine may act more effectually, the bleeding must 
be stopped and the surface made as dry as can be. A free use of 
cold water, alternately with the pressure of the sponge, will soon 
eheck the hemorrhage. When this is done, an assistant should hold 
the sponge firmly pressed upon the part until the very moment that 
the surgeon applies the bromine. 

This is applied by means of a small bit of sponge fastened on the 
cad of a probang, and the application should be made rapidly and thor- 
oughly to the whole surface. The wound is then to be instantly filled 
witii lint and the whole covered with oiled silk. Bandages or other 
Beans are then used to retain the dressing. 

The irritating effect of bromine vapor upon the mucous membrane 
of the air passages should be obviated as much as possible, by prevent- 
iagits diffusion around the patient and attendants. This is best done 
by having the bromine in a large-mouthed glass vessel, which one of 
tb assistants should keep closely covered with a bit of glass, except 
when the surgeon is charging his sponge. The prompt application of 
tbe oiled silk confines the vapor to the wounded part. 

The surgeon should guard against filling the sponge upon the pro- 



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144 WESTERN JOURNAL OF MEDICINE. 

bang with an excess of bromine, so that it will not dribble or drop in 
passing it from the vessel to the wound. 

The sponge should be firmlj tied upon the probang with thread or 
twine, thoroughly waxed, otherwise the bromine will destroy the thread 
and the sponge come off. 

When sinuses exist which have not been opened, the bromine may 
be applied by pushing the sponge charged with it into them, or a solu- 
tion of bromine may be injected into them. Before doing this, it will 
be necessary, by careful examination, to ascertain the size and direc- 
tion of the sinuses, and there should be a full supply of probangs, large 
and small, with sponges attached according to size, so that the surgeon 
may select, to suit the dimensions and direction of the sinuses. A 
solution of bromine, made by dissolving one hundred and sixty grains 
of bromide of potassium in three ounces of water, and adding one 
ounce of bromine, may be used in the sinuses in place of the pure 
bromine. If, however, the sinuses are of easy accesd, so that the pro- 
bang can be introduced and withdrawn easily, the pure bromine is 
preferable. 

Where the cellular tissue between the large joints of a limb is de- 
stroyed, it will be necessary to make a counter opening and pass a di- 
lute solution of bromine by means of a syringe through the sinuses of 
the limb, washing out the dead matter, and producing a change in the 
action of the part. 

It is neither practicable nor judicious to produce the caustic action 
throughout the whole interior of the limb, when the inter-muscular 
fasciae is destroyed ; but a high degree of stimulation may be pro- 
duced by injecting a solution of suitable strength, and the decomposi- 
tion of the slough be checked. 

We had several cases of this kind, only two of which survived. 
One, a sergeant, of strong constitution, from Posey county, Indiana, 
had a gun-shot wound at the upper part of right leg, about three 
inches below the upper extremity of the fibula. The ball fractured 
the fibula, and passed out on the inner and back part of the fleshy 
part of the leg. 

The gangrene destroyed all the areolar tissue below the wound 
down to the ankle joint. There was great swelling of the leg. An 
opening was made at the inner border of the tendo Achilles, near the 
ankle, and injections were passed from the upper to the lower opening. 
The parts were washed out twice every twenty -four hours, first with 
tepid water and lastly with a weak solution of bromine — ^about one- 
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HOSPITAL QAKaBXNB. 14& 

lutlf IB ouBce of the above solution to two quarts of water. The dead 
areolar tissue and accumulated matters were freely discharged, and the 
nreUiag, in time, subsided, when the leg was kept firmly bandaged, the 
openings kept patent, the ^injections continued, the gangrene firmly 
endicated, and the patient removed from our ward. 

Baring all his stay in the gangrene ward, he had very little general 
trouble. Daring the time of the full action of the disease in the leg, 
wlien the swelling was at its greatest and before the counter-opening 
was made, he had some fever, poor appetite, &c., but soon after the 
counter opening was made and the discharges became free, the swell - 
iog snbfiided, and with it vanished the general trouble. 

It would be interesting to know in what state the muscles of the 
limb were after complete recovery in this case. This I am unable to 
give, aa the sergeant went home on a furlough, and I lost sight of him. 

In a case like this, it would be unwise to lay open the whole limb and 
tpplj to the whole gangrene surface the pure bromine. If the patient 
his sufficient power of resistance to the disease, he may live through it 
with the little aid the surgeon can give him as above directed. Few 
eoDstitntions have this power. 

Aa before stated, when the sinus is not of any very great extent, 
tnd easy of access, it is better to apply the pure bromine to it. 

In its local action, bromine is one of the most powerful escharotics 
known. It instantly destroys the surface of the part to which it is 
applied, producing a thin superficial eschar of a yellowish-brown color. 
If there be little or no bleeding at the time of its application, it will 
be of a yellowish -white color. It coagulates the albumen of the tis- 
sves. In the rapidity and completeness of its action, it is probably 
Bot surpassed even by the actual cautery. The burning pain it causes, 
■oon passes away. The most important feature of its action is, that 
the eachar it produces is thin and superficial, and soon separates from 
the living parts. In this respect, it differs from many other eschar- 
otics, such as potassa fusa and nitric acid, (unless the acid is perfectly 
pure and of the proper strength), the eschar produced by these agents 
tt generally thicker and more slow of separation. 

The treatment subsequent to the application of the bromine, is 
■unple. The eschar generally separates in from one to three days, 
the time rarely extending beyond forty-eight hours, and in most cases 
ksTea a clean healthy surface, free from the disease. There may be, 
Werer, in a few cases, one or more points left with the disease upon 

*P lm Ik* Utttr pMTt ot the tnatmant In tkis cam, a w«ak •olotioa of fMrmangaiwta of 

*"*>■»«« and ia pteo* of bromlM •olntlMi. 



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146 WESTERN JOTTRNAL OF MEDlCtNE. 

them, and requiring another application of the bromine or its solution. 
When these patches are found after the separation of the eschar, they 
«re mostly thin and superficial, and it may not be necessary to cut 
away the diseased surface before using the bromine. 

If the gangrene patches are small and the other parte of the wound 
begin to put on healthy action, the application of the bron^ine solution 
may be sufficient to check the morbid action and promote a separation 
of the slough. 

Should there remain a large patch of gangrene, it may be proper 
to apply the pure bromine, and if it be of much thickness, it sboald 
be cut away and the bromine then applied, being cautious to limit its 
use to the location of the disease, and not to produce an eschar on the 
healthy surface.* 

A frequent characteristic of gangrene wounds is a torpid, sluggish 
vital action. In these cases, the eschar separates very slowly, and the 
wound is slow to take on healthy action. Then it is necessary to use 
some stimulating appUcation to rouse the languid vitality and aid in 
separating the eschar. The solution of permanganate of potassa, was 
found just the desired article to meet this indication. 

In every case during the existence of gangrene in the wound, a 
Bolution of greater or less strength was daily used just previous to 
reapplying the dressing to the wound. 

If the wound was doing well and the eschar separating finely, the 
solution was weak, say a table-spoonful to a quart of water, or suffi- 
ciently strong to produce a mild stimulation* 

When there seemed to be much local inactivity, the strength of the 
solution was increased so as to cause considerable pain and irritation. 

The effect of ihe solution in destroying the fetor and disinfecting 
the slough, is an item of no small value in its use. 

It is not essential in every case of gangrene, that the diseased part 
be cut away. If the wound be of limited extent and there exists little 
or no constitutional trouble — if the slough be thin — the application of 
the bromine may suffice to destroy the disease and insure a separation 
of the slough. If, however, the wound be large or the system be 
much affected, the gangrene should be carefully cut away and the 
bromine applied to the living parts. 

As regards the use of nitric acid, our experience is too limited 
to speak from actual observation. The bromine and solution of per- 

*Dr. Ooldsmith cautions against ths too frsquent application of bromine. After the eepar- 
mtloB of the eloogh, if email patchee of gangrene remain, the application of eolntion of penman* 
«anate of potaaea, of the fall strength, as furnished by the Med. Dep. of the Army, is often lufictent 
%o destroy the remains of the €' 



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BOBPITAL OANGRENX. 147 

nunganate of potash Beemed to act so mucli more Buccessfully than the 
mtric acid had previously been known to do, that there was no desire • 
to experiment with the latter. For three days time, however, we were 
out of bromine, the supply being temporarily exhausted, and we were 
obliged to use nitric acid in its place. Its action was not satisfactory. 
It wu used in three cases only. In all, the slough was longer in sep- 
arating, and in two, the gangrene was not destroyed, and bromine had 
to be used subsequently. I ascribe these unsatisfactory results, as due, 
ia a great measiiTe, to the inferior quality of the acid used. It was 
neither pure nor of full strength. From the statements of many ex- 
perieoced writers, some of them of recent date, I should have confi- 
dence in the success of the judicious use of nitric acid of proper 
strength and purity on hospital gangrene ; yet comparative results are 
more favorable to bromine. 

Some form of application to the diseased part, capable of destroy- 
ing a portion of the sound flesh in immediate contact with the gan- 
grene, has long been the practice of all who believe the disease to be 
a loeal poison, and even of some of those who consider the malady 
constitutional. 

The actual cautery is an old and favorite remedy with the French 
surgeons. A national prejudice foolishly forbids its use by the £ng- 
tisb. I should judge this to be an effectual agent, and would have 
more confidence in it than any other next to bromine. Its use in hos- 
pital gangrene has recently been revived by a German physician. 

Artenic was first applied by Blackadder, in 1813, and since then, 
oceasional instances are given in medical journals of its use, and it is 
generally recommended by those who have tried it. The reports of 
its use are quite favorable, but the fear of its poisonous action upon 
Ae system by absorption, has probably deterred many from using it. 

OUric acid, nUrate of silver ^ chloride of zinc, chloride <^ antimony, 
fotaua fiua, ndphate of copper, have all been more or less used as 
eanstics in thift disease. 

But little need be said upon general treatment The ordinary prin- 
ciples of practice were observed. As stated at the commencement of 
^ article, strict attention was given to cleanliness of patients, bed- 
&g, clothes, ward, &c., &c. Fresh air was bountifully supplied. An 
abundance of nourishing, digestible food was furnished. A large num- 
W needed only hygienic care. No medicine was given unless some 
syrtemic disturbance existed. 

When there was much debility, a sustaining course was adopted. 

01) 

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148 WISTEBR JOUENAL OF MEBICIVZ. 

Quinin&«iid opium, whisky, milk punch, ale, wine, &c., &c., were giTen, 
according to present condition and previous habits of the patient. We 
did not (as we have seen done) simply because the patient had hos- 
pital gangrene, dose him with quinine or keep him fuddled on milk 
punch or whisky. 

When there was decided debility, we gave alcoholic stimulants in 
some form, if they a^eed with the patient and were tcell home. 

No writer, as yet, has been able to give infallible rules for the 
administration of alcoholic stimulants in disease. In many cases in 
which there seem to be strong indications for their use, yet, upon trial, 
either in large or small quantities, they are found to entirely disagree 
with the patient and do harm instead of good. 

I have for a long time been accustomed in those cases in which I 
deemed stimulants advisable, to administer them cautiously at first, 
and be governed in their subsequent use by their effects in each par* 
ticular case. 

I have been the unwilling and silent observer of the injurious ad- 
ministration of whisky, or punch, or wine, or ale, simply because the 
patient was said to have typhoid fever, or typho-marial fever, or hos- 
pital gangrene. 

Any medical philosopher who will establish reliable rules for the 
use of alcoholic stimulants in disease, without previou$ experiment in 
each catCf will deservedly receive the encomiums of the profession. 



INFLAMMATION OF THE VOCAL CHOKDS— PATHOLOOI- 
CAL ALTERATIONS. 

TranaUted from the Oermui of Prof. Lndwlg Turck, of Vienna, 
BT TH08. C. HENRT, M. D., CINCINNATI, OHIO. 



Contraction of the vocal chords can be caused through disease of 
the brain and spinal column. Till of lat«, but few very peculiar cases 
of this nature have been reported. Oibb avers that in some recent 
cases of hemiplegia passed by, inflammation of the^vocal chords of the 
side of the portion affected has been observed to take place. Also, 
through the so-called progressive muscular atrophy, can inflammation 
of the vocal chords occur, of which I have myself had a case. There 
is known to be a disease of the motor nerves of the larynx founded 



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r 



IKFLAMXATION OF THB VOOAL CHORDS. 149 



upon inflammatioii of the vocal chords. It is currently known that 
Bischof has called attention to it — stating that by the diyision of the 
root of the nervus accessorius in the interior of the brain, the voice 
becomes entirely lost. He observed that this was owing to the division 
of the recurrent nerve of the vagus, from the left, as we know numer- 
ou filaments of the nervus accessorius run off. It is maintained that 
from the recurrent nervus vagus to the muscles of the larynx, still 
other fibres concerned in motion are included, and, also, of the crico- 
thyroydei — the extension of the vocal chords, separately and alone, 
from the nervus laryngeus superior can be seen. One case of mine, 
with fatty degeneration of the muscles of the larynx, apparently not 
long ago, having been under my charge, proved to me that this last 
statement is not altogether correct. By means of physiological expe- 
rimentB, instituted with relation to this subject, for the most part da- 
ting prtor to the discovery of laryngoscopy, recording observations — ^in 
esse of diseases affecting nervous (or dependent upon nervous irrita- 
tion), with consecutive hoarseness or laxness of vocal chords. I will 
relate a case in point — ^relating to my experience in a case of com- 
pression of both nervi accessorii in the foramen lacerum. This case 
ippertains to a man of thirty-one years of age, who, for two years 
past, suffered with pain in both sides of the larynx, and double vision, 
and since then severe and permanent paralysis of the tongue, and 
spasms— evident at the period of his admittance into hospital — one 
year before his death. Difficulty of speech was another symptom, and 
atrophy of the entire tongue, hoarseness without catarrh, which latter 
increased up to the period of his death — surely denoting disease (as 
an appearance of cancerous infiltration on section proved,) some part 
of the breast and a portion of the skin of both temples — so both con- 
dyles of the occiput; the latter with a considerable swelling in addi- 
tion. Both the hypoglossal nerves in the transit through the bony fora- 
Bttn, were in a condition of degeneration on account of disease. 
Throagh the cancerous infiltration there was connection between the 
condyles of the occiput and the two corpora pyramidalia apparent. 
Throagh that passed the foramen lacerum on both sides together, and 
both nervi accessorii were under the free side of the upper segments 
«f the fascicles, in a state of compression by this foramen. So that at 
this point there was very evident degeneration recognised, by which 
means the modified hoarseness resulted in the laryngeal affection. (Those 
muscles were not examined.) The extremity of the corpora pyrami- 



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150 WESTERN JOURNAL OF MEDICINE. 

dalia were swollen yery uneqDally on account of deprivation of nutri- 
tion — nervuB trigeminus degenerated.* 

Still again, some cases of injury of the substance of the yagus 
nerve in the neck, caused by swellings of the glands, cancer, aneurism 
of the carotid, or scrofula, are spoken of by Friedreich as taking place. 
Beside, in this connection, belongs apparent injury of the recurrens 
nerves. Both nervi recurrentes come off usually from the main por- 
tion of the vagus, the right short division turns around the arteria sub- 
clava dextra, and from its place of origin around backwards to the 
left deep concave portion of the arch of the aorta, from thence both 
pass between furrow caused, or the inter-space formed by the trachea 
and the oesophagus, then upwards to the larynx. The nervi recurrentes 
can from this point lose their faculty of conduction by aneurism of 
the arch of the aorta — perhaps, also, of the right arteria subclaya. 
and from chronic inflammation, as is admitted by laceration or* disor- 
ganization, and, as I have observed, through compression without dis- 
organization, (see Consecutive Stenosis of the trachea), through an 
apparent compression of the swollen glands, as verified (Gerhart) 
through the sinking of the nerves in cancer-swellings or indurations, 
especially the glands of the neck in tuberculous degeneration of lym- 
phatics. I have determined by observation, in cases of tumors of the 
glands, on three several occasions in which were tumors of the neck 
extending under the clavicle, with evidence of lymphatic degenera- 
tion, tuberoulous in its nature, with unmistakable tubercles degenerated, 
indicating a tumor with inflammation of the vocal chord on the same 
side. 

In the fouvth case, being the last in the designated locality found 
in the left cavity of the chest, viz : the upper lobes of the lung, taken 
hold of by the cancerous swelling. Lastly, it is allowed that the con- 
ductibility of Ihe laryngeal motor nerves, viz: the accessorii, from 
their exit from their forasften in the skull, also, in some cases substan- 
tially, or by itself by transplanted meningeal inflammation, plainly, 
so as that by the nerves of the skull, and by the spinal marrow, other 
nerve-roots were found. By peirpheral degeneration of the nervua 
recurrens it is often atrophied. Huguier had, in 1834, a case in which 
was aneurism of the aorta and atrophy of the left nervus recurrens 
had been caused. 

Brenton saw, in 1852, the two left nervi recurrentes for one and one- 

* Torek, oommniiicatioiii oonoeraiog diMMM of tlie nenrM of the bnia. 

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INFLAMMATION OF THB VOCAL CHORDS. 151 

liaif inches in extent, affected with an aneurism of the arch of the 
aorta. Their tissue exhibited a striking alteration and fatty degenera- 
tion, according to his statement. I haye noticed the same in my cases 
of Ute. In front of the entrance to this fluctuating swelling, already 
alluded to, its point of exit, the appearance viewed by the microscope 
vas normal, that is to say, between the swelling and the larynx, was 
an atrophied condition apparently, with diminution in size or fatty 
degeneration of the nerve tissue. 

There are still other cases which might be alluded to, in which un- 
doubted disease of the central nervous system, or of the motor nerves of 
Uie larynx are at the base of the disturbance. To speak of them 
would not throw any further light on the matter, as far as the na« 
tore of the inducing cause is concerned. In this connection, also, 
belong eases of undoubted tables, cases of progressive muscular atro- 
phy. As one such has been noticed by G-erhardt and myself; other 
eases in which, together with paralysis of the vocal chords, the same 
condition attending other nerves controlling motion, that of diph- 
theria is obscure. Independent paralysis of the vocal chords with 
paralysis of the soft palate, of which I, in the first place, and subse- 
quently Gerliardt has alluded to form other cases. Although the mus- 
eks of ihe soft palate, also those of the vocal chords, likewise those 
of the aocessorious were innervated ; much in that condition at all 
events, judging by other causes, previously happening — still, in one of 
my plainly diagnosed cases, when severe paralysis of the palate was 
present with unsymmetrical movements, and degradation of the tissues tff 
the reeorrent nervus vagus — there being, as will be supposed, hemi- 
plegia at the time (of the chords.) In this case, it was ascertained 
that after decease— the parts being examined — a small twig of the re- 
eorrent was given off through the muscles of the palate. A similar 
ease, happening subsequently, it was noticed that with paralysis of the 
Toeal chords, there was paralytic dysphagia, on account of imperfect 
elosure of the glottis, limited, dependent action not to be mistaken. 
In the plain usual kind of cases — is such consecutive atrophy in the 
ihres of the constrictor pharyngeus inferior apparent that it causes 
loon wasting of the substance of the recurrens nervus vagus, and dys- 
phagia, consequently. 

The atrophy of the paralyzed muscles of the vocal chords, must 
he by the compression of a vagus nerve or a recurrens, inducing a so- 
eailed snorting or barking sound, which has been compared to the whin- 
nying of a horse, or the whining of a dog, Brenton alludes to it as 

.,y,u..uuy Google 



152 WESTERN JOURNAL OF MSDICINB. 

occurring with some of his cases lately. It is a compression of the 
air- vesicles of the lungs, so affecting the respiration. I, myself, haye, 
in a late case, likewise a case of decline of peripheral ailment of the 
recurrens nerve, found a similar condition, by laryngo-scopical exami- 
nation — noticed left-sided paralysis of the vocal chords existing. At 
this time I found the muscular crico antenoidees posterior and lat- 
eralis, also filaments of the thyro-arytenoideus externus of the two 
sides pale yellowish red, and in a decided state of atrophy. By micro- 
scopical investigation, a streaked appearance of the transverse diame- 
ter of the throat generally seemed to constitute the ailment, or was 
only here and there indicated to be partly obliterated. In addition, 
there was a slight degree of atrophy occurring in the case of both cri- 
co-ihyroie muscles — very considerable degeneration, with appearances 
of paleness, yet both thyro -arytenoid were not colored yellow (proper 
muscles of the vocal chords.) The atrophy was caused by the caving 
out of the unadjusted larynx — and both the vocal chords, from in- 
specting them above, standing or remaining, symmetrical in a cross- 
wise light to the naked eye, the ulcerated free side being plainly seen. 
And then, indeed, in that ulcerated portion under the musculi aryt- 
enoideus transversus and obliqui, was recognised but little atrophy, 
evidently. The musculi ary-eppiglotiidei were only much weakened 
on both sides. The left nervus laryngeus superior, microscopically 
viewed, usually normal. G^rhardt met with a similar case. I have 
yet, in some other cases, noticed the same condition of things. The 
condition of musculus cricothyroydeus in the cases just last alluded to, 
proved the same, viz : atrophied. That which in a more recent period 
was stated, maintained of the nervus laryngeus superior, is inferred 
was not true; at all events, it must be nourished by a considerable 
number of fibres through the recurrens. 

I had, also, an opportunity to pass judgment in a case of atrophy 
of the same laryngeal muscles, with an equal degree of intensity of 
ailment as in the foregoing cases, in which the corresponding nervus 
recurrens, as, also, the nervus laryngeus superior healed entirely nor- 
mally. Besides the vessels were normal, except upon the diseased 
side, somewhat atrophied. 

These former cases of mine, of peripheral disease of the nerve re- 
currens were exemplified in the case of a man of forty-six years of 
age. In 1846, with a chancre, accompanied by a severe syphilitic 
affection on its heels, soon after swelling on the shin-bone. In Feb- 
ruary, 1860, he was barely improved during the night, and remained 



XNFLAHMATION OF THE VOCAL CHORDS. 153 

and the eacceeding year, affected with severe hoarseness. First, (it may 
be,) IB the spring of 1863, there appeared to a diminution of the hoarse- 
ness, co-existent with the looseness of the vocal chords, also de- 
cided paralysis, also, in the muscles of the legs, beside doable vision 
to a certain extent, continuing until the year 1863. There was insuffi- . 
cieDcy of the aortic valves, and of the left arteria subclava — there be- 
ing scarcely a sign of pulsation. Circulation had been carried on 
through the collateral branches, the axillary artery, and also the rad- 
ial seemed to carry on a normal circulation. The left true vocal chord 
was perceived in a state of action by the seventh July, 1863, and 
since repeated examination in the median line, and on the side ap- 
proaching the median line, together with the corresponding arytenoid 
cartilages, only partial motion could be induced. 

The fourteenth September, 1864, death ensued. The nature of the 
fkalsy of the vocal chords was apparent, more particularly, in the up- 
per portion of the nervus accessorius or its place of origin, or enough 
ao, without investigation in the central nervous system. 

In regard to this case of disease, constant formication, and imper- 
fect anaesthesia, and in the entire body, or both sides, was indicated. 
Unfortunately the examination of the brain and spinal chord was post- 
poned to such an extent that no thorough examination could be made. 

In the first of the cases quoted, it seems, as it is mentioned, that 
the atrophy of the musculus crycoideus internus, by inspection from 
above of the free sides was plainly seen. 

One can, laryngoscopio examination of the palsy of the vocal 
chords, atrophy of the chords in some cases, and so on, detect an ex- 
cavation on the inner sides of the throat, somewhat curved in shape, 
appearing like the curve of a sickle. This excavation, which we see 
at times in the cadaver, upon section, being of no great extent, is no 
proof of atrophy. In this present day, such a case of irregular ulcer- 
ation, with impaired mobility of the vocal chords, in the case of a per- 
son affected with syphilitic atrophy of the vocal chords, would not 
be taken notice of. 

The atrophy of the muscles of the vocal chords, or rather with 
the muscles connected with them, can not yet be inferred in all cases 
by pathological anatomical researches. In cases, also, not old, of the 
periphery, in regard to the progress of the disease of the left recur- 
rent nerve, even when sought for in the cadaver. The first laryngo- 
•eopie examination gave us the true form of the appearance of paraly- 
sis of the vocal chords, and never before the time of the invention of 



154 WESTERN JOURNAL OF MEDIdNB. 

the laryngoscope. It alone can exhibit both double and single paralj- 
sis of the vocal chords, to each form of which we can, now, lend a 
skilled hand. 

Nora BT Tbanblatok.— There are well-eiUbliflhod points of anatomy and physiology in re- 
gard to theae lax7ngeal nerrea. 

The larrngeos, snperlor and recnrrent, formed of motor elements derived from the ragoa 
aocessory and the sympathetic, go to the larynx on each side, from above and beneath. 

The recurrent is chiefly a motor nerre, concerned in the mechanism of respiration. 

The superior laryngeal supplies the cryco thyroid muscles. 

Dilatation of the glottis is caused by the posterior crico arytenoid muscle. 

Contraction, by the two transTerse and oblique muscles aryetenofdei. 

Tension and elongation of Tocal chords occur through cryco thyroid muscles, by meana of 
the ennerration of the superior laryngeus. 

Tension and shortening through the lateial thyroid— edges of vocal chorda— approximated by 
the innervation of the recurrent luyngeal. 



SPASMODIC COUGH. 



In this connection, we should allude to spasmodic cough, which 
occurs not unfrequently and much to the disturbance of innervation, 
particularly with reference to the larynx. Mandl has directed atten- 
tion to this, and described the symptoms and appearance. It is of 
the nature of a quick and irresistible, rapidly succeeding one another, 
succession of short, violent fits of coughing, like barking in a deep 
tone, with apparent spasm throughout the whole entire larynx, trachea 
and bronchi. A case which occurred in my practice, happened to be 
a youthfiil woman, neither hysterical nor to be considered of a spe- 
cially nervous temperament. 

The attack comes on mostly very irregularly, often during the day. 
The intervals of coughing vary in length of time of occurrence, and 
like a double cough, so rapidly do the spasms succeed one another. 
This case of mine exhibits the typical condition to which Mandl calls 
attention. The affection is, according to my observation, a very stub- 
born one, thwarting the various methods of inhalation, narcotic anti- 
typic, so-called nervines, emetic means, cold water cure and cod liver 
oil. 

The fourth in particular, of my cases observed, occurred three 
times — young women of nine, eleven and fourteen years. In case of 
the one nine years of age, proved typically fatal. 

Upon one evening, the fourth case happened in a nineteen years 
old, strong young man, in whose case only a very trifling bronchial 
catarrh existed. 

In the case of a young maid, in whom the intensity of the cough 

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IPA8M0DI0 CMTOH. 15S 

[ to liaye arriyed at the poriod of its natural seyerity, a catarrh 
of the yocal t^hords was diagnosed. 

The fifth case was something anomalous, a seamstress of eighteen 
jears old, Laura Op. She suffered, perhaps, fiye years, more or less ; 
but the beginning attack was, for the length of a year, more especially 
serere. It came on of mornings eyery day, accompanied with acute 
pain in the throat — at times, intense stupidity. By yiolent ezer- 
tioD, overheating and the like, brought on cough, occurring more fre- 
quently as time progressed^ so that she would have these spasmodic 
fits of coughing ten to twelye times in the twenty-four hours, one after 
mother, with short intervals of quiet. She was kept on wine, and 
eared for in a warm room ; hut in less than a week she was suddenly 
seiied with a general conyulsion, and subsequent unconsciousness. 
During the progress of the case, ahout the 22d of May, 1862, occurred 
a similar series of coughing fits. An ordinary respiratory effort, fol- 
lowed by a remarkably hoarse sounding cough, singularly high in tone, 
ending with a whispering sound. Usually, there followed two or three 
such fits of teoughiug, with much apparent effort to cough in the inter- 
nk, causing much uneasiness — respiration otherwise normal in the 
interyals; but much effort yery apparent and producing noise. By 
means of laryngoseopic obseryation, the throat, the back of the tongue, 
aad the soft palate with the tonsils, present a normal aspect; but men* 
atmation appears more ofbener than usual. Examination by the ear 
ihowed rattling noises in both sides of the throat during respiration. 
The cough is a deep, harsh tone, but subsequently, a yoice perfectly 
aormal. Cold water cure here adyised. 

In one case of a ten year old boy, otherwise healthy, affected 
howeyer, with a slight catarrh, and beside, with a deep, croup like 
eoogh, and coughs then as usually in a natural way. So often when he 
eonghs strongly, the cough comes out deep and rough in tone, resem- 
bling croup, and is always limited to a sharp or shrill intonation. The 
larynx and the yocal chords, are proyed to be in a normal condition, by 
inspection with the aid of the laryngoscope. 

To conclude this article on spasmodic cough, I will append a few 
obseryations f^om Dr. Tobold : 

''Nerrons also called spaamodic coagha, have something in common 
vilh those that are denominated hysterical Tbey are charaotertsed by 
Mama that occur with extraordinary yiolence. Theae attacka are separated 
from each other by long and entirely free interrals. They often appear at 
eertain hours of the day, and are excited by other oauaes than the Tarioua 



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166 WESTERN JOURNAL OF HEBIGINE. 

forms of cough that depend on morbid ch anises of the m aeons membrane of 
the respiratory branch. In the majority of cases, I have met with nervoas 
coughs in old women; in isolated cases also, in young;, otherwise healthy 
maidens. In some cases, I was inclined to regard a strikingly anemic condi- 
tion of the mucous membrane of the larynx, as the chief disease. Perhaps 
the nerve fibres in anemic mucous membranes are more inclined to hyper 
sesthesia." 

Dr. Tobold recommends the use of a sponge applied locally, the 
same being saturated with tinct. ferri chlorid; also the use of elec> 
tricity; other tonics also to be employed assiduously at the same 
time. Our few laryngoscopists in this country, use alum and glycer- 
ine locally, with much apparent success, combined with constitutional 
tonic measures. 



FORTY YEARS' PRACTICE, OR REPORTS OF EXTRAOR- 
DINARY CASES. 

BT NATHANIEL FIELD, M. D., 
Of JeffenoiiTille, Indiana. President of the Indiana State Medical Society. 



Forty years in the medical profession, will familiarize the physician 
with all the diseases to which flesh is heir in the locality of his prac* 
tice. He will become experimentally acquainted with their symptoms 
and treatment; so that when he meets with a case, however dangerouB 
and complicated it may be, he is not compelled to resort to his books 
to enable him to make out a correct diagnosis, or to treat it success- 
fully. Haying often seen and combatted it before, he is fully prepared 
for it again. He is practically acquainted with the different modes of 
treating it, and he has firmly settled down upon what he considers the 
best remedies in the case. It matters but little to him what may be 
the speculations with regard to the etiology or pathology of the dis- 
ease, or the modus operandi of the medicines which he knows will cure 
it. Having often administered them in similar cases with success^ h^ 
is willing to trust them again. This is what we call << practical knowl- 
edge or experience,*' supposed to be of more value than the knowledge 
of a score of medical novitiates. 

But in the course of many years' practice, cases will arise ^)f an 
abnormal or extraordinary character, for which we have neither author- 
itj nor precedent; and which will tax the judgment of the physician 
to its utmost capacity. The following case is an illustration : 

Some years ago, a -small boy about five years of age, residing in the 



^iyiiiz.cu uy ■ 



REPORTS OF EXTRAORDINARY CASES. 167 

eitj of Jeffersonyille, apparently in perfect health, and while at play 
with other children of the family, was suddenly attacked with an epi- 
leptic fit, from which, however, he soon recoyered. I was sent for to 
flee him, hut before I arrived, he was as well as though nothing had 
happened, having resumed his customary amusements. The parents 
of the boy were much surprised at the occurrence, and were unable to 
account for it. There was nothing in his appearance to indicate the 
dightest predisposition to the disease. He was the very picture of 
good health. As no cause could be discovered for the convulsion, and 
•s there was no fever or any other sign of disease, no prescription was 
Bide. 

About two weeks afterward he had another strong convulsion^ last- 
iag several minutes; but as before, passed off without any constitu- 
tional disturbance following it, and he was soon as rational and playfVil 
as ever. Being at the time absent from my office, Dr. W. F. Collum 
was called in, but finding the boy perfectly well, and like myself, not 
being able to detect any cause for the attack, and conjecturing that he 
might have worms, prescribed some anthelmintic. No worms, however, 
were expelled. In a day or two the fits returned, and were repeated 
at short intervals for about ten days, during which time I am confident 
he must have had a thousand ! After an ineffectual effort to arrest 
them, Dr. Collum retired in despair. I was again summoned to attend 
hiB, and exhausted every resource in my power to relieve him. The 
fiunily were in great distress and were prodigal in the employment of 
the best medical advisers. Prof. Powell, Prof. Drake and Dr. Kicha,rd- 
loii, of Louisville, were called in to assist me in searching out the mys- 
terious eause of the terrible affliction. The patient was examined from 
the crown of his head to the soles of his feet, in the hope of detect* 
lag some local irritation, but none was found. After a few visits, the 
int two distinguished gentlemen, satisfied that nothing could be done 
to arrest the convulsions, abandoned the case. Dr. Richardson, how- 
ever, persevered in assisting me to the end, curious as it seemed to me, 
to lee the result. As he made but one visit a day, the burden of the 
labor necessarily devolved on me. Day and night, I was annoyed 
with repeated calls to visit the patient, and <*do something for him." 
It was impossible to sleep at home or at the residence of the distracted 
fimily. Every antispasmodic had been tried in vain. All kinds of 
remedies, internal and external, based upon all manner of theories and 
hypotheses, respecting the pathology of the disease, had been employed 
to the fullest extent, and to no purpose. The convulsions were still 

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158 WESTERN JOUBNAL OF MEDICINE. 

going on at intervals of ten minutes, defying the combined wisdom of 
two medical schools and two old doctors besides. 

Driven to desperation, and worn out with fatigue and anxiety, I 
resolved to sit by the bedside of the patient one whole night, and try, 
if possible, to ascertain the cause of the trouble. It was in the month 
of December ; and, long as the night was, I requested the family to 
retire to rest, and leave me alone with the patient, assuring them, if 
he grew worse, they should be notified of it. They assented to the 
arrangement, and I accordingly took charge of the patient for the 
night. 

From the first, I had come to the conclusion that the irritation, 
whatever it was, had its seat somewhere in the periphery of the ner- 
vous system, and not in the encephelon or medulla spinalis, as my friend, 
Dr. Richardson, supposed; and the idea occurred to me that if I would 
notice what muscles were contracted first when a paroxysm came on« 
it might possibly give me a clue to the precise point of irritation, and, 
perhaps, the cause of it. With this impression, and in the hope tliat 
I might make a discovery that would relieve the little sufierer and my- 
self, I carefully watched the commencement of the paroxysm. I ob- 
served that the muscles of the left side of the face invariably began to 
twitch on the recurrence of a fit. After the passing off of a conTul- 
sion, and while in a state of unconsciousness, I raised the upper lip as 
high as possible, and passed the index finger of the right hand around 
the alveoli, and lo, and behold I the coroi|a of the second canine tooth, 
instead of having caused by its pressure the absorption of the root of 
the deciduous tooth, had passed behind it and forced it through the 
alveolus and gum and into the lip. I had often seen the same ihing, 
but as this little boy was not quite old enough to shed his first crop 
of teeth, nothing of the kind was suspected in his case. Fondly hoping 
that I had found the latent cause of the frightful malady, I hastily 
slit the gum vertically and removed the old tooth. Afler pressing the 
edges of the incised gum together, and wiping the blood from the lips, 
I sat down to await the result. In less than an hour the convulsions 
began to subside, and before day they were entirely gone. As soon as 
it was light, the parents of the child entered the room, anxiously in- 
quiring how he was. I informed them that between midnight and day 
the fits entirely disappeared. They could scarcely believe it. fiut 
there was the patient as bright, cheerful and rational as though he had 
never been sick. They were at a loss to account for the wonderful 
change; and acted as if they thought I had performed a miracle on 



WHITE CORPULCLES OF THE BLOOD. 169 

their son. I did not relieve tbeir suspense) but kept what bad trans- 
pired during tbe nigbt a profound secret from tbem and tbe numerous 
friends visiting tbe bouse. I did not tell Dr. Ricbardson^ wbo visited 
him in tbe afternoon, as usual ; but left bim in tbe dark as to tbe sud- 
den change. He manifested mucb surprise ; and made many inquiries, 
respeeting tbe treatment during tbe nigbt — ^wbetber any new remedy 
had been tried, and bow it came tbat tbe fits left so abruptly under tbe 
treatment wbicb bad bitberto proved a failure. But no explanation 
was given at tbe time, and not until tbe family bad removed from Jef- 
ferBonville, did I reveal to my colleague tbe facts in tbis singular case. 

My reason for tbis reticence was, tbat I felt tbat tbe oversight of 
the cause of all tbe suffering to patient and relatives, and all tbis la- 
bor and vexation to tbe pbysicians in attendance, was a reproach to 
the profession. 

It was a humiliating reflection, tbat five old and respectable prac« 
titioners of medicine, and two of tbem professors in medical schools, 
should allow a child to have fits for ten days, the result of so simple a 
cause, and not soon detect it! Here we were, day after day, holding 
consultations and philosophising about the pathology of the disease — 
oae proposing the moxa, another ptyalism, another a blister on the 
head or the nape of the neck, and another something else equally as 
vseleis and injurious, when there was nothing tbe matter but an insig- 
nificant mechanical irritation, which could have been removed in one 
minute, provided we bad been blessed with just common sense enough 
to see it. 



♦ON THE IDENTITY OF THE WHITE CORPUSCLES OF THE 
BLOOD WITH SALIVARY, PUS, AND MUCOUS CORPUS- 
CLES. 

BY JOSEPH Q. aiCHABSON, M. D., 
tormetXf Beaident PhyrieUn at the PenngylTanU Hospital. 



The nature of the nucleated corpuscles so abundant in tbe saliva 
bas long been a subject of some uncertainty, and although they have 
probftbly, as favorite test objects for the higher powers, been more fre* 
qoentiy examined by microscopists than almost any other constituent 
of the glandular secretions, observers seem to have been generally con- 
tented to accept tbem simply as useful measures for tbe capacity of tbe 

*Ftui7lT«aia Hoqiltal Reports, 18G9. 

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160 WSffTSBir JQITRNAL OF HXDICINE. 

higher objectives, and passed on without any attempts to solve the mys- 
tery of their origin; Koliker indeed advanced the theory that they 
were essentially a form of exudation corpuscles, but hitherto his hy- 
pothesis does not appear to have been generally accepted by micro- 
Bcopists as a fixed fact. 

The following experiments, undertaken to elucidate their constitu- 
tion, were performed with the large Powell & Leland's instrument, so 
long a denizen of the "Microscope Boom" in the Pennsylvania Hos- 
pital, and no doubt endeared by constant association to many genera- 
tions of "Residents," as well as myself. When it was discarded by 
the institution, I became the purchaser, and after undergoing some re- 
pairs, and having adapted to it a one-twenty-fiflh inch objective (made 
by Mr. Wales, of Fort Lee, N. J.), it has accomplished the work be- 
low described. 

The salivary corpuscles examined under a power of eleven hundred 
diameters present the appearance of perfect spheres, varying from the 
one-fourteen hundredth to the one-twenty-five hundredth of an inch 
in diameter, each having a very transparent but beautifully defined 
cell-wall of exceeding tenuity, which incloses from one to four almost 
equally transparent nuclei of a circular or oval form, whose diameters 
range from one-three thousandth to one-four thousandth of an inch. 
These nuclei are situated sometimes centrally but more commonly near 
one side of the corpuscle, and the cavity between the margin and tlie 
cell wall is generally filled with from twenty-five to fifty molecules, not 
more than one-twenty thousandth of an inch in diameter, whose char- 
acteristic is that of constant and rapid motion. Some of these molec- 
ules seem to be elongated into an oval or hour-glass form, but the 
activity of their movements renders it difficult to ascertain this with 
precision. In my observations these corpuscles have appeared to en- 
large and become flattened, from the pressure of the glass cover, as 
the stratum of liquid beneath became thinner from marginal desicca- 
tion, so that usually in the course of an hour or so they burst, and 
discharge about one-fourth of their contents, when two, three, or more 
of the molecules swim away, continuing their revolving movements un- 
til they pass out of view ; the other granules outside and those remain- 
ing within the cell become in a very few seconds entirely stationary. 
If a solution of aniline red, of the strength of one grain to the ounce 
of distilled water, be allowed to penetrate at the margin of the cover, 
the nuclei of the salivary corpuscle are readily stained of a bright crim- 
son, and are thus exhibited with beautiful distinctness; the dye ap- 
pears, however, to exert an immediate influence upon the movement of 
the molecules, as I have rarely been able to find cells in which they 
continued to move after the nuclei became at all colored. 

In examining some urine, obtained on the eighth of August, 1868, 
near my late residence, in western New York, from a patient who com- 
plained of severe pain in the kidneys and bladder, I was surprised to 
find that a deposit, which appeared to the naked eye purulent, was 
chiefly composed of cells, exactly resembling in form, size, definite 
cell-wall, contained nuclei, and actively revolving molecules, the sali- 
vary corpuscles with which I had become so familiar; and should have 

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Wfiin COaFl78GUS8 or TS« BtOOB. 161 

iiiugiiied that these proceeded from an accidental adikltetation with 
spntom, had I not heen fortunate to have ocular demonstration to the 
eontrary when procuring the specimen. I examined these corpuscles 
lepeatedly in the course of the two following days, during which the 
moyements of the molecules continued, which I carefully preserved. 

On consulting the text-books to which I hkd access, I found that 
neither Beale, Roberts, Bird, nor Naubauer and Vogel, in their works 
on the Urine, mentioned cells such as those above described, althoueh 
tke editors of the Micrographic Dictionary, in their description of the 
nlivary corpuscles, state that they have been seen by myriads in the renal 
secretion \ nevertheless, numerous specimens examined during the fol- 
lowing few months, seldom without special scrutiny for similar bodies, 
afforded none, until in a deposit occurring f^om urine brought me by 
a medical friend about December first, the corpuscles I had so long been 
IB search of were at last recognized, and on this occasion I was able 
to exhibit them to several microscopists, among others to my friend, * 
Dr. H- C. Wood, Jr., Professor of Botany, in the University of Penn- 
lyjvania. 

On the fifth of December I procured a sample of urine iVom a 
ease of cystitis, which had only been passed a few hours, and on plac- 
ing it under the field of the one-twenty- fifth, I found many of the pus- 
globules exhibiting the amoobaform movements described by Dr. Beale 
in his late elaborate work on the ^^ Microscope in Practical Medicine;'* 
no corpuscles containiog moving molecules were visible, but observing 
that seme of the pus-cells having a spherical outline were almost 
opaque and only about one-three thousandth of an inch in diameter, 
it occurred to me that they were perhaps only contracted by the ex- 
osmose of their fluid contents into the surrounding denser medium, 
and the idea suggested itself to try the effect of diminishing the specific 

fmiy of the urine by the addition of water. Under this treatment 
found that the cells which had been exhibiting amoebaform move- 
nents, soon assumed a spherical shape, rapidly enlarged until they 
leaehed the diameter of about one-seventeen hundredth of an inch, 
when the contained molecules began to revolve, and ere long took up- 
on themselves the extremely rapid and confused movements which I 
W twice before seen in cells occurring in urine, and hundreds of 
times in the salivary corpuscles; the action of aniline solution ren- 
dered beautifully distinct, definite nuclei similar to those found in the 
nlivary bodies. 

The opportunity of corroborating the interesting and remarkable 
Rssarehes of Dr. Cohnheim, of Berlin, on the identity of the pus and 
wkite blood corpuscles thus obviously presenting itself, I proceeded 
vith the following experiments. Drawing a drop of blood from the 
tip of my finger upon a '* growing slide,'' I oovered it with thin glass 
ud placed it upon the stage of the microscope. After finding a white 
Mood corpuscle showing well marked granules, I raised the objective, 
asd arranged a fine filament of thread from the reservoir filled with 
fresh water to the upper edge of the cover, and a fragment of wet pa- 
per to the lower, according to the usual method of securing a constant 
euntni beneath the thin ^ss. On depressing the body of the instru- 



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162 WSSTEBN J0T7BNAL OV HXDroiKX 

ment and bringing the corpuscle again into view, I foand it still ad* 
hering to the surface of the cover, notwithstanding the torrent of red 
globules hurrying over the field, and as these became paler and less 
distinct by reason of the diminished density of the serum, the white 
cell first gradually expanded and displayed its delicate wall with two 
rounded nuclei, then, after acquiring ^e magnitude of about one-sev- 
enteen hundredth of an inch, it exhibited the rapid and incessant move- 
ment of its contained molecules, and finally, when its diameter reached 
about one-fourteen hundredth of an inch, it burst suddenly, discharg- 
ing a portion of the contents, whose outbreak resembled that of a 
swarm of bees from a hive, and some particles of which actively re- 
volving as they went, swam off the connnes of the field. On repeating 
the ol)servation, and allowing some of the aniline solution to flow in 
with the water after the first few minutes, the nuclei were strongly 
stained and rendered beautifully distinct, although the movement of 
'the molecules promptly ceased, in this respect as in all the others^ 
showing a precise ideatity with the reactions afforded by the pus and 
the salivary corpuscles, as above described. It should be noted that a 
oertain variabh proportion of the white cells of the blood thus treated 
exhibited no moving molecules, and apparently consisted solely of nu- 
cleus and cell-wall. 

It is worthy of remark that this experiment amply demonstrates 
the inestimable advantages of high objectives (which some even yet 
pretend to doubt), for the remarkable movement of the contained molec- 
ules seems to have escaped the attention of Prof. Yirchow, the great 
author of "Cellular Pathology," himself (mde p. 181, Chance's transla- 
tion, 1863). Although the observation was first made with the aid of 
a one-twenty-fifth, yet afterwards, knowing exactly what to look for, 
I had little difficulty in demonstrating to various gentlemen the re- 
volving molcules thus brought into view with powers as low as the one- 
eighth of an inch. 

A portion of fotid pus from an abscess, and a specimen of mucus 
from the nasal fossa, under a like treatment, gave similar results, which 
did not materially vary in numerous trials. 

Tracing now the white blood corpuscle from its condition of irreg- 
ular outline and amoebaform movement, as observed in serum and heayy 
urine, when the cirumambient fiuid approaches the density of 1028, 
through its round form with slightly more distinct nuclei, in the liquor 
puris, and in urine of lower specific gravity, we find that immersed in 
a rarer liquid, approximating to the mean density of the saliva (1005), 
it has an accurately spherical outline, is more than twice the magni- 
tude, and contains a number of minute actively moving molecules, 
thus exactly resembling in all sensible characters the true salivary 
corpuscle; and it therefore seems reasonably certain that the bloodf, 
under the appointed nervous influence, congesting the buccal mucous 
membrane and associated glands, moves slowly enough through their 
capillaries to allow some of its white globules to penetrate the walls of 
the vessels, as they are said to do those of the frog's mesentery in 
Cohnheim's experiment (Yirchow, Archiv, Band 40, S. 38, u. s. w.), 
which under the influence of the rarer saliva, expanding them and set- 
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WOMBtBSfl WOMSN. 163 

tiag free to move their contained molecules, constitute the bodies so 
long known to histologists, as the corpuscle of the salivary fluid. 

Dr. Lionel Beale, in his work on the ^^ Microscope in Practical 
Medicine/* remarks in reference to the examination of the saliva : " In 
the somewhat viscid matter of which the salivary corpuscles is com- 
fwaed, are multitudes of highly refracting particles in incessant mo- 
tion. The nature of these particles is extremely doubtful. They look 
Terj like the germs of bacteria, and it is possible they may be of this 
iitnre." If the hypothesis thus guardedly endorsed by the celebrated 
English mieroscopist be correct, it seems not improbable that the white 
eorpoBcles, either in the capilliaries or lymphatic glands, collect du- 
ring their amaebaform movements, those germs of bacteria, which my 
own experiments (^American Journal of the Medical Sciences, July, 
1868). indicate always exist in the blood to a greater or less amount. 
And Anther, it appears not impossible, that when thus loaded, their 
elimination through the saliva, under the mercurial influence, and their 
cTacoation by a discharge of pus from a seton or a tartar emetic ulcer, 
really constitute that therapeutic value of these remedial measures in 
certain cases which has long rested unexplained. 



WOMBLESS WOMEN. 



(Tht snljoiDed is an abstract from an article entitled Surgieal Oasetj Devon and 
biter Bo^kilf found in the last rolame of Saint Bartholomew^ t Boepital Report»:) 

That an incapacity for menstruation should consist with female 
health, is a strange fact. In two of the three following cases of womb- 
lea women, the defect was congenital. 

Case I. — About nine years since, I removed the womb by ligature. 
In the "Address in Surgery" of I860, I gave this case very circum- 
stantially. The main facts were, that the patient was twenty-one; 
tlutitwas her first labor; that she was delivered while standing; that 
the midwife tagged at the naval string ; that the womb was everted ; 
ud that she nearly bled to death on the spot. After many months, 
vhen she was utterly exhausted by recurring hemorrhage, I tied the 
vomh with Gooch's canulffi. 

As I was going into the operating room, the nurse, a worthy old 
vonian and a favorite, said, "rlease, sir, if you take out her womb, I 
suppose she can never have her courses again, and if so, what then?'* 
I replied. "Nurse, if I do not take out her womb, she may die before 
■ight. If I can, I will save her life now. That is my present thought, 
lean not look beyond that." 

After all manner of perils, she made a thorough recovery. Of 
c^'one she has never menstruated since, but when I saw her, three 
jean after, she was in good health and good spirits. I know that she 
vas perfectly well several years after that. Her whole aspect is femi* 
>u&e, her complexion is fair and delicate, as it always has been, but in 

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164 WESTERN JOURNAL Of IIEDICINS. 

DO wise chlorotic. She walks with her joiing man like any other ser- 
vant girl; she cares nothing for the loss of her womh, which seems to 
have produced no other effect, moral or physical, than the cessation of 
her menses. That is the answer to the nurse's question, '^if so, what 
then?'' 

Case II. — About four years ago, a very delicate young woman, act. 
twenty-five, evidently in declining health, came under my charge at the 
hospital. • She told me she had been left an orphan, (I believe one at 
least of her parents had died of consumption), that she was delicate, and 
had not been able to retain her water like stronger girls;- but that she 
had been brought up carefully; was now the mistress of a national 
fichool, and had married at twenty-three. She then added that coition 
had from the first been accompanied by pain, which instead of dimin- 
ishing, as she expected, had increased, until she could not bear it; 
and that her urine escaped from her involuntarily. She and her bus- ' 
band, who were reputed to be very worthy young people, and a most 
attached couple, were greatly distressed, as they well might be. I 
learnt then, also, that she had never menstruated. 

Her pudenda were perfectly natural. About three inches up the 
vagina there was a sudden narrowing, like a stricture. Its circular 
edge was soft, and the orifice sufficiently open to admit the finger ; but 
it could have been easily dilated to a greater extent. It exerted a 
gentle compression. 

This was the sphincter, and beyond it was the bladder. There was 
no trace of a womb. 

I told her that sexual intercourse must cease forever. She was 
much grieved on her husband'^ account; of whose regard for her she 
spoke with genuine feeling. I recommended tonics, and she went home. 

I heard nothing of her until lately, when she and her husband 
called on the nurse. They appeared a fond couple still. Her health 
was restored ; and the incontinence of urine not worse than when she 
was a child. 

Case III. — I was consulted in the case of a lady's maid, «t. 40, 
who previous to the last six weeks, had enjoyed excellent health. She 
was a neat little figure, a brunette, must have been pretty, and was 
young looking for her age. She had a swollen knee, and flying rheu- 
matic pains, for which she could not account, but she was cnieny har- 
assecl by an irritable bladder. Micturition was freqpient, scarcely to 
be restrained, and painful both at the time and afterwards. She had 
used a hip-bath and opiate fomentations, with partial relief. I was to 
ascertain if a urethral wart or a calculus occasioned her distress. 

Her urine had always been apt to escape when she coughed, but 
she had not been subject to leucorrhoea, and she never menstruated. 

The external appearance of the genitals had nothing peculiar. The 
pubes and the labia were natural; the glans of the clitoris and the 
nymphao were fully developed; but I could not find the urethra. 

The vagina was such as might be expected in a virgin, except that 
there was neither transverse rug», nor hymen, nor carunculse, nor fossa 
navicularis. It opened abruptly, just in front of the perineum. It 
admitted the finger, which, when it had penetrated somewhat less than 



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TRXATMENT 0? CARBUNCLES. 165 

tluee inches, came upon a dimple. This yielded, circnlarly, on gen- 
tle pressnre, and the finger entered the bladder. As it was withdrawn, 
the sphincter closed again. The bladder was not set on obliquely like 
a womb ; but quite at the end of a canal, which was no vagina at all. 
It was simply a preternatural urethra applied, as in the male, against 
the rectum. There was not the slightest trace of an os uteri or cervix 
—-neither could any womb or corresponding body be felt from the 
bowel. 

She told me that, some years before, she had been engaged to a 
jouDg man, who died. Spoke of him, as a woman should, tenderly 
ind regretfully; but did not affect to represent her love for him as 
Platonic. 

Judging from these cases, the menstrual discharge is not necessary 
to the health of a woman who has no womb. In the intervals between 
one pregnancy, or lactation, and another, it would appear that the pres- 
ence of a womb has a special and accumulating influence on the consti- 
tution ; and that it is thus the organ which, by its own periodical dis- 
charge, affords that relief to the whole frame, of which it has itself 
created the necessity. 

It is the womb alone, and not the whole generative apparatus, or, 
indeed, any part of it. Looking at their personal appearance, their 
views, manners and habits, and their womanly, albeit their correct and 
eitimable feeling toward the men they loved, I believe the subjects of 
the cases II and III to be real women — saving their wombs. If it 
be contended that their ovaries may likewise be wanting, I can only 
reply that, in case I the generative system was undoubtedly com- 
plete, for that woman lost her womb, and nothing else, after bearing 
a child ; and yet she is as healthy, without menstruation, as the two 
others, who never had a womb. 



CLINICAL LECTURE ON TREATMENT OF CARBUNCLE. 



BY JAMES PAGET, D. C. L., F. R. 8., 
flarseon to St. Bartholomew's Hospital. (Short-Hand Beport, rerised by the Anthor.) 



Gentlexsn : You have recently had the opportunity of seeing four 
eases of carbuncle treated in my wards after methods which you would 
probably describe, if asked to do so, by saying that " nothing was done 
fer them." Here are the patients' papers; and there is, to be sure, 
00 medicine set down for them to take, and you know that no surgerv 
vas inflicted on them — and yet a good deal was done for them, though 
the treatment was what does commonly pass by the name of " doing 
aething." They were carefully fed, washed, cleaned and bedded; and 
their carbuncles were very skillfully dressed and washed with proper 
tkings, and every care was taken to shut out all untoward influences 
from them. And if any complication in their cases had arisen, these 

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166 WE8TEKN JOURNAL O? MBDICmE 

would have been immediately met. Bat no complications occurred; 
and, therefore, the cases passed through their course without treatment, 
as it is said — that is, without medicine, and with no surgery, no aetiyo 
surgery, no incisions or anything of that kind. And since all these 
cases passed through their course very favorably, and all the patients 
were, or will be, discharged at a comparatively early time after their 
admission into the hospital, I will take this occasion of giving yoa 
some observations on the manner of treating this disease. 

Although you may not have seen much of it, you must all havo 
heard of the ordinary manner in which carbuncles were treated for- 
merly, and still are by some; a method which consists mainly in mak- 
ing large incisions through them, and giving very large quantities of 
food and stimulants, as well as considerable doses of quinine, bark 
and other tonics. I do uot at all mean to say that the things which 
in these cases I left undone would have done any harm; but what I 
hold of them is, that they would have been quite useless, and some 
would have been sources of great discomfort to the patients. And in 
the way in which I speak of these things you may notice that I exem- 
plify that rule which I always impressed upon you, of asking your- 
selves, when you seem to have been successful with some medicine, 
^^What would have happened if I had not given it?" The apparent 
consequence of giving a medicine may be plain enough; but you can 
not too often repeat to yourselves the question — as a rule, I will not 
say of practice, but of the study of your own practice — ** What would 
have happened if this or that, which seems to have been successful, 
had not been done?" 

First, with regard to the incisions made in carbuncles. The ordin- 
ary plan, still recommended by some, is, as soon as a carbuncle is seen, 
to make two incisions crucially from border to border. It is said that 
they must go even beyond the edges of the carbuncle into the adjacent 
healthy textures. I have not followed that method of practice verj 
often, but I have followed it quite often enough to be sure that it does 
not produce the effects which are commonly assigned to it. It is com- 
monly said that if you will thus make crucial incisions into a carbun- 
cle, you will prevent it spreading. If you can find a carbuncle two or 
three days old, and cut that right across in both directions, I think it 
very likely that you will prevent it spreading. But even therein is a 
fallacy ; for there is no sign by which, on looking at a commencing 
carbuncle, you can tell whether it will spread or not, whether it will 
have a diameter of one inch, or of three, six, or ten inches. The ques- 
tion, therefore, that I spoke of comes back, *^What would have hap- 
pened if I had not made these incisions?" And the answer to that 
question will be rather according to temper than to knowledge. For 
as I watch men in their conclusions upon such cases as that, I gener- 
ally find that self-satisfaction says, "I saved the man's life;" self-dis- 
satisfaction, "I did him no good." The truer scientific temper stands 
midway, and says, ^^I will wait for further information on the matter — 
till I have seen more cases, and then decide whether, in the earliest 
stages of carbuncle, incisions are useful or not." After this time of 
three or four days I have seen sufficient numbers of carbuncles thus 



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TBXATUSMT OF OAKBI7NOLB8. 167 

dmded, and have divided enough for myself, to say that it will not 
prevent spreading. I have seen carbuncles spread in as large a pro- 
portion of cases after incisions as in cases that have never been incised 
at all. I have in my mind a striking case that occurred to me early in 
practice, when I followed the routine, and, in a friend of my own, 
divided a carbuncle most fVeely. I cut it after the most approved 
fiuhion, in depth, and length, and width, and then it spread. After 
two or three days more all the newly formed part was cut as freely as 
the first, and then it spread again, and again it was cut as freely. Then 
it spread again, and it was not cut. Then in a natural time, it ceased 
to spread, and all went on well. These are only general impressions 
that I give you, because one can not count the cases in which cut- 
ting has been practised, and those similar cases in which it has not; 
nor even then could it be said whether those in which the cutting was 
practised would have spread if left alone. On a very strong general 
impression, however, I say that carbuncles will spread after cutting in 
as large a proportion as they will spread in without cutting. 

Then it is said that carbuncles are relieved of their pain if they 
an thus freely cut. Here, again, however, is only a partial truth. A 
carbuncle of two or three days standing, which is hard, tense a&d 
brawny, is very painful ; and cutting it will relieve, in many cases, a 
considerable portion of the pain. But after this, when the carbuncle 
begins to soften, and when pustules begin to form upon its surface, 
and pus in its interior, it ceases to be painful of its own accord, and 
without incisions. Thus there are two distinct stages of carbuncle in 
reference to the pain; the early stage, when hard and still spread- 
^^1 ^ generally intensely painM, and the latter stage, in which the 
pam nearly ceases. A carbuncle divided in the first stage, in the first 
two or three days of its existence, may be relieved of some of its pain ; 
if divided in the latter stage, what little pain may exist is altogether 
ttnaffecied by the cutting. And even cut as you may, you can not al- 
ways put aside the extreme pain that a carbuncle sometimes has, even 
to its latter time. Some two or three years ago, I was called to a mem- 
ber of our profession with a large carbuncle in the middle of his back. 
His ^ends had been much alarmed about the state of his mind, for 
be bad been suffering great mental anxiety for some time, and they 
were in fear lest the excessive pain of the carbuncle should, in its dis- 
turbed state, do his mind permanent damage. So they persuaded me to 
evt it, and I cut it after the old plan, very wide across, and far into the 
adjjacent textures, as freely as could be. It did not in the least relieve 
bim. I never saw a carbuncle through its whole course so painful as 
tbat was, and up to the last, until the healing was nearly completed, 
be suffered more or less pain in it. So that the conclusion in reference 
to the pain must be this : if they can be divided in the first three or 
four dajs, while still hard and brawny, it may relieve some measure of 
tiie suffering; at a latter period the incisions have no influence at all. 

The third point is stated thus, that by the incision of carbuncles 
Toil accelerate their healing, giving facility for the exit of sloughs. 
Bnt herein is the greatest fallacv of all. When the cutting of car- 
Wncles was more customary in this hospital than it is now, when I did 



168 WESTERN JOURNAL OF MEDICINE. 

not cut them and some of my colleagues did, I used to be able to com- 
pare the progress of cases cut and of cases uncut, and time after time 
it was evident that the cases uncut healed more readily than those cut. 
A man who is now in the hospital I have brought round here that I 

may illustrate this point to you. This is the man, Timothy C , 

aged fifty-five. When he came in, his carbuncle had a length of more 
than six inches, and a breadth of three and a half; and it formed the 
ordinary hard, compact, tense and brawny mass that a carbuncle 
usually does. It had at that time already taken to suppurate, and 
little pustules were pointing on the surface. If I had followed the 
practice of incisions, I should have had to make a cut in one direction 
of about seven inches, and the other of about five, and after that I 
should have had not only the wounds wide, open and gaping, and hay- 
ing themselves to heal, but a great part of the substance of the car- 
buncle fairly exposed, and also under the necessity of healing. But 
you will observe that the whole of the space that now remains to heal 
18 a series of openings in the middle of the carbuncle, through which 
the sloughs are to be separated, through which, indeed, nearly the 
whole of the sloughs have already been discharged, and which now 
merely remain to be healed like the cavities of small abscesses. In 
that way you narrow greatly the extent of the wounded surface to 
be healed. Indeed, it by no means always follows that the whole car- 
buncle, or its whole base, sloughs. Carbuncles, if not divided, not 
unfrequently only suppurate about their centers, and slough only in 
their central parts, and the borders merely clear up by the softening 
and dispersion of the inflammatory products in them. In every case 
of that kind you save greatly the amount of healing which has to be 
gone through. Nay, in some cases carbuncles completely abort. One 
of these cases, of which I have the paper on the table, was that of a 
woman, aged sixty-four, who came in with a carbuncle nearly as large 
as this, in a condition which, it might be said, required incision at 
once; but, with the exception of two or three small points, no sup- 
puration or sloughing ensued. That carbuncle dispersed, aborted, 
cleared away. This case shows the more ordinary course of events — 
the sloughing of the central part, the gradual discharge of the sloughs, 
and the comparatively small spaces which are left in the center of the 
carbuncle as the sole space in which the process of healing has to be 
achieved. 

On these three points, which are the grounds that have been as- 
signed as reasons for cutting carbuncles, I have now given you the 
evidence on which I have ceased from the practice. I fully believe 
that crucial incisions do not prevent extension; that it is only a 
limited set of cases in which the incisions diminish pain; and that 
with regard to the time that is occupied in healing with or without 
incisions, the healing without incisions is very clearly and certainly a 
great deal the quicker. 

The kind of incisions that I have been speaking of is the old plan 
of crucial incisions. Another method which I have occasionally tried, 
but of which I can only state the same general results, is that of sub- 
cutaneous incision. This has been supposed to have the same general 



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TEEATMKNT OF GABBUNCLE8. 169 

effect as the other ; and I think the same general conclusions may be 
drawn respecting it: that it is a measure unnecessary in the treatment 
of carbuncle, and that it retards rather than hastens the healing. 
When I -speak thus of the incision of carbuncles, however, I do not 
mean to say that there is no condition of carbuncle in which an incis- 
ion is not useful. Sometimes a carbuncle sloughs in its central part, 
with one continuous slough of integument holding a quantity of pus. 
In that case you would cut through the slough, or through any adjacent 
part o£ the carbuncle, to let out the pus, as you would open an ordin- 
ary abscess. But this is not a measure which is commonly under- 
stood by the "incision of a carbuncle." 

If you ask why one may not cut a carbuncle though it may do no 
good, I reply that you should never be actively useless, and that there 
are some eases in which cutting does considerable harm. Carbuncles, 
for the most part, occur in persons broken down in health, exhausted 
by over-work, or by bad food, or in general deteriorated health — as 
sometime in diabetes or albuminuria; and in all these states it is a 
good general rule to save the blood they need for healing. The loss 
of blood from the carbuncle itself would not be considerable; the hard 
sabfitance of the carbuncle, when cut into, does not bleed, or bleeds 
but little. But to carry out the incision perfectly, you have to cut in- 
to the adjacent healthy texture; and this sometimes bleeds very pro- 
fusely, so as to lead to all the distress and pain of pfngging the wound 
with this or that substance to arrest the blood. 

Another measure in the treatment of carbuncles which is supposed 
to be necessary, is very high feeding and large quantities of stimu- 
lants. I learned the opposite of this in one of those cases which you 
will do always well to study — those, namely, in which the patient re- 
fnses to do what you advise him. It is from such cases that we may 
often learn what is commonly called the " natural history of disease " — 
its coarse undisturbed by treatment. A case occurred to me once of 
an old gentleman, eighty years of age, who had a carbuncle, as big as it 
could be, on the back of his neck, for it extended from one ear to the 
other, and from his occipital spine to the third cervical vertebra. He 
measured it for his own amusement, and it was fourteen inches over its 
sor&ce transversely, and nine inches vertically — a carbuncle, then, of 
the largest size, and one, it might be supposed, attended with con- 
nderable risk to life. I urged him very strongly to take a large quan- 
tity of what is called "support," for I was at that time under an 
impression of its necessity, fie absolutely refused, however, and no- 
thing would induce him to take it. I was therefore content to stand 
by and study the natural history of disease in this huge carbuncle ; 
and the natural history of it was a history that one would have wished 
to witness in every carbuncle of its size, for no case could pass through 
ita course in a better method. He led his ordinary abstemious life, 
took moderate quantities of food and of stimulant, lived through a car- 
bancle of the greatest severity, and finally made a complete recovery 
and lived for several years after. 

Another ease which impressed me very much was that of a friend 
of my own in the profession, who had a carbuncle on the back of his 

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170 WI8TBRN JOURNAL OF MXDIOINS. 

neck, of very considerable size. Sir Benjamin Brodie and Hr. Staalej 
attended him with me, and under their advice the carbuncle was cut. 
I watched its course afterwards, and felt sure that the cutting had 
done neither good nor harm. It went on as carbuncles do when not 
cut. But the gentleman was subject to intense headaches, of which ke 
knew by experience the only possible remedy was almost entirely to 
leave off food, and absolutely and entirely to leave off stimulants. One 
of the headaches occurred during the course of the carbuncle, at a time 
when we had put him upon very full diet and abundant stimulant. He 
said then that he must leave off his stimulants and food, and we looked 
with some alarm on what would be the result on the progress of the 
carbuncle. I remember Mr. Stanley saying to him, in his distinct 
manner, " My dear fellow, if you don't take food, you will die." "Very 
well," he said, "then I will die, but I will not take food and iacrease 
my headache." According to his own wish, therefore, we reduced his 
diet to a very low level. The course of the carbuncle was not affected 
at all, unless it were for good ; and after three or four days of this, 
which might be called comparative starvation, he described himself in 
his own emphatic fashion as being "as jolly as a sand-boy." 

Since that time I have watched carefully all cases that I have seen, 
and I am certain that there is no good to be obtained by large feeding 
or abundant stimulants in ordinary cases of carbuncle. The whole of 
these cases that have been in the hospital were put on our ordinary 
meat diet, with a pint of porter daily; and I see that two of thenk 
have had four ounces of wine a day, one of these being a person aged 
sixty-four and the other sixty-three, and both having carbuncles of 
considerable size. You will find that for patients in private life it will 
do very well if you tell them that they may have about two-thirds of 
their ordinary amount of food, and about the same proportion of their 
ordinary quantity of stimulants. But indeed there is scarcely an^ 
reason to change in any material degree the ordinary mode of life of 
a patient with carbuncle. So far as he can with comfort take that to 
which he is accustomed, so far he may. If his diet has been habituallj 
low, so it may remain ; if habitually high, so, within certain limits and 
somewhat reduced, it may still remain. 

Now you may ask what I should set down as the' things to be done 
for a carbuncle. These boards, nearly bare as they are, may tell you. 
In local treatment one of the best things you can do, if the carbuncle 
is small, is to cover it with emplastrum plumbi spread upon leather^ 
with a hole in the middle through which the pus can exude and the 
slough can come away. That, occasionally changed, is all the covering 
that a small carbuncle will need. It is difficult thus to cover the whole 
surface of a large carbuncle, and to keep it clean; therefore, I think 
the best application for that is the common resin cerate. This should 
be spread large enough to cover the whole carbuncle, and over it should 
be laid a poultice of half linseed-meal and half bread. And, if yoa 
want to exercise your skill, learn to make that poultice well, and to 
put it on well, and to keep it in its place well. That niode of dress- 
ing the carbuncle, so far as the materials are concerned, will last 
through its whole course; but whilst the caxbunole is making progreaa. 

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TKXATHSKT OF CAKBUNCLXS. if 1 

ind diseharging its slough, yon will find plenty of room for the exer- 
cise of considerable Bkill in dressing it, and filling np the caTities 
with soft substance spread with this ointment. Besides this, the car- 
buncles are to be carefully washed, especially with some deodorising 
sabfitanee, as Condy's fluid, or weak carbolic acid, and the caTities 
may be syringed out with it. The importance of cleanliness is very 
grest You noticed in the man whom I showed you just now, the 
spots of acne and boils around the edges of the carbuncle. This points 
cat the necessity of care, which I suppose had not been taken there, 
to keep the surface of the skin adjacent to the carbuncle perfectly dry, 
and free from any contact with the discharge, which seems really to 
lisTe the power of infecting the neighboring skin, and so producing 
the boils which are apt to arise, sometimes in clusters, around the car- 
buncle. Of diet I have already spoken to you. Of medicines I say 
lothing. Quinine, bark, and other medicines of that class, may be 
giTen if yon please, or in case of evident need, and so may aperients ; 
imt there is really no need of them in an ordinary case of carbuncle. 
Bat there is one medicine which you may find very valuable, and that 
is opium, especially in all the earlier painful stages of carbuncle, in 
which it relieves the sufferings as thoroughly as incisions, or anything 
I know. After the early stages, even that is unnecessary, except for 
seme patient who may be unable to sleep. 

But there is one measure in the treatment of carbuncle which is 
leldom employed, and yet is of great importance, and that is letting 
the patient have very free air. The general idea that carbuncles are 
very dangerous diseases, has commonly led to the patients being en- 
tirely confined to bed and kept shut up in their rooms. There is in 
that an unnecessary care; and this, too, I learned from a patient who 
refused to comply with injunctions — ^a gentleman with a large car- 
biiDcle on the back of his head, who would not keep his bedroom. 
He had been accustomed to an active life, and after seventy or eighty 
years of that custom, he was quite indisposed to remain in his room. 
So with that carbuncle he daily came down stairs, changing his room 
and moving about the house as well as the pain and weakness would 
allow him. No carbuncle could go on better ; all the stages were passed 
through without any risk or trouble, and it healed with unusual speed. 
After that I had a yet more striking case. A lady came to London 
^for the season,'' as she called it; and she had not been here more 
than a week or ten days before a carbuncle came out on the back of 
her head, just under her hair. It was a great vexation to her that she 
had to give up all her amusements ; and so, as she did not mind the 
pain, she would go out. And it was then that, for the first time and 
the last, I saw any value in a '^chignon." She dressed her carbuncle 
under the chignon, and went to the park, to the theater, and to dances 
■nkarnied, and with her carbuncle quite unseen, and no trouble what^ 
ever followed. It healed up after the ordinary fashion in about the 
ordinary time. But, indeed, you may see cases of this description on 
a much larger scale, if you watch the carbuncles that come to us in the 
out-patients' room. There we often see them of considerable size, and 
ihey do as well among the out-patients as among the in-patients ; and 

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172 WS(R«Uf JOURNAL OF KEDIGmB. 

jet these out-patients are freely in the air all day. And inany of tbem 
continue at their work. So you may set it down as one point to be 
Attended to in the management of carbuncles, that patients should not 
be confined to iheir room. They should at least have change of air 
in their own house ; and, unless they are too low, they should not avoid 
•exposure to the fresh open air. 

Treating your cases of carbuncle upon this plan, I .believe you 
will find that the great majority will pass through their course well. 
I can not tell you what the ordinary proportion of deaths from car- 
J>uncle is ; but I know that carbuncles 4ire commonly looked upon in 
•the profession as dangerous things, and a large carbuncle on the back 
of the head is considered to be fraught with risk to the patient's life. 
But that is very far from being the case in my experience. Remem- 
bering, as far as I can, or rather guessing at the number of carbuncles 
I have had to treat, I should say that there is no other disease «f the 
same extent and general severity which is attended with so little risk 
to life, During twenty years of hospital and private |>ractice, I can 
not have treated less than two hundred carbuncles : and of these two 
hundred, four have died, giving a mortality, at a fair guess, of only 
two per cent. — ^a mortality which is less than that of most of the minor 
operations of surgery, and less really than that of any disease of equal 
severity that you can name. Of those four deaths, one occurred in a 
|)atient aged seventy-eight, who died of erysipelas after the carbuncle 
had nearly healed. Another was a gentleman of about fifty-five years 
of age, who died of chronic pyaemia. The third was a gentleman aged 
fifty, who died with acute pyaemia. And the fourth was a patient of 
about fifty years of age, who died rapidly exhausted. The first three 
were from causes which may almost be called accidental ; for so wc 
call them when occurring after an operation, and it would be unrea- 
sonable to suppose that any other method of treatment would have 
averted the consequences. The other died, possibly, on account of 
the deficient stimulation ; for iie was a man who had lived freely, and 
took during treatment less than he had been accustomed toiiave. The 
main point, however, to which I wish to direct your attention, is that 
the mortality may be as little as two per cent. I can not doubt that 
the mortality was considerably larger when carbuncles were severely 
cut; for the severe cutting meant often sevej^e bleeding, and was 
attended with all the consequences of large wounds. Thus, though 
I do not know the exact |)roportion, I believe that the general repu- 
tation of the danger of carbuncle was well founded, and that among 
the reasons for the diminished mortality of carbuncles may be set 
down as chief, the more frequent avoidance of the custom of cutting 
them. 

Speaking of the mortality of carbuncle, however, I must remind 
you that I am not speaking of a disease which sometimes passes under 
the name of carbuncle — the carbuncular inflammation of the lip which 
Bometimes occurs in young persons ; a disease which you may not have 
jeen, and may pass many years without seeing. It was described by a 
former house-surgeon of this hospital, Mr. Harvey Ludlow, as malig- 
nant pustule of the lip. Dr. Budd, of Bristol, has also so described 



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BIBLIOGBAPHY. 173 

ii CommeDcing at one spot, inflammation of the whole lip follows 
and spreads to the face, and then disease of the lymphatics snsues, 
with pyaemia as its consequence. It is a disease so unlike carbuncle, 
that it ought not to be known under the same name. It seems to me 
not like the accounts given of the malignant pustule abroad, and I 
hiTe seen no other disease like it in England. It attacks especially 
Tonng persons from fifteen to twenty-one ; and of fifteen cases that I 
hare seen, only one recovered. That disease is not carbuncle, nor is 
the mortality of that disease to be counted in estimating the mortality 
from carbuncle. Ordinary carbuncle on the lip and face has none of 
those special characters, and is not more fatal in those situations than 
in tny other. — Lancet^ Jannary ISth, 1869, 



BIBLIOGRAPHY. 



ESSAY ON THE THERAPEUTIC VALUE OF CERTAIN AR- 
TICLES OF MATERIA MEDICA OF RECENT INTRODUC- 
TION. . 

BY JOHN H. GRISCOM, M. D. 

SepciBted from tbe Tranmctions of the Now York State Medical Society for 18C8. Albany : Van 
Benthuyaen k Loos* Staam PrinUng Houae, 1808. 



This hrochure of nineteen pages, presents 'Hhe results of an ex- 
tended and successful experience with the employment of two articles 
of the materia medica of comparatively recent introduction" — the 
taipkiU talt$ of soda, and glycerine — the first as an internal, and the 
second as an external remedy. 

Dr. Griscom states that he has employed the first named article in 
tboat three hundred instances, with scarcely a single failure in those 
cues, to which, according to his theory of its modus operandi, it was 
speeially adapted. 

Dr. G. helieves that this medicine, when used internally, acts not 
wly as an antiseptic, a preventer of decomposition and of fermenta- 
tion; hut also a promoter of digestion in cases in which the gastric 
juice may he deficient in some of its essential acidulous ingredients. 
The diseases in which it has proved most useful, are diarrhoea, dysen- 
tery, cholera morbus and dyspepsia. The dose is " from five, to twenty, 
forty, or sixty grains, according to the age of the patient and the 

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174 WE8TEBN JOURNAL OF MEDICINE. 

force of the symptoms, administered two, four, or six times a day." 
We are informed that in all zymotic diseases, this remedy may be 
employed with assurance of powerful aid to other medical measures. 
When all the author's sanguine expectations in regard to this medi- 
cine are realized, we may say that for most diseases, 

— — " The lOTereigii'st thing on earth/' 

While we regard the sulphite salts of soda as valuable medical 
agents, our limited experience leads to the conclusion that they have 
less value than has been assigned them by Dr. Griscom. 

The valuable results the author claims to have obtained from the 
external application of glycerine, were dependent upon the affinity 
possessed by this agent for aqueous fluids, including the serum of the 
blood. The following extract presents the views of Dr. G.: ''In 
furuncles, erysipelas, ophthalmia, nasal inflammation, urethritis, and 
other inflammatory and congestive troubles — in not one of a large num- 
ber of such cases, have I been disappointed in the alleged tendency of 
the oil to drain o£f the serum, even through the perfect integument, 
and the effect has been almost as uniformly demonstrative of its de- 
pletory power as if the blood ^itself had been removed from the part. 
In fact, glycerine may be regarded as a good substitute for leeches 
and blisters, and in some instances, for surgical operations." 

J. R. W. 



PRONOUNCING MEDICAL LEXICON, CONTAINING THE 
CORRECT PRONUNCIATION AND DEFINITION OP 
TERMS USED IN MEDICINE AND THE COLLATERAL 
SCIENCES, WITH ADDENDA, CONTAINING ABBREVIA- 
TIONS USED IN PRESCRIPTIONS, AND LIST OF POISONS 
AND THEIR ANTIDOTES. 



BY C. H. CLEAVBLANB, M. D. 
Elerenth Edition. PhilAdelphia: Lindsay k BUkiston, IMD. Price, $1.25. 



Daily observation renders the fact evident that a work of this kind 
is needed. Students, in their pronunciation of medical terms, usually 
follow the usages of their preceptor and the professors of the colleges 
they attend. These persons are, unfortunately, not always entirely 

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BIBLIOOBAPHT. 175 

reliable, and as a consequence, the habit of mispronouncing certain 
words is acquired, a habit that will certainly, sooner or later, canse ite 
possessor great annoyance. The use of a carefully prepared pronoun- 
cing lexicon, will do much to prevent such a result. The one under 
consideration may be generally depended on for correct pronunciation ; 
jet it is not always infallible. The phonotypic alphabet is used to 
represent pronunciation. This alphabet, containing, as it does, a dis- 
tinct character for each of the forty-three elementary sounds, allows 
the precise pronunciation of a word to be represented without diffi- 
enlty. This alphabet is giyen and a knowledge of it can be acquired 
in a short time. J. R. W. 



THE PHYSICIAN'S DOSE AND SYMPTOM BOOK, CONTAIN- 
ING THE DOSES AND USES OF ALL THE PRINCIPAL 
ARTICLES OF THE MATERIA MEDICA AND OFFICINAL 
PREPARATIONS, &c. 

BY JOSEPH H. WTTHE8, A. M., M. D. 
Kghlh Edition. Philadelphia : Lindaay a BlaklBton, 1868. Price, $1.00. 



The faTor with which this little mannal has been received, as shown 
by the demand for an eighth edition, sufficiently proves its value. It 
was compiled for the use of students ; but it also seems as a vade mecum 
for the general practitioner, and serves the trouble of reference to larger 
and more elaborate works. J. R. W. 



ON CHRONIC BRONCHITIS, ESPECIALLY AS CONNECTED 
WITH GOUT, EMPHYSEMA, AND DISEASES OF THE 
HEART. 

BY E. HENDLAM QREENHOW, M. B. 

Philndelphia, FennsylTanift : Undnj a BUtkiston, 18G9. Price, $2.60. 



The author of this exceedingly instructive little volume comes not 
unheralded among us. His very valuable observations on Dvpliiheria^ 
published in The Lancet^ not long since, are still fresh in our memory. 
Evincing, a^ those articles did, so much careful thought. Dr. Green- 
how haf> impressed us with the idea that he is a writer, from whom, to 

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176 WESTERN JOURNAL OF KSBICINE. 

use a common expresBion, "we expect great things." To say tbftt in 
his present undertaking, all of our anticipations are fully realised, 
would be but paying him a compliment to which he is justly entitled. 

The subject of his book, Chronic Bronchitis^ will appear to many, 
rather trite and prosy. So it is, as ordinarily treated of in the yarious 
text books; but Dr. G. throws around his theme so much of freshness, so 
much of novelty and originality, that he seems, as it were, to be ad- 
vancing into a territory altogether new and unexplored. 

The work, which is eminently clinical, does not, as our author 
states, profess to be a systematic treatise on bronchitis, but is simply 
a record of certain opinions and conclusions concerning the patholog- 
ical nature of that affection, to which he has arrived, after a careful 
study, and collation of cases. It is thus, happily, devoid of much of 
the dryness incident to a descriptive detail of symptoms, diagnosis, 
prognosis and treatment, found in systematic works. 

It is divided into eight lectures. The first and second lecture be- 
ing devoted to the general etiology of bronchitis, and bronchitis arising 
iVom cold, and mechanical irritation ; the third and fourth to bronchi- 
tis in its relation to gout; and the remaining ones to bronchitis in 
connection with emphysema and diseases of the heart. 

It will strike many with surprise that the author devotes so little 
space to the consideration of exposure to cold as a cause of this affec- 
tion. Cold, which is so universally regarded as a powerful and ever- 
acting factor in the production of bronchial inflammations, and other 
pulmonary lesions, he disposes of without much ceremony, as possess- 
ing but a modicum of etiological importance. He bases this view, not 
upon mere theoretical grounds, but upon what he regards as firm clin- 
ical data. In but five out of sixty-six cases, could he trace the bronch- 
ial trouble to the action of the cause mentioned. That cold produces 
bronchitis, is the exception, rather than the rule. 

While Dr. Greenhow relates not a few cases resulting from mechan- 
ical causes, the great bulk of them are brought forward to demon- 
strate the very intricate relationship existing between the various 
forms of bronchial inflammation, and the gouty dyscrasia, and it is 
just in this connection that our author evinces great cogency of rea- 
soning. 

His arguments to establish so close a relationship between two such 
seemingly different pathological conditions, are not at all specious, but 
show such analytical tact^ and such power of tracing effects back to 



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BIBLIOGBA?HT. 17T 

eansea, t&at they seem to carry conviction with them, and we feel al- 
moat compelled to sabscribe ourselves believers. 

Since the history of medicine began, catarrhs have been said to- 
arise from exposure to cold, vague as it is in its action. On the inquiry 
being made by sufferers from bronchitis, as to the cause of their trouble, 
prmctitioners are content with the answer that it arises from '* taking 
eold." The same question has been asked, and the same answer been 
given fer generations back. A cold, and* a dronchitiSy have, in fact^ 
become synonymous terms. 

As has been remarked before, Br. Greenhow is opposed to this ex- 
clttsiTe view as to- the causation of these affections ; and his cases, with 
the deductions based thereon, indicate, if they indicate anything at alf, 
that we must look a little further for* it. The gouty dyscrasia, is, with 
bim, a powerful factor in these causations. After all, may not olher 
pulmonary inflammations, such as pneumonia and pleurisy, be the re- 
sults of some profound* diathetic or constitutional disorder? If such 
be the case, we may possibly explain the beneficial action of some of 
the therapeutic agents often brought to bear against them. The good 
effects of alkalies in acute bronchitis, and of the iodide of potassium 
in the chronic form, are proverbial. Instead of referring the action 
of these remedies to some vague alterative or defibrinizing influence, 
may we not attribute it to a directly antidotal or eliminative power? 

Bheumatism is, also, mentioned as being in some manner connected 
with attacks of bronchitis, but not so frequently as gout. The latter 
affection, on account of its much greater frequency in England than 
this country, may play a very prominent part in its association with 
bronchitis, but can not be a very fruitful source of the affection here. 
Rheumatism, which prevails so largely in our country, to the exclusion 
of gouty may take the place* of it, in its bronchitic tendencies. 

In this connection, it is well to state that Dr. Greenhow is not al- 
together alone in his views as to the relationship existing between 
rheumatism, gout, and certain pulmonary affections; for Pollock, in his 
admirable monograph on the '^Elements of Prognosis in Consumption," 
states distinctly as his opinion, that the tubercular, rheumatic and 
gouty diatheses are closely allied. This may, in a manner, explain 
the remarkable statement of our author, that the tubercular dycrasia 
engenders a hereditary tendency to bronchial inflammations, and that 
these, in their turn, may give rise to a tubercular tamt. Gout and 
rheumatism, are^ as it were,, sandwiched' in between. According to 
this, one generation may possess an organic weakness of the respira- 



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178 WSSTXRN JOUaKAL OF IfEDlClNB. 

tory apparatus, evidenced by a broncliitiB, whicli will transmit to a suc- 
ceeding generation another organic weakness in the form of phthisis; 
gout and rheumatism being mere modifications of the same diathesis, 
but spending their force on different tissues. 

The assertion that bronchitis engenders phthisis, and phthisis bron- 
chitis, will not seem orthodox teaching to those authorities who be- 
lieve in their mutually protective influence. 

Practitioners, as a regular thing, are too apt to regard bronchitis 
in the light of a trivial affection. When patients with some chronic 
pulmonary disorder apply to them, it is very common to hear the med- 
ical adviser say : ^^ You need not be alarmed, you only have a little bron- 
chitis.*' It is not true that bronchitis is an affection which is to be 
treated lightly. Following in its train, and dependent on it as a cause, 
are many morbid conditions which tend slowly, but only too surely, to 
a fatal termination. We will merely mention emphysema, hypertrophy 
with valvular disease of the heart, disease of the liver and renal affec- 
tions. To all of these, as resultants of bronchitis, Br. Oreenhow en- 
forces attention. 

The two lectures devoted to cardiac affections, develop the facts 
that bronchitis may stand in a causative relation to disease of the 
right side of the heart, and in relation of effect, to disease of the left 
side. Bronchitis in the one case being a cause of disease, and in the 
other, an effect. 

The author's remarks upon emphysema are practical and instruc- 
tive. After reviewing the theories of Laennec, Jenner and others, 
as to the causation and mechanism of emphysema, he clearly states 
his own. While he thinks it may arise, in some* instances, from 
bronchitis, asthma, and other antecedent diseases, he regards it as of- 
tenest due to an organic weakness of the lung tissue, dependent upon 
some constitutional or diathetic condition. 

There is nothing particularly new in his selection of the special 
remedies for bronchitis. They grow naturally out of his peculiar 
views as to the pathological nature of the affection, being mainly tonic, 
antidotal and eliminative. The tincture of larchy which seems to be a 
favorite remedy with him, is efficacious, we suppose, like all the other 
terebinthinates, without the objection of its producing nausea and irri- 
tation of the stomach and bowels. 

If the author but continues his investigations, we may hope that 
he will effect as much towards the elucidation of bronchitis as have 



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BIBUOOftAPHT. 179 

tboee of Herard and Comeil, Yillemin, Niemeyor, Wilson Fox and 
others accomplislied for its oongener, palmonary phthisis. 

We close oar notice of this little work, by stating that we have 
rarely experienced so much pleasure from reading ai^ production as 
we hare from this. To those who are especially interested in the study 
of this class of affections, "and even to the general practitioner, we will 
say that ita perusal will fUly repay them. C. B. 



THE USB OF THE LARTNOOSCOPB IN DISEASES OF THE 
THROAT, WITH AN ESSAY ON HOARSENESS, LOSS OF 
VOICE AND STRIDULOUS BREATHING, IN RELATION 
TO NERVOMUSCULAR AFFECTIONS OF THE LARYNX. 

BT XORELL MACK;XNZIS, X. D., 

UndoB., V. n. C P. PlijrsteiaB to the HotpiUl fbr DImsms of the Throat, etc. Seeo&d Xditioii, 
vlth additloas, and • ehaptor od the Bxamination of the Naial P e wge e, by J. 8ou« Cownr, 
M. D., anthor of ** Inhalation ; Its Therapeutics and Practtee," etc., pp. S89, with 
two Uthogranhic plates ssd flftyone illostratlonvon^rood. Philadelphia : 
LIndaej M Blaklston. IMO. 7or nle by 0. P. Wftder, Indiana- 
polls; Robert Clarke a Co., ObKHnaaal. tMoe, $3.00. 



The appearance in England of a second edition of Dr. Mackenzie's 
** Treatise on the Use of t)ie Laryngoscope," within a comparatively 
short period after its reprint in this countiiy, lias required the Ameri* 
can publishers to issue a new edition equally complete. This comes 
to us in the shape of a handsome Tolume, printed in large clear type, 
on fine paper, making its examination a pleasure, instead of a task for 
OTcrworked eyes. 

The favorable reception awarded to Ae first edition of this book, 
renders praise of it now a ^0i4 of supererogation, therefore, we will 
simply call attestion to the n^W matter contained in this edition. This 
oonsiats of '< Additions on (he Use of the Laryngq^ope,'* a report of 
several interesting oases, and a recent essay on *< Hoarseness, Loss of 
Toiee, and Stri'daloi^s Breathing, in relation to Nervo-Muscular Af- 
feetions of the Laicyns,'' l(j Dr. Mackeniie, and ''Some more Explicit 
Instmctions wMh regaird to the Manipulation of Laryngeal Instru- 
ments," together with a description of some which are more readily 
procarable in this countiy than those described by Dr. Mackeniie, and 
which experienoe has proved most serviceable, ''Additions on Apho- 
nia," witfc ilfautrative cases, and a chapter on "Examination of the 
Haaal Passa^aa," by ika American editor, l>r. J. Solis Cohen, of Phil- 
•delphia. 

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180 WSSTIKN JOUBNAL Of MBDIdHB. 

There is now no division of sentiment among the intelligent mem- 
bers of the profession in relation to the valuable aid afforded by the 
"art of laryngoscopy/' in the diagnosis and treatment of diseases of 
the larynx. To all who now practice, or would acquire this art, we 
most warmly recommend the work we have just examined. 

J. R. W. 



JOINED TWINS— THE OBSTETRICAL AND SURGICAL MAN- 
AOEMENT, WITH REMARKS. 



BT A. B. COOK, A. If., If. D., 

ProftMor of tba Principle and Pxmctic« of Bmgtrjy Kontvoky School of Mediolno. Lonisrille, 

Ky., 18M. Vp. M. 



This pamphlet gives the history of the delivery of a case of joined 
twins, in the practice of E. C. Bright, of Eminence, Kentucky, in 1865, 
a description of the monstrosity after it was delivered, and the resulta 
of a poBt'fnartem inspection of the dead bodies* 

Some attention is given to the general consideration of human 
monstrosities, together witli the rules which should guide the accoucheur 
in attendance on their delivery ; and the brochure closes with a dis- 
cussion of the condition of the Siamese Twins, and the propriety of 
their separation by surgical art, deciding pointedly against such an 
operation. while the twins both have health and comfort. We do not 
join the author in his reasoning or conclusion about the Siamese Twins ; 
but recommend the pamphlet as a valuable monograph on the subject 
of human monsters. J. F. H. 



MEDICAL COMMUNICATIONS, WITH THE PROCEEDINGS 
OF THE SEYENTY- SIXTH ANNUAL CONYBNTION OF 
THE CONNECTICUT MEDICAL SOCIETY, HELD AT NEW 
HAVEN, MAY 27 AND 28, 1868. 

New BaTVD : Poblbhed by tbe Society. Moos C. Whits, M. I>., Socretary. 



These communications, together with the transactions proper, make 
a handsome volume of two hundred and eight pages. The '< annual 
address "'of the president. Dr. C. Woodward, of Middletown, has fov 
its subject, " our Organization, its Rektioas and Responsibilities." The 
distinctive characteristics of the founders of the society, the claims 

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BIBLIOQKAPHT. 181 

the commuDitj has upon it, and its future improvement and advance- 
ment, are the topics discussed in this address, which contains more pith 
and value than similar addresses usually do. 

Dr. H. A. Canington, of New Haven, contributes an article on the 
'* Belation of Theory to Practice." A correct estimate of the value of 
theory to practice is made. The difference between receiving a theory 
'^ merely as a provisional statement or explanation, the truth of which 
remains to be established " by experiment or otherwise, and of taking 
the theory of this or that one as ^'the ultimate expression of truth," 
and thas becoming partisans instead of seekers, is clearly shown. 

The author thinks '^ that one of the most encouraging signs of prom- 
ise in the medical world is this, that schools and systems, theories and 
hypotheses, find so few heated, bigoted partisans; and that the profes- 
sion, as a whole, stands so far above the narrowness of sectarianism." 

The third article, on "Army Hygiene," is by Dr. R. Bartholow, of 
Cincinnati. To this essay was awarded the "Jewett" prize offered for 
the best essay on the question, " By what Hygienic Means may the 
Health of Armies be best Preserved?" This is a lengthy and very 
valuable paper. Dr. B. is familiar with his subject, and has done it 
and himself justice in this essay. The conclusions arrived at after a 
careful survey of the whole ground, are expressed in the following 
summary : 

" 1. The minima m age of the men composing an army, should be twenty- 
fire. In addition to the ordinary requirements of recruiting regulations, the 
influence of diathesis and cachexias over the health and physical stamina, 
should be considered. 

"2. In the training of recruits, the conditions of the military service 
should approach as nearly as possible, to those of civil lifa As the mortality 
of this period is greatly in excess of the other periods of military life, spe- 
eial hygienic precautions should be taken as respects habitations, diet, cloth- 
ing, exercise, amusements, etc. 

** 3. As the chief danger to the health of the soldier arises from crowd- 
poiaoniag, scorbutus, malaria, a morbific cause compounded of these, and 
from contagious and epidemic diseases, the sanitary regulations of armies 
should be especially directed to the avoidance of the evils of permanent 
eaiape and barracks; to the providing a varied and ample diet, to instituting 
the most approved measures of private and public hygiene, and to enforcing 
police laws against the spread ol probable zymotic diseasea" 

The fourth article is the "Bussell prize essay." This is also by 
Dr. Bartholow, and is on the "Therapeutical Uses and Abuses of 
Qoinia and its Salts." We think that the majority of the profession 
will not be likely to accept as true all the conclusions arrived at in 
this essay; yet we believe that the best observers will endorse them. 

The fifth paper is on the "Treatment of Paralysis by Hypodermic 

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182 WSSTERM JOUSKAL 0¥ XSDICINS. 

Injections of Stryclinine, with remarks on Infantile Palsy/' bj Dr. 
M. G. Echeverria, Superintendent of the Mahopac House for epilep- 
tics and paralytics, at Lake Mahopao, New York. This is a Talaa- 
ble and interesting paper, and gentlemen interested in the subject will 
do well to consult it. 

The sixth paper is by Dr. S. O. Hubbard, of New Hayen, and com* 
prises '^Obserrations, Ante-Mortem and Post-Mortem, upon the case 
of the late President Day." This paper contains a clear and concise 
description of an highly interesting and instructive case. 

The Seventh paper is on the " Relation of Albuminuria to Puerperal 
Convulsions," by Dr. P. M. Hastings, of Hartford. This paper con- 
tains nothing new, and is mainly taken up with a report of cases, and 
a consideration of the treatment of puerperal enclampsia. 

Dr. H. Pierpont, of New Haven, presents a paper describing a <;^Me 
of " Ichthyosis Sauriderma Spynosum," occurring in a girl ten years 
old. No new facts concerning the pathology of this rare disease are 
made known. 

The last scientific paper in this volume is by Dr. £. F. Coates, and 
gives an account of an interesting case of " Traumatic Lesion of the 
Knee-Joint." 

The remainder of the volume is taken up with biographical notices, 
reports of committees, proceedings, etc. J. R. W. 



CORRESPONDENCE. 



Nmr York Oirr, T^bruart 15, 18G9, 
Dear Journal: The annual report of the Metropolitan Board ef 
Health, being their third report, has recently been publiAed, and is a 
most interesting document. Our ci^ has, fortunately, been visited witk 
no epidemic diseases during the past year. The mortalHy among infants^ 
however, has been exceedingly great, especially of those under que year of 
age. From one-fourth to one-half of the whole mortality for the year is 
to be found among children under one year old, and, in some parts of the 
city, eighty per cent of the mortality occurs in the infant population. 
The city and county of New York show a total mortality for the year, 
of twenty-five thousand, four hundred and fifty -nine, and Brooklyn, 
nine thousand and fifteen deaths. 

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(X>BUB8P0N1>XNCM. 183 

Aecording to the Begistnur, daring the past forty years we have 
hBd no sammer so hot, damp and unheal thful as was the last. 

"A separate special history of deaths in tenement-houses is made 
vp, week by week, in the Bureau of Vital Statistics, and the number 
and causes of deaths in every such house, constitute important ele- 
ments in sanitary maps, which are prepared for the use of the Board 
and ite officers, as well as for future reference and analysis. An im- 
proTement in the health and comfort of the tenement-house popula- 
tion, and a decrease in the rate of mortality, must continue to be the 
result of the constant inspection, by the officers of this board, of this 
class of dwellings, and of the thorough enforcement of the wise provis- 
ions of the tenement-house act." 

The report, after disposing of the subject of markets, slaughter- 
houses, streets, returns of coroners, foundlings and nurseries, takes up 
the subject of public baths, which, in such a city as ours, can only be 
r^arded as a great sanitary necessity. The experiment in other cities 
has been eminently successful. Public baths were first erected in 
Boston, in 1860, and in 1867, twelve were in operation, at which, dur- 
ing the summer, eight hundred and seven thousand,. two hundred and 
one baths were given. 

During the past year, over seven thousand patients were treated at 
Bellevue Hospital for various ailments, five thousand, eight hundred. 
of whom were admitted to the wards of the hospital. The out-door 
poor department shows a large increase in the number of patients 
treated. Of this class of patients, ten thousand, one hundred and 
twelve were treated year before last, while twenty-five thousand, five 
hundred and fifty-seven were treated last year. This well shows the 
extension of the usefulness of the institution, as well as the growth of 
poverty. At this out-door relief department, which is intended for 
those whose diseases do not require the treatment afforded by a hospital, 
there are twenty consulting and twenty attending physicians and sur- 
geons. " The cases treated and classified as follows : Diseases of the 
chest, digestive system, nervous system, urinary system, skin, eye and 
ear, women, children, orthopedic surgery, and general surgery. To 
each of these classes two physicians or surgeons are assigned. They 
attend at certain hours each day, and prescribe for those who may 
present themselves. The medicines are prepared by the apothecary of 
the institution, and are furnished gratuitously. Such patients as re- 
quire rest and continuous attention, are transferred to the hospital of 
the department." 

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184 WESTERN JOURNAL OF MEDICINE. 

The usefulness of the Morgue is shown by the fact that one hun- 
dred and forty-nine bodies were brought there during the year, of 
whom seventy-eight were recogniEod by their friends. This year pho- 
tographs will be taken of all bodies brought to the Morgue, and then, 
eyen after burial, they may be recogniied by their friends, and taken 
possession of. 

The Commissioners of Public Charities and Correction have pur- 
chased Heart's Island of the general government for seventy-five thou- 
sand dollars. It is intended to use it as a 'Spotter's field." The 
buildings erected by the general government on the island, during the 
war, and which still remain, are said to have cost over one hundred 
thousand dollars. 

The following figures of our great metropolis, recently published, 
may not be uninteresting to you of the great West: 

The total number of persons united in marriage in the city in a 
year, is seventeen thousand ; of births, thirty-one thousand ; of deaths, 
"twenty -three thousand, four hundred and forty-three; of dwelling 
houses, fifty-four thousand, three hundred and thirty -eight; of fami- 
lies, one hundred and fifty-five thousand, seven hundred and seven; 
there are nearly three families, on an average, to every dwelling ; nearly 
fifteen persons to every dwelling. There are eighteen thousand, five 
hundred and eighty-two tenant houses, containing four hundred and 
eighty -six thousand persons; city taxes are twenty -four millions dol- 
lars a year; money spent in public amusements amounts to seven mil- 
lions dollars a year ; for the support of the public schools, three mil- 
lions dollars; for police, two millions, six hundred thousand dollars, 
^venteen thousand emigrants land per month at Castle Garden ; there 
are four hundred and thirty churches, chapels and missions, with ac- 
commodations for three hundred thousand persons; the number of 
licensed drinking saloons is five thousand, two hundred and three. By 
actual count, the number of visits made to two hundred and twenty- 
three drinking saloons, during twenty-four hours, was found to be 
twenty-nine thousand, nine hundred and fifty. At this rate, the total 
visits made to five thousand, two hundred and three saloons amount to 
two hundred and fifty-three millions, seven hundred and eighty-one 
thousand, five hundred and twenty-eight a year. The amount of mo- 
ney received at the two hundred and twenty-three saloons named above, 
in a week, amounted to one hundred and forty-one dollars and fifty- 
three cents for each. At this rate, the total receipts of five thousand, 
two hundred and three saloons, for the year, would be thirty-eight 

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COlUBSPOMDmCX. 18ft 

niUioiifl, two hiukLred and ninety-one thousand, seven hundred and 
ninety dollars and sixty-eight cents. The of&cers of the United States 
Berenne Department estimate the total amount of retail liquor sales 
io be sixty-eight millions dollars. The latest police reports state that 
there are five hundred and twenty-fiye houses of prostitution, ninety- 
nine houses of assignation, thirty-three saloons where waiter-girls at- 
tend, and two thousand and seyenty public prostitutes. 

Total number of arrests by the Metropolitan Police, for the year, 
eighty thousand, five hundred and thirty-two. 

Arrests for crimes of violence, eighty thousand and sixty-two; 
commitments to the city prison, forty-seven thousand, six hundred and 
forty-six ; lodgings furnished at public stations, one hundred and five 
thousand, four hundred and ten; lost children taken care of by the 
police, five thousand, nine hundred and seventy-nine. 

Out-door poor relieved, twenty thousand, three hundred and ninety. 
In the prisons, hospitals, etc., under the care of the Commissioners of 
Public Charities and Correction, there were ninety thousand, eight hun- 
dred and fifteen persons relieved during the year. 

A free course of lectures en Ophthalmology, is being given to phy- 
Bicians and medical students, on the first Saturday, and the second, 
third and fourth Tuesdays of each month, at 8 P. H., by Pr. John P. 
Garrish, at his Eye and Ear Infirmary, 65 West Thirty-fourth street, 
comer of Broadway. Daily clinics are also held there at 2 P. X. 

Not being entirely satisfied with their present location down Broad- 
way, in connection with the New York Hospital, the trustees of the 
University Medical College have been endeavoring, for some time back, 
to secure a proper locality in the upper part of the city for building a 
new medical college. They have at length succeeded in purchasing a 
lot opposite Bellevue Hospital, and intend erecting a fine edifice there, 
which will be ready to be occupied by the coming fall. Thid will be 
a fine move for the University, as it will then, on account of its prox- 
imity to Bellevue Hospital, be able to present to its students those hos- 
pital advantages that have made Bellevue Medical College so popular. 
The many friends of the good old uoiversity, the annals ef which have 
been rendered ever illustrious by such names as Mott, Oross, Pattison, 
Dickson, Revere, Bartlett, Meredith Clymer, John T. Metcalfe and 
others, as teachers, and by its long array of distinguished gradu- 
ates, who are each year adding new lustre io its name, will heartily 
rejoice at this projected change. 

The Medical Record says: <*We are pleased to learn that a strong 

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186 WBSTXEZr J017BNAL OT MIDICINB. 

effort is being- made to collect ftinds for the erection of a saitable 
building for the uses of tbe medical profession of this citj. The in- 
itiative has been very properly taken by the Academy of Medicine, 
which has appointed a committee of ways and means, composed of 
its most responsible members, who haye the power to solicit and col* 
lect funds, select a site, and erect the buildings suitable not only for 
present wants, but also the future exigencies of the profession. The 
immense utility of such a central organisation as this must prore to be, 
if the design be carried out, will be acknowledged by every one inter- 
ested, and can not fail to call forth a liberal pecuniary support." 

A new "Medico-Forensic Society'' has recently been organized in 
New Tork, the object being to render medical jurisprudence familiar 
to physicians and lawyers. Mock courts will be held, and cases regu- 
larly tried. Meetings are held on the first and third Wednesday eve- 
nings of each month. The following oflcers have been elected : John 
Beach, M. D., President; W. B. Putney and Wm. Gibson, Vice Presi- 
dents; W. J. Wright, M. D., Recording Secretary; C. C. Terry, M. P., 
Corresponing Secretary; Charles K. Briddon, Treasurer. 

During last fall St. Luke's Hospital held its ninth' anniversary. 
Last year one thousand and twenty-seven patients were treated, one 
hundred and seventy-two of whom were children. The deaths num- 
bered one hundred and thirty-seven. Of these fifty were of scrofii- 
lous consumption, eleven of Bright's disease of the kidneys, and eight 
of cardiac disease. Other ailments caused the death of only from one 
to four persons each. Dr. Muhlenberg, the superintendent of the hos- 
pital, in a few remarks, said the title of St. Johnland was given to 
four hundred acres of land, five miles from Northport, L. I., purchased 
two years ago. It was independent of St. Luke's Hospital. A house 
had been built upon the spot by benevolent individuals, with a view 
of ultimately creating a home for aged and infirm men ; but at present 
it would be devoted to children. 

St. Luke's Hospilal, situated on Fifty*fourth street, between Fifth 
and Sixth avenues, was incorporated in the year 1850, mainly through 
the efforts of the Rev. Dr. W. H. Muhlenberg, then pastor of the 
church of the Holy Communion, and at the present time pastor and 
superintendent of the hospital. It was not until May 13th, 1858, 
however, that the institution was ready for the reception of patients. 

"The hospital building is placed on the northern part of a plat of 
two hundred feet wide/ and four hundred feet long, leaving six hun< 



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ooKmaBPomiRcx. 18T 

dred feet for eonrt yard. The principal front is on Fiffcj-fonrth street^ 
iacing south, and extending east and west two hundred and eightj 
feet in length. The general plan of the edifice is an oblong parallelo** 
gram, with wings at each end, and a central chapel, flanked with tow- 
ers. The eleyations of the seyeral fronts, even to the members of the 
eomices, are of square red brick." The wards of the hospital are one 
hundred and nine feet long, twenty-six feet wide, and fourteen feet 
high. Each bed has one thousand and ninety-two cubic feet of atmos-- 
phere. The great distinctive feature of the institution is the central 
ehapel. This has accommodations for about four hundred persons, is 
eighty -four feet long, thirty-four feet wide, and forty feet high. Here 
religious serrices are regularly held. 

There are four attending and consulting physicians, three attending 
and four consulting surgeons, a resident surgeon and physician and 
hb assistant, an examining physician, and a pathological cabinet. The 
board, for those who are able to pay, is seven dollars per week for 
adults, and four dollars for children, for whom a special ward is appro- 
priated. No contagious diseases are admitted. Many patients are 
maintained on charity beds, to endow one of which, costs three thous- 
and dollars, or three hundred dollars annually. There are fifty-five 
charity beds in all. Although this hospital is under Episcopal auspioes, 
still patients are admitted without regard to religious creed. This is 
truly one of our noblest charities. 

Yours, very truly, 

Jambs B. Burkxt, M. D. 



LETTEK FROM DR. CATLIN. 



T. Pakvin, M. D. — DxAB Doctor: My letter to you, published in 
the December number of your Journal, was so exclusively a statement 
of facts that I did not anticipate it could be disputed; I have just 
seen Dr. McElroy's letter, in your January number, attempting to 
ridicule and question my statements. 

I did not attempt to give general instruction respecting the use of 
the hypodermic injection, or the doses of morphine to be used in differ- 
ent kinds of oases. I only stated a few cases and their happy results; 
though I remarked at the close of my letter, <'It is perfectly safe 
when judiciously administered." 

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148 WSSTSftN KKWNAL OF HBDICINS. 

I hft^ as I wrote, used the hypodermic syriage, smce 1S60, n m, 
^reat variety of cases, carrying my syringe with me as constantly as I 
do my lancet, and using it fifty times more frequently. 

I do not remember more than one or two cases where the leasli an- 
{>Ieasant effect followed. My practice is to deal out a dose of mor- 
phine in powder, dissolve it in rain or distilled water. I often carry 
with me grain doses, oarefnlly weighed, vsisg the wAk#le or such part 
as I find necessary. At other times, as in the<case of vomiting in preg- 
nancy, when I stated that ahotU half a grain was used, I select the 
dose without weighing, but an -experience of over forty years enables 
me to do it with great accuracy. 

I purchase my morphine of Sisson A B«itler, Hartford, Connecti- 
cut., some of the best dmggists in the country, whose sales extend to 
the West as well as East. My patients were none of them opium 
eaters or drunkards. 

In my letter of November 19, 1868, I write, page seven hundred 
and seventy-nine, in your Journal: "From that time I have treated 
every case in the same way, and they have been cured in ten or fifteen 
minutes." In my manuscript I say every severe case. The omission of 
thb word I observed on first reading the printed copy, but did not 
think it necessary to request you to correct it in the next number. 
Indeed, I might have omitted the qualifying word in copying the ar- 
ticle for the press. 

The cases which I stated were all severe cases, where no judicious 
practitioner would have hesitated in giving, years ago, a grain of mor- 
phine, or two or three grains of opium, by the mouth. 

Whatever may be said or written, the facts remain the same. My 
patients are relieved in ten minutes, asleep in twenty, are well the next 
day; suffer no inconvenience from secondary effects of morphine — 
(never having witnessed the slightest in cases of cholera morhuB.^ 

Dr. McElroy's patient obtained partial relief in three miuntes, " but 
the lower extremities were still very painful. * * The sick stomach 
continued." "Before eight o'clock she was asleep," something less 
than one and a half hours after the injection, though, from the record, 
she was visited three days after this. 

No amount of ridicule will alter the facts. They speak for them- 
selves. With much respect, yours truly, 

B. H. Catlin, M. D. 
MsRiDEN, February 12, 1869. 



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EDITORIAL AND MEDICAL NEWS. 



A BI8TINQUI8HSD Citizen of Indiana died at Indianapolis some two 
weeks since, a few hours after taking about one-half of a mixture con- 
taining eight ounces of brandy, twenty grains of quinine, and one ounce 
of Uncture of gelseminum. The dose directed by the physician who 
prescribed this mixture was, a table-spoonful every two hours. 

As to the condition of the party prescribed for, all our knowledge 
is derived — as are the statements above — from newspaper accounts of 
the event. According to one paper, he "had been suffering for sev- 
eral days from nervous prostration.*' According to another, "he had 
been ill for some weeks, and latterly had been drinking quite hard. It 
is stated that for four or five days he had not tasted solid food, sub- 
sisting entirely on intoxicating liquors." 

We apprehend it is not assumiikg too much to say that this patient 
was laboring under alcohoUvm. Letting this be assumed, two or three 
questions are suggested. Was this patient in a condition to be trusted 
with any medicine powerfol in its effects? Was he fit to be trusted by 
himself even? And knowing that alcoholism when fatal, generally is 
■o from coma, asphyxia, syncope, or exhaustion, was gelseminum a 
suitable medicine in such a case? Here are statements of different 
authorities as to the action of this agent: 

"From the accoants given by varioas authors of tbe effects of yellow- 
jasmine, it appears to be a nervous and arterial sedntive, without nasueating 
or pnrfcative properties, bat sometimes causing diaphoreais, espeoially in 
febrile diseases. In moderate doses it produces agreeable flensations of lan- 
guor, with muscular relaxation, so that the patient finds some difficulty in 
moving the e]^e-lid8, and keeping the jaws closed. More largely taken, it 
oeeasions dixziness, dimness of vision, dilated pupil, general muscular debil- 
ity, and oniversal prostration; reducing the frequency and force of the pulse, 
and the frequency of respiration, aqd producing insensibility to pain; but 
wiUioat stupor or delirium. After a short time, these symptoms pass off, 
leaving no unpleasant effecta It usually begins to act in half an hour, and 
ceases to act after one or two hours. It Is, no doubt, capable of producing 
death in over doses." — United 8iale$ Diapensaiory. 

* '* Death has followed the employment of what was supposed the tincture 
of gelseminum, in a few instances, and further investigations are required 
to determine its probable cause, and whether this agent will produce any fatal 

^Dr. JotaD King, tba aathor of the nispeontory we qaote, ii not remarkable, as thie ex- 
tnct ehowi, for the accuracy of hie conpoeitioo— his words lodulge in a sort of promlwcnoos in- 
lercon r e e which most be annoying to any one trained up in tbe Tirtuons use of language. Ob- 
■■nre the second sentence and tell us to what word the relatiTe which refers ; so, too, in the third 
sentence— Che which is in trouble as to ownership— so fltr as grammar can guide us it refers to 
ayee, "and which gradually pass off in a few hours;" "Ihtal resnlU in large medicinal doMi** 
is so obrlously an absurd expression that it needs no comment. 



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190 WESTBBN JOURNAL OV MEDICINE. 

resalts in large medicinal dones. » » * Gelseminam is, an- 

doubted]^, an anrivaled febrifuge, and which appears to be dependent upon 
its relaxing and antispasmodic properties. Whether it is a narcotic is not 
yet satisfactorily explained. * * * Its effects are clouded vision, 
doable-sigh ted n ess, or even complete prostration, and inability to open the 
eyes, and which gradually pass off in a few hoars, leaving the patient re- 
freshed and completely restored. * * * If carried to such an 
extent that the patient can not open his eyes, the relaxation may be too great 
for the system to recover from, nence its use should cease as soon as the 
symptoms above named have been produced. 

** The tincture is the form in which it is employed. The dose is from ten 
to fifty drops in a wine glass half full of water, to be repeated every two 
hours." — American J)Upen$atory. 

** Possessed of narcotic properties to a very considerable degree/' * * 
many employ the tincture or the root in fevers. It acts in a similar manner 
to digitalis and F. viride, with the addition of some narcotic property. It 
has to be used with caution on these accounts, and because it induces delir- 
iam in overdose." — Resoureei of the Sauthem Fieldt and ForesU^ by Dr. 
Francis Peyre Porcher. 

However, without disouBsing these interrogatories, because there 
are details in reference to the death — ^how soon it occurred, what symp- 
toms marked its approach, et cetera — and facts which a poit-mortem 
examination that ought to have been made in the interests of medicine 
at least, would have discovered, which are wanting to us, we wish to 
make this positive and general assertion, that the administration of 
alcohol to a patient suffering with alcoholism^ is wrong, both on scien- 
Ufic and moral grounds ; and this position is taken without special refer- 
ence to the case above mentioned. We imagine that hemlock ifl not 
often given for paraplegia, strychnia for tetanus, or ergot for excessive 
uterine contraction; and if alcoholic stinralants have been resorted to 
frequently in the treatment of the disease in question, it has been from 
erroneous views of its pathology, and probably the practice has been as 
successful in furnishing victims for the undertaker as has that which ad- 
ministered opium larga manu in the same disorder—- each plan is fraught 
with incalculable mischief. We often think of the anecdote told by 
Dr. Theophilus Thomson, we believe, of an old lady upwards of eighty, 
who was suffering with fatal disease, and for the prolongation of whose 
life the doctor was urging the free administration of alcoholic stimu- 
lants, when she uttered the urgent request, ^^Doctor, let me go home 
fo&er." And should we not permit our patients, when they must die, 
to go home sober — not drugged to utter stupor with opium, nor drunk 
with alcohol? - 

As to the pathology of alcoholism^ some of us who are not very 
old can remember when we were taught that the disease arose from the 
withdrawal of an accustomed stimulant; but this teaching, with the 



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XBITOBIAL AKD MEDICAL NXWS. 191 

pernicious practice which was its natural sequence^.has been exploded 
by the advance of modern scienee. Here is what we are taught by 
some of the best and most recent authorities: 

"The essentia] nataro of delirium tremeiu is associated with the loss of 
eerehral power, eTinoed especially in the want of control over thoughts, 
emotkms, and muscular action, consequent on the direct influence of the 
alcoholic poison.'* — Aitken, vol 1, p. 776. 

**The pathology of alcoholism naturally divides itself into three portions. 
The Morbid influence which the poison exerts is of three kinds. In the first 
plaee, it acts as a local irritant (when highly concentrated) upon the mucous 
membrane of the stomach, and of the alimentary canal generally; and in 
the second place, after absorption, it affects the rate of movement and the 
vitality of the blood, and as a conseouenoe of this impairs the nutrition of 
every orsan in the body. And, thirdly, it is clear that the nervous centres, 
independently of the ill effects on their n«trition of the blood-changes, hare 
a certain chemical attraction tor alcohol, which accordingly is found to ac- 
eumolate in their tissues. * * The successful treatment of delirium 
iremenBy in nine cases out of ten, depends on the regular and continuous 
supply of suitable nutriment, whereby the functions of the nervous system 
are sopportod during the struggle towards recovery." — Rtynolde' SyeUm of 
Medicine, vol ti 

*' Delirium tremene -is but the acute form of chronic alcoholism." * * 

'* Science has determined that the administration of stimulants and alco- 
holic drinks in this disease, is at once irrational and experimentally dan- 
geroQs." — Nauveau DietumnairedeMedeeim'Hde Chirurgie PraHquee, Tome 
premier, Alcoolisme, 

'*The view of its pathology now prevalent is, that alcohol, a poison dan- 
gerous to life in large doses, is also cumnlative taken habitually in small 
quantities. * * Formerly the treatment used to consist of supply* 
ing the usual stimulus; but, tbeeretically, it is clear that this is tantamount 
to adding coals to fire, and, practically, it has been shown that patients more 
rapidly recover under the use o^ nutriment" — The Prineiplee and Practice 
of Medicine, Prcf. J. Hughee Senfuti, M D, 

We think the authorities adduced are ample to establish the gen- 
eral principlu that alchehel is not a suitable agent to administer in 
alcoholism. 

There are certain noral considerations which should enter into the 
diaeuBsibn of this question, but which we have not space now to con- 
sider. If the poor wrcltohes who hsTO been narcotised with opium, 
alcoholixed or chloroformed, because they had delirium tremeM^ were 
fikfthfiilly enumerated, we believe it could be shown that vastly more 
were killed than cured by such irrational tMatnMnt. 

The ComneNCEMEifT exercises of the Medical College of Ohio will 
^ held in the lower lecture room of the college building on Monday, 
the 1st of March, at eleven A. M., the valedictory to be delivered by 
Ihrof. James Graham, M. B., the degrees being conferred and an ad- 
dress delivered on behalf of the Board of Trustees, by Judge Dick- 



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192 WXBTSBir JOURNAL 0¥ HXDICINX 

son. The number of graduates will be between sixty and serenty. 
Next month the Journal will contain the list of questions asked the 
candidates for graduation — it will be remembered that this Institution 
has for some years pursued the plan of written instead of oral examin- 
ations — and also, we hope, Prof. Graham's address. 

Arranqements are being made, and will be completed in time to 
be announced in our April issue, for conveyance on some first class 
Mississippi steamer of those desiring to attend the meeting in New 
Orleans next May, of the American Medical Association. At present 
we can only announce that the time from Cairo to New Orleans will 
not exceed four days, and the /are, going and returning included, will 
not be more than thirty-five dollars. Our friend. Dr. Hibberd, has 
the matter in charge, and it could not be in better hands. 

The late Dr. Addison, (A Collection of the Puhlished Writing oj 
the late Thos, Addison, M, i>.. Physician to Guy's Hospital, Syden- 
ham. Society's Publications, London, 1868), concluded an article cm <Ae 
Diseases of Females conneeted with Uterine Irritation, thus : 

'* But, eentlemen, if you really require an apology for detaining yon so 
long, I find ample material for that apology in (he uvely interest which we 
mast all feel in the comfort and hanpiness of the other sex, doomed as thev 
are,' both by the decrees of ProTidenoe and by haman institations, to drink 
deep of the bitter cup of suffering. Whatever may be her lot in this world, 
we, as men, must at least acknowledse that whilst Infinite power gave as 
being, Infinite mercy gave us woman. 

This extract from a paper — (it was originally prepared as a clinical 
lecture — a paper that will especially delight the venerable Dr. Hodge, 
for so much of it is in correspondence with what he has taught in his 
own lectures and writings), we give partly as an answer to a criticism 
which was made by a most competent critic upon some of oux own 
expressions as to the special interest and importance of the study of 
diseases of women. 

The British and FoREiazi Ikdico'Chirurgical Review, Jamutry, 
1869, is not at all complimentary in its notice of Thomas on Diseases 
of Females: 

*< Thomas' work on the diseases of women is simply a compilation. The sur^ 
gery, illustrations as well as matter for the text, taken from Sims, the medi- 
cine and pathology from various well-known authors. Like all books of the 
kind, its real practical use is limited to giving the student some soperiknai 
information, acting as a kind of hand-post pointing oat the direction which 
mast be taken to arrive at real knowledge.'' 



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xmroAtAL AMD MBBicAL nxwb;- 198 

Ifow UoB is anjuBt. Dr. Thomas has written on many snrgicail dis- 
eases of women upon which Dr. Sims has never written a line, nor are 
his medicine and pathology exclusively derived from various well- 
known anthers, and we must regard the book as an excellent compend, 
and, in some respects, in advance of any similar work from an Ameri- 
ean pen. 

ExsECTiON OF THE Enzz-Joint, IN 1825. — (In the Lancet, Janu- 
ary 8th, 1825, there is quite a racy sketch of the late Mr. Crampton 
given, and in the course of it the author refers in the severest terms 
to^an operation performed by Mr. C, which is now established as per- 
fectly judicious.) 

He in^Kasiably performs the numerous experiments that are daily 
put forward in the world for well-known purposes, but which are very 
often nurtured in ignorance and propagated by credulity. While we 
profess ourselves the ardent admirers of rational experiment, we shall 
never countenance, by a concealment of our feelings, an innovation 
which would give one moment's pain to a fellow creature, without a 
well-grounded prospect of ameliorating his condition. 

We happened to be present, some time back, at one of those scenes 
of scientific butchery at the Meath Hospital. The patient was a fe- 
male; the complaint, if we recollect rightly, open scrofula of the knee- 
joint. A great concourse assembled to witness the operation : it was 
quite 2k gala day with the dissectors — a festival, seemingly, held in 
honor of the virtues of "Steel" It was the first time, we believe, that 
the removal of the knee-joint was attempted here; we earnestly hope 
it will be the last. The operator, of course, accomplished his purpose 
with his usual dexterity. But could he have beheld, as we did, the 
contorted countenances of the spectators, the knife would have fallen 
from Mb hand, never to be resumed where it was not more imperiously 
indicated. To be present was indeed to be in torture. One man vented 
his feelings in a wink; a second in a hem; a third overcame his sym- 
pathies in a forced fit of langhter; a fourth put his fingers in his ears 
to shut out the wretch's screams; all, to be sure, admired, yet all dis- 
approved; and before the performance was entirely finished, Colles 

cried out, in rather an audible tone, *" by J s f "— drew the door after 

him, and vanished. We saw this poor creature a long time after, endeav- 
oring to drag her limb with her, by means of sundry wooden contriv- 
ances. How much more preferable would amputation have been in this 
ease? A wooden leg to a useless member, kept from falling asunder 
by bandages and splints. And, forsooth, this is called cleverness I 
admirable surgery ! Very well, let it be called by whatever name the 
sanguinary desperadoes of the profession choose, but we shall never 
be cheated out of our judgment, or fear to expose such practice when 
it falls under our observation. 

•CollM WM aa IkmovB for this oath as a late President of the United SUtes for **Byth» EUr* 
Ml,** or as a noted New \ork olwtetrician is for "By Jot;'' 

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194 WBSmN JOURNAL 09 HSDIcniB. 

It pains us to annoance the death of Dr. William Haye, of Cov- 
ington, Kentucky. Dr. H. had been a contributor to this journal, and 
he was one of its warm friends. Only a short time before his untimely 
death, we received a most kind and encouraging letter from him. Per- 
sonal acquaintance with him, though not intimate, led us to appreci- 
ate him highly. We regret that the action of the Covington profes- 
sion, in reference to their late associate, which ought to have been 
received ere this, has, so far, failed to reach us; we hope, however, it 
will appear in our next issue. 

The New York Medical Gazette^ after being in a state of sua* 
pended animation for several weeks, makes its appearance again, and 
is sprightly and vigorous as ever. We hope it will meet with*libcral 
patronage. 

Baron Anselm de Bothbcbild has given the sum of two hun- 
dred thousand florins for the erection of an hospital for Jews, to con- 
tain one hundred beds, in Vienna. 

MoRTALiTT FROM Snake Bites IN India. — It appears from the 
Oude Administration Report, that during the past year, one thousand, 
one hundred and twenty-seven persons died from the effects of snake 
bites in that province ; and from the Central Provinces Administration 
Report, that one thousand, eighf hundred and seventy-four deaths had 
occurred in them from the same cause, during the three preceding 
years. 

The Neue Preste states that eleven men and three women died in 
Ickutsk, in 1867, all of whom were over one hundred years old ; of 
these, six are said to have been over one hundred and ten, one being 
one hundred and twenty-six, and another one hundred and thirty-one 
years of age. 

In Reference to the failure of the attack lately made on the fac- 
ulty of Paris, by the Bishops, Ricord is said to have remarked that it 
was an evidence of mitral int^ficiefu^. 

Wanted — A few copies of the Cincinnati Journal qf Medicine^ 
fbr February, 1866, and of the WeBtem Journal for April, 1868. 

For Sale.—- An order for an artificial limb. 

We call attention to the advertisement of Practice /or Sale — an 
excellent opportunity for a physician with a little capital and mwB 
experience* 



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THE WESTERN JOURNAL OF MEDICINE, 

(Formerly^ "Cikcinnati Journal o» Medicine.") 



Thoa it will be seen that if man has passioDS which impel him to the dettrnction of man, if 
be be the only animal who, devpising hif natural means of attack and defence, has derlsed new 
■eaa* of deatmetlon, he Is also the only animal who has the desire, or the power; to reliere the 
snflearinga of his fellow citizens, and In whom the co-existence of reason and benerolence attests 
a moral as well as an intellectual superiority.— Obatis* Glxnxcal Mcnicim. 



Vol. IV. INDIANAPOLIS, APRIL, 1869. No. IV. 



ADDRESS BY THE HON. WM. M. DICKSON, AT THE ANNUAL 
COMMENCEMENT OF THE MEDICAL COLLEGE OF OHIO, 
MARCH 1, 1869. 

GsKTLEMEN: It hsLB Wen customary upon these occasions, for the 
President of the Board of Trustees to address a few words of congrat- 
ulation and advice to the graduating class. Perhaps it is a custom 
that were better broken than observed; yet homilies and platitudes 
have their uses, and a kind word from your Alma Mater may make your 
separation the more agreeable. 

The profession you hare chosen opens to you a wide field of use- 
^InesB. More than either of the others, is it allied to, and connected 
with that which particularly marks the age in which we liye. 

The law can not, in our time, claim any particular preeminence 
over the past. It is a question whether we have made any real pro- 
gress — ^whether, indeed, our law, as a system of remedial jurisprudence 
and a rule of property, equals that of the old Roman law. Nor in 
the domain of theology, have we any to equal the great name» of the 
past. Eyen in metaphysics, modern speculations it is said are but 
chips knocked off the original granite rock of Plato. 

In the department, howeyer, of experimental science, ovr age is 
specially distinguished. In this, the ancients made comparatiyely lit- 
tle progress. Cicero writes that ^' the inyestigation of nature either 
a4) 

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196 WX8TSRN JOURNAL OV KXDICINI. 

seeks after things which nobody can know, or after such things as 
nobody needs to know.'' 

Now, to this department of knowledge, your profession is closely 
related. To it mainly, in certain branches, must our country look for 
the maintenance of its rank among the nations, in the generous riraliy 
of the developments of science. For example : Your profession in- 
Tolves a knowledge of chemistry and its kindred subjects, electric- 
ity, magnetism, &c. These introduce you to investigations, in which 
the greatest results have been reached, and the end is yet afar ofif. Al- 
most while we arc speaking, in the wonderful revelations of the spec- 
troscope, we have a striking illustration of the kinship and inter-de- 
pendence of the sciences. With the vapors of chemistry and the 
spectrum of optics are revealed the constituent elements of the heav- 
enly bodies; and thus the boundaries of astronomical science are en- 
larged. Nor have these. discoveries been a thing of chance, but the 
result of intelligent, well directed effort. 

By a happy coincidence, the investigations of the Frenchman, Jans- 
sen, made in India, and those of the Englishman, Lockyer, made in 
England, were crowned with success at about the same time, each in- 
dependently making the same discovery — the nature of the red flames 
of the solar eclipse. Nor did the coincidence stop here. M. De La- 
Rue had scarcely finished the announcement of Lockyer*s discovery to 
the French Academy, when French patriotism was gratified by the 
reception of Janssen's letter announcing his own independent discoT- 
ery of the same thing. 

To come more closely to your own profession. A French chemist 
discovers chloroform, and the inquiring genius of a Scotch physician 
utilizes it in the discovery of its anesthetic properties. Thus one dis- 
covery prepares the way and leads to another. This fact is also illus- 
trated in the progressive discoveries in electricity and magnetism, util- 
ized in the invention of the telegraph. 

Again. Your profession requires a knowledge of anatomy, physi- 
ology and zoology. These bring you into close connection with the 
inquiries now pressed with unwonted zeal and almost startling results 
in the departments of comparative anatomy, pre-historic archaeology, 
biology, involving the questions of 'Hhe origin of species,'* and "man's 
place in nature." These inquiries relate to the most hidden things 
in nature, yet of surpassing interest. For "to search out the whence 
and whither of .existence, is an unquenchable instinct of the human 
mind." But I will not detain you longer on these matters. 

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ADB&SSB BT THE HON. WH. H. DICfKSON. 197 

Enongh, perhaps more than enough, has been given to show you 
the intimate connection between your profession and the experimental 
sciences, the stndy of it leading to a knowledge of these, even when 
apparently far removed from it. Indeed, growth in medicine is, in 
great measure, dependent upon the growth of these sciences. There 
is not a discovery in chemistry, optics, electricity, magnetism, &c., that 
does not minister immediately or mediately to medicine. Science, the 
production of reason, is the natural enemy of charlatanry as well as 
superstition. With its advancement these must disappear. Beneath 
its white and gladsome light, they, twin o£fspring of ignorance, can not 
live. Medicine itself is a science, founded, like the other physical 
sciences, upon observation and induction. It is as erroneous as it is 
degrading to it, to suppose that it is a mere collection of nostrums or 
specifics, to be learned by rote by the student. 

Nor is it to be narrowed down and circumscribed by any exclusive 
dogma. Water-cure, botanic remedies, infinitesimal doses, any special 
system, neither separately nor collectively constitute the philosophy or 
the entire remedial agencies of medicine. It is no Procrustean bed 
for the diversified forms of humanity and of human ailment. It is 
catholic in its nature, seeking knowledge wherever it may be obtained, 
and subjecting all science to its demands. It is the science of human 
nature, having for its end the " prevention of disease, the cure of dis- 
ease and the improvement of the condition of man.'' 

You will readily understand that mastery in it can only be reached 
through years of patient, devoted effort, guided by the spirit of scien- 
tific inquiry. Yet it invites to no unrequited toil ; the rewards of sci- 
ence are among the greatest that wait upon human endeavor. I know 
under our democratic polity we are all necessarily more or less poli- 
ticians; and hence, political success has had an undue preeminence. 
Yet who would prefer the pomp and circumstance of great office, to 
the pleasure and the fame of the student of the closet whose years of 
patient toil have at last been rewarded by the discovery of some great 
law of nature, or by an invention utilizing these laws to the benefit of 
mankind? 

The Greek word eureka is domesticated in every language, because 
it is inseparably connected with an incident that touches the heart. 
Who does not sympathize with the philosopher of Syracuse, upon the 
solution of his problem, rushing from his bath crying, "Eureka! eureka! '* 
" I have found it ! I have found it I " Who does not sympathize with our 
own Franklin, when, having brought down the lightning from heaven, 

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198 WX8TSBN JOURNAL OV MSBIdirB. 

thus establisliing its identity with electricity, he tells us that he then 
felt that he was ready to die? 

Agassiz has said that the name of our late lamented townsman, 
Prof. Mitchell, would live longer than that of the most distinguished 
politician — referring to his invention for sidereal obsenration. 

Still, the universal stimulus with expectant parents is, ^'My som, 
you may be President,'' as if that were the acme of all greatness. 

Tet, how many Presidents have left office with a reputation that 
any one would envy? And as to fame, with the flow of time and tbe 
brevity of their terms, the historian will soon cease to mark the ord«r 
of events by a reference to their names. These will pass into tabular 
lists, and like the tables of Rome, sink into the forgotten rubbish of 
the past. A few, from their connection with great events, will escape 
this fate. But the names of science, associated with the discoveries 
and inventions, marking the developments of knowledge, will be as 
enduring as knowledge itself. When the blood ceftses to circulate, 
and the hideous variola is no more, and pain shall have ended, the 
names of Harvey, Jenner, Morton and Simpson may pass from memory. 

These are the benefactors of man. No fields of mangled victims, 
no ruined country, no mourning friends, no stricken revengeful foe 
attend the conquests of science. Nature joyously yields her treasures 
as the refreshing fountain^flowed from the smitten rock. 

I would not depreciate political eminence, but I feel that the dispo- 
sition to seek office is wasting in our country talent and genius tliat 
might in the departments of science, be an ornament to our race. So 
that he is a public benefactor who leads one ingenuous, inquiring youth 
from the slough of office-seeking to science. 

I would that you should devote yourselves to the noble profession 
you have chosen, with all its great opportunities for useMness and 
fame. Tou are quite aware that the diplomas you have this day re- 
ceived, are not testimonials that you have finished your education. 
Indeed, they but indicate that you are now fairly prepared to begin 
your professional studies ; and if you have learned how to study your 
profession, you have done well, and your teachers also. 

It is not a difficult thing to commit to memory the teachings of a 
text book. But this alone is not sufficient. We must bring to the 
study of any subject we would master, a spirit of scepticism and criti- 
eism. Prove all things, hold fast that which is true. We are apt to 
take as truth that which our text books and teachers tell as, and quite 

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ADDRESS BT THE HON. WH. H. DICKSON. 199 

likely they are right; but knowledge obtained in this way does not 
become oar own ; it sits uneasily, as a garment made for another. 

It only becomes our own when we have gone through for ourselves 
the process by which the original investigator reached his results, and 
kaye supplemented this by such independent modes of investigation 
and reflection as may occur to us. This manner of study, uniting with 
reading, well directed observation and reflection, gives knowledge and 
discipline of mind, securing soundness of judgment. These lead to 
wisdom, the true end of all education. 

A credulous person of retentive memory and industrious habits, 
nay fill his mind as a store-house, with facts, ^yet, without his own 
reflection there is no wisdom. There are men of much learning and 
little wisdom; and there are men of much wisdom, yet with little 
learning. 

And this is well understood. We have in public life men of great 
and varied erudition, who pour it forth on every occasion in copious 
streams. People are startled and wonder, but in hours of trial, they 
do not look to them for guidance. They instinctively feel that wisdom 
ia not here. There is a maxim, '^ beware of the man with one book " — 
that is, much reflection with little reading is better than much read- 
ing without reflection. 

Bo not ukistake me, I am not underrating the importance of learn- 
ing; but I would increase its value by adding that reflection and study 
which may make it our own. 

While the investigator of science should doubt and criticise, let 
him not carry this unnecessarily into the domain of theology. There 
ve men of science, of merit, who are continually contrasting their dis- 
coTeries with the teachings of revelation. These commit the same 
«rror which theology did when the church invaded the province of 
Bdenee and commanded the earth to cease it revolution around the 
««». "It moves, notwithstanding," said Oallieo. 

Dr. Hooker advises : " Let each pursue the search for truth — the 
ttchaM)logist into the physical, the religious teacher into the spiritual 
kistory and condition of mankind." Enlarging upon this, I may add, 
let the scientific inquirer pursue his investigations after the methods 
of science, let the theologian pursue his studies in his own way. Each 
^y be equal to his own, but not to both departments. There need 
le no apprehension of conflict if each reaches truth, for there is no 
^ordance in the work of the Author of all harmony. 

It may be inferred from what has been said, that while you should 

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200 WESTERN JOURNAL OF MBDIGDnr. 

endeayoT to have a general, and, as far as may be, aa accurate knowT- 
edge of all the branches of your profession — yet that you are more 
likely to reach high excellence if you make some particular branch, to 
the inyestigation of which your tastes, aptitudes and opportunities 
lead, the subject of your special inquiry. It is in this way that men 
of the old world study, and hence their great attainments. We, led 
by the multitude of matters, which, in a new country, demand oar at- 
tention, spread ourselves over too much surface and dissipate our ener- 
gies. Life is too short to permit any one, however great his capacity^ 
to attain to a complete mastery of all science ; yet, every one that pre- 
tends to scholarship,, owes it to himself and to his fellow-man to so 
niaster some one branch of knowledge that he will be upon it an ac- 
knowledged authority. If each who can, does this^ selecting different 
branches in the aggregate, the public will have the advantage of ripe 
scholarship in all tUe departments of knowledge. 

Tou will observe, gentlemen, that I have not referred specially to 
the practice of your profession. It is not because I do not feel the ex- 
ceeding importance of this branch of your duties. It is owing partly 
to the fact that on this you have already had the better instruction of 
your teachers; partly to the fact that whatever is likely to promote 
the money -making part of your profession will not be overlooked ; bat 
mainly because I would fain stimulate in you the desire to elevate and 
advance your noble calling. I would that you should look upon it as 
something higher than a mere money-getting art. Yet, even in thif 
narrow view, a thorough knowledge of the principles of medicine will 
not hurt you. For I take it, notwithstanding the depressing example 
of successful charlatanism, that, other things being equal, your capac- 
ity and success will depend upon the mastery you obtain over the sci- 
ence of medicine. 

It is true that there have been instances in your profession, of high 
scientific capacity not coupled with practical skill ; yet this has been 
owing, perhaps, to the fact that the practice was neglected, or perhaps 
to some peculiarity of mind or temperament unfitting for practice. 
But there are many noble examples of high scientific capacity united 
with the highest practical skill. 

You will pardon me if I shall name a living one. Dr. Simpson, of 
Edinburgh, is perhaps at the head of his profession in his country, hav- 
ing an unequaled practice : yet he has illustrated the annals of medi- 
cine with many happy inventions and important discoveries; aDd per- 
haps there is scarcely a number of the leading medical joumals in 



CASE OF DIPHTHERITIO CR0X7P. 201 

ibe United KiDgdom which has not a contribntion from his unwearied 
Aod productive pen. I mention him the more readily because there 
is that in his career which appeals peculiarly to American youth. 

There is not a young man before me who commences his profes- 
sional life under difficulties greater than those which surrounded Prof. 
Simpson in his youth. Living in a country where the classification of 
society opposes serious barriers to the advancement of the young man 
without family or fortune, he yet, beginning life the son of a baker, 
by his indomitable energy and perseverance, has risen to his present 
high position. 

Gentlemen, your Alma Mater and your country expect much from 
you. May they never be disappointed. Let it be your worthy ambi- 
tion to be masters in the science of medicine ; so study it as to make 
it your own. Select some branch suited to your tastes and opportuni- 
ties, and make this the object of your special, Ufe-long investigation; 
and then, with the blessing of heaven, your name, may yet be written 
among those who have advanced the boundaries of knowledge. 



CASE OF DIPHTHERITIC CROUP— OPERATION— DEATH. 



BT DR. J. C. REEVE, DATTON, OHIO. 



January 29th, 1869, was called to see a boy aged seven years, under 
the care of Dr. Searles, of Osborn, with whom had been associated Dr. 
Green of Fairfield. For about a week before, the patient had been 
suffering under the symptoms of an ordinary cold; only on the second 
day preceding had he became severely ill, and only since the day be- 
fore had his breathing been seriously affected. I learned that on the 
day previous he had passed part of the time looking at his book, 
■othing apparently the matter with him, except what was betrayed by 
eoogh, breathing and voice. He had been rapidly getting worse, howr 
ever; during the night he had three suffocative attacks, so severe that 
his friends did not think he could survive another. I found him to 
be an extremely healthy looking child, of a very healthy family, but 
BOW presenting all the symptoms of suffocation from laryngeal obstruct 
tion; his cough suppressed, voice whispering, chest walls working vio<^ 
lently with the efforts to respire, face and hands livid, pulse frequent 
and tolerably feeble. Upon the tonsils and larynx were scattered. 



202 WESTERN JOmtNAL OF MEDICtirE. 

patches of false membrane ; they were not extensire or thick, but suf- 
ficient to characterize the case as one of diphtheria. In the opinion 
of the gentlemen in attendance, he had pneumonia, or broncho-pneu- 
monia of the left lung ; but the noise of respiration in the trachea so 
interfered with an examination that I could not distinguish it. I sat- 
isfied myself there was no hepatization. The treatment need not be 
detailed ; he had frequently inhaled the vapor of slacking lime. 

As soon as preparations could be made, and the parents had, after 
candid statement of the risks and probabilities of the operation, con- 
sented, I proceeded to perform tracheotomy. He was slowly and care- 
fully brought under the influence of chloroform, which somewhat deep- 
ened the liyidity of his countenance, but did not affect ^the pulse. 
Hasmorrhage was abundant, and so obscured the parts that the trachea 
was opened with great difficulty. Some delay was also occasioned by 
one branch of the dilating forceps not being in the trachea, but be- 
tween the muscles. During this time only partial relief was afforded by 
the artificial opening. Some blood found its way into the air-passages, 
and the appearance of the patient was very critical. ^The instrument 
being adjusted, however, the intruding blood was expelled, the patient 
rallied and soon began to mend. Having to send home for a tracheo- 
tomy tube, the forceps were allowed to remain in place, the handles 
being tied together and fixed down to the sternum by adhesive plas- 
ter. The opening was free, and respiration through it perfect, so that 
when the tube arrived I decided not to introduce it, but to allow the for- 
ceps to remain ; especially as I believed the tube to be too small for a pa- 
tient of his age. In half an hour after the operation, the patient was 
asleep, breathing easily and regularly, color good, and pulse, by the tes- 
timony of all, better than before. Arrangements were made to fill the 
air of the room with steam. He was ordered milk for nourishment, and 
ice was allowed freely. At three o'clock P. M. I left on the train for home 
six hours after the operation, he was still doing well, so well that I 
felt strong hopes of his recovery ; but was bitterly disappointed the 
next morning to learn that he died fifteen hours after I left and twen- 
ty-one after the operation. 

As to the cause of death I can not be sure ; he seems to have begun 
to fail about one o'clock in the morning. In the opinion of Dr. Oreen, 
the membrane had extended to the trachea, and by its dislodgmeot 
suddenly interfered with respiration and caused death. The manner 
of his death corresponds with this view; but the relative part played 

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CASK OF DIPHTHERITIC CBOUP. 203 

by the diplitheria or the pneumonia, in producing the fatal result, 
18 not clear. 

Bjsmabkb. — ^This ease demands publication, if only for the rarity 
of the operation in this section of the country. So far as. I can learn, 
tracheotomy for disease, has been performed in this city or yicinity 
in but one other case within fifteen years. In that case the patient 
died under the operation. I have also known of but one or two other 
cases where the operation would probably have been beneficial. 

As to the case being one in which the operation was justifiable and 
presented a fair prospect of success, there is not a question in my 
mind, nor is there with the other gentlemen in attendance. His age, 
and his unimpaired powers from the short duration of the disease, 
were strong arguments in favor of it. It was impossible, of course, to 
decide how much the depression of ihe pulse depended upon the asphy- 
sia or upon other conditions ; but it certainly, in any case, was no 
eontra-indication to an operation. Looking very carefully at the symp- 
toms in every respect, and at his condition, the conviction was forced 
upon me that it was a fair case for tracheot<>my, that he would certainly 
die without it, and that it was my duty to perform it. 

By some it may, perhaps, be maintained that because it was diph- 
theria an operation should not have been performed ; that in crtnip it 
may be resorted to, but that in a disease which is constitutional, the 
operation does not promise enough to justify it. Upon this point, the 
first necessary step would be to reconcile authorities and teachers as to 
the identity or non-identity of the two diseases. The membranes in 
both diseases are anatomically alike, and very high and very respect- 
able authority can be cited in favor of the view that they are essen- 
tially the same disease. This doctrine is maintained by Hillier in his 
recent work on the Diseases of Children.* 

Trousseau, while he admits that croup, as we understand the term — 
what he calls croup d'emblee — may occur, yet says that in the great 
majority of cases the membranous formation begins in the pharynx 
and extends from there to the larynx. Bretonneau held this doctrine, 
and Guersant adopted it after having held the other and more gener- 
ally received view of the British school. 

But whether the pathological unity of these diseases be established, 
admitted or denied, there should be practically no question in refer- 
enoe to an operation. Whenever the danger depends more upon the 
local than the general disease, the operation should be performed. The 

•American Edition, page 141, and AiMriean Journal M^dkml BcUncn, January, 1888. 

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204 WESTERN JOUBNAL OF MBDIOINE. 

case is well stated by Trousseau, an authority upon everything relating 
to the subject second to no other in the world, and I translate what he 
he says in regard to the probability of success of the operation:* 

"It has a chance of snccess when the local lenofiy whetfihe croup j eonetituisi tkt 
jprincipal danger to the patient. 

" This restriction is important ; for if the diphtheritic infection has profouadlj 
affected the economy ; if the skin, the nasal fossae are attacked by the pecial in- 
flammation ; if the frequency of the pnlse, the delirium, the prostration indicate a 
profound iatozication ; if, in a word, you hare a case of malignant diphtheria, 
where the peril is rather in the general condition than in the local lesion of the 
larynx or the trachea, the operation ehould not be attempted— ^it is inyariably followed 
by death." 

Thus, in contrast to the case under consideration, was one of about 
the same age treated this winter. Thick diphtheritic patehes on the 
throat, were followed by well-marked symptoms of their extension to 
the larynx; but the general state of the patient was such that thfi 
question of an operation was not entertained for a moment; she waa 
pale and strikingly anaemic, her pulse like a mere thread, and extreme 
depression marked upon every feature. She recovered, however, and 
is the only case I ever saw recover of laryngeal affection in diphtheria. 
The treatment was with tr. ferri mur., chlorate of potash, quinia and 
alcoholic stimulants with inhalation of the steam of slacking lime, 
and lime water and solution of tannin, alternately in vapor from the 
steam atomiser. 

In giving authorities in favor of tracheotomy in diphtheritic laryn- 
gitis, I must not omit Dr. Jacobi of New York. In a recent article 
upon croup, which, in my humble opinion, is one of the best contri- 
butions ever made to the medical journal literature of this country, 
he acknowledges no contra-indication te the operation, if the patient 
be suffocating : f 

" Now, while I admit that with symptoms of general diphtheria, complicat- 
ing a case of laryngeal diphtheritis, called membranous croup, the prognosis of the 
operation becomes more doubtful, I lay stress on the very same fact, for the reason 
that eren in such cases, the only indication for the operation rests in the local 
obstruction." 

The same doctrine is taught by Guersant| — marked evidence of 
general infection of the system lessens the chance of success. 

" If there are false membranes in the nares, behind the ears where ulcerations 

*Climque MedicaUt tome I, page 451. 
^Amerioan Jourtial of OMeln'oi, Hay, 18G8. 
Xlsoticu Sur la Chirurgie dm Et{faut$, Paris, 1SC4. 



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CASK 07 DIPHTHKRITIC CBOmP. 206 

often exist; if tiie sub-Biaxillary ganglia are enlarged, and if the urine is albn- 
nunooa, the operator tbonld know that there is xettj little or no hope of success." 

A debilitating coarse of treatment — '' low diet, antimonial», leeohes 
and blisters" — lessen the chances of the operation; but extension of 
the false membranes to the bronchiae, are not for him, a contra*indi- 
cation: 

"We hare seen patients spontaneonslj expel false Membranes representing the 
earitjr of the trachea and bronchial tabes, and recover without an operation, and 
others who hare also thrown them up after tracheotomj, and also recover." 

In a discussion of the operation by the Medical Faculty of tike 
Hospitals of Paris,^ M. Archambault reeogniaed the existence of bron- 
cho-pDeumonia as a complicati<Hi exercising great infiuence upon tke 
result of the operation. His remarks are of interest in reference to 
the case under our care : 

" M. Archambault insisted upon broncho-pneumonia being among the graTOSt 
eompHcations and one almost surely fiital if existing at the time of the operatiiMi 
or shortlj afterwards. It is, he added, extremelj difficult to recognize the phjs- 
ical signs during the asphjxial period of croup; it can be rather judged to be 
present, than diagnosticated, by the frequency of the pulse and respiratory move- 
ments, (140 and 40), while in cases where there is only croupal asphyxia, the fre- 
quency of pulse and respiration are much less." 

Having begun with the simple intention of reporting a case, we 
have extended our remarks, perhaps, already too far, and will not, 
therefore, enter npon any statistical evidence to sustain the operation 
of tracheotomy in diphtheria. It might be doing good service to 
adduce it. True membranous croup occurs in this section so rarely, 
diphtheria with laryngeal affection and without too severe general 
symptoms for the operation, is but occasional anywhere, the situation 
is so painful for parents and trying for the medical man, that it would 
be well to have at hand the fair support which statistics will give to 
the measure. We must defer this tasJE, however, to another time, and 
content ourselves with quoting here the noble words of Barthezif 

**If children, the subjects of bad croup, having reached the stage of confirmed 
asphyxia, and having no longer anything to expect of medicine, oflfer to the sur- 
geon the chance of one recovery in ten, in twenty, or even less, I for one, have 
not the courage to refuse them.*' 

Hillier, in his recent work on diseases of children, teaches the doc- 
trine of operation whenever death is threatened from laryngeal ob- 
struction. 



*ArcUt€» Gmtn^lm ds Mtd^cm, Juillett 1868. 
\M9dieal Timt$ amd (7as«tt«, Aogmt 8, 1868. 



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206 WESTERN JOURNAL OF MEDICINE. 

We may all of us at least expect as good success as Nelaton ; lie 
saved his first case and then operated twenty-three times without a 
recovery!* The particulars of the cases are not given; hut it is to 
be presumed that the French rule was followed, of operating under 
any and all circumstances. 

Finally, in considering the propriety of an operation, the relief to 
suffering given by it should have due weight. This was answered in 
the case reported. It is a strong point, for of all the painful scenes a 
medical man is called upon to witness, few are more distressing than 
that of a strong and vigorous child suffocating from "laryngeal obstruc- 
tion. If only a quiet and peaceful death be attained by the operation, 
that can not be considered a trifling gain. 



CORRELATION OF THE PHYSICAL AND VITAL FORCES. 



BY JAS. F. HIBBERD, M. D., RICHMOND, IND. 



On the 12th of October, 1868, the winter conrse of lectures in the 
Jefferson Medical College of Philadelphia, was opened by an inaugural 
address by J. Aitken Meigs, M. D., recently appointed to the chair of 
Institutes of Medicine and Medical Jurisprudence in that honored 
seat of learning. 

Prof. Meigs takes for the theme of his address, the Correlation of 
the Physical and Vital forces, and after a somewhat elaborate review 
of the progress of science in this regard during the last one hundred 
years, apparently arrives at the conclusion that at the present day there 
is no man of eminence or ability who is not a convert to the doctrine 
of the correlation of physical and vital force. Possibly this was not 
the author's intention ; but the reader is certainly led to this view of 
his labor. One would hope that the erudite and accomplished profes- 
sor is not going to make of himself an addition to that not inconsid- 
erable class of teachers in medicine, who having adopted a theory, 
bring forward abundantly of authority facts and arguments to sustain 
their views, without intimating that the opposite opinion has earnest 
and honest advocates to support it. 

The status of scientific opinion in relation to vital force in the last 
kalf of the eighteenth century, is fixed by Prof. M., by citing the 

♦Ofaiooi L0elmr«$ om SKryryt Philadelphia, 1855, page 54. 

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THE PHTSIGAL AND VITAL fOECBfl. 207 

ideas promulgated at that time by John Hunter, in England, Hum- 
boldt^ in Germany, and Bichat, in France, all of whom were earnest 
advocates of the doctrine that vital force is something gut generU, a 
special endowment of living things. He refers to many other emi- 
oeDt men, active and of authority, in the earlier part of the present 
century, who held the same views strongly, one of them declaring that 
in the whole range of medical literature there is not a single author 
of note who does not admit the existence of "a governing vital prin- 
ciple as a distinct entity, distinct from all other things in nature/' 

He then alludes to the work of Dr. S. L. Metcalfe, of Philadelphia, 
ojk^^Ckloricy* published in 1843, as being the first complete treatise 
that clearly set out and maintained the doctrine of the unity of all 
force; vital phenomena being the product of one of its correlated 
phases. 

Br. Metcalfe's book did not meet with much recognition as an 
exponent of the truth of science. Indeed, Dr. Richardson spoke of 
the author as an "immortal heretic in science,'' and Dr. Carpenter 
characterized him as "an enthusiast and system maker, and declared 
that his views were very unphilosophical." Now, however, these two 
eminent London physiologists are among the most earnest advocates 
of the doctrine which they almost ridiculed a quarter of a century ago. 

Prof. Meigs recounts the labors and recites the opinions of a host of 
the leading medical men of to-day, who in various ways illustrate the 
correctness of the idea of a unity of force. After informing us that 
recently "Wurtz announced that he had e£fected the synthesis of neu- 
rine; while Kolbe, at a late meeting of the chemical society, stated 
that he had obtained urea from carbonate of ammonia," Prof. M. con* 
tinues: "It is highly probable, indeed, ihat the time wjD come when 
^ the products of living organisms will be crvated or closely imitated 
by the chemist. The complete realisation of this probability will 
shortly tend to deprive nutrition or assimilation of its mysterious 
Titalistic character, and bring it, in common with other organic or 
vegetable functions, within the pale of physico-chemical actions." He 
then quotes from Dr. Gull, the great practical physician of London, 
and a profound thinker, this sentence: "Daily advances in science 
Bttke it more and more probable that organized beings are the neces- 
ttiy development of the physical condition of our globe." Other dis- 
tinguished scientists are cited to the same general tenor. 

The microscope, by its revelations, has revolutionized many of the 
histological notions that were very confidently taught thirty years ago. 

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2W WSSTERN JOURNAL OF HBDiciNS, 

The most important point, for onr present purpose, that it has revealed^ 
is the fact, now accorded such by all classes of biologists, that the cell 
t« the unit of vital activity in all organic existences. The theory of 
cyto-genesis, in the animal kingdom, is in its infancy yet; but it is a 
vigorous and a popular infant, recognized by all wise men as the com* 
ing giant in biological science, its growth assured and its develop- 
ment rapidly promoted, by the fostering attention of 9Qch untiring and 
zealous scientific wet-nurses as "Remak, Virchow, Weber, Redfem, 
His, Bottcher, Billroth, Paget, Beale, Max Schultze, Robin and many 
others." 

According to Prof. Meigs, the physico-vitkl correlation of force is 
as much an established fact as tho cyto-genesis of tissues, and as fully 
accepted by biologists. He calls it he "highway of research leading 
to the true theory of life," and tells us that among the great men 
who are radiating this highway with their intellectual light, are to be 
found Yanuxem, Metcalfe, Grove, Carpenter, Faraday, Mayer, Rad- 
oliffe, Hinton, Leoonte, Yierordt, Bonders, Fick and Wislicenira, Ranke, 
Tyndall, Frankland, Lawes and Gilbert, Parkes, Odling, the Rev. Dr. 
Haughton, Bence Jones, &c. 

The careful reader will notice that this last catalogue of names, 
long as it is, omits all mention of one of the most industrious, pains- 
taking, and candid microscopists in the world, an English biologist 
whose enviable reputation extends throughout the borders of civiliza* 
tion, a penetrating observer and a profound reasoner, who quarrels 
with no one, but gives the results of his labors with a elearness and 
perspicacity that others might follow with advantage; we mean Ihr. 
Lionel <S. Beale, of London. 

Beak, in his work "on the structure and growth of tissues, and on 
life," devotes the last chapter to a consideration of Life in the light of 
the histological facta presented in the preceding part of the book. 
He had already shown that the cell consists essentially of two parts^ 
the ^^ germinal matter'^ and the ^^ formed material;^* of these, the 
lat^r exists exteriorly and the former centrally. The pabulum for 
the nutrition of the cell is received into the center of the germinal 
nmtter, and there begins its outward course, and as it progresses, under- 
going the metamorphsis into the living structure of the cell, so that 
by the time it has reached the limit of the germinal matter it has be- 
come formed material, and is no longer subject to vital processes car- 
ried on in the cell. Now, according to Beale, when this unorganised 
pabulum reaches the center of the germinal matter and begins its out- 
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CHILD BORN WITHOUT CALYAmiA OR SKCEPHALON. 209 

ward progress, its transfonnatioii is accomplished by a force baying no 
uiuson with any conceivable plan of physical force; bnt on the con- 
trary, it is acting in direct antagonism to all recognized laws of that 
force. 

There is nothing in Ascherson's observations of the oil globules 
taking a coating of albumen — nothing in the "progressive physical 
changes which take place in the chyle as it passes onwards through 
the lacteals into the thoracic duct" — nothing in Prof. Bennett's lec- 
ture on the "Origin of Infusoria," that satisfactorily accounts for the 
phenomena that Beale asserts are accomplished only by a vital force, a 
foree unlike anything else in nature, and he claims that it is a special 
endowment of living matter conferred on it by the great Author of 
the universe. 

Quite possibly Beale may be mistaken, and in a little while some 
lynx-eyed philosopher may penetrate the mystery of interior cell action 
tad show us clearly enough that it is but a peculiar modification of 
eommou physical force, so ordered by the Creator for the construction 
of oiganiaed liTing tissues ; and when this is done, no man will be more 
ready to say it is done than Beale. But until we attain to such knowl- 
edge, it must be regarded as something in the nature of a sin of omis- 
sion in even so good a man as Prof. Meigs, when he, summing up the 
statos of the scientific world upon the point, in an inaugural address 
to a house fiill of students and others, conveys the idea that there is 
BO one of meritorious eminence who does not yield credence to the 
theory that sun force and vital force are correlated — are but phases of 
the same power that floats the aeronaut through the air — ^that holds the 
ocean in its bed in the diurnal whirl of the earth — that forces the 
melted viscera of the earth up through the volcano's crater, and that 
lends our thoughts through the wires bounding over the continent, or 
shooting beneath the deep sea from hemisphere to hemisphere. 



A CHILD BORN WITHOUT CALVARIA OR ENCEPHALON. 



BT DR. C. H. SMITH, KIRKLIN, IND. 



July 27th, 1867, was called to see Mrs. H , aged thirty years — 

German — ^vito-motor temperament — finely developed — mother of three 
living children. 

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210 'WB8TSB1I JOTTBNAL 09 MSDIGINX. 

On arrival, found she had given birth to a healthy male child whieh 
was separated and given to the nurse, and within twenty minutes more 
a female, breech presenting, was delivered still-born and without cran* 
\nm or brain. 

Some ten minutes were taken up in attentions to the patient, and 
removing placenta, which was double, when the monstrosity was more 
closely observed. 

The parietal bones were entirely absent. The occipital and firontal 
were absent, except the inferior part of the former and orbital plates of 
the latter. The superior part of the temporal bones was also wanting. 
The eyes were quite prominent, but the optic nerves dwindled to a shred 
before decussating. A thin, transparent membrane stretched loosely 
across the base of the skull, beneath which was a small amount of 
pulpy substance, and serous fluid tinged with red. The medulla spin- 
alis terminated in a soft, roundish mass. Development otherwise nor- 
mal and child of medium size. 

Up to this time, no signs of life had been manifested, neither heart 
sounds nor respiratory gasp ; but on touching the superior termination 
of the medulla spinalis, convulsive movements of the limbs followed 
repeatedly, but no reflex action could be elicited by irritating the pe- 
ripheries. , 

Parturition was natural, except an excessive amount of lienor amnii 
with second birth. Neither was there any occurrence during gestation 
that would likely have influenced development. In October, 1865, 
patient had typhoid fever, and in December following, empyema, from 
both of which she had made an excellent recovery. It might be well 
to state that the husband was a very intelligent and healthy farmer. 
We leave the subject without comment. 



ON LITHOTOMY OF THE GALL-BLADDER. 



BT GEO. G. BLAOKMAN, M. D., 

;eof Ohio; Sorgo 
, Ohio; etc., etc. 



Professor of Surgery in the Medical College of Ohio; Sorgeon to the Samaritan Hospital, Cincin- 
nati, 0" • 



CbWtetMci from pag0 87, Ftbruarg M«m5«r. 

Mr. Samuel Sharpe, who was surgeon to Guy's Hospital, in his OrU- 
ical Enquiry into the Present State of Surgery^ London, 1750, at page 
222, thus remarks: "I have hinted that though the opening of the 



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LTTHOTOXir or THE OAJJi-BLADBSB. 211 

gall-bladder is exceedingly dangerous, where it remains loose, yet when 
it happens to adhere to the peritoneum, the operation may be advisa- 
ble. The gall-bladder, like the urinary-bladder, by excessive disten- 
sion is sometimes burst; but if previous to the rupture, it adheres to 
the neighboring parts with which it falls into contact, as is usual with 
inflamed membranes, it will be proper to make an incision in the upper 
part, lest it should burst into a part that should evacuate the bile into 
tbe abdomen. There are several examples recorded where it has broke 
externally, and the patients by this accident have done well. These 
exunplea, therefore, show the fitness of making such an opening, where 
an adhesion is certain ; but what recommends an operation still more, 
is the possibility of extracting a stone or stones from the gall-bladder, 
which by their residence, would continue to keep up the inflammation 
and the consequential complaints. This operation was first performed 
where it was not originally intended, the surgeon only proposing to 
eore by dilatation a small fistula of the gall-bladder; but in examin- 
ing the cavity with his probe, he 'felt a stone as large as a pigeon's 
egg, which he extracted, and the patient recovered. It is true, this 
operation is not yet established; but besides the case here recited, 
there are several histories of patients whose gall-bladders have burst 
externally, and whose stones have worked out of themselves, which 
ought to encourage a skillful surgeon always to examine if there are 
uij stones in the gall-bladder, whether the opening into it be made by 
Mtore or art." 

Wm. Bromfield, Surgeon to Her Majesty, and to St. George's Hos- 
pital, in his Chirurgical Observations and Cases, published in London, 
1773, volume ii, page 174, speaking of distended gall-bladders, adds: 
''The tumor in this part has often been mistaken for an abscess of the 
H^er, which at length bursting, has given credit to the person who at- 
tended the case ; for by dilating the orifice, some biliary calculi have 
been discovered, which were then extracted with great solemnity, as 
if the whole operation was done in consequence of the superior skill 
of the operator. The same thing has happened in abscesses of the 
kidneys from the same cause ; and authors very gravely describe the 
operation of nephrotomy, as if an able anatomist, once convinced of 
a stone being generated in the kidneys, and too large to pass into 
the ureter, would judge it might be taken out as safely as from the 
bladder. Surely this want of candor is unpardonable, as the credit, 
if any, is certainly due to chance ; but relying on the reputation of the 
relator, a young rash practitioner may think the authority sufficient 

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212 WSSTSBN JOirftNAL OF HSDICINB. 

for him to make the attempt. I am afnkl some of my brother au- 
thors are rather too fond of relating cases of the marrelous kind, 
attended with success, without mentioning those which miscarried. 
The integrity of Hippocrates has done more service to physiciana, in 
setting down the practice when unsuccessful, as well as where tho pa- 
tients recovered, than if he had put down twenty times the number 
that did well, and omitted those that died under his care." 

Delpech, in his Pr6c%$ BRdmentaire des Maladies repiUSes Chirur- 
gicalcy Paris, 1816, tome ii, page 189, thus comments upon the opera- 
tions which have been proposed for the removal of biliary calculi: 
'^After the spontaneous or artificial opening of tumors formed bj dis- 
tended gall-bladders, it has often happened that biliary concretions 
have been found and easily extracted. This has been followed by an 
abundant escape of bile, which these foreign bodies had caused to be 
retained, and in some instances the patients have been cured. From 
this it -has been inferred that when biliary tumors have terminated in 
such openings, a grooved sound might be introduced and calculi de- 
tected, as well as removed by enlarging the opening. But verj few 
cases have been brought forward to prove that biliary concretions have 
been extracted from the gall-bladder itself. Judging from observation, 
it would seem that almost always these bodies have been removed from 
the thickness of the abdominal walls, where they had become engaged, 
and often they have been found in a sinus in the abdominal muscles, 
or beneath the integuments, which sinus has been caused by the infil- 
tration of bile in the cellular tissue. If it must be admitted thai, in 
certain cases, these concretions had been formed in the gall-bladder, 
and were afterwards thrown towards the surface by the process of sup- 
puration, we are led also by analogy, to believe that under certain cir- 
cumstances these biliary concretions have been formed in the sinuses 
in which they were found. It is an important rule, taught by experi- 
ence, that we must not touch biliary tumors except where there has 
been ^evidence of external inflammation which has led to adhesions of 
the abdominal walls and the surface of the gall-bladder. Bat even 
then, how can we be assured that in carrying the knife to this or that 
point of the circumference of the abdominal ulceration or opening, we 
may not pass beyond the limits of adhesion, and give rise to infiltration 
of bile in the peritoneal cavity with all its dreaded consequences? 
In cases where the opening has been of long standing, and has become 
fistulous from the escape of bile, there may be less difficulty and dan- 
ger from the proceeding. Cases have been observed in which the ad^ 



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LCrBOTOMT OV THJB OALL-BLADBUSU 213 

besions between the gall-bladder and the walls of the abdomen have 
resembled an elongated ligament. Into this cord-like substance, which 
nay be compared to a vessel — a narrow sinus existing — a sound pene- 
trates only with difficulty, showing on the one hand an external orifice, 
while th^ other end communicates with the gall-bladder, the cavity of 
the latter containing several biliary concretions, which are not free, 
bat closely embraced by the walls of the gall-bladder. It is evident 
that in such a case, the focility with which the gall-bladder has emptied 
itself of the bile deposited in its cavity, has permitted it to contract 
closely upon the concretions which it contains, and hence the forma- 
tion of the pouches in which they have been found. It is evident, 
also, that however limited may be our incision through the coats of the 
cord-like sinus, bile may escape into the abdominal cavity. Finally, 
it is very doubtfil whether, even if we should penetrate safely into the 
ctTity of the gall-bladder, we could seize and extract the calculi there 
deposited." 

Delpech then lays down the following precepts : 

The immediate removal of biliary concretions by means of the 
knife, should be attempted only in those cases where they present 
themselves at the external opening in the abdominal walls, or are en- 
gaged in the sinuses connected with this opening. In no case should 
sQch operation be attempted where they are still enclosed in the gall- 
bladder. Dilating instruments, incapable of destroying the walls of 
the sinus, are the only means by which an attempt should be made to 
reach calculi in the gall-bladder, especially if the biliary tumor has 
long been open. 

M. Cruveilhier, in his TraMD^Anatomte Pathohgique G^nSrale, Paris. 
1852, tame deuxteme^ page 570, reports the following case which occur- 
red in the practice of M. Robert, then surgeon to the H6pital Beau- 
jon: '«In 1836, a female, set 35, was admitted with an umbilical fistula 
of eight months duration. It was the result of an abscess which spon- 
taneously opened, giving issue to a yellowish pus. A sound detected 
a calculus at the bottom, which M. Robert deemed to be about the 
nie of a hazel-nut. He thought that by breaking it into frag- 
ments with the crushing forceps, it might be the more readily ex- 
tracted; but the simple introduction of the dressing forceps into the 
fifltola for the purpose of exploration, gave rise to a peritonitis which 
destroyed the patient. The fistula, being opened at the umbilicus, fol- 
lowed the course of the suspensory ligament of the liver, and termin- 
ated in the gall-bladder which was extensively ulcerated. Here was 

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214 WB8TEBN JOURNAL OF MSDICOffS. 

found a biliary oalcnlus the size of a peach stone, which was just within 
the fistula, the walls of which presented considerable resistance.'' 

Chaissaignac, iii his Th*aM Pratique de la SuppurcUion, et du 
Drainage Chirurgical, Paris, 1859, tome ii, at page 368-9, after refer- 
ring to the cases quoted by Ploucquet, in which biliary calculi through 
an abscess have escaped spontaneously, remarks : When the abscess 
opens spontaneously, if the opening is too narrow, or too remote front 
its fundus, we should enlarge it by means of caustics, and especially 
the Vienna paste, and he adds that a cure of the biliary fistula gener- 
ally takes place after the extraction of the calculi. 

At a meeting of the Medical Society of London, October 17th, 
1859, Mr. Thudicum read a paper On the Pathology and TreatmnU of 
Gall-Stones. From the report published in the London Lancet, Oc- 
tober 22, of the same' year, we extract the following: "After some 
remarks upon the dietary and hygienic rules to be observed by gall- 
bladder patients, the author suggested that in some appropriate caseSr 
an operation for the removal of gall-stones through the abdominal 
walls, should become a subject of consideration for surgeons. Dr. 
Bichardson having alluded to the effects of loss of bile by a biliary 
fistula in animals, which he thought was contra-indicating the pro- 
posed operation, referred to points of diagnosis. The President (Mr. 
Hilton) remarked upon the operation which the author had hinted at, 
and thought there were many difficulties in it« way. He should like 
to hear from physicians, the number, nature and prospects of snoh 
cases in which the operation for extracting gall-stones could be thought 
of. The operation would be impossible in cases where the calculus 
was closely embraced by the bladder. But, from his knowledge, he 
thought it not impossible that cases fit for operative relief might pre- 
sent themselves; and in cases of distended gall-bladder, (which might 
occur with calculi), an operation, such as the author had mentioned, 
had actually been performed with success." 

Mr. Thudicum, in his excellent Treatise on Gall-Stones, London, 
1863, page 45, says that Petit's plan was adopted in Germany by A. 
Q-. Bichter, and that the latter in his work on Surgery, gives an excel- 
lent description of biliary fistul» and their treatment, and of enlarge- 
ments of the gall-bladder from calculi, and their treatment by sor- 
gical operations. He adds: ^^The essays of Petit and Bichter must 
be careMly perused in order to see that the propositions of their 
authors were by no means so chimerical as subsequent writers have 
endeavored to make out.'* At page 251, Mr. T. refers to a case in whicli, 

.,y,u..uuy Google 



LrrHOTomr or the qall-bladdbr. 21S 

aeeording ta Schurigias (Ltthologia, page 268), J. Fabricina remoTed 
two biliary ooncietions from a living man by means of cutting. At 
|ttge 253, he mentions the case of Lespine, in which the abscess was 
opened with the knife, and the calcnlns reached. 

Mr. Thudicnm has copied from the London Medical Timet and 
GazeUej May 10th, 1862, the report of a yery interesting case, under 
the care of Dr. Cockle, at the Royal Free Hospital, in which a number 
of biliary calculi were discharged through a spontaneous opening about 
two inches below the umbilicus. This opening was about the size of 
a crow's quill, and from its orifice there was a constant oozing of nearly 
colorless mucus. A probe passed readily obliquely upwards when it 
came in contact with a solid body. After several ineffectual attempts 
to extract it with the dilating forceps constructed expressly for the 
purpose, Br. Cockle was compelled to slit up the sinus as far as the 
stone, and then readily removed it. The wound quickly healed ; but 
at the end of two or three weeks, the old symptoms returned and another 
ealeulus was detected about two inches distant from the outer ori- 
fice. ^'Mr. Hill again tried to dilate the sinus and grasp the stone, 
but after a few attempts, so much tenderness and purulent discharge 
followed, that it was not considered safe to interfere further at present. 
Secently, these signs have ceased, and the fistula has again relapsed 
into its former indolent state, contracting, and only discharging nearly 
eolorlesB mucus. The patient has now returned to her ordinary occu- 
pation; but there can be no doubt that the sinus will again open from 
time to time, as many calculi are still in the gall -bladder." Dr. C. 
then refers to the case which we have already quoted in the practice 
of M. Bobert, to show that fatal results may easily follow the attempt 
in some of these cases to dilate a sinus and extract the calculus. 

In the Gaxeite des EopitanXy Paris, March 24th, 1866, is a paper 
on the l^eaiment of Biliary Tumor^ by M. Luton de Reims, who is 
also the author of the article Biliairet ( Voiet) in the Nouv. Diet, de 
Med, et de Chirurgie Pratiqueiy torn. 5th, Paris, 1866. In this he gives 
u analysis of the case reported in the Bull, de la Soc. Anat, 1856, where 
Leclerc (de Senlis)^ in a female SBt. 62, opened a fluctuating tumor in 
the right hypochondriac region by means of caustic potash, and from 
which at first a serous looking fiuid escaped, followed by a large num- 
ber of biliary calculi. The patient made a complete recovery. M. 
Luton adds that some two years before, Demarquay communicated to 
the Sadeti de Chirurgie the particulars of a case in which a man, SBt. 
35, had in the inferior part of the right hypochondrium a fistulous 



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"«3 



le 



216 WS8TBBN JOURNAL OF MKDIGINX. 

opening succeeding to an abscess of the gall-bladder, and throiigk 
which, from time to time, biliary calculi escaped. A careful examim- 
tion showed that the fistulous passage and the gall-bladder were filled 
with concretions of the same nature. With the forceps, it was easy 
to remove those which were of small sise and which occupied the vicin- 
ity of the external orifice of the fistula; but those of greater sixe 
could not be removed until they had been crushed with a small hrii- 
pierre. The patient was restored to perfect health. From which he 
remarks that lithotrity, as well as lithotomy, may be applied to the 
treatment of biliary calculi. M. Luton states, in conclusion, that he 
has seen a patient who, after an attack of jaundice, had a biliary tumor 
which increased rapidly. An opening was made hy means of caustic 
potash, and in the course of a month, a few calculi escaped. Four 
months afterwards the fistula was still open, when the track was in- 
jected with iodine. Three years afterwards it was not closed, and yet 
the patient's health was good. 

It is well known that cases have been reported of eongenital 
absence of the gall-bladder, and yet no inconvenience seemed to have 
attended such defect. Whether the cases reported are sufficient to 
warrant the following statement by Matthew Baillie in his Morbid 
Anatomy, London, third edition, 1807, page 251, we do not pretend to 
determine. Under the head of The Gall-Bladder Wanting, he re- 
marks: ''The gall-bladder has also been known to be wanting, from 
a defect in the original formation. (See Dr. Sosmmering*s Oerm. Trans- 
lat., page 150.) It has never occurred to me to see an example of this 
kind of monstrosity; but it may be the more readily believed some- 
times to happen, as the gall-bladder does not serve any necessary pur- 
pose in the body. There are many classes of animals which are natu- 
rally without a gall-bladder." 

According to Malgaigne, {Traite d' AnaUnnie ChirurgicaU et dt 
Chirurgii Experimentalej Paris, 1859, tome ii, page 363), Herlin and 
Campaignac have proposed either the extirpation or the ligature of the 
gall-bladder, both for the purpose of removing biliary calculi and pre- 
venting their return. Herlin advised the application of the ligature to 
the neck; but Campaignac to the gall-bladder itself. The former tried 
his experiment on a cat, which retained its appetite and all its func* 
.tions unimpaired. 

According to Malgaigne, Langlas and Duchainois extirpated the 
gall-bladder in three dogs, and they recovered. The well known fatal- 
ity of wounds of the gall-bladder in the human subject, except where 



^iyiiiz.cu uy ■ 



LITHOTOIIT or THE aALL-BLAJ>DSB. 217 

ftdiiesiona liad formed, is well understood, and their results lead no 
support to the heroic operation aboye proposed. 

M. Luton in his article in the Nouv. Diet de Med, et de Chir.y tome 
T, page 98, states that in cases of doubtful diagnosis we may venture 
to puncture with an exploring trocar, even when we have reason to 
believe that no adhesions have formed between the tumor and the 
abdominal parietes. He adds that this "petite operation" is devoid 
of danger, and that he has himself resorted to it in one instance with- 
out accident. He has also seen at the clinic of the Hotel Dieu of 
Beims, M. Thomas, by this means, detect the nature of a tumor in the 
right hypochondrium, which was formed by a distended gall-bladder, 
and in which the instrument struck a biliary calculus. This explor- 
ing trocar should not exceed one millimetre in diameter. 

In conclusion, we will now present an analysis of the very inter- 
esting case reported by Dr. J. S. Bobbs, of Indianapolis, in the Trant- 
actions of the Indiana State Medical Society for 1868, pages 68-73. 
As will be seen from the report, the Doctor, with all the counsel called 
in, eould form no accurate diagnosis, nor even an approach to it. It 
is stated that although the tumor had the position and appearance of 
ovarian, she was informed that its ovarian character was very doubtful ; 
but it is not even hinted that it had any connection with the gall-blad- 
der. We mention this, not in the spirit of criticism, but to show that 
the difficulties, until the cavity was laid open, were, in this respect, 
insnrmouutable. Even after the exploratory incision had been made, 
tbe embarrassment was sufficiently great to perplex the most experi- 
enced surgeon, and Dr. Bobbs is certainly to be congratulated on the 
fortnnate 'termination of the operation and the subsequent progress 
of the case. Old Mr. Bromfield, from what we have quoted of his 
writings, would certainly have questioned the propriety of the heading 
given to Dr. Bobbs' report, viz: Lithotomy of the Gall-Bladder, and 
this, simply upon the ground that no such operation seems to have 
been contemplated when the removal of the tumor was commenced. 
Bat as this may, perhaps, afler all, be regarded merely as a matter of 
taste, it can not detract from the skill displayed in the performance of 
this difficult, and in many respects, unique operation. With these few 
reflections, we now copy from the TS-anmctiom in the Doctor's own lan- 
guage, the most important details of the case : 

"B. W., aged thirty years, requested my adyice by requeat of Dr. Newcomer, 
for an enlargement in the right side. She is of spare habit, medium siae, and 
aerroos temperameDt. Has asnally enjoyed pretty good, but never robust health. 

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218 WESTSRIf JOTTRNAL 07 nDICm. 

About fonr years ago she obseryed an enlargement in the right iliac region, about 
the size of a hickorj nut. Its position she represented to have been low down in 
the iliac region. There was no tenderness of the part Her health at the time 
was bad, and continued so for several months. She had neuralgia of the stomach, 
and food and drink created much distress. This was produced bj much exercise 
also, and usually lasted three or four hours. The enlargement continued to in- 
crease !n size, and become tender after exercise, and ultimately disabled her from 
walking, or, as she expressed it, 'last winter (1867) she could not put her foot to 
the floor.' Since January, 1867, the enlargement has grown faster and given more 
trouble. 

" Examination revealed a tumor just inside the right iliac bone, tender to pres- 
sure. "Its outline could not be well made out, except on the right side, where its 
boundary was pretty distinctly defined. The course of the tumor could be traced 
on its lower border, while its inner margin, toward the spine, was less distinctly 
defined, and its upper limits still more obscurely marked. It admitted of a alight 
degree of motion from side to side and upward, but its movements left it uncertain 
whether the most prominent portion was the chief part of the enlargement^ or 
only a projection from a deeper-seated growth. The walls of the abdomen were 
tense and slightly protuberant. The most careful examination, per vaginam and 
otherwise, disclosed no connection with the uterus or its appendages, although the 
limited motion in the parts did not demonstrate that no such connection existed. 
The uterus was tender, but did not seem to be enlarged, as if could not be felt 
above the pubis. 

" So much obscurity surrounded the case that I requested further examination 
and consideration at sonfe subsequent period, before attempting to diagnose the 
character of the tumor. This examination was made, but revealed nothing new. 
and tended to confirm the opinion partially arrived at on the previous occasion, 
that the enlargement had uo connection with the uterine organs ; but beyond this, 
nothing definite as to its character or connections could be made out. It had the 
position and appearance of ovarian tumor, and the patient so regarded it, from the 
opinion of other physicians whom she had consulted. She was informed that its 
ovarian character was very doubtful, and its true nature very uncertain, and that 
if it were the former I could give no assurance that it could be successfully re- 
moved. She, however, so persisted in the request that I should undertake its 
removal, that I finally consented to make the attempt, and on the 16th of June, 
1867, assisted by Drs. Newcomer, Todd, Comingor, Mears, Avery, and a medical 
student, proceeded to do so. 

"An exploratory incision was made between the umbilicus and pubis, the 
patient being under the influence of chloroform. The omentum was found to be 
thickened and adherent to the walls of the abdomen. It was separated by a fin^rer, 
as far as this could reach, toward the right side, along the whole extent of the 
section — about four inches in length — in hopes of reaching some part where no 
adhesion existed. Failing in this, with two fingers of either hand the omentum 
was torn through over the tumor, so as to admit the finger which came upon the 
protuberant portion of it. Passing the finger around this, some adhesions were 
broken up, and the tumor traced upward. Other adhesions which it had formed 



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LITHOTOMY OF THS GALL-BLADDSB. 219 

with the parts around it, were also discoyered, and what seemed to be a smaller 
lobe in its npper part, but no pedicle or attachment could be felt. Enlarging the 
opening through the omentum, the tumor was plainly yisiblc, but the orifice would 
not admit of its exit. The wound through the abdominal walls was carried an inch 
aboTe the umbilicus on the right side, over the prominent part of the enlargement, 
which was made to pass through it. This was found to be oral in form, about fire 
inches in length, and two inches in diameter at the widest part, tense, and eri- 
dentlj contained a. pellucid fluid. No pedicle could be made out, and the sack 
diowing its contents to be transparent, its lower margin was cut through, when a 
perfectly limpid fluid escaped, propelling with considerable force, sereral solid bodies 
about the size of ordinary rifle bullets. Introducing the finger, other solid bodies 
were felt, but not in the main sack. A number were hooked out with the finger, 
and raried in size from that of a mustard seed to that of a bullet. One of the lat- 
ter size could be distinctly felt, but no communication between the space contain- 
ing this and the main sack could be found, and it was not remored, being situated 
at the extreme end of the finger. The sack had the appearance, externally, of an 
hydatid, its walls were of the thickness of ordinary cuticle, smooth in its inner 
aspect, and were whitish and semi-pellucid. Pulling it downward, after being 
eracnated, brought into plain riew the right lobe of the liver, to the lower surface 
of which it was attached by a broad linear base like the gall-bladder. The finger 
introduced into the sack detected what seemed to be smaller sacculi, opening into 
the main one. 

" It had the appearance of an enlarged gall-bladder, or an appendage to this, 
aMiongh its size, the clear serous character of its contents, and the thickness and 
semi-transparency of its walls, might justify some degree of doubt upon this sub- 
ject. From its form, attachments and solid accretions, one of which could be so 
distinctly felt in a diverticulum, but which I did not succeed in removing, seemed 
to mark its identity with the gall-bladder, and deterred me from the excision of 
the sack, as I should otherwise hare done. I therefore put a stitch in the cut lips 
of its walls and cut the ends closely. This step was suggested by the apprehen^ 
sion that if any portion of its solid contents should hare been orerlooked, their 
escape into the carity of the abdomen would be prerented, and the belief that the 
sack, in the erent of its refilling with fluid, would become adherent to the walls 
of the abdomen, and be within the reach of a trochar, and make it practicable to 
obliterate it by injection, if it became necessary. 

*'It w^oiild hare been gratifying to hare determined the condition and relation 
of the parts more satisfactorily, but the adhesions existing, as the result of past 
peritoneal inflammation, rendered this impracticable, without increased hazard to 
tiie patient. 

^ The wound was closed by sutures and adhesire plaster, no ressel requiring 

to be ligated, and thirty drops of laudanum giren after the patient was placed in bed. 

" From the 22d, her recorery was progressire and requires no special remark. In 

about two weeks she was permitted to sit up, and in three weeks to more about 

her room, and in four to ride out. 

** Careful examination of the solid concretions remored, leares no doubt of 
tlieir being biliary calculi. They are irregularly spherical in shape, smooth on the 



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WESTERN JOURNAL OF MEDICINE. 

surface, which is of a maho^ny color, and polished. The interior is of a whitish 
yellow, striated and poroas. They are of light specific gtayity, and numbered 
some forty or fifty, the minority being of the size of small shot. When access to 
the enlargement was reached, the surrounding parts were so agglutinated by old 
adhesions as to prevent a satisfactory inspection of its deeper portion. After the 
sack was opened, more simce was obtained, and its attachment to the under sur- 
face of the liver could be both seen and felt, and had the appearance of an hyper- 
trophied gall-bladder. Its lower extremity projected about five inches from the 
free margin of the liver. The cystic duct was probably obliterated from irritation 
produced by these concretions, and the one felt at the extremity of the finger was 
probably lodged in one of the biliary ducts. 

" Various authors have reported cases of hypertrophy of the gall-bladder, but 
I believe they have usually found traces of healthy or vitiated biliary matter in ths 
fluids contained in the cysts. In this instance, the fluid was perfectly pellucid and 
watery, the solid and coloring matter having either been appropriated by the con- 
cretions, or had become absorbed or diffused." 

Dr. Bobbs' case is not the only one in which the fluid found in the 
cyst has been "pellucid and watery." Thus, M. Luton in his article 
on Biliaires (Foics) in the Nouveau Dictionnaire de Medecine et de 
Chirurgie^ pages 100-1, quotes the cases reported by Sonnie-Moret 
in the Bull, de la Soc. Anat; by Barth and by Bourdon, in, the same 
journal, 1840. The same Bulletin, &c., for 1847) contains also similar 
cases reported by Deville, and Laoaze-Duthiers. We have found ser- 
eral cases reported in which a biliary flstula was not productive of the 
serious consequences referred to by Dr. Richardson, when he opposed 
the operation approved by Dr, Thudicum in the discussion already no- 
ticed, and yet, after examining all that we have been able to find upon 
the subject, were we required to decide in reference to the propriety 
of the so-called lithotomy of the gall-bladder, we should unhesitat- 
ingly follow the suggestions of Boyer and Durand, viz: wait until 
the unmistakable evidences presented of adhesions between the tumor 
and the abdominal walls, indeed, until it assumed the appearance of 
an abscesE about to open spontaneously, when the operation is sure to 
be one of the greatest simplicity, (de la demiere Bimpliciti,) There is 
nothing in the special treatises of Bonnet, Budd, Frerich, or Thudi- 
cum, which could have enabled us, in a case like that reported by Dr. 
Bobbs, to have formed a positive diagnosis as to the real character 
of the tumor; and as the same doubt must exist in many of the cases 
which present themselves, we should feel disposed to restrict the ope- 
ration to the cases in which adhesions have formed. 



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DB. COHNHEIMS RESEARCHES ON INFLAMMATION AND 
SUPPURATION. 

TxwiaUMd from an article by Pr. Wbaxt, in the ninety-ninth Tolnme of the Proffm- Vi«rU^0kn* 

BY SAMUEL NICKLES, M. D., 
Demonstiator of Anatomy in the Medical College of Ohio. 



The researches of Dr. Cohnheim ( Virch, Arch., xl, page 1) on in- 
jiaxnmation and suppuration, have been attended with new and highly 
interesting results. He commenced his inquiries with the study of 
keratitis, which he produced artificially in frogs and rabbits, either by 
brushing the cornea with tincture of cantharides, or by cauterizing it 
with a stick of nitrate of silver, or by drawing a piece of thread trans- 
Tersely across the globe or the cornea. By all these methods, he 
obtained corresponding results, which differ, however, from the views 
generally received; for it has been held, since the investigations of 
His and Strube, that tbe changes taking place in inflammation of the 
eomea are confined to the stellate corpuscles of this structure, which 
become enlarged, and partly by direct division, partly by endogenous 
development, produce pus corpuscles. C, it is true, confirms the 
opinion that the dimness of the cornea depends on the presence of 
elements resembling lymph corpuscles — i. e., pus corpuscles — and its 
degree upon their number, but he became convinced that the stellate 
eorpuscles of the cornea are present, besides the pus corpuscles, in 
the same regular distribution and without any material deviation with 
regard to form and dbportment, as in the normal transparent cornea. 
The stellate corpuscles do indeed exhibit, as long as tbe tissue has not 
perished, all the manifold forms which living pus corpuscles assume 
by virtue of their contractility ; but the pus corpuscles, in consequence 
of their more considerable size, duller lustre and characteristic pro- 
longations (offshoots), are easily distinguished from the latter. More- 
over, the stellate corpi&cles of the cornea retain their normal distri- 
bution, while, on the contrary, the arrangement of the pus cells is 
quite irregular, since many of them lie on the same plane with the 
former and may be seen scattered among them at the same focal dis- 
tance, while others occupy the interspaces between the successive par« 
ellel layers of the corneal corpuscles, occasionally lying immediately 
over and partly concealing some of them. Sometimes they are found 
isolated, dispersed here and there in the tissue, or they arc ooUeoted 



222 WESTERN JOURNAL OF MEDICINE. 

in larger or smaller groups ; but, as ReckliDghausen has alre^ j shown 
of the lymph corpuscles of the normal cornea, all wander or change 
their place by virtue of their contractility. Thus, in the course of a 
few hours one may see a pus corpuscle gradually move onward, mount 
a stellate corpuscle, or recede from it; further, one may observe a small 
group disperse, so that a previously-concealed corneal corpuscle comes 
into full view ; and again, a number of isolated pus cells are seen suc- 
cessively to unite to form a group, so as completely to hide from view 
a stellate element. 

Although our author has become convinced that the corneal corpw- 
eles with their protrusioTit are preserved in their normal distribution, 
however great the number of pus corpuscles at any one place may fte, 
yet he does not wish to be understood that they are not sympathetic- 
ally affected by the inflammatory process. Of course, this participa- 
tion is only of a passive subordinate kind, limited, in very advanced 
keratitis, and particularly in the immediate vicinity of a highly in- 
flamed spot, to the assumption, on the part of the stellate corpuscles, 
of a very granular aspect, retraction of their protrusions, and some- 
times of the appearance of vacuoles in their protoplasma. 

In the inquiry as to the origin of pus cells, it was now possible, in 
conformity with the observations described, possitively to exclude the 
stellate corpuscles of the cornea, and to take into consideration bat 
two possible sources. Either the pus corpuscles had their origin in 
the pre-existing migratory lymph corpuscles, or they did not originate 
in the cornea at all, but had an external source. As to the first source, 
it may be objected, on the one hand, that the number and distribution 
of the wandering lymph corpuscles in the normal cornea vary so muck 
that it is hardly possible to account for the constant and homogeneous 
course of inflammation by their increase, and, on the other hand, that 
nobody has really observed the process of cell -formation and cell-mul- 
tiplication in lymph and pus corpuscles. The second possible source 
alone need, therefore, be considered, especially as the results of a sys- 
tematic series of experiments on the course* of traumatic keratitis 
point in this direction. C, namely, has come to the conolusion that 
simple traumatic keratitis — t. e., the cloudiness produced thereby, 
always commences at the margin of the cornea and then gradually 
approaches the center. This observation rendered it improbable that 
the corpuscles, perchance immigrating into the cornea, could come 
from any other source than its outer periphery; nevertheless, C. sub- 
mitted the possibility of an anterior or posterior entrance to an expe* 

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BS. COHNHXIU'B &S8XAKCHX0. 223 

rimental inTestigation, adopting the method parsned by Beckling- 
baasen for a similar purpose. Anilin blue, namely, was applied in 
one instance to the conjunctiyal sac, which was then closed by suture ; 
in another experiment it was injected, by means of a Pra vat's syringe, 
into the anterior chamber; but in neither experiment were corneal 
corpuscles with blue granules observed. 

A third possible source, the entrance of the pus corpuscles from 
the sclerotica could forthwith be excluded, as the sclerotica of the 
irog consists of cartilage in which pus cells are never observed, neither 
ia its normal nor pathological state. Under these circumstances, there 
were but two ways left by which the pus corpuscles might have ad- 
Taneed to the cornea, namely, the lymphatics and the blood vessels. 

C. now injected anilin blue into a lymphatic vessel of a frog and 
observed in an artificial keratitis subsequently produced, that a part 
of the pus cells always contained granules of coloring matter, whilst 
the tissues of an animal treated in the same manner, and especially 
the cornea, presented no granules of coloring matter, either free or 
within the cells. But the circumstance that it made no difference as 
to the result, whether the anilin blue was injected into a lymphatic 
ressel of the head, back, lower limb, or abdomen, as long as the amount 
of fluid injected was considerable, rendered the direct transition of 
pas corpuscle6 from the lymphatics to the tissue of the cornea less 
probable, and suggested the idea that the blood vessels are the me- 
dium of their passage, particularly as Recklinghausen had already 
shown that corpuscular elements introduced into the lymphatics of 
the firog very readily enter into the blood vessels. Indeed, on the same 
day after injecting anilin blue into a lymphatic vessel, and still more 
OQ the following day, C. found blue granules in the blood, most of 
them situated within the colorless blood corpuscles. The direct injec- 
tion of the coloring matter into the blood was now to decide whether 
the appearance of pus corpuscles with colored granules in the inflamed 
cornea was independent of the presence of colored granules in the 
white blood corpuscles, or connected to the latter as an intermediate 
step. The result of this experiment corresponds fully with that of 
the injection into the lymphatic vessels; in a short time a number of 
colorless blood corpuscles admitted colored granules into their interior; 
tad whilst one never, even w^ks after these injections, if they are 
earefally oonducted, meets with colorless granules in the tissues, either 
free or in the interior of cells, in keratitis, on the contrary, no matter 
how produced, there immediately appears a more or less large number 

.,y,u..uuy Google 



224 WS8TSRN JOtJ&NAL Of MCDICtNl 

of pUB corpuscles, which are distingtiisliable by colored granttlos. 
FrotQ this it may be concluded that some pus corpusclet in the inflamed 
cornea were formerly colorless blood eorpii6cles and that they have forced 
their tcay into the cornea from the blood vestels. As to the modes in 
which the pus corpuscles move onward in the cornea, G. considers the 
doctrine of Recklinghausen^ of nutrient canals in the connective tis* 
tues, as that b^st founded. 

The investigation having arrived at this point, fbrther researshes 
could not be pursued in a tissue having no vessels like the cornea; 
hence the field of observation had to be a vascular structure and there- 
fore C. transferred it to the mesentery of frogs, firmly fixed, and made 
motionless with curare poison ; but he also obtained the same results in 
subsequent experiments on rabbits and kittens. An inflammation is eas- 
ily produced in the serous membrane by brushing with tincture canthari- 
des, or by applying nitrate of silver; indeed, exposure of the intestine 
with the mesentery to the atmosphere, suffices for this purpose. Hy- 
peremia is pretty rapidly developed, and in the course of several hours, 
a light cloudiness appears which gradually becomes dimmer and denser, 
so that the individual vessels become very indistinct. Finally, after 
fifteen, eighteen, or not until twenty-four hours, or even thirty-six 
hours, the intestine is wholly incrusted with a thin, soft, pale-grey, or 
greyish-yellow, somewhat adhesive layer which can be removed in 
smaller or larger shreds, and which consists entirely of closely crowded 
contractile pus corpuscles and isolated red blood corpuscles, all imbed* 
ded in an amorphous fkintly granular material, which may be com* 
pletely cleared with acetic acid. In short, peritonitis with fibrino* 
purulent exudation, hai been developed. Before passing to the micro* 
scopical analysis of the details of the process, it would seem necessary 
to determine the normal conditions of the circulation. Respecting 
the current of the blood in the arteries, it is characterized by four 
peculiarities. Fir$t — By its direction, which, in the mesentery, is 
from the fixed point to the intestine. Secondly — By its extreme rapid* 
ity, which renders it impossible to distinguish a single corpuscle in the 
current of blood. Thirdly — By the presence of an axial current car- 
rying all the red blood corpuscles, while the colorless plasma near the 
walls of the vessels here and there contains a white corpuscle. Finally 
<— By the rythmical acceleration and Vetardation of the current of 
blood. In the veins, the direction of the circulation is the opposite 
of that of the arteries; the rapidity of the current is considerably 
less, hence, one is able fluntly to distinguish the outlines of some of the 



DE. OOHNHIIH'S HKSEARCHBfl. 225 

eorpusoles; tlie Btratum of plasma is narrow, and carries isolated col* 
orless blood corpuscles in regular order, which slowly move onward, 
snd occasionally stand still. Finally, the current is uniform and con* 
tioaous. The circulation of the capillaries differs from both the arte-* 
rial and yenous. According to their capacity they permit two red 
blood corpuscles, or a red and a white one, to pass side by side, or 
admit but a single one, and they do not present a special axial stream. 
The current, as a general rule, is directed from the arteries to the veins, 
but frequently stagnates for a longer or shorter time in some branch 
or other, and noay turn back at some points. The rapidity is, therefore, 
unequal, and always so inconsiderable that the individual corpuscles 
can easily be distinguished; besides, the colorless corpuscles always 
tdvanee more slowly than the colored ones. In the capillaries, as is 
▼ell known, there are no intimations whatever of pulsation. During 
the development of inflammation, the individual stages of the process 
exhibit a very changable duration, always, however, succeeding each 
other in a definite order in which they will be considered in the fol- 
lowing pages. First of all, a dilatation of the arteries takes place with- 
out previous contraction. This constantly increases with, at furthest, 
bat slight and short intermissions and remissions, and has generally 
arrived at its acme in one or two hours, at which it remains during the 
nicceeding stages of the process. The extent of the dilatation may 
exceed two^fold the original diameter. At the same time the vessels 
become elongated, which is exhibited ih pretty well marked sinuosities. 
Dilatation of the arteries is succeeded by a like condition in the veins, 
in which, though supervening much more slowly, it yet reaches and 
CTon exceeds double the amount of the original diameter. In these 
Teasels, however, meanderings and sinuosities, as well as partial con- 
tractions and dilatations, are absent. 

The dilatation of the vessels having continued one or two hours, a 
dimnuHon of the rapidity of the current takes place without excep* 
tion; the circumference of the individual corpuscles may now be read- 
ily distinguished ; and the pulsation of the arteries becomes very evi« 
dent; but the current has lost its axial character, and the arteries show 
luimistakably that the colorless corpuscles tend to the walls of the ves- 
ael. The deportment of the peripheral zone of the current of blood 
in the veins now becomes highly interesting, since here and under the 
eyes of the observer the original stratum of ploMna hecome$ filled ioith 
^anherlcMB eolorlets blood corpvtclet which, finally, adhere to the peri- 
phery of the vessel in a single wall-like layer within which the red 

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WXBTI&N JOUENAL 09 MSDICQIX. 

blood column floats onward with uniform rapidity. This conditioii 
does not continue long, however, before the eye of the observer is cap- 
tivated by an unexpected event. On the external surface of the venous 
wall, there appear small bud-like isolated elevations, which slowly and 
gradually enlarge. After a while, there seems to rest on the exterior 
of the vessel, a hemisphere, about half the size of a white blood cor- 
puscle which gradually assumes a pyriform shape, and, finally, pro* 
trudes from its periphery very delicate offshoots and processes whioii 
impart to the previously rounded contour a variety of forms The 
principal mass of this small body, the swollen indented end, recedes 
more and more from the surface of the vessel, whilst the narrow ex- 
tremity elongates to a very fine pedicle. But ultimately, this pedicle 
separates from the wall of the vessel and we now observe a colorless, 
somewhat brilliant contractile corpuscle, with some short and a very 
long offshoot; this fully coincides in size, as well as in the possession 
of one or more nuclei, with the colorless eletnents of the blood. This 
process is repeated at many other points of the wall of the vessel, so 
that one may observe simultaneously all the stages which were sucees- 
sively displayed in the individual corpuscle. Within three or four 
hours after the appearance of the first elevation on the external sur- 
face of the vein, this latter is encircled by a simple, but dense layer 
of such corpuscles, and after the lapse of a few more hours, an im- 
mense swarm of them encloses the vessel. Moreover, the corpuscles 
situated in the outermost rows present shorter and shorter protrusions, 
so that, finally, nothing else is seen than the ever changing forma of 
contractile blood or pus corpuscles. During this gradual and gradually 
increasing poMage of colorleu hlood corputeles from the interior of the 
vein through its unbroken wall, the previously perfect condition of the 
blood-current remains unaltered ; as before, the inner peripheral stratam 
presents a simple, uninterrupted layer of white blood corpuscles, witihin 
which the red blood discs glide onward in a continuous current. It is 
necessary to call attention to the fact that not a single red blood cor* 
puscle is seen among the colorless corpuscles which have passed through 
the walls of the vessel. In order to avoid deception, C. also observed 
the whole process in other animals in which some of the white blood 
corpuscles had been impregnated with coloring matter by means of 
the proceeding already detailed, and found the correctness of his ob* 
servations most clearly confirmed. 

About the same time, when the arteries, and subsequently the veiaSy. 



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r ' 



ML OOHNKBIX'S/EttKARCBlB. 227 

80 mvtch dilated, the capillaries aleo increaae in Yolume; but 
their aqgmentataoB is only one^siztb, or at most, one-fourth of their 
tiuneter. Their eurrent of blood exhibits, in regard to direction, 
iipiditj and unif^rmiiy, the same Tariations as in the normal state, 
la lome of the capiDaries, the blood corpuscles moTC onward with 
•ttltersd nf idiij.) And uniformlj in the same direciioo, and with the 
mie r^alari^ ; in others, on the contrary, their moyement is gradu- 
illy msie and more retarded, and, finally, ceases entirely for hours, so 
duU the e^llaij seems to be crammed for longer or shorter distances 
fifth anmoTed red aad white blood corpuscles. Lastly, one may ob- 
nnre, particularly in the more capacious capillaries, a resting, and a 
■OTiDg Btratum, and the first may 4>ccupy the whole of the periphery, 
tr obIj one-half #f the caliber with the corresponding half of the per- 
iphoy. If oreover, we would specially note that the quiescent stratum 
4mb not on]j contain colorless corpuscles, but also red ones. 

Coiresponding fully with these inequalities, the subsequent erents 
tike place in Farious ways. In those capillaries whose blood-stream 
gott on continuously and with the same uniform rapidity, no kind of 
chttge n^ireses. But wherever, on the contrary, partial or com- 
plete stagnation has become established, there a new state of things 
^giofl to be developed in a short time. The first thing observed at 
neh places^ is an alteration of form of the spherical colorless blood 
MtpBsele, taking place more or less rapidly and completely, but always 
tihibitiag the well known amoboid movements. Soon afterwards, a 
M-iike elevation, or a spinous protrusion, is observed on the external 
iv&oe of the capillary wall at a point corresponding to the situation 
^ a white corpusele on its inner surface. This offshoot gradually in- 
CNuei ia stae, and is, finally, changed, just as was obsenwd with the 
viim, into a colorless corpuscle which is now conaected with the cap- 
iiuy wall only by a much elongated pedicle which is subsequently 
^^■pletely detached. Durbg this often very protracted process, a 
<te of things is frequently seen which is not obtained in the profile 
^ of the large veins on account of the relative thickness of th^ir 
viUi, aad which must banish every doubt as to the interpretation of 
^ process — namely, a corpuscle aitnated partly within and partly 
vi^at the capillary wall. But in the capillaries, not only the color- 
k« blood corpuscles, as is the case with the veins, but also the red 
Aei|NUi through the wall to the eaUerxor. Views are now j>resented to 
^eje like those described hj Strieker as existing in the amputated 



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tails of tadpoles, namely, red blood oorpfMcles are seen, one^halT of 
whose bulk has already peaetrated through the wall of the ireaMir 
while the part ooatainiag the nueleus is still within the oapillary, and 
oonnected with the external portion by a narrow neek whioh is enoir* 
cled by the eapillary wall. Generally the inner half follows the enter 
portion in the coarse of a few hours ; but if the current of blood is 
reestablished during the process, the red blood corpuscles rolling by 
communicate an osmllatory motion to the inner half which may, eTen^ 
with a gradual return of the ourrent, be separated and floated away 
from the external portion which preserves the most undisturbed rest. 
Thus it happens that twelre, eighteen, twenty-four hours after es^ 
posure of the mesentery, a large number of capillaries are enoircled 
by dense rings of corpuscular elements, consisting mostly of colorless 
contractile Uood corpusles, and measurably of red Mood corpueeles, 
the latter presenting ordinary, uninjured, nucleated blood disoe, and 
smaller shpericiU or elliptical, apparently homogeneous bodies without 
a nucleus, the remains undoubtedly of the red blood corpuscles mutil* 
a ted in the manner described. 

C. now discusses the question, how it happent iluU tke^cohrku Mood 
c<npti9cle$ accumulate in ike marginal layer of the veinty and ealls at* 
tention to their morements in the liquor sanguinis under normal eom-^ 
ditions, in explaining which, he adopts the views of Donders. Accord- 
ing to this opinion, as the rapidity of the current increases towaids 
the axis of the vessel, that half of the spherical colorless blood cor- 
puscles which is nearest the axis is impelled by a more rapid current 
than that half which is turned away Arom it. The corpuscle, is there- 
fore, not only urged on in the direction of the current, but also turned 
round ite own axis, and under this combined influence, it is at last 
. forced towards the periphery of the vessel. On the contrary, the flat- 
tened form of the red blood corpuscles whose long diameter advances 
parallel with the axis of the vessel, permits but a small portion of 
their border to be infiringed upon by the current, and hence rotation 
does not occur. If now the rapidity of the current is diminished in 
consequence of dilatation of the vessel, thb change mtust be most ap- 
parent in the peripheral stratum where the current is slowest in the 
normal state; and hence the colorless corpuscles which were before 
impelled in short and protracted movements, may now become wholly 
quiescent. But as every fresh quantity of blood conveys more white 
corpuscles, these must ultimately flll the whole domain of the pe- 
lipheral part of the dilated veina. 

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SB. ooxNRim'8 mmEAMemmL 229 



C. endeaYOTB, ftnrtker, to answer Ihe question, Bg what mode amd 
h^ what power ike blood eorptucki fom through the walU of the V9meli 
into the mrrounding fiMuesf Bespeeting the int pert of this questioD, 
one is forced a priori to the admission that the blood discs adyanee 
only by pre-formed ways penetrating through oanal-like spaoes in the 
walls of the yeaeel, as it ia not possible du4 they can perforate a solid 
anbroken wall. As the principal part of the walls of the vessels con- 
rials of connectiTe tissne, and the possibility of moyement of the lymph 
eorpnscles in this tissue has been sufieiently established, there remaina- 
only tiie simple epithelial layer of the inner coat, of which kind of 
Btmctare the capillary wall also eonsists, according to the researches 
of ihe last few years. Now C. beiieyes that he has demonstrated open- 
ings (ttomata) between the indiyidual epithelial plates, by means of 
iajeetions of silyer, and therefore considers the existemie of canal- 
like spaces in the wall of the yessel more than hypothetical, and does 
not doubt, eyery dilatation of the yessel increasing their siie, that they 
msy come into play in the simple process of exudation. 

In regard to the second part of the question, it is necessary to 
obserre that the white corpuscles, as long as they adyanee in an unin- 
tempted stream, preserve the spherical form, the state of their great- 
Mi eontraetion; that, on the contrary, ai soon as they rest for any 
lengtli of time, amoeboid movements rapidly become manifest. When, 
Iberefore, under the pathological conditions above considered, the col- 
orless corpuscles stagnate in the peripheral stratum of the veins, it is 
ta easy matter to see that the ultimate eifect of the amoDboid movements 
wUeh now supervene, must be a peneteution into the wall of the ves- 
sel, as they can extend the protrusions now formed only against those 
points which offer the least or no resistance, and these are the slomata 
tnd canals of the connective tissue. The red blood corpuscles, as is 
veil known, do not possess the power of contraction so as spontane- 
osflly to alter their form, and all their movements must be attributed 
to impulses exerted upon them flrom without. There remains, there- 
fore, nothing to explain their exit Arom the capillaries, but the in- 
ereased pressure of the blood, which, in consequence of the simnlta- 
aeons diminution of the resistance of Ike arteries with their dilatation, 
must supervene in the eapillaries to the same extent as in the arteries. 
Whether the augmented pressure of the blood can become euftoientto 
force the red blood corpuscles through the somewhat distended, but 
sdierwise unprepared wall of the vessel remains undecided; experi- 

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WSBTIRII JOUKIfAL OV MBDICmX. 

enee, however, teaches that red blood corpuBcles are never seen to force 
their way through the wall of the veaeel, unlets white *ones have passed 
through before, and have thus caused a certain dilatation of the stO' 
mata. 

While the described processes have taken place in the vessels, the 
remaining tissue of the mesenterj has been in no way altered; the 
ba$i$-4ubitance of the connective tieeue i$ jtut om train»partnt as before^ 
the nuclei, the epithelial, cm teell a» tho$e of the connectitfe tisiue, are eeen 
.in the tame form and at the tame place, with nndiminithed dietinctneUy 
provided that they are not concealed by exuded blood corpuscles. 
While most of the exuded red blood corpuscles remain in the imme* 
diate neighborhood of their capillaries, the white ones recede further 
and further from the vessels, to make room for other emigrants, and 
gradually, thickly crowded, break through the tissue, and arrive, 
finally, by ifay of the ^'stomata," shown to exist between the epithe- 
lial scales by Recklinghausen, Oedmanson, and others, on the surface 
of the serous membrane, where they take part, with the plasma 
exuded at the same time, in the formation of the fibrino-cellular layer 
characteristic of peritonitis. After carefully separating this latter, 
the epithelium may very often be brought to view again, a proof that 
the latter aho takes no part in the cell-formation of inflammation, but 
only perishes, if at all, when cast off. 

In the microscopic examination of spontaneous fibrino-purulent pleu- 
ritis and peritonitis, C. observed the same conditions, and there can be 
no doubt that the laws found to obtain in serous membranes are gener- 
ally valid for all acute inflammations. The new formation of the 
^*pus cells," which was formerly attributed to the inflamed Ussue itself, 
must now be wholly transposed to those organs of which we know by 
sure physiological experiments that colorless blood corpuscles are pro- 
duced in them, name^f, the lyphaiic ganglion* and the wpleen; and, in- 
deed, during the inflammatory process, these organs are found to be in 
a state of marked hyperplasia. Moreover, without vessels there is no 
inflammation ) dilatation^ injection, and hyperemia neceuarily form it* 
firttpart; in vascular parts the vessels normally appertaining to them 
are implicated ; in non-vascular ones, the neighboring vessels, which 
being the medium of their nutrition under normal circumstances, also 
constitute the point of origin of their inflammatory changes. The 
presence of vacant spaces permitting the passage of the colorless blood 
corpuscles, has proved to be the second condition. Such canal-like 



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BR. COHNHEIX'S &B8IABCHE8. 231 

dilatable spaces are present in the oonneotive tissue, and this is the 
reason why the suppurative process is still united to the connective 
tissue, why suppuration in the compound organs runs its course in the 
interstitial substance. In cartilage, which belongs to the series of 
connective tissues, but in which canal-like hollow spaces are wanting, 
nobody has, as yet, observed real suppuration. The daily observation 
that an inflammation may retrograde without any injury to the integ- 
rity of the affected part, is now construed without difficulty, by the 
explanation that just as the exuded plasma may be absorbed, so also 
the lymph corpuscles which have wandered out of the vessels to a new 
position, may leave this and be "discussed" in the neighborhood and 
in the lymphatic vessels, and thus the affected part which has not been 
essentially injured, may remain unaltered. C. observes, furthermore, 
that there is now a rational explication of the beneficial effects of local 
and general blood-letting, and that the old experience now seems very 
plausible, that the development of pus may be restrained under the influ- 
ence of energetic cold which prevents the dilatation of the vessels, 
while increased warmth, on the contrary, must promote suppuration. 
He also alludes to the fact, to which Traube first called attention, that 
pus corpuscles make their appearance in the urine in every case of 
nephritis, although pott-mortem examination does not show any com- 
plicating cystitis or pyelitis, and explains this phenomenon by the emi- 
gration of colorless blood corpuscles from the glomeruli, and he, finally, 
directs attention to pneumonia, in the course of which such immense 
numbers of pus corpuscles may accumulate in the alveoli without any 
trace of change in the surrounding connective tissue, and without any 
■Iteration in the flattened epithelial scales of the air cells, pointing to 
them as the source of the pus corpuscles. 

We would only remark, in addition, that recently, Fried. A. Hoff- 
man, in a paper on the development of the pus in the cornea, ( Virch, 
Arch, torn 4^, page 204), has confirmed the observations of Cohnheim, 
ind Prof. Thiersch, (Pxtha und Billroth Hdh. d. Chirurgte, torn 1, 
Abeth. B, Heft 2^ page 539), has also in part convinced himself of their 
eorreetness, although he withholds all criticism until further investi- 
gations. 



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CORRKSPONDENCE. 



LETTER FROM PHILADELPHIA. 



Philadelphia, Maach 16, 1869. 

Editor of thb Western Journal of Medicine — Dear Sir: As 
mortoary and bospital reports are always interesting to the profession, 
I yentnre to commence my letter with brief extracts from the annual 
reports of the Board of Health, and Officers of the Philadelphia and 
Pennsylvania Hospitals, issned for the year 1868. 

The first report exhibits the mortality of the city, as follows : 

Total number of deaths, - • 14,163 

Adults, - - 6,888 

Minors, 7,805 

Males, r,674 

Females, •••••...... 7,108 

Boys, 4,163 

Girls, 3,662 

Among the adults, the largest number of deaths occurred in the 
monih of April — seyea hmidred and nineteen. 

The month of July was ihe most fttal to the children, as indicated 
by the groat number of deaths occurring during that month—^ne 
thousand, two hundred and seven. 

July shows the highest number of deaths— one thousand, nine 
kuiidred. 

NoTember the lowest number — eight hundred and seventy-eight. 

Nativities of the deceased were: 

United States, •••«....., 11,080 

loreig^n, 8,808 

People of color, .-.-....-. 768 

Unknown, .....--.-•. 644 

Among the diseases enumerated as "causes of death," "Phthisis'* 
stands first on the list, contributing to the adults one thousand, five 
hundred and eighty, and to the minors two hundred and sixty-six. 
Then follow, 

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eoluusroiniiaiiCiL 

IntAninos or noi Luxos — 

Adolta, 308 

Minon, ............ 386 

THoLAMEa or n» Hbakt — 

Adnlta, 327 

Minon, ..-• .....•••6t 

Among fevers, typhoid is the most prominent in the adult class — 
tcarlet with the children. Coup de soleil, one hundred and four. 
Casualties, one hundred and sixty-eight. Suicides, twenty-nine. Hur- 
den, twenty. 

These close a list embracing fifty diseases and conditions given as 

I ^aiues of death.^' The two last do not speak well for the social and 
moral condition of the inhabitants of the "City of Brotherly Love." 

I Turning to the hospital reports, we have that of the Philadelphia 

Hospital, by the recording clerk, incorporated with the report of the 
Board of Guardians of the Poor, this institution being a department 

i of the Blockley Almshouse. The Almshouse is one of the largest 
eleemosynary institutions in the country, and embraces the Out-Door 
Department, Out- Ward Department, Philadelphia Hospital, Philadel- 

I pHia, Ho&pital for the Insane, and the Children's Asylum. 

AuiBoun— 
I Knmber receiving out-door relief, ...... 144,642 

Kamber admitted into the House dnring the year, .... 38,627 

blAII DCPABTKBITT— 

Komber treated during the year, . • - • • • i,01( 

Diich a iged as cared, improved and unimproved, • • . * 224 

Died, Ill 

ficoeining, 680 

HaVfTAL DiPABTVBXT — 

Patients treated, 6.202 

I DtMharged— cared, ......... 3,925 

I iMproTed, 900 

DW, ....••. 6es 

Bemnining^ ..••...••• 808 

Mortality for the entire hospital, nine and seventeeB-one hundredths 
I per cent. Excluding the fbundlinga and the phthisis, it is reduoed to 
I "wen per eent. 

The Pennsylrania Hospital Report ie a more elaborate document, 

I «a^ is presented to the publio in the form of a handsome octaTo vol- 

I «B6, bound in oloth. The plan adopted in the preparation of the 

nfCfi is the same as that of the London hospitals, a^d I think this 

I ^ital is the only one in this country iseuing its report in this way. 



oxSgle 



234 WESTERN JOUBlfAL OP MEDICINE. 

This volume, the second thus far issued, is edited by Dr. J. M. Da- 
Costa and William Hunt, members of the Medical and Surgical Staff, 
and is dedicated to Prof. Geo. B. Wood, M. D., who was for many 
years physician to the institution. Besides "Abstract of Cases and 
« Statistics," it contains papers of a practical character, based chiefly on 
obseryatioB made at the hospital. I hope at some future day to notice 
at length this very valuable work. At present, time and space onlj 
permit mo to commend it to the attentive perusal of all the members 
I of the profession who are interested in the development of our hos- 

pitals, and in the proper utilization of the vast amount of material thej 
contain. 

From the. statistics far the^year 1867-68, we learn that the number 
of patients treated was one thousand, nine hundred and fifty -eight. 

Of the palientt discharged, the proportion cared was, - * 71.4a per oeol, 

" relieved, 10.99 " 

" remoYed without material improvement, - - . 7.27 " 

" discharged for misconduct or eloped, . - - 1.78 " 

" died, 8 63 « 

Cases of accidental Injury treated during the year, - - - . 768 

Since the establishment of the Hospital in 1752, there have been 
admitted into it eighty thousand, nine hundred and sixty-eight pa- 
tients, of whom fifty-two thousand, four hundred and fifty-four were 
cured, and seven thousand, seyen hundred and eight died. During the 
year, a new Clinique has been erected, connected to the main building by 
a short oovered passage way. A building designed especiallj for clin- 
ical instruction has been long needed, and the one erected, though de- 
fective in some very important particulars, is a decided improvement 
upon the contracted quarters in the "cupola'' of the hospital building. 

I have on my table a monograph by Dr. Addinell Hewson, "On the 
influence of the weather over the results of surgical operations, and 
on the value of the barometer as a guide in the choice of the time for 
and the prognosis in such operations as shown by the results of imme- 
diate amputations, during a period of thirty years in the Peiinsjlva- 
nia Hospital." This is certainly a new field of investigation, and the 
conclusions arrived at are bpth novel and interesting. An ezamina* 
tion of the tables prepared by Dr. H«, shows that the most unfavora- 
ble results have followed operations performed in the months of De- 
cember and May, two months almost as much antipodal of each otbet^ 
as regards temperature, as any other two in the whole year. From 
the fatal effeots of shock, we have Docember also taking the lead^and 



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commK8Fmii>mcB. 23ft. 

inaediately followed by NoTember, June and May, as giviiig the next 
highest in order. For deaths from py»mia, etc., we have the last 
months of the summer and spring tevms gmng the highest rates for 
the year. 

As to snccesses, the month which stands preeminent in total resvlts, 
b that of October, the* comes January, and then ApriL Ooteber, 
^hty-nine per cent. — April, OYer eighty-six per cent. 

From the effects of shock, it will be observed that there was not a 
sbgle death amongst all the cases operated on in the months of Octo* 
ber during the whole thirty years. The months which follow this as 
yielding the least mortality from this canse, are September, August, 
January, March and April. 

From ferer, pysomia, etc., we find the months of February pre^ 
seating the same clean record that October did for shock, and after h 
we haye the months of November, Pecember and January giving the 
next least mortality. 

The conclusions are, that fktal results from shook occur in a con- 
ttant ratio with the dryness of the weather, and that those f^om fever, 
pyemia, etc., bear a direct ratio to the opposite state. 

In connection with this subject, it may be interesting to note the 
fiict that the mean temperature of the past forty-four years, as shown 
by the records kept at the Pennsylvania Hospital by Dr. John Con- 
nd, is fifty-three and one-half degrees. The warmest year was 1828, 
fifty-five and three-fourth degrees; and the coldest, 1837, forty-nine 
degrees. 

During the past two weeks, the various medical institutions of this 
eity have held their annual commencements. I think that we have 
aw0 of all kinds — two Eclectic, two Homosopathio, one Wontan's, two 
Dental, the Jefferson College and the University of Pennsylvania. It 
is safe to assert that four hundred and fifty degrees were conferred by 
these different institutions. 

At the seventeenth annual commencement of the Women's Hed« 
>esl College of Pennsylvania, tho degree of Doctor of Medicine was 
eonferred upon fifteen graduates. Latterly, much interest has been 
■aaifested in the question of the status of female phyaicians, and the 
lelations which should exist between them and members of the pro* 
fiMion« If it is true, as asserted, that three of the most prominent phy-> 
iMans of this eity^ one of them a distinguished professor, have accepted 
positions as consulting physicians to the hospital in charge of the Wo^ 
lien's Medical College^ then this fact muat be accepted as «n etideM% 

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SM WBSTSKH JOUBHAL OF KSDICINS. 

of ft decided reaction ia public opiDipn. It is alto stated that tlie 
reaaon glTen by theae gentlemen for their aetion is, as they are unable 
to prewnt the movement, the next beat thing for them to do, ia te 
guide it properly. Certainly very good logic if the premisea are 
eenrect. 

Learing the entangling question of women's rights, I return to 
note briefly the incidenta connected with the annual commencements 
at the University of PennsylTania and the Jefferson Medical College. 
As has lately become the eustom, and a very good one it is, the com- 
mencement exercises of the Uniyersity were held in the Academy of 
Music. The degree of Doctor of Medicine was conferred upon one 
hundred and twenty>eight graduates, representing twenty-three States, 
and the valedictory address was delivered by Prof. Alfred Stille, M. 
D. This address, as with everything which emanates from the pen of 
the distinguished professor, was an able production and well suited to 
the occasion. 

The forty-fourth annual commencement of the Jefferson Medical 
College waiB held at the Musical Fund Hall. The degree of Doctor 
of Medicine was conferred upon one hundred and twenty-six gradu- 
ates, representing twenty-three States. The valedictory address, by 
Prof. Samuel Henry Dickson, was one of the gentleman's happy efforts, 
graceful and learned. The alumni of the college will Ailly appreciate 
his remarks upon the retiiement of Prof. Robley Dunglison. I give 
you the following extract: 

" lianjr of you have misMd personftUy, and all traditionally, during the past 
se8»ion, as we lament to mlM now from among us, a once fitmiliar face, a manly 
presence, tall of intelligence and dignified simplieity. The place which he of whom 
I speak, long oecapied, shall kaow him no more foiever; but he has left imper- 
ishable records of worth and usefiilnees as teacher, author and administrator ; hoa« 
ored and lo^ed as instmctor ; " primus inter pares," in the midst of his colleagnea. 
The annals of onr school contain no name more distinguished than that of Robley 
DnngKson ; none more dear to those who have had the happiness to enjoy his so- 
ciety and profit by his wise counsels, his fhmk cordiality, his kindly and courteous 
Biaaner. We offer him the homage of our respeotftil remembrance in his patient 
raliitment, oar profound sympathy with his suffering." 

The classes this year were not as large as usual, owing, no doubt, 
to Ae re-opening of the schools of the south and west. For the past 
two or three years, summer courses of lectures have been given at the 
University and Jefferson College. At the former, the subjects lectured 
upon are. Zoology and ComparatiTC Anatomy, Botany, Mineralogy and 
Geology, Hygiene, and Medical Jurisprudence and Toxicology. • In 

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oouuBSPomwiGB. 289 

tie autoBiii, a prelimiitftry course is giYen upon Microsoopy, RegianU 
AialDvy, Ph jsieal Diagnosis, Diseases of the Skin, and Morbid Aaat- 
mj. At the Jefferson College, the eovse is strictly jn'actioal, ent- 
hwfiBg important specialties in medicine and surgery, with exteasiye 
flfimeal illustrations, as Clinical Surgery, Clinioal Obstetrics, Medioftl 
Jixispmdence and Toxicology, Materia Medioa and Therapeutics, Clia- 
ial Medicine, Visceral and Surgical Anatomy, Operative and Minor 
Surgery, Operative and Aural Surgery, Venereal and Cutaneous Dis^ 
tises, Pathological Anatomy, and Surgical Diseases of the Genito'- 
IMasry Organs. 

While on a visit to a ^end at Newport, Rhode Island, last Octo- 
ker, I had the opportunity of examining the Earth-Closet, the inven- 
ftiott of Bev. Henry Moule, of Fordington Vicarge, Dorsetshire, Eng- 
had. My friend, during a recent visit to England, became so fully 
impressed with their value as substitutes under almost all circum- 
ituices, for the ordinary privies and water-closets, that he i]|^>orted 
tve Commodes. Recently, one of these was sent to this city, and placed, 
hj the direction of Dr. Addinel Hewson, in the lower surgical wards 
of the PennsylvMiia Hospital. In these wards it was used by twenty 
fttients, (the hod is calculated to hold from eighteen to twenty evaou- 
stions), and the contents were not removed until evening. Patients 
ia die fracture-beds were each given a paper bag, holding about a 
poand of dry earth, and were required after using the bed-pan (attached 
to etch fracture-bed), to empty the contents of the bag into the pan. 
Although the Commode stood in the middle of the ward, surrounded 
only by a screen, still there was not the slightest odor perceptible. 

Col. Geo. £. Waring, of Newport, Rhode Island, in a pamphlet 
ipon the subject, states the principle to be 'Hhe power of clay and the 
decomposed organic matter found in the soil to absorb and retain all 
ffcisive odors and all fertilizing matters; and it (the closet) consists, 
Meatially, of a mechanical contrivance (attached to the ordinary seat) 
fer measuring out and discharging into the vault or pan below, a sufir 
sieat quantity of sifted dtp earth to entirely cover the solid ordure 
aad to absorb the urine.*' 

Beleetiag upon thia absorbent power of elay. Dr. Hewson was led 
IQ use it as a dressing to suppurating wounds^ and so satisfactory were 
the results obtained in these eases, that since February 9th, every case, 
10 matter of what character, has been submitted to the dry earth 
^vesriag. Its advantages have been most fully demonstrated in oases 
ef aeald and burns, and intractable bed-sores. In the former, when 

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238 WB8TXBN JO0BMAL OF MXDICINX. 

applied immediately upon receipt of the injury^ the pain is at once 
relieved, and the reparatiye proeefls goes on rapidly. In the latter, 
and also in all chronic ulcers, its action is most decided. In one case 
of paraplegia, in which there was dribbling of urine, the oiFensiye 
urinous odor was entirely removed, and the patient made comfortable, 
by placing a layer of earth, protected by the sheet, beneath the but- 
tocks. The patients speak of it in the highest terms, as a cool and 
pleasant dressing, and it is by fkr a cleaner application than those or- 
dinarily employed. The results are truly remarkable, and have been 
critically examined by Dr. H. His experience thus far, confirms him 
in the belief that the earth acts not alone mechanically, but chemi- 
cally — that, under its application, chemical action takes place as indi- 
cated by the fact that the pus, from the wounds, is found by the lit- 
mus paper to be neutral, instead of alkaline, its normal state. May 
it not act, he suggests, upon the exudations from the tissues so aa to 
preyetft alkaline fermentation, and thus prevent the formation of pus? 

This subject is of great interest, and its consideration by Dr. Hew- 
8on, will furnish an article in the next Pennsylvania Hospital Reports. 

I obgerve, by a circular sent me, that an earth-closet company has 
been established in this country, at Hartford, Connecticut. This will, 
I hope, secure the speedy introduction into use of this valuable inven- 
tion. Yours, very truly, J. E. M. 



FROM BERLIN TO VIENNA. 



YisNNA, January 8, 1869. 
Dear Editor: Almost embowered among a grove of trees at the 
far end of a broad boulevard that skirts the crumbling old wall which 
formed her medieval ramparts, stands a handsojme, square, stone build- 
ing of the chaste Doric style, which is klaown as the University of 
Halle Saxony. Ascending a broad flight of stone steps, graced on 
each side by a recumbent statue of a bronze lion, we enter a high, 
spacious hall, around which in small wire-protected frames the an- 
nouncements of lectures are posted. Another flight, and we stand upon 
the level of the- various lecture rooms of all the departments of sci- 
enoe. Four fluted columns of stone on each side, support the oma* 
mented roof, extending the distance of the second and third atoriea. 
The rooms are all small, and famished simply with the long woodei 

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ooBBSSPomisnci. 289 

knelies of our country aeliool honsM, aad a small pulpit for the leo* 
tnrer. Tbe hours of lectures are deuoted by placards on the various 
doon, and are so arranged that seyeral departments of science are 
tan^t in the same apartment during different hours of the same dayi 
dms discourses on philosophy, medicine, mathematics or theology, may 
all be delivered in the same room. The clinical instruction always 
oeenis in the hospital building; and except the branches of anatomy, 
physiology and chembtry, all the branches of medicine in this, as in 
^ the schools of Oermany, are taught there. The University of Halle 
imiaben now some seven hundred students in all its departments-^ 
mostly theologians. The school was founded in 1694, in the old build- 
ing, and received a considerable accession in 1817 by the transfer of 
Ae college at Wittenberg, the scene of Luther's action. The proxim- 
ity of the city, however, to Leipsic and Berlin, injures it very materi- 
ally, in its medical advantages, as the celebrities of the profession are 
always attracted there. Oldhausen is the professor of obstetycs at 
present; being, however, one of Martin's assistants, it was fair to sup- 
pose that his views were mostly imbibitions. And as our haste to Vi- 
enna was rendered urgent by the fact that most of the short courses 
would commence in the following week, we were fain to content our- 
selTCB with the above mentioned visit to the University. 

We pushed on through Leipsic— only a day for the city and its old 
UniTetsity, a long pile of yellow buildings, part of the Augusteum, 
ftcing the main square of the city, a hurried glance through its lec- 
tue rooms, and its aula, a large saloon of busts and statues of Saxon 
Princes, with twelve reliefs of the history of education, then a peep 
into several of the old antiquarian book stores, which only nkade us 
lament our limited means, for all the curiosities and relics of literature 
in all languages are there. Leipsic is the grand oenter of the book 
tnde in Oermany. It has some one hundred and ninety-two book 
stons, forty printing oftoes, one hundred and nine hand and one hun- 
dred and thirty-nine machine presses. During the Masse, which are 
great jEurs held three times a year, and which attracts ^'Armenians, 
Tvks, and dwellers beyond Jordan," book dealers from all civilised 
lands visit the city for purchase and sale. A few years ago they erected 
tteb own exchange, whioh is now their business resort. 

Two days travel on a rather circuitous route, carries us into Wftrs- 
Wg, one of the wealthy cities of the little kingdom of Bavaria, 
wkither we have come to see and hear Scansoni. Most of the publio 
bnildings of the city were erected at a time when WUrsberg was a free 

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S4iO WX8T1BK jrOtrtHAL Of MBDXCINX. 

city, the capital of an episoo]^! see, which piMiitioii it heid upwards of 
a thousand yean, undef the svoMmve jnriidietion of aome •ighty-iwa 
biflhops. Hence the biiildinge hare been erected with that laTishmeni 
of means which the verj large revennes of ench positions permit. 
The hospital is an immenBe stniotare, corering noiore than two solid 
squares, inclnsiYe of the medical college in its rear. The endowment 
of the whole institution is some two and a half million dollars in gold; 
it contains about six hundred inmates, of whom not more than one- 
half are patients ; a large, handsome bronie statue of Julius Echter, its 
founder, one of the city's primates towards the latter part of the sijt- 
teentH century, stands at the front. The appointments of the whole 
building are eren much finer than those of the Charity of Berlin. The 
consequence of this rich endowment, is the security of a magnificent 
fkeulty, for which this institution has always been famous. Kdttiker 
on microscopic anatomy, Bamberger on internal medicine, Reckling'* 
hausen on pathology, and Scanaoni on obstetrics, are among the most 
fkmous. The lying*in hospital stands apart from the main building, 
forming a neat, rather small two story stuccoed building, with accom- 
modations for about fifty cases, which is a fair allowance for a city of 
only forty thousand inhabitants. By the kindness of Br. M undi. Prof. 
Scanioni's first assistant, we were permitted to visit the building and 
make the rounds with him. Patients are divided into first, second and 
third classes, according to their means, the latter class being charity 
patients, and private apartments are furnished for those sad cases in 
the upper circles in which "a child is found for the cradle befbre a 
husband for the bed." Except one or two cases of pelvic abscess, the 
wards were remarkably free from disease of any character* on our visiti 
much to our wonder, for every window throughout was as hennetio* 
ally sealed as the general Gkrman hygiene in practice demands-«tbe 
peculiar puerperal odor was actually sickening* The immunity of dw-^ 
ease under such conditions can only be explained on the thorough 
habituation from infhney on, and the intense aversion every son of 
Teutonia cherishes against a draught. The babies were all bundled 
and rolled, and their little arms tied down inside, so tiiat they eotdd 
be lifted by any one of half a doien bands and tossed about like a 
papoose with perfect impunity. The delivery bed was elevated at the 
back to such an extent as to cause the assumption of a semi^reoum* 
bent posture in labor, resembling no little some of the oM Ckbfor 
Stfihle or delivery chairs, which were so common in G-ermany Itffy or 
sixty years ago, and which are now universally discarded. Tlie lee- 

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<D BM*K W Bl lT C J k Ml 

im room c^atens a very fine array of iaatraBMats asd a valuable ool- 
IwtioB of defonaed pelyesj i^ origtaal Bobort'a peWis, in whioh the 
tcuererM diamotar uras ooatraotad to two iaohm, while t^e coigagaite 
lemuBS Donaal) boiag anong ike aumbar. Among ike novelties may 
be neationed a peculiar oepkalotribe, an ivrention of Scansoni's, which 
■ffits a deaoyiption. In addition to the two blades of the ordinary 
wphalotribe, the inatnunent was provided with a perforator, whoae 
cxtreniity was a pointed oroid of perhaps an inch in diameter, the 
Mter sarface grooved or threaded like a screw; after the cephalotribe 
atppHed in the nsnal manner, the perforatov is passed between the 
laiidles, thmst through the craninm m fontanelk, as the case may be, 
•od ^n carried on throagh tiie brain uutil its point ledges in the 
hnmtn magnnm, several turns of the handle screw it into the fora* 
, MB, when the handle of the perforator is attached to the handles of 
the cephalotribe by a elamp. The advantage claimed for it is solidity 
•f giasp; the attaehment at the base of the head and in its most nn- 
jieUiag bone, even into the eommencement of the spinal canal, will 
ant permit it to glide. We wete infbrmed that on the manikin the 
imtraaeat worked ehurmingly; an opportnnilT' for its application in 
Hmo had noty as yet, presented. The only objection that occwrred to 
ti, woidd be the ad|ttatment of the machine, for its complicated char- 
seter certainly entitles ft to that name. A finger, provided with Ae 
cfaeated obstetrical eye, might recognise the foramen, if it conid reach 
it; bat the ocnlarisation (?) if of the end of a twelve inch steel rod, 
weald imply a delicaoy of tactile sensibility in the hands of the man* 
fibtor, that it would require an eye of faith to take cognisance thereof. 
We do wrong, however, in attempting a jest on a scientiflc subject. If 
As pointed end conld be fastened into the occipital bone anywhere, it 
hpiebaUe that it we«ld answer the purpose. Seanzoni, himself, is a 
^ ef a gentleman and a scholar, and we conld not avoid contrasting 
kiM ia this light with some of his wnmeroos detractorsi who all snffer 
tyAe oemparisen. In peraon, rather portly, now that he is vexging 
ta te Us mMA decade, with a genial, placid face, pleasant to look npon 
mi that feela at peace with itself and mankind, a clear, rather ftiU eye, 
iMaeath a lid with Aat rednndaaey of tisswe which the physiogno- 
afali till na 18 a sign of decision, never dull or slow of comprehension, 
fcf H Aoota a fniek glaaee o«t of its angles ooeastonally, which takes 
tegaiaanee of things wUeh am not always mentioned ; in manner tA* 
Mi, ewrteena, more, even inviting, delivery easy, elegant, chaste^ an 
ki k a o i i on the bed, with eno hand in geelnre ever it and one slipped 

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in hiB p«oket, in perf^t flelf-posaeeaion, expresnng himaelf ob kis suV* 
j^Bot in Uie most beautifal Itngn^e, witkoat effort or affectation, wa 
felt our reapect for him rapidly warming from enrioaity to venerationi 
and left him finally, in our regard, as #nr ideal of an obatetncian. 

The diacourse Was on the sulject of hematoma, selected, as he said, 
from dearth of material, a dificnlty, we were informed, with which his 
clinic is frequently aiHioted; yet he pictmred the case so clearly and 
forcibly as almost to render the presence of a patient unnecessary. 

Scansoni is a disbelioTer in the frequency of this disease. In twen- 
ty^fiye years he hae met with but three cases in which he could con- 
soieutieusly state that hmmatoma existed. Just from a school, as we 
were, in which this was a disease of daily diagnosis) this was rather a 
strange statementi explicably partly, however, from the difference of 
different authors' conceptions of the disease ^ Scansoni only regarding 
those cases as blood tumors, in which an effusien really occurred in 
the peritoneal cavity, and that generally in the earity of Douglas, 
retro-uterine; whereas, accordinig to Martin, the most frequent seat of 
tttravasatioDs is between the folds of the broad ligaments, the most 
of which cases Scansoni regards as simple perimetritis without effusion. 

In his lecture, Scansoni narrated a peculiar case in which it became 
necessary to establish a diagnosis between a hasmatoma and a retro- 
verted pregnant uterus. The introduction of the sound, which in 
other cases would have been sufficient, was here, for evident reasons, 
necessarily excluded. By placing the patient on elbows and knees, 
however, he succeeded in establishing a reposition of the retroverted 
uterus as the case thus proved to be, and the p»^nancy terminated 
fiivorably. Scansoni is deservedly a great favorite among his patients, 
of whom, as you can well imagine, he has a goodly quantity, and a 
choice. For two visits to the Empress of Kussia, recently, during one 
of which he was only present in case his aid might be called, he re- 
oeived, as his assistant informed us, some thirty thousand dollara in 
gold, besides a residence and a handsome equipage. He has refused a 
dasaling offer from Baden Baden, one of the former assistants in the 
hospital there informed us, as it would remove him from his schooL 

We were unable to fee Kdlliker, who would not lecture until the 
following day. Bamberger we met at a post-mortem by Becklioghauaen. 
He is altogether about the last man whose outward ^»pearanoe pre- 
sents any index of the ability which characterises him. Small in stat- 
ure, with heavy side whiskers which almost completely conceal his 
features; he stood there the picture of wrapt attention over an autopqr 

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tf one of his patients which he had followed to the end. He enjoys 
the repntatton of being one of the finest clinicians of (Germany. His 
two late works on Diseases of the Heart and Abdomen, are consid- 
ered standard. 

Mamich has a very fine nnirersity, a spacious stone structure, with 
elegant appointments, erected by the late King Lewis I, whose munifi- 
cence in every respect has contributed so much towards rendering this 
ene of the most beautiful cities of the world externally, as well as 
enriching her galleries and nurseries of art and science, with untold 
treasures within. 

During our entire stay in the city, although we made it exceedingly 
profitable and interesting in sight-seeing, we were unable to glean any- 
thing of medical interest, on account of the inopportune season of one 
of the numerous church holidays, which are religiously observed by 
all the schools. We contented ourselves, therefore, with the purchase 
of photographs of Liebig and Pettenkofer, of world wide fame, and of 
Hedter, the present professor of obstetrics, and hastened on our way. 
As true disciples of Esculapius, however, we eouMnot resist the tempt- 
ation of visiting the home and haunts of Paracelsus, so that we were 
detained another day a.t Salzburg, Austria. A beautiful little city we 
foand it, encamped down amongst some of the loveliest scenery which 
utore oeuld command, and rich in historical interest. Moxart^s birth- 
plaee and home, Hayden's home, the residence of the family of Weber, 
three of the world's greatest composers. What being who has ever 
heard the music of these three inspired men as rendered by the royal 
eferas of these Calliope-worshiping people, who would not feel an 
iispiration in traversing the scenes of their daily lives? Not fiir fVom 
the bridge crosring the river which bisects the town, crowded in among 
iti neighbors, stands a high house with dark weather-scarred WftllS| 
bearing about its centre a half*efi5aced portrait cf the celebrated nat- 
wtlist and empiric, Paracelsus. This wa« his home — nothing else to 
be learned of him there. His manifold virtues, which he himself her- 
alded forth trumpet-tongued, have not been sufficient to have preserved 
ft tingle relic of our hero's greatness. The first half dosen whom^e 
iaterrogated, could not direct us to his house. A little more than three 
eenturies have elapsed since our great medical Mundhausen, the prince 
of braggarts, flourished in the hight of his glory, healing diseases Kke 
the traveling charlatans who take up a temporaiy abode in onr western 
elties until suffering humanity elsewhere makes a sudden call for relief 
in other quarters; but his reputa^on has been, alas ! nlmoitas*e5C|iBe»-. 

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244 msarsftii jomuiAL or xxdicinx. 

cent as theirs. Pancelsus adopted ereiy precaution to propagate lib 
name and fame to posterity. In the vestibale of the charch of St. Se- 
bastian, there is a large monument boilt into the wall oyer his graye, 
a tall column of red nurble of obelisk shape, resting on a square base, 
on the anterior surface of which a scroll bears the following modest- 
epitaph: ^^Insignis medicinae doctor, qui dira ilia Tulnera lepram 
podagram hydropsim aliaque insanabilia corporis artes subtulit." 

Another day en route and we are snugly domiciled in Vienna, the 
place of the present writing; and still another beholds us in arail 
of the magnificent advantages of the clinics of, perhaps, the most prac* 
tical school of medicine in the world, of which, anon. 

Whittakeb. 



BIBLIOGRAPHY. 



A TEEATI8E ON THE DISEASES OP THE EAR. 

BY ANtON VON TB0LT8CH, M. D., 

ProfcMor in the Vmtrfnitj of Wanbnrg. TnuiBUt«d by D. B. St. John Boom, X. D., Cliakil 

ProfeMor of the BiMwee of the Bye and tmt in the tTniyeralty of Hew Toik. 

S e e oBd A»e rl c ? Mi, inm the Fourth QeraMn Bditton. Wm.Wood; 

New York, IMS. For ude by C. P. Wilder. Indiui»> 

polla; BobertClai1ce4(Cto.,Chielnnnti. 

No branch of the noble art of healing has been so much neglected 
■a that of aural snrgerj. Thie neglect has certainly been due to a 
rerj genervl impreuien that Yery little could be done for the aflfectioBa 
of the organ in qneetton. Bat a patient and concentrated attention 
given to ita pathology^ has lately done much to enlighten the obeonritj 
anrronnding the anbleei, and deBK>Batrated the practicability of doing 
mnoh for the relief of aaral diaeaaes. This ia certainly a dedderaitm, 
when we eonaider how ft^qnently they preaent, and how generally one 
of the moat important senses is thereby impaired* To the bnsy, gea- 
«ral pnelfilioner, few aources of information on this subject, hsYC been 
BceessiMe^ In fi^t, hitherto, the only one waa the very excellent work 
of Toynbee. 

In the Yolnme under conaideration, the medical man will find a com- 
plete exposition of all that relates to aural soiencei with all the lataat 
improYoments in treatment, which have done so much to foroe a reeeg" 

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BIBLIOGRAPHY. 246 

iiition of the importance of this branch of tbe medical art. It is a con- 
sideration of facts, garnered in years of patient inrestigation and prac- 
tice. The book is presented in the form of lectures, but is much more 
Eystematic than is usual in such arrangement. The classification and 
nomenclature of diseases, is not entirely satisfactory, after having con- 
sidered the admirable system of Toynbee ; but this is a point of minor 
importance, especially when the great practical excellence of the book 
is 80 patent. Every detail of practice is thoroughly illustrated and 
explained ; more than a hundred pages being devoted to the most im- 
proved plana of examining the outer ear, the use of the eustachian 
catheter, and Politzer's and Valsalva's methods of investigating the 
diseases of the tympanum. The anatomy of the organ is given in a 
clear but concise manner. As regards therapeutics, the most approved 
plans and agents are minutely considered. Most of them will be found 
to be novel ; but, baaed as they are, on simple principles of science, will 
command confidence. 

The American physician is deeply indebted to the translator for 
presenting this admirable work, as well as for his translation of Stell- 
wag on the Eye, the latter, filling, aa it did, a wide chasm in English 
ophthalmoiogical literature. J. G. B. 



PATHOLOGICAL ANATOMY OP THE FEMALE SEXUAL 
0KGAN8. 

BT JVLIUa Jl. KIiOB, M. D., 

in tk« iralTWiltf of VImimi. XnailataA ky J€»«pl XMUitnr, If . D., aad 

r. JDftWKm, M. n. K«w York : Wm. Wood M Co. For nls by C. P.. WU4tE» 
iBdUoapotlf ; Bobort Clarke 4 Co., dndnnAfi. 



This translation, first issued about a year since by a New Tork 
firm no longer in existence, haa bow become the property of the vete- 
nn publishers, Wm. Wood k Co. In a previoua number of the *Jo«r* 
*a2, we made a brief analysis of the book,, giving it such hearty ooqi- 
nendation as its careftil atudy led us to believe was <][uite just. By 
^ judgment then expressed we are quite willing to abide. The higli- 
Mt eriticj^l fauthority in Great Britain in our profession, haa recently, 
Jannary last, spoken of it thus: **A translation of Kloh'i Pathology 

jmnuh ami FtMlgm mMt^Cktrm§U0i Rmim, 

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946 WESTERN JQVWAh 09 KBDICINB. 

ical Anatomy of the Female Seo^ual OrganSy has been fairly accom- 
plished by Dr8. Kammerer and Di^wson, of New York, and we welcome it 
bere as a work of great use to those whose attention Ls specially direct- 
ed to those organs.*' T. P. 



PENNSYLVANIA HOSPITAL REPORTS, VOLUME 11, 1869. 



PhiladelphU : LindMj A Blmkiston. For aahs hj G. P. Wilder, Indiaiuipolis ; Bobert Clarke k 

Go., CittcinB»ti. 



The contributors to this handsome Tolume are Drs. Hewson,^ Mor- 
ton, Da Costa, Hutchinson, Edward Hartahorne, Ashhurst, Hunt, J. F. 
Ueigs, Packard, Agnew, Harlan, Richardson and Pepper. 

As our talented Philadelphia correspondent, Dr. J. Ewing Mear», 
proposes the consideration of this volume in a future communication, 
we will now merely say that these reports are nearly, if not quite, equal 
io those for 1868, and that they are creditable alike to the editors and 
publisher. We hope both parties nxay be encouraged by seeing this 
annual widely circulated. T. P, 

A HANDBOOK OP UTERINE THERAPEUTICS, AND OF 
DISEASES OF WOMEN. 



BT EDWARD JOHN TILT, X. D. 

SeooAd AnericiiB edition, thoroughly reTieed and amended. New York : D. Appletoti h Co. Be* 
eeiTed through Bowen, Stewart A Co., IndianapoliJi. 



The author haa reTised the third British editiom of his well known 
work, for re-publioation in this country, aud contributes a preface 
to this American issue. 

A communication made a few months since to the Lancet^ and which 
struck us as being of such interest that we re>published it in this Javr- 
naZ,* constitutes a large portion of this preface. In the course of it, 
Dr. Tilt compliments "the splendid achievements of those American 
sturgeons who have taught us that we can safely remove ovarian tumors, 
and how to cure vesico-vagipal fistula;" and justly speaks of his admi- 
ration of "the sprglcal genius,^ great skill, and the perfect honesty of 
purpose that characterixe Dr. Marion Sims, who is an honor to hi^ 
eom3ktry and to our profession." 

Wettait Jvmmoi ^ JfMMne, 1868, page 3l(^ 

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BIBLlOOftAPHT. 24t 

The author states that the main points to be developed in *' Uterine 
Tkerapetitics,^^ are: 

^^Firtttp — The paramount importunce of hygiene for the relief and cure of dis- 
eases of women. 

^Seamdi^ — The constituttonal nature of manj diwases of women, and the 
Impo slbilitj of curing them without constitutional remedies. 

^^ Thirdly — The manifest reaction of uterine diseases on the female system, and 
the impossibility of curing many uterine complaints, without surgical measures. 

"FourM/y — The great value of therapeutics to assuage and cure diseases of 
women, and the belief in the Value of those remedial measures, that are as old as 
medicine itself— «nch as renes^ction, emetics and caustics/* 

The preface concludes thus : 

" It affords mo very great pleasure to shake hands, as it were, in this preface, 
with so many ralued American friends. A common language unites the members 
of the same profession in America and Great Britain, by the strongest bonds of 
affection; and there is no danger of it being severed by difference of climate and 
form of government, or even by those occasional causes of misunderstanding that, 
for party pnrposes, are magnified by professional wire-pullers. 

'*This union of the two professions is the type of the perfect unity that should 
erer exist between the great Anglo-Saxon natiohs, to Whom Providence has given 
progenies to people the waste places of the earth, and the firm determination to 
weigh more and more heavily in the scale of nations for the welfare of mankind.*' 

Following the preface, is the Introduction, in which various topics 
are discussed, e. g., Difficulties Besetting the Study of Uterine Com- 
plaints, Lady Practitioners and their Chances of Success, Old and 
Modern Pathology, Diseases of Women to be Studied by the Light of 
Menstruation, et eet.^ ei cet 

The following observaUons we commend to all our readers, espeoi- 
iUy to the junior members of the profession: 

"To be successful in the treatment of the diseases of women, a young medical 
man should make women the study of his lifo, so as to underttaad their metatal 
pecaliarities as Well as their physical constitution; and li; With equality of med- 
ical skill, the senior practitioner is mach more suoceesftil in the treatment of women 
than the junior, it is that he has discovered how to bespeak tkeir confidence^ to 
itimaUte their hope, and to keep up their perseverance until the recovery of 
healtii." 

The conclusion of this chapter, too, is admirable : 

"We must trust in oataie, and believe tbat an Almighty power is operating 
ia the human frame, ever working to restore health by successive changes and 
Ruewals, having definite laws and successful issues, often erroneously ascribed 
to oar remedies. Let our motto be that of the father of French surgery : *' Ji la 

rASB4T, DUO LA OViaiT." 

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248 WK8TBBN JOUBIIAL Of MBDICINK. 

In referring to female pbyBicians, the author states that the prin- 
cipal reason why the knowledge of diseases of women has so little ad- 
vanced, is, the hitherto undisturbed belief that one sex only is quali- 
fied, by education and powers of mind, to investigate and cure what 
the other sex has alone to suffer ; and then a little while afler, point- 
edly averts that the great migority of women will continue to conauU 
us, so long as they recognize the mental superiority of man. We have 
quoted the author's very words, and we fail to be able to reconcile the 
assertion of man's mental superiority, with the retarding influence 
which the fact of these dlseaises not being made the subject of inves- 
tigation and the object of cure by woman herself, has had upon ihe 
advance of knowledge of such diseases. Either the one or the other 
assertion is wrong. 

The first chapter treats of Surgical Appliances and Modes of Ex- 
amination, and will be found quite up with the most recent inventions 
in this department of art, e. g., the sponge tents of Dr. Ellis, prepared 
with carbolic acid, and those of Dr. Aveling, in which permanganate 
of potash is placed, both of which were presented only last year to 
the London Obstetrical Society, are referred to. We are somewhat 
surprised to read from the pen of an author whose generally chaste 
and classic composition we never weary of admiring, this expression : 
"pottering on for months." Pottering on may be forcible, but it surely 
does not come from the ^'pure well of English undefiled." 

The second chapter is upon Uterine Dietetics and Home Treat- 
ment; the third, upon Tonics; the fourth, Sedatives; the fifth, Anti- 
phlogistic Treatment; the sixth. Caustics; the seventh, Emmena- 
gogues; the eighth, Hemostatics; the ninth. Specifics; the tenth, 
Uterine Misplacements; the eleventh. Treatment of Uterine Complica- 
tions; twelfth. Treatment of Sterility; thirteenth. On the Treatment 
and on the Prevention of Uterine Inflammation in India — a chapter 
which few American readers will ever find of any practical value: 
chapter fourteenth, Prevention of Uterine Inflammation ; and, finally, 
Formulss: et eet 

Did time and space permit, we would gladly present an analysis 
of some of these chapters. We must conclude, however, with ex- 
pressing our very high appreciation of this book as one of eminently 
practical value. The physician will find its perusal exceedingly inter- 
esting, and frequent reference to it exceedingly useful. It is hardly 
necessary to say, since it is issued by Appleton & Company, that in 
paper, typography, &c., the book is all that could be desired. 

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BiBLioQftAnrr. 

ATRBATISE ON THE DISEASES OF INFANCY AND CHILD- 
HOOD. . 

BT J. LBWI8 SMITH, If. D., 

PhjaieUo to the laftrnt*! HMpital, Wur<*i Ii]*n4 ; Profcwor In B«ll«Tm HMpltol, Ac Pub^ 

lahed by H. C. Lea, PliiUd«lpblft. For Mle by a P. Wilder, IndiaoA- 

polia ; Robert CUrko A Co., Cincinnati. 

Price, $5.76. 



We believe tkat the profeseion generally, feel that there m a place 
and a need for a good, practical treatise on diseases of children, in 
American medical literatare. We have good works in considerable 
Biimber, by importation and translation, hot we have not now, any 
natiTC prodaction that is satisfactory. Oar anther has probably felt 
this deficiency, though he makes no comparisons, but simply offers his 
labors so as- '*to meet the requirements of the medical student and 
|waetitioner." 

The author has included in his treatise, something more than the 
mere diseases of children and infants. The first part is taken up with 
chapters on Infancy and Childhood, Care of the Mother During Preg- 
nancy, Mortality of Early Life, Lactation, Selection of a Wet-Nurse, 
Oooree of Lactation, Weaning, Artificial Feeding and Diagnosis of 
Infantile Diseases. These topics are not treated at any great length, 
Imt afford occasion for judicious remark and advice. There are some 
points that we would like to have seen more elaborated. One of them 
is eoncerning the management of the mother, who has become, either 
directly or indirectly, syphilitic. Details of management and treat- 
ment might have been made a satisfactory feature in this chapter, inas* 
mnch as we not infrequently meet with such cases. In his subsequent 
chapter on syphilis, he treats of it as developed in the child. 

In the chapter on Mortality in Early Life, we have the well known 
causes of it given ; but we think, though we may be mistaken, that 
New York could have afforded sufficiently forcible statistics without * 
relying almost entirely upon those of European cities and countries. 
His only mention of the proportion of mortality which any particular 
disease shows is, that scarlet fever is one of the most fatal diseases in 
New York city. Another suggestive topic too briefly mentioned, is 
t^ influence of our school-system on the mortality of early life. 

The chapter on Lactation contains brief but pointed remarks on 
its difteulties and eaBtmndicatiotte, such as depxeased nipple, too long 
deUy before applying tin kifiukt to the breast, tuberculosis in tho 

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2S0 WESTERN OOVBIIAL OP MBDICIIfE. 

mother, constitutional syphilis, iniamiMitorj affection* and mammar j 
inflammation. Prominently among the galsctagogves are mentioned 
the use of electrical currents and the eastor oil plant. Among the 
anti-galactics he seems to conide aomewkat in BelladoBna, a martter in 
vhich he docs not agree with the editor of the Wettem J&umaL 

We do not find anything new er suggestiTe in the chapter on tW 
Diagnosia of Infantile IKseases. 

Part II is the practical part of the book, beginniBg with Diseases 
of the Cerebro -Spinal System. Here we have a very proper rtcom^ 
mendation of the •pthalmoaoope as a means of diagnosis in diseane^ 
of the brain. The results of its use, in the bands of Br. Clifford 
Albutt and •thets, are snficient to proTe that it should not be confined 
to the specialist. 

The chapter on Congestion of the Brain, is wanting iu fullness of 
description, pathology and treatment. In such oases, the young prac- 
titioner is glad to have the benefit of the fullest experience. This defi- 
ciency is not observed in the author^s treatment of the subject of Eclamp- 
sia. His remarks on the inhalation aud internal use of chloroferm, opium 
and bromide of potasium, will interest and instruct. The use of opium, 
where the brain is directly or iMiirectly concerned, rehires nice dia- 
crimination, and any one who reads and follows his directions, will 
profit by them. This section doses with an interesting review of the 
subject of Internal Convulsions. 

The section on Diseaaes of the Respiratory System, occupies about 
eighty pages. When we come to examine the chapters on Croup and 
Pneumoiiia, there are modes of treatment of these diseaaes which 
attract notice because of tBeir variance from the established plana. 
'^LoBs of bleed is not required in the treatment of croup.'' That, 
we presume, to be in accordance with American practice. For it are 
substituted aconite and veratrum viride. A fuller aocount of the au- 
thor's experience in the use of these articles would have been. better. 
He employs the tinctwre of veratmok. viride ^*in doses ef half a drp|if 
to one drop every three or four houtu, fer those over tihe age of threes 
years." As a substitute for oalemel in liquefying and removing the 
false membrane, be says <* physicians of this city are using more aud 
more a mixture of ehlosate of potassa or of soda and muriate of am- 
monia given frequently." As a local remedy, he highly. Mcommenda 
fVom perseoal experience, the sub-sulphate of iron. He devotes some 
pages to Tracheotomy ef Croup, giving the statistics of Drs« Krack- 
ewviier and Voss. In the treatment of Pueumenia, he gives one drojp 

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BlBLIOOXAraT. 8S1 

•f tinctore Tdratntm erery three honni, to a child of five yeara of vig- 
•1008 constitutioD ; also^antimoBj with morphia, in the secoBd stage. 
Id feeble children he advises a differeat coarse — ipecac, carb. ammon., 
lenega, ke. In blistering, he advises applying cantharidal collodion, 
in spots of the sise »f a ten cent piece, half a doiem or more. As the 
Mister treatment of disease is being discwsed, we nention this» with 
Bome belief ia its usefulness. 

We have net time to more than allude t» oae or two topics in the 
Mction on Piseases of the Digestive Apparatus. Cholera Infantum is 
one in which every physician in this country is particularly interested. 
He does not devote much space to itj we observe, however, that he 
faintly praises calomel in small doses. 

Under the head of Zymotic Diseases, first appears Diphtheria. 
For treatment, first mention is given to sulphites ; but he has na expe- 
rience that would recommend them. Chlorate of potash and iron are 
recommended, and also local applications, such as he advises in croup. 

Qnite a number of important diseases of children are not men> 
tioned. We leave the book with an impression of its incompleteness 
in many matters. Yet it is the basis of a good treatise. Possibly an 
addition of clinical matter or matured personal experience, will bring 
it np to the Btandard which the author sets up in his preface. y 

W. C. 



OUTLINES OF PHYSIOLOGY— HUMAN AND COMPARA- 
TIVE. 

BT JOHN MARSHALL, F. ft. 8., 

ft^tenor at Surgery In tha UnlTerifitj GoUoge, London ; Surgeon to th6 Unftctiitty C«t)egt Hos- 
pital ; wltti addtliooa by Francis 6. Smith, M. D., Profeflsor of th« VniYeff^ 
Aity of Pmaeyliraiila^ Ptiblialied ill PhUadslpbia, by 
Henry C Lea, 1868. Price, $7.fiO. 



Nothing has appeared in. o«r language, eiace the last edition of 
Oirpenter'B great work^ that h oomparahle to this of Mr. Haiahall ; 
and, it ig quite singular that it should be produced by a sufgeoD. 
Every one interested in phpiology has been looking and waiting pa- 
tiently for a ttftw edition of Carpenter, which should bring us up t^ 
Ike latest aocumulations of this subject; but it is to be feared ourex- 
lectations will not be realized. But Mr. Marshall has given us a wotk 
tqpal im artangenent, and more full and satisfactory on many of thft 

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2B2 wssTEaN joumn al of HSDiaNS. 

topics thatt Oarpeiiter*B. So that while ezpressing our regrets for the 
apparent close of this great man's labors, we can rejoice in the snc- 
oeesfttl work of the new author. 

I wish I could spare the time to offer an extended review of this 
superb work. It really merits an elaborate comparison with other 
recent and familiar works, not for the purpose of showing its superi- 
ority, so much as to exhibit the rapid and splendid development this 
attractive science is making. Physiology may be studied in this work 
f^om the lowest forms of vegetable and animal existence, to man, the 
richest and noblest observer of all the marvelous works of the Creator. 

Science has discovered that a law of progre$sum actually pervades 
the whole universe, not in the sense of the Dar|7inian, or kindred 
theories of imiversaZ development^ which have no established facts nsv 
stringent analogies to sustain them; but the unbroken series in the 
works of nature which present themselves from the phenomena of hare 
forms up to the highest manifestations of organisation and the vital 
forces. 

In the presentation of the cell doctrine, Mr. Marshall makes allu- 
sion to a subject that I have never seen referred to by any other wri- 
ter, but which I have ventuved to teack for €fteen years past as a rea- 
apnable inference from the phenomena of all proliferation, and that is, 
that each tissue and organ is represented in the spermatazoon, when it 
penetrates the germ cell or ov«aa of the female and finds there the 
peculiar pabulum for the beginning of organization. In other words, 
the different organs of the body cast off imperfect cells or gemmules, 
which in the generative organs becomes elaborated into the spermata- 
zoa. I do not say that the reader will find the statement I have made 
so definitely stated ; but well defined allusions are made to it. 

In a most interesting department, this work falls below our wishes, 
and that is, in those profound, yet luminous psychological and meta- 
physical discussions into which Carpenter has entered in his views of 
the structure and functions of the brain. 

I have been struck with the prominence which many of his original 
views have in receat works, such as Luys (French) on the Nervoui 
Syiiem, and Maudsley's JPk^swlogy and Pathology of the Brain^ which 
latter seems to be leading some into the unsatisfactory doctrines of 
materialism. And while both writers use freely Carpenter's scheme, 
they are devoid of that reverence and veneration of God which marks 
that great man's work. 

For the present at least, the vaunted pride of science had better 

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EDITORIAL AND JiSDIOAL NSW0. 

teeept the statement of Prof. Tyndall in his recent address as presi- 
dent of the British Association : " That while a definite thought and a 
definite molecnlar action may occur simultaneously in the brain, we 
do not possess the intellectual organ, nor, apparently, any endowment 
of the organ which would enable us to span by a process of reason- 
tag, from the one phenomenon to the ather." 

One thing is always to be regretted in the re -publication of Eng- 
lish works by the house to which we are indebted for so many, and 
that is, the miserable wood-cuts ; they usually disgrace the works which 
th^y are intended to illustrate. Why not get them from our trans- 
atlantic friends, if we can not get them made here? C. G. C. 



EDITORIAL AND MEDICAL NEWS. 



Wx HOPE the meeting of the American Medical Association at 
New Orleans will be largely attended. For years, a great gulf divided 
between north and south ; and now that gracious peace has bridged 
tliat gulf, now that the ^* war-drum throbs no longer," and all battle-flags 
are furled, the deyotees of Medicine — which knows neither clime nor 
caste, neither political nor sectarian beliefs, which is all-embracing the 
nee as the atmosphere the earth — ought to hasten together with the 
tbobbing of fraternal hearts and to the grasping of fraternal hands. 
Let tbe men of the north and of the south, of the east and of the 
west, meet together in an everlasting peace, revive old memories of 
Wmony and union, and inaugurate new measures for the honor, the 
dignity and usefulness of the profession. Space does not permit us 
to urge upon our readers the importance of sustaining by sympathy, 
aad by presence at its annual convocation, the American Medical Asso* 
cJation, and especially of attending this New Orleans meeting ; nor can 
ve urge certain subjects which we hope will be presented to the Asso- 
oation. However, there is one thing we want to suggest to our brother 
aditors, viz: That we have a meeting of our own at New Orleans, 
lometjme during the period when the Association is in session. We 
caa meet together, become better acquainted, agree, possibly, upon 
icme plan of medical education, for example, upon the most advisable 
lelieme of State medical legislation, and advocate these measures in 
Mir journals. What say you, gentlemen of the medical journals, to 
ftit suggestion? 

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254 WEdtKRK JOUlftKAL OF MKDlOlN*. 

LIST OF QUESTIONS AT THE RECENT EXAMINATIOHB 
IN THE MEDICAL COLLEGE OF OHIO. 



Prof. Blackman: Sui'gery — 

1. What is an abscess and faoW diaghosed 7 

2. Definition and tt'OAtment of anUeristn. 

8. Describe Garden's amputation at knee-joint. 

4. Indications for trephining craninm. 

&. Best method of reducing vcrticle luxation of patelbv. 

6. Describe ordinary operation for strangulated oblique hernia. 

7. Difference between CoUes' and Barton's fracture of radius. 

8. Diagnosis between luxation of humerus and fracture of tlie neck. 

9. Differential diagnosis of fracture of neck of femur and luxation on dor- 
sum ilii. 

10. Characteristics of luxation in sciatic notck. 

11. Best method of reducing luxation of femur. 

Prof. Grahatn : Theory and Practice of Medicine — 

1. What are the physical signs of different stages of pneumonia? 

2. In valvular disease of the heart, how find the particular valve affected? 

3. Diagnose between remittent and typhoid fever. 

4. Diagnose between peritonitis and enteritis. 

5. Diagnose between lumbago and nephritis. 

C. How would you treat a case of acute dysentery ? 

Prof. Wright: Obstetrics— 

1. What are the bonndarics of the inferior strait? 

2. Name the vertex presentations and the one most frequpnt. 

3. What direction must the face assume to make a natural labor? 

4. What are the positwt signs of labor? 

5. Hotr manage prolapse of funis in fittt stage of labor? 

6. Give symptoms and treatment of puerperal fev( r. 

7. How treat puerperal convulsions? 

8. Give signs of rupture of uterus in labor. 

9. How treat tmavoidahle hemorrhage ? 
10. How treat retained placenta? 

Prof. Comegys: Physiology — 

1. Describe a cell. 

2. How is food classified, bow digested and how absorbed? 

3. What are the chief constituents of the blood and what is the average 
proportion to the weight of the body ? 

4. What time is reqfciired fof the whole tu pass through the heart t 

6i How rapid is the capillary cik^eulation, aiid what eondUioa of the ves- 
sels is necessary to maintara tbe normal moveiaeDt ? 

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XD^TOllUL JJXh MXDtCULI. HXW8« 8M 

6L What effect on the capillary moYcoienti resalts from increased benrt no- 
tfttinfcTer? 

7. What is the theory of respiration ? 

8. What amount of space for each person should be allowed, due regard to 
TntilatioR being had ? 

9. Whiit constitutes a nervous system, and what are the functions of its parts? 
lO. Gire an example of escito-motor, sensori^metor and ideo-motor acts. 

Prof. Parvin : Medical and Surgical DisesBes of Women— 

1. Whiit are the normal dimecsioas of the nnimpregnated uterus? 

1 How would you distinguish a simple from a specific TaginitisT 

3. The differential diagnosis of a fibroid of the posterior wall and retro* 
Isioa of the uterus. 

i» Diagnosis between uterine prolapse and hypertrophic eloagatlon ot the 
lifiipTigiDal neck* 

6. The treatment of asthenic amenorrhoea. 

t The treatment of intra-uterine polypus. 

I The treatment of epithelioma of the uterine neck. 

8 The treatment of uterine catarrh. 

S. How are ulcers of the neck of the uterus divided ? 

10- The different methods of treating the pedicle in orariotomy. 

Prof. Gobreeht: AiHitomy-^ 
1. Describe a rib. 
I Describe a bony thorax. 

X What parts are necessary to fem afi$ noTable joint. 
i Describe the hip-Joint. 
5. What muscles form the quadriceps extensor cruris, and bow are- thcf 



i What is a satellite muscle (gi^e an example)? 

^ fieseribe the heart. 

8. Girc the coats of an artery. 

•• Describe the Inaga. 

10. Gire the principle dirisions of the encephalic nerYous mass. 

Prof. Bartholow : Materi Medica and Tt^ertvpeutics — 
I. Give rule for administering arsenic* 
t Write a prescription containing Powler's solution. 
SL Describe physiological effects of Calabar bean. 

i \rbat is the aatttte of the phys»ol«gU»il a^tagpnism of morphia s«4 atropi^? 
& Cadei; what circumstance would joxk prescribe morphJA and atropia 

^. Describe the physiological effects of the bromides. 

'i What is the therapeutic value of oil and water in the trfatraeat of ski* 

<h«Mir 

t. Qtre rules for the hypodermic use of remedies* 
t. Describe the preparation of ealomeL 
10. How administer Urtar emetic t».pi!od«flt emeiia? 



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266 WMPSElf JOtTRKAL OF MEBICmK. 

Prof. Seely: Diseases of the Eye and Ear — 

1. Of what does the organ of sight consist? 

2. How many bon«8 enter into the composition of the orbit, and name tfaem 7 

3. Name the ocular masclea, give their origin and insertion, and the nenree 
that inerTate them* 

4. Qive structure of the tlds. 

6. Define accommodation, by a change in what structure is it brought about, 
and what produces the change 7 

6. What is the macula lutea, and what the blind spot of MariotteT 

7. Bound the anterior and posterior 4shamber. 

8. What are granulations, divisions, -diagnosis, etiology and treatment? 

9. Iritis, what its diagnosis, cause, and treatments? 
10. What is cataract? 

Prof. Conner: Chemistry — 

1. Define boiBf acid, talt^ haUndj hodjff with examples of each. 

2. /odine-^From what source obtained, physical properties, combi&atioa with 
other elements, methods of distinguishing iodide from bromide of potassium. 

3. Iran — Oxides, method of preparing hydraUd seajuaocHle for use in omcs 
of poisoning by arsenic 

4. jDecM/— Physical properties, oxides, lists, effect as poison, 

6. General difference between ixwrfome and oryonttf compounds. 

6. CarhoUe Aeid-^Yrom what source obtained, physical properties, sofTeali 
of, strength of saturated aqueous solution. 

7. JhrodueU qf DicompoiUion ^ Mmeral matter — Action upon lead pipe df 
water containing decomposing animal matter; method of purii^lng water contaaa- 
iag animal matter. 

8. jDMtffi^fctofito— Classes of, actions o( those commonly employed, methedi 
of employing them. 

9. Alkaloida—ln general, from what obtained, physical properties? Mer* 
phia and quinine, how distinguished one ftom the other? 

10. CTrtfis— normal and abnormal constituents— tests for each. 

Thk cohmencehsnt exercises of the Medical College of Ohio took 
plaoe on the Ist of March. Judge Dickson — ^whose scholarly, thoaghi- 
All and useAil Address upon the occasion, we are stire our raaden will 
rejoice in haying the opportunity of reading — represented the tmsteeB 
in conferring the degrees. Prof. Graham deliyered the Taledtotoiy, 
its subject being Faith in Medicine^ and it is needless to add, tlmt ia 
oomposition it had the peculiar, vigorous and logical style which char* 
acteriie the author's habits of thought, and that it was delivered with 
that gracef\il oratory which all who have ever heard Prof. Orakaa 
know that he possesses. 

*tu thto addran, page lt7, Um 16, §ot "co&&Mt«4 ** reed Msoeiaied ; also, peg* in, 
nt» from fiMt ef pega, fn •« true*' mWlltato good. 

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xmroEUL Aim ntmcAh mwa. 



SB7 



GRADUATES OF MEDICAL COLLEGE OF OHIO, SESSION 

186S-69 



S. W, Aodenon, 
Henry J. Abbett, 
John D Azline, - 
Charles F. Basford, 
William E. Bnrcb, 
Daniel N. Brown, 
John H. Brace, 
Clinton Brown, 
Jowph R. Bidlflrd, 
SiBon L. B. Blaeke, 
Samntl L. Beder, 
A. L Cbenoweth 
Geo. B. Gnwford, 
Robert H. Galrert, 
Bobert H. Golbertton, 
Perry D. Corington, 
Lawaon Drais, 
Kber (1. Dorr, • 
W.KUjahd* Cower, 
hm 0. DnTj, 
S. B. BnenoB, 
MiPord, 
fl[^ W. Ford, 
Ml P. FreeUwd, 
Jail B. Gnhnm, • 

Dttnaa H. Harriaon, 
P.CHolUnd, • 
8. 8. Borne, • 
Benry Hancke, 
Aaa B. lahaa, 
Williuii H. Jonci, 
J.8.Ke]aej, 
John B. Harkle, 
J. B. F. Xorgnn, • 
BcnniaF. Moss, 
L W. HcQinnis, - 
John Xackoj, Jr^ 
Thoaaa C. Moore, 
John G. McVay, 
Bamoel B. Morgan, 
BathanT.Nobla, 



Ohio 

Kentucky 

Oiiio 

• Ohio 
Kentncky 

• Ohio 
Ohio 

- Ohio 
Ohio 

- Ohio 
Ohio 

- Ohio 
Ohio 

Indiana 
Indiana 

- Ohio 

• Ohio 

• Ohio 
Ksntocky 

. Ohio 

• Ohio 

• Ohio 

• Ohio 
Indiana 
Indiana 
Indiana 
Indiana 
Indiana 
Indiana 

- Ohio 
^ Ohio 
Kentncky 

Indiana 

Indiana 

Ohio 

Indiana 

Kentncky 

Kentucky 

• Ohio 

• Ohio 
Indiana 

• Ohio 



.Thomas Orr, 


Kentncky 


Geo. B. Orr, - 


• Ohio 


T. S. Potter, 


- Ohio 


Lientellis L. Porter, • 


Pcnasylirania 


L. 8. Rice, . - 


- . Ohio 


John C. Rickey, 


IlUnoii 


Theodore K. Rafferty, 


^ T«ill«»^ 


Robert 0. Redd, 


. Kentucky 


William H. Rogers, 


Indiana 


Henly G. Rntter, 


• Ohio 


John C. Sloan, 


Pennsylrania 


William a. Smith, 


Indiana 


N.W. Spring, . 


• Ohio. 


OliTer H. Sazton - 


Ohio 


Bererly W. Snlllran, 


Indiana 


Bdwln I. Thorn, - 


Ohio 


William B. Tocker, • 


- Ohio 


Waddy Thompeon, 


South Garolina 


George F. Thomin, - 


• Ohio 


Will. W. Tinnedge, 


• ladiauA 


Daniel Wilson, 


• Indiana 


J. Owen Wall, « 


. • Okio 


Jno. H. Wniiafd, 


• - OUo 


James M. Wood, « 


• ladiani^ 


Jonathan M.Wright, 


• • Ohio 


H<a»es T. Wilson, 


• • Ohio 


Jeff. D. Tonng, 


• - Ohio 


Martin y. Young, 


• Indiana 




CINCWIUn aOtPXTAL. 


S. W. Anderson, 


• Ohio 


J. W. Dawson, 


• • Ohio 


J. L. Qttinn, 


- Ohio 


J. B. Bitchy, 


Ohio 


H. Illoway, 


• . Ohio 


W. W. Tinnedge • 


• . Indiana 



OOOO tAJCA&ITAll BOSPITAL. 

W. Blijah de Gourey, - Kentucky 
Henry G. Butter, • • • Ohio 
B. J. Galfaraitti, - • Indluia 



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as VC8TERN JOUENAL OV MIDlClim. 

American Medical Association, soutb-weBt corner Broad and 
Pine streets, Philadelphia. Wm. B. Atkinson, M. D., Permanent Sec- 
retary. The twelfth annual session will be held in New Orleans* Lou- 
isiana, May 4:th, 1869, at 11 a. JI. The following committees are ex- 
pected to report: 

On Diseases of the Comeft, Dr. #. S. Hildreth, Illinois, cbairmaB. 
On cultivation of the Chinchona tree, Dr. Lemuel J. Deal^ Pennfjlrania, 
chairman. 

On Excision of Joints for Injuries, Dr. J. B. Reed, €korgia, chairman. 

On Alcohol, and its Relation to Medicine, Dr. John Bell, Pennsylvania, chairs 



On the Crjptogamic Origin of Disease, with Special Refhrance to Recent 
Jf icroscopic Investigations on that sul^ect, Dr. Edward Curtis, U. 8. A^ chalrmaa. 

On Operations for Hare- Up, Dr. A. Hammer, Missouri, chairman. 

On Clinical Thermometery in Diphtheria, Dr. Joseph G. Richardson, New 
Tork, chairman. 

On Inebriate Asyluma, Dr. C. H. Nichola, D. C, chairman. 

On the Influence of the Pneumogastrio Nerve on Spasmodie tmA Rytbnkal 
Hovemente of the Lvngs, Dr. Thomas Antisell, D. C, chairman. 

To Examine into the Prtsant Plan of Organization and Management of l^ 
United States Marine Hospitals, Dr. D. W. Bliss, U, C, chairman. 

On the Utilisatioa of Sewerage, Dr. Stephen Smith, New York, chaiimaA. 

On the Influence of Quarantine in Preventing the Introduction of Diaeaae iai* 
^« ports of the Diiited States, Dr. Blidia Hatria, New York, cbairmaa. 

On Nurse Training Institationai Dr. Samuel D. Gross, Pennsylvania, cbalnBan. 

On Commissioners lo aid in Trials Inv<4ving Scientific Testimony, Dr. Jobs 
Ordronaux, New York, chairman. 

On Annual Medical Register, Dr. John H. Packard, Pennsylvania, ckairaao. 

On Demising a Plan for the Belief of Widows and Orphaae of Medical M€b» 
Ihr. John H. Griscom, New York, chairman. 

On Veterinary Colleges, Dr. Thomas Antis^l, D. C, chairman. 

On Specialties in Medicine, and the Propriety of Specialists advartising, Dr. 
H. Lloyd Howard, Maryland, chairman. 

On Library of American Medical Works, Dr. J. M. Toner, D. C, chairman. 

On Vaccination, Dr. Henry A. Martin^ Massachusetts^ chairman. 

On the Decomposition of Urea in Unpmic Poisoning, Dr. H. R. Noel, Maryland, 
chairman. 

On the Best Method of Treatment for the Different Forms of CMI Palate, Dr^ 
J. R. Whitehead, New York, chairman. 

On Rank of Medical Men in the Navy, Dr. N. S. Davis, Illinois, chairman. 

On M« dical Ethics, Dr. D. Francis Condte, Pennsylvania, chairman. 

On American Medical Necrology, Dr. C. O. Cox, Maryland, chairman. 

On Medical Education, Dr. J. 0. Reev«, Ohio, chairman. 

On Mfidlcar Literature^ Dr. B. Warrei^ Maryland, chairraah. 
On Price Bssagrs, Dr. 8. M. Bemiss, Lquitiaaa, chairman. 



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SBlTOaiAL AND ITEDICAL NEWS. 259 

On the Climatology and Epidemics of Maine, Dr. J. G. Weston ; New Hamp- 
shire, Dr. P. A. Stackpole; Vermont, Dr. Henry Janes; Massachasetts, Dr. H. I. 
Bowditch; Rhode Island, Dr. C. W. Parsons; Connecticnt, Dr. B. E. Hant; New 
York, Dr. W. F. Thorns; New Jersey,' Dr. Ezra Iff. Hunt; Pennsylrania, Dr. D. F. 
Condie; Maryland, Dr. 0. S. Mahon; Georgia, Dr. Jnriah Harris; Missoarl, Dr. 
Geo. Sngelman; Alabama, Dr. B. F. Michel; Texas, Dr. T. J. Heard; Illinois, Dr. 
R. G. Hamil; Indiana, Dr. J. F. Hibberd; IHstrict of Golambia, Dr. T. Antisell; 
Iowa, Dr. J. G. Hughes; Michigan, Dr. Abm. Sager; Ohio, Dr. T. L. Neal; Gali- 
fomia, Dr. F. W. Hatch; Tennessee, Dr. B. W. Avent; West Virginia, Dr. E. A. 
Hildreih; Minnesota^ Dr. Samael Wiley; Virginia, Dr. W. 0. Owen; Delaware, 
Dr. L. B. Bosh ; Arkansas, G. W. Lawrence ; Mississippi, Dr. — » Gompton ; Lon- 
isiana, Dr. L. T. Plsm. 

Secretaries of all medical organisationB are requested to forward 
lists of their 'delegates as soon as elected, to the Permanent Secretary. 

Any respectable physician who may desire to attend, bat can not 
do so as a delegate, may be made a member by invitation^ npon the 
leeommendation of the Committee of Arrangements. 

W. B. Atkinson. 

American Medical Association — Meeting at New Orleans, Tues- 
day, May 4th, 1869. 

I am anthorized by the Atlantic k Mississippi Steamship Oompanj of St. Louis 
to aay, that they will carry doctors and their ladies to attend the meetiftg of the 
Aworiation, at the following sates, viz: 

Tnm St. Loslt to New Orleans, each puiettger, ........ |ao.00 

«• Cairo •• •* •* 18.00 

" Menphie " " " " - 15.00 



FfeMB Nev Oricant to Meaphie, MUih puBenger, .....«•- $15.00 

" " " OUro, " " lft.00 

•• •* "St. LoQii, •• " S0.00 

The Companj start a first class steamer from St Louis erery forty eight honrs, 
Sundays included, and the nsnal time from St Louis to New Orleans, is about six 
days, and from Cairo to New Orleans, about four and a half days. Passengers can 
go <m any of their boats at the above rates^ which includes meals and state-rooms. 

The steamer which will, however, take down the great body of the doctors 
wishing to travel by the river, will leave St Louis at five o'clock p. x , on Wednes- 
day, the 28th of April; Cairo on Thursday evening; after the arrival of the afternoon 
train on the Illinois Central R^lroad; and Memphis on Friday evening, reaching 
Hew Orleans firom MoUday noon to Tuesday morning. 

Parties arriving by railroad, to take this boat, at either St Louis, Cairo, or 
Monphia, had better make thieir calculations to reach the point of embarkation, at 
least one train in advance of the time of the boat's departure. But, if any one 
should arrive at Cairo or Memphis too late for this boat, he will find one or more 
boats passing for New Orleans every day, at ordinary fare. ^ j 

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260 WI8TXEN JOUBKAL OF lUBDIOIMB. 

It was deemed best to make the arrangement for a definite fare each wa/, sa 
that one can go either down or up, or both, as he maj choose, hj the rirer, and 
know in advance just what he will hare to paj. 

To arail hiouelf of this boat, one may apply on board, making it known that 
he is on his way to attend the Association, or, perhaps, better write me a line as 
early as conrenient, stating how many ladies, if any, will accompany him. 

Good steamers also leare Loaisyille for New Orleans erery two or three days, 
occupying firom six to seven days in the passage down. If a considerable number 
of doctors should wish to take passage from Louisville, and would make applica- 
tion in a body to B. T. Sturgeon, Superintendent Louisville k New Orleans Packet 
Company, at Louisville, or the Captain of a Steamer, staYting at the proper time, 
he would probably give them a liberal reduction from the ordinary &re, which 
varies from thirty to forty dollars, acccording to the style and accommodation of 
the boat 

From Cincinnati, no suitable boat can be taken through to New Orleans, but 
the Cincinnati k Louisville U. S. Hail Lme, will take one going to the Association, 
from Cincinnati to Louisville, on one of their fine boats, and from thence to New Or- 
leans by rail, for forty dollars, and return him on the same route to Cincinnati, free. 
Two Hail Boats leave Cincinnati every day at twelve u^ and six o'clock p. m., 
except Sundays, one at twelve m. I am not advised as to what arrangements have 
been made with other railroads. Jamib F. Hibbied, M. D.^ Biekmond, Ind, 

A 8UB8CBIBXB in Miflflouri presents the following interrogatories, and 
we shall be yery grateful if some of oar readers will respond to them; 
indeed we believe the J<mmal can be rendered especially interesting 
and instmctive, by haying a department devoted to the presentation of 
professional inquiries and answers to them: 

" What is the pathology of dropsy setting in suddenly, in cases where persons 
have been constant drinkers for years ? Is it necessary in such cases of dropsy, 
that some organic lesion of the heart should be first superinduced? Is dropsy af- 
fecting persons who have drunk say from five to ten years, ever curable 7 What is 
the most rational treatment in such cases 7 Having had a large experience in cases 
similar to the above named, and not finding any very satisfactory description of 
them in any work, I take the liberty of making the above inquiries." 

An Indiana physician recently wrote ns, protesting against that 
feature of the law, recently before the Indiana Legislature, to regulate 
the practice of medicine and surgery, which permits a man, no matter 
how infamous a quack he may be, to continue his nefarious trade, if 
he has been engaged in it for at least ten years — thus recognizing long 
continuance in crime as a license. 

We must firankly say that we have but little faith in any law being 
sitstained in the courts, should the test be made, which interferes with 
. those already engaged in practice. A right once even tacitly granted 

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XDITOBIAL AND UXDICAL V1W8. 261 

by tlie State, and accepted and exercised, can not readily be with- 
drawn; or, in other words, a%. ex pott facto law will not be upheld. 
And our hope for better qualified physicians is not in legislating for 
those who are already in the profession, but for those who are yet to 
enter it. But be this as it may, one thing is certain, as long as col- 
leges are dependent upon students for support, a higher standard of 
qualifications for license or diplomas is not soon probable ] and hence, 
the great step to be taken is, divorce tectchinff from licennn^ — let the men 
who examine and give degrees, have no connection whatever with med- 
ieal colleges — be entirely independent of them. But we must defer 
other remarks upon this subject to a future number. 

At a hzsting of the CoTington and Newport Medical Society, held 
at Coyington, Kentucky, February 19th, 1869, at the residence of Dr. 
R. Pretlow, the death of Wm. Hays was announced, whereupon a com- 
mittee consisting of Drs. T. N. Wise, Henderson and Jessup, was ap- 
pointed to draft resolutions expressiye of the sense of the Society in 
regard to the sad eyent. The committee reported the following : 

WBiaxAB, It has pleased Almightj God, in the wise dispensation of his Proyi- 
dence, to take from among us our friend and co-laborer, Dr. Wm. Hays, in the 
morning of his professional usefnlness ; therefore, 

Rt96bHd^ That we proudly bear testimony to the calmness with which our 
friend met the rapid approach of the fril destrojer, death, and that we are beyond 
measnns gratified in knowing that it found him all prepared. 

R£9ohedf Thftt we sincerelj deplore the death of our friend, who had bound 
himself with strong cords to our hearts, by a most consistent professional deport- 
ment and his many manly virtues. 

Reaolved^ That in the death of Dr. Hays, our profession has lost one of its 
brilliant ornaments, and society a most useful member. 

Eetokfed, That the Medical Society offers to the bereaved &mily of Dr. Hays 
our warmest and most heartfelt sympathy. 

Buohftd^ That a copy of these resolutions be published in the city papers and 
in the Cincinnati medical journals, the W99tem Jcumal of Medidnej the Jiiekmond 
and Lommnlie Medical Journal^ and that a copy also be sent to the family of the 
deceased. 

On THE 29th of March, jnst as the last form of the Journal was 
going to press, we received from the office of the Richmond and Lou* 
iimlte Medical Journal, the proof-sheets of two letters from Dr. Bald* 
win, of Montgomery, Alabama, President of the American Medical 
Association, and one from Dr. J. G. Nott, formerly of Mobile, now of 
New York, accompanied with the statement : ^' Dr. Baldwin desires the 
medical journals of the country to publish these letters in fulL or give 

.,y,u..uuy Google 



262 WBSmif JOURKAL OF xcBicmx. 

an tnalysis of tbem in April." The correspondence came altogether 
too late, even if it were not too long, for publication ; and we mast be 
content with a brief reference to some of its salient features. 

Dr. Baldwin, under date of March 2d, writes to Dr. Nott, urging 
his attendance at the approaching meeting of the Association, states 
that the great mass of southern physicians are in full sympathy with 
the AssociaUon, that the few who are dissatisfied ground their com- 
plaint upon the rejection of the Gardner resolutions in 1864; he then 
discusses these resolutions, as to the propriety of the action of the 
Association, Ac., ftc; finally, promising a hospitable welcome* to the 
delegates at New Orleans next May. 

Dr. Nott replies briefiy under date of March 9th, speaks of the 
kindness of the profession to him in New York, refers briefly to the 
Oardner resolutions, Ac, and concludes thus: "My many old friends 
must throw aside all minor considerations and come forward in sus- 
taining your efibrts to maintain the true honor of the south, the dig- 
nity of the profession and the cause of humanity." 

The third letter is to Dr. Oaillard. If Dr G., who lost an arm in 
the war, if Dr. Nott, who lost his two sons thus, and Dr. Baldwin, 
whose only son likewise perished in the strife, are foremost in the cul- 
tivation of amity and cordial friendship, not even the smallest frag- 
ment of the southern profession ought to feel or act otherwise. 

Vaocjinb Aoent of Wsstebn Viboikia. — Dr. J. C. Hupp was 
appointed State Vaccine Agent a few days since by Governor Steven- 
son. Dr. Hupp, we believe, has filled this position since the forma- 
tion of the State, and has given universal satisfaction. 

Our Fbienb Dr. J. D. Jackson, of Kentucky, requests us to make 
the following announcement: All the railroads in Kentucky, the 
"Kentucky Central" excepted, have offered half -fare (full fare going, 
return free,) to delegates attending the "American Medical Associa- 
tion" at New Orleans, in May next. The "Louisville k Nashville & 
Memphis Railway," have very kindly effected an arrangement with the 
roads connecting with it south, by which through half-fare tickets to 
New Orleans can be obtained at Louisville. 

NoTWiTHBTANBiNa the addition of four pages to this number of 
the Jimrnal^ we still find ourselves compelled to defer several matters, 
bibliographic, items of news, editorial notices, et cet^ until our next 
issue. 

Digitized by VjOOQ IC 



THE WESTERN JOURNAL OF MEDICINE, 

(jnM*fn«r%f, "CixoiirKATi Joubnal of Mbi>ioinb.") 



Thus It vill be seen that if man has pawlons which impel him to the deetroction of man, if 
ke be the only animal who, despising his natural means of attack and defence, has doTfaed new 
mm a m «f dastmetion, he is aloo the oalj aalaal who has the destn, ct the power, to nUere the 
ssiiGrinKS of his fellow citiaens, and in whom the co-existenoe of reason and benetolence attests 
a moral as well as an Intellectual superiority.— Gsathi' CLiincA.L MsDicim. 



Vol. IV. INDIANAPOLIS, MAY, 1869. No. V. 



ACCOMMODATIVE ASTHENOPIA. 



BY DE. J. O. BOOMB8, M ADIflOM, IMD. 



Thii annoying affection of the eyee, the sooree of bo mnoh phjB- 
ieal and mental misery, remained a 0ub|eot of pnre speculation and 
enpirieiam, from the birthday of medical soienoe almoet to the present 
time. In the last decade, however, Donders and others, in their ex- 
kaastiTe researches in the physiology of the eye, have been led to a 
eemplete elucidation of the pathology of this hitherto mysterious mal- 
ady, so that now it is so clear and exact that he that runs may read. 
As a consequence of this exact pathology, sadly too often lacking in 
Btny instances of diseases, the treatment and cure are now as fixed 
tod certain as any thing relating to so complex a machine as the phys- 
leal man can be. 

Asthenopia is characterised by intermittent blurring of Tision, ten- 
sion around eyes and frontal region, yarions facial neuralgia, lachry- 
■ation, congestion of conjunctiya, slight intolerance of light, &c., all 
induced or aggravated by reading, sewing, or other close work. It is 
essentially an irritability of the ciliary apparatus of the eye. This 
irritability is due to exoessiye straining in the effort to accommodate 
the yision for near objects. This excess of effort may either be f«{a- 
five, as where, owing to debility, the muscle is not able to do a normal 

(19) L^yitized by GOOglC 



264 WS0TBRN JOURNAL OV MKDICINK. 

amottnt of work in accommodating, or it may be necessitated by the 
condition of the bypermetropia, an abnormal proximity of retina and 
crystalline lens. This arrangement of the optical apparatas requires 
an abnormal intensity of action on tbe part of the eilliary mnsele in 
all positive accommodation, snch as is essential in viewing near objects. 
This strain can be borne without inconvenience, until the age of thirty 
or thirty-five years, if not excessive. Then, by the gradual failure of 
accommodative power, it will have increased to such an extent as to 
induce an ' irritability of the muscle itself, and if continued, finally, a 
train af reflex irritations referable to the various nerves of the head 
and face, and sometimes of the whole nervous system. Such cases are 
truly pitiable, for often the suffering has continued for years, in spite 
of all sorts of empirical efforts. 

At a much earlier age, asthenopia will supervene, in hypermetropic 
eyes, if the strain if excessive tind eoiUinuedj as in all employments requir- 
ing close and fixed vision. These two varieties of accommodative asthe- 
nopia, that ftom hypermetropia, and that from debility, may coincide in 
the same cases, and generally do, as even when the congenital defect is 
very considerable, unless debility assists in the evil, the powers of the 
eilliary muscle will be able to overcome the deficiency without any un- 
pleasant result, until age weakens them. Hence, asthenopia is oftenest 
found in constitutions broken down by uterine disease, spermatorrhoea, 
iudulgence in prostrating vices, &c. However, it is present sometimes 
iu the most robust persons. In such cases, there is always marked 
hypermetropia. 

The indications for treatment are to afford artificial accommodative 
power, and remove nervous and muscular debility and their causes. 
As to the latter, the requisite therapeutics, all will know and need not 
to be particularised. The artificial assistanee to the accommodation 
is afforded by a convex lens. As before intimated, hypermetropia is 
due to an abnormal nearness of retina and crystalline lens. This makes 
requisite a relatively abnormal increase of convergent power on the part 
of the lens, in order to concentrate the rays emanating from any object 
on the retina. This increase of power may be obtained by interposing 
an artificial lens. Its strength should be proportionate to the natural 
deficiency. The d^^ee of this deficiency may be determined by sev- 
eral methods. The simplest is that of comparing the nearest point of 
distinct vision in a given case, with the near point normal to that age. 
The working formula is as follows: Unity divided by normal near 
point, minus unity divided by given near point, equals the hyperme- 



▲OOOMMODATTrB A81IHBNW1A. 2M 

Irapia. Tbe denominator of the last fraotion indicatee ike fooal length 
of a glass whieh will totally aaonl the hjpermetropia. In praotiee, 
however, it is fonnd to be better to use a glass of somewhat less power, 
ss the habit of over-exertion is not to be snddenlj laid sside withont 
ineonvenience. Eventaally, tiie whole deftcieney may be artificially 
Mpplied. 

The following eases illnstrate the f!»regoing: 8. W*-«— , aged ten 
years, stsrong and healthy, presented herself as suffering severely from 
neuralgia of the forehead. In answer to questions, complained of 
inability to read withont indacing severe pain and tension in frontal 
region, watering of eyes, blurring ef vision, headache, &c. On care- 
ful examination by the means before noted, also by ophthalmoscope and 
by test glasses at distance, I found a hypermetropia of one-thirtieth, 
that is, a deficiency of convergent power equivalent to the force of a 
thirty iiicb lens. The asthenopia had supervened, in the course of a 
winter's severe study at school, the patient being remarkably diligent 
for one of her age. It had been increasing for six months, and lately 
had entirely prevented her from reading. A forty-eight inch glass was 
applied; with it all the discomfort was gone at once, and she was able 
to read for half an hour or more with ease and distinctness. She was 
ordered to wear tpectaeUi with the same power, until all trouble had 
disappeared. This she did for three weeks, during which time she 
ezperieneed little or no suffering, being able, in the meantime, to con- 
tinue her studies at school. They were then laid aside. Vacation, 
with its rest, completed the cure. A year later, the same causes in- 
duced the return of asthenopia, but a short term of assistance from 
the spectacles again afforded complete relief. Another year has since 
passed; no occasion for treatment has occurred, but the little patient 
cherishes her glasses, well knowing, from experience, what good friends 
they Biay be in time of need, although they have brought upon her 
the 9oubriquet of "little old woman,'' a title which the Berio-comio 
appearance of a child of ten years with spectacles, would induce one 
naturally to apply. 

In this case, asthenopia was induced by excessive straining of ac- 
commodation in a case of marked hypermetropia. 

In the following, debility cooperated with the congenital deficiency, 
to induce the same condition, but in a hundred fold more painful 
degree, and much more obstinate : 

Mrs. , aged thirty years, when first seen, had suffered for two 

years from asthenopia to such an extent that the mere effort of fixing 



S66 wMEBHEi mawMAL or mamoiMM . 

Tision for a moment induoed aerere frontal pains, tootliaofae, laehry^ 
nation, palpitation of the heart, and an intolerably *' nerrons " oondi^ 
tion of the whole system, even pains in the lower extremities. Coupled 
with this, was an inability to walk or make any marked exertion with- 
out the same exhibition of inability of the whole muscular and nervous 
system. The foundation of all this trouble was, chronic metritia with 
retroyersion, which had existedf or several years. On examining the 
eyes, I found a hypermetropia of one twenty-fourth. Number thirty 
glasses were ordered to be worn constantly. The habit of oyer exer- 
tion on the part of the aooommodatiye apparatus, was ao ixed, how- 
ever, that their assistance was not kindly accepted, and no change was 
experienced. Thereupon the ciliary muscle was paralysed by installa- 
tions of atropia, and it was found necessary to continue this fbr five 
months before the habit was obviated. Then the glasses were com- 
fbrtably borne, and began to fulfil the indication of doing part of the 
work, of accommodation, which, in ordinary cases, they will do ftom 
the moment of applying them. From that time to the present, two 
years, the irritability of the eyes has gradually lessened, and now the 
patient can read for a short time quite comfortably. In the meantime, 
the glasses are constantly worn, though at times, they are laid aside 
without discomfort. Moreover, by rational application of every possi- 
ble means, the general nervous irritability ancT its cause, the organic 
uterine lesions, have been slowly made to succumb, until now, although 
yet somewhat an invalid, the patient expresses herself as enjoying a 
comparative elysium, when she refers to the torments she once suf- 
fered. 

In practice, cases of asthenopia present themselves, affording great 
variety of symptoms. Some are very readily relieved by simple means ; 
others require great perseverance with every measure that can be 
brought to bear. The latter, are those in which general nervous debil- 
ity is prominent. All of them should be objects of careful attention 
from the medical man, and it is to be hoped that the profession will im- 
prove its very generally insufficient knowledge upon this subject, for 
then relief will be accessible to thousands of suffiarers who now bear 
their ills with hopeless fortitude. 

For a full consideration of the subject, the interested reader is 
referred to Soelberg Wells' late work, or Donders on Re/ractiom and 
Accommodation, this article being merely a hurried note written for 
the purpose of suggesting attention to an opprobrium medtcarum which 
ought no longer to remain such. 

Digitized by VjOOQ IC 



THE CONVERSION OF GRAVITY INTO ORGANIC FORCE 
IN RESUSCITATION FROM IMPENDING DEATH FROM 
OVER-DOSES OF CHLOROFORM. 



BT K. C. m'XLBOT, M. D., ZANBSYILIiE, OHK). 



Some months since, a leading editorial appeared in a widely eircu- 
btiig eastern medical journal " on the medico-legal relations of chlo- 
idorm" the pnrpose of which was to show the necessity for coroners 
te aeevie the serrices of ^* experts" to determine definitely whether 
dtath was due to chloroform in all suspected or known cases. The 
whele tenor of the article was so absurd, that within a few hours after 
the reception of the journal, a criticism was prepared, embodying the 
'Oaly possible definite conception of ''how chloroform destroys life," 
eoDsislent with the known facts of the anatomy, physiology and pathol- 
egy of the human body, and sent to the editor. As the criticism had 
M fogar-ooaling, but few expectations were indulged that it would be 
psblished. But it was published, (including many typographical blun- 
den), and elicited a short communication from a southern correspond^ 
««i, commenting on it finvorably, and asking for '' more light" on the 
abfeet; and detailing a case of impending death from chloroform, 
itBcned, apparently, by the depression of the patient's head and shoul* 
tos. Though considerable time has elapsed, it is no fault of mine 
tkat a reply has not been published before. 

"AcnoM or Chloeofobic. — • • • • 1 amputated, at the junction 
ef die spper and aiiddle third, the right arm of a boy four years old, in conse- 
fM&ee of a leirere injury to the limb. It required a good deal of chloroform to 
pBodaee aiuestheeia. After I had ligated the Teasel, it was discovered that the 
fittlt fellow vas rapidly sinking. Several teaspoonfuls of whisky were^given, as 
leeg as he could swallow, water was thrown in his face, etc. By this time, the 
pake had become almost imperceptible, and the movements of the thorax had 
alaost ceaaed. Jvst at this juncture I thought of elevating the table, and as soon 
M the body was brought to about an angle of forty-five, the respiration and pulse 
siaort im m niHaff fy im^rofHd, This was even readily observed by unprofessional 
ICfsoBi present. ♦ ♦ » • 

**KoWy will Dr. McElroy tell me how this was brought about? Of course I 
kaow the additional flow of blood to the head caused the train of more remote 
vital proceasea which ended in recovery ; but the brain was not empty, and in 
what way does the additional amount cause the effect produced ? Does chloroform 
have aay tendency to dkcreau the amount of blood in the brain, thereby causing 
the heart to fidl in its Ainctions, or does the drug directly act upon the heart? .^.^T^ 



268 WI8T1RN JOURNAL Or mEDICINX. 

"Hoping that Dr. H. will bring his erudition in the "Philoeophj of Force" 
to bear on this subject, I remain very respectftilly. J. C. Moblst, M. &. 

"HSBNANDO, MxaSISSIFPi.'' 

To understand the whole matter from the beginning, it may be 
proper to state that when death oocurs from chloroform, it is always 
due t6 paralysis of the heart or lungs, or both ; further, that the par- 
alysis is invariably owing to arrest of destructive metamorphosis in the 
nerve masses supplying their dynamics, vix: cerebellum and medulla 
oblongata; and that all possible lesions are confined to the distribution 
of the circulation, the points of congestion determined, to some extent, 
by the primary failure of the heart or lungs. If the lungs fail first, 
they would present accumulations of the circulation; if the heart, the 
greater vessels, organs, &c., and no two alike, for these reasons. Hence, 
a very slender amount of thought and study would qualify one man, 
quite as much as another with large experience, to determine by post- 
mortem^ whether death was due to chloroform. In replying, then, to 
Dr. Mobley, it may be proper to state certain fiindamental propositions 
applicaUe alike to his case, and to the study of the phenomena of all 
organic life. 

Fir$i — The hitherto regarded vital force or forces of organic life, 
seem to be confined entirely to the preservation of the types and forms 
of organs, tissues and textures, in the midst of constantly dissolving 
and renewing materials. 

The so-called vital force, or forces, have hitherto been the great 
stumbling block in the pathway of investigation of the phenomena of 
organic life. As evidence of the truth of this first proposition, the 
whole of pathological anatomy, disease and death are offered, for, if 
the types and forms of organic life were constantly reproduced, in full 
dynamic integrity, all organized beings would be immortal. As an 
appropriate designation of the so-called vital force, or forces, and as 
expressive of its objects and purposes, form force or architect of organ- 
ization is suggested — the preserver of form with changing material. 

Second — The organizing force, that which builds up formless or- 
ganic matter, as well as the various organs, tissues and textures of the 
human body, under the control of the form force, or architect of 
organization, is common to all organic nature, and is connected with 
the ordinary physical forces of the universe. 

These two propositions, in the shape in which they are here given, 
are, to a great extent, original with myself, and as they are given almost 
for the first time in print, lack confirmation and acceptance by the 



■FFE0T8 07 OYlR-IXMnCB OV OBUmOVORM. M9 

seienttfie world. They are aMamed to be trae, beeauM they aeoovBt 
for and explain more satisfactorily than any previoiis fornralation of 
force, all the varied phenomena of organic life. 

Third — ^That the dynamics of the human body are due, in tke 
main, to the destmctiye metamorphosis of its own nenre and other 
dasnes. 

That arrest of destructiYe metamorphosis is death. After death, 
putrefactive decomposition restores the elements of organic matter 
back to their stateift in the inorganic world. 

Fourth — ^That fluids, in or out of the human body, obey the ordi- 
nary laws of gravity, when uncontrolled by superior forces or dynamicfl. 

Chloroform, by suspending destructive metamorphosis, arrests ^le 
liberation of force, and with the decrease of organic force, the circu- 
lation comes under the control of the ordinary laws of gravitatk>B, 
and settles to the most dependent parts* of its circuit in the dying body. 
Some parts losing blood would appear pale and flftbby, while others 
gaining it would present congestions, &e. 

With these fundamental principles for our guidance, Dr. MoUey's 
inquiries can be satisfactorily answered. 

The facts of the boy's case, so ftr as they conoem the present 
investigation, may be summed up as follows : 

Firtt — That he must have been severely shocked by ^e accident 
to the limb, rendering amputation necessary. 

By shock must be understood a more or less complete suspension 
of nutrition, or constructive metamorphosis, as well as of oxidation^ or 
destructive metamorphosis. These organic processes of life at the time 
of deepest depression, are nearly brought to a stand -still. What is 
called reaction, is a practical resumption of nutrition, with a largely 
increased waste, or oxidation, the increased waste being more generally 
manifested by increased temperature of the body, though occasionally 
by mechanical results in addition, as spasms, convulsions and tetanus. 

Second — Chloroform has to be given largely and for a considera- 
ble time, to obtain the desired ansssthesia. 

Third — That in obtaining the requisite degree of amesthesia, the 
motor power of the heart and lungs was nearly, if not quite, suspended. 

Fourth — ^That he was resuscitated from impending death, appar- 
ently, by placing his head and chest in a dependent position — ^angle of 
forty-five degrees, though other means were used. 

A earefol study of these fkcts, guided by the propositions hereto- 
Digitized by VjOOQ IC 



iM mmamm ^oubimx ot umcmM. 



fiwe kud down, wiU, it is beUeTed, jpoiat to aad jitstify tba following 
eoneluflioiis : 

First — That from the shock of the aooideat to the patient^ nutri- 
tkn in his syatem was rery aearly, if aot wholly arrrested. 

Second — ^That oxidataon, waste, or destmctiTe metamorphosis, if re- 
action had heen established, was largely increased. 

What are called tHmukmU^ as alcohol and malt liquors, opium, &c., 
siaif^ly serre to hold this waste in partial check, while they are uaed. 
They do not add anything to the sum of the forces of life, they simply 
supply eonditioDS to limit moleoular transformations, both of nutrition 
and oxidation, bat more notably of oxidation or destructive metamor- 
pkosis. Dr. M. does not say anything about his temperature either 
befere, during, or after the operation, but it is well nigh certain that 
it mast hare been sereral degrees above natural, at the time the chlo- 
rofom was givea. 

With nutrition arrested, and the waste of the body more or leas 
increased, as would have been shown by an increase of temperature, 
though the waste was probaUy less in the nerve masses than elsewhere, 
as would have been shown by the state of the pupil, and the absence 
of mechanical phenomena, as spasms, and convulsions, the correlation 
of the waste, was, most likely, increased heat, which always indicates 
iMveased waste of tissifte. 

Third — ^That the chloroform, did, in fact, suspend the molecular 
transformations in the nerve masses furnishing the force or dynamics 
for the working of the heart and lungs. 

Though it may never be vouchsafed to material vision to watoh 
with the naked eye, each little molecule or particle of organic matter^ 
braak away f^m its highest state of organisation, combining with its 
beloved oxygen, forming new and simple compounds, simultaneously 
liberating the dynamics or forces of organic life; yet, as the antecedent 
and consequent are definitely known, definite conceptions of the mode 
or modes by which the ends are accomplished, are best obtained by 
studying matter and force in more elementary states. Conclusions 
arrived at in this way, have probabilities of truth, and if they explain 
and harmonise all the facts, conditions and circumstances present, must 
be so accepted. Mental vision, however, can alone oomprehend them. 

Fawrth — That the diminished motor power of the heart and hmga, 
owing to the nearly total arrest of oxidation, placed Ae cireulation 
more and more under the control of the ordinary force of gravitation 
than it was before the chloroform was given, and as a consequence, 



^iyiuz.cu uy ■ 



INTKBNAL ADJaNBCTSAVlON OF JJ^MHGENTS. S71 

Uood amred at and departed from the brain and nerve maaaea niiieli 
flMre alowly and imperfeetly, with less of tke daatractiye as well as 
life giTiDg oxygen than was necessary to carry on destmctiTe meta- 
morplkosis to furnish the requisite force for their functions. Dimiu* 
kked reapiralion supplied less oxygen, diminishad yolume of eireula* 
tion less blood, than was needful for the purposes of life. 

^/th — That by depressing the head and chest of the patient^ the 
Mood, obeying the law of gravity, passed to the brain and nenre m as s es, 
the then lowest portions of the body, in fyier quantity; and with the 
increased volume of blood, increased quantity of destructive oxygen: 
the conditions being supplied, destructive metam^phosis was reammad 
in the nerve masses, with the result of liberating more force, and with 
inereasing force, the lungs and heart slowly resumed their functiona. 
Dr. Mobley then and th^e transmuted gravity into organic force — 
gravity disappearing— organic force reappearing — the oorrelatioa of 
one mode of force into another — with the result of saving his patient's 
fife, for the other means employed, in the absence of the conversion of 
gravity into organic force, must have surely failed. 

This, it seems to me, presents an understandable, and to my men- 
tal vision, a most pracHcal explanation of the phsnomena attending 
Ih'. Mobley's case of impending death from the inhalation of chloro- 
form, and the rescue of his patient by the depression of his head and 
eheat. 



ON THE INTERNAL ADMINISTRATION OF ASTRINGENTS 
IN HEMORRHAGE,* 

BY DR. J. R. WEI8T, RICHMOND, IND. 



In former times, when the parts played by witnre and art in the 
cure of disease were less definitely known than now, theory led to the 
adminiatration of many and various drugs in cases of disease, and the 
jwH Aoc, ergo propter hoc mode of reasoning, so common among phy- 
sicians, decided upon their curative or non-curative influence, while 
the reapeot that attaches to the dicta of the fathers of medicine, lead, 
in many instances, to an almost universal belief in the remedial action 
of agents, that are now known to be either without influence, or deci- 
dedly harmful, in the conditions in which they were administered. 



ntMd before the Wayne Gounty Hedicia Society, April 1> 18<«. 



Digitized by VjOOQ IC 



2T2 WMSIRN ioxnuxAJL or iiidicinx. 

We can not flatter oarselreB with the belief that^he errors of this 
kind are things of the past only, for it is a fact that ean not be ques- 
tioned, that despite the floods of light that have been thrown npon the 
real nature of many diseases, and the therapeutic action of most medi- 
cines during the last few decades by the aid of pathology, chemistry 
and the microscope, many physicians, at the present time, daily admin- 
ister drugs with full fiiith and confidence in their medical action, whose 
ehdm to a place among the medical agents applicable to the condition 
ohserred, is unreal and unsubstantial. 

Beflections of this kind lately passed through my mind while witness- 
ing an alarming attack of pulmonary hemorrhage, and seeking to decide 
upon the best measures, medical and otherwise, to be instituted for the 
well being of my patient. Within the last few days, a serious case of 
uterine hemorrhage, of which I hare had charge, has served to recall 
them ; therefore, I propose to briefly present some of the conclusions 
arriyed at in relation to the ralue in these cases of a certain class 
of medicines that hare been, from almost "time immemorial," much 
relied on in the treatment of these same hemorrhages — pulmonary and 
uterine: I refer to astringents. I can hardly deem it necessary to 
refer to authorities, to sustain the statement that astringents are much 
relied on by the majority of the profession in the treatment of hemor- 
rhage from the lungs and uterus, when scarcely an author is known to 
me, who, when detailing the treatment to be practiced in these eases, 
does not recommend their use upon the ground that their property of 
astringency will exert, if not a curative influence, at least a restrain- 
ing one on the bleeding. 

In presuming to question the truth of the opinions so generally 
held, in relation to the value of astringents when administered inter- 
nally in the hemorrhages referred to, I do not for a moment deny that 
a certain remedial value may, and perhaps often does attach to them 
under such circumstances, only that this value comes from and is de- 
pendent on their astringent qualities. 

To show what I mean, Prof. Harrison>l^ among others, hold, in refer- 
ence to the well known astringent, acetate of lead, that '4ts capa- 
bility of arresting uterine hemorrhage has been most thoroughly tested 
by an enlarged experience of the entire body of the profession," and 
that " in hemoptysis its astringent property has been amply displayed." 
Now, while it is admitted that this "enlarged experience" may show 
that the medicine, acetate of lead, does sometimes exert some curative 



^EUmmtti of Materia Mediea mtd Thtrmftrntiot, Toiame 11, pnge 410, 



kd by Google 



INTBSNAL ADMINIBTRA'noN OP ASTftlNQENTSL 273 

aetioB in these cases, it entirely fails to sliow tbat it does so in conse- 
quence of any astringent quality it possesses, and tbat its good effects are 
not entirely owing to its action as a sedatiye. Tet this medicine, as well 
as alum, and the vegetable astringents, tannin, kino, catechu, rhatany, 
galls, &e., are administered daily in cases of hemorrhage, under the 
belief that they will do good in consequence of their exerting a oon* 
stringing influence upon the capillary blood vessels, and the power they 
possess of coagulating or precipitating albumen — effects they are known 
to produce when externally applied to bleeding surfaces — that their 
action is the same, whether used as externa) or internal medicines. 

In an effort to show that the assumption that astringents, when ad- 
ministered internally, control pulmonary and uterine hemorrhage by 
virtue of their astringency, is an entirely gratuitous one, it beeoses 
necessary to examine the theories proposed, accounting for this sup- 
posed power, and see if they are truthful or fallacious in eharaoler. 

Aecordiog to Dr. Stille,* the manner in which astringents aet in 
controlling hemorrhage, " is not regarded in the same light by all who 
have examined the subject.^ Some suppose that it is in consequence 
of their power to coagulate the albumen of tbe blood, while Br. 
Headlandf holds that they ^'act directly and especially on muscu- 
lar fibre ; they cause this to contract, whether it be striped and vol- 
untary, or of the involuntary and unstriped kind." According to Mb 
view, 'Uhey are taken into the blood in a state of solution," they ^^pass 
through the walls of the capillaries to the muscular tissue," and -^stim- 
ulate to contraction the unstriped muscular fibres existing in the mid- 
dle coat of the arteries, in the walls of the capillary vessels, in the lin- 
ing of the ducts of glands generally, in the substance of the heart, 
and in the ooats of the stomach and intestines." How this contrac- 
tion of the miuscular fibre is brought about, is not very well explained. 
Dr. Headland, however, says that ^4t seems to depend somehow on 
the chemical power just mentioned, for astringents appear to eonstringe 
fibrinous as well as albuminous tissues by a chemical action." The 
''chemical power referred to," is that by which astringents coagulate^ 
and pricipitate an albuminous or fibrinous solution. 

The slightest examination of the first theory, that astringents when 
internally administered, control hemorrhage because of their power to 
coagulate the albumen of the Rood, will show it to be unworthy of 
consideration. If it is claimed that when so administered, they have 



^Huraq^emtiea amd Mitria Medica, Tol. i, page 178. 
fTlw Action of XedlclBe»— ABtriocBDtB. 



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HH wsarE&N j<>criial of xbi>icins. 

ike power of eoagalatiag the blood within the yeaaels, how is it that 
this effect is not general? That it is not so, we know, because were it 
so, death would be the immediate and inevitable result. And what is 
the wottderfy intelligence that holds in abeyance the chemical affinity, 
which in general, causes the coagulation and precipitation of albumen, 
where this substance and astringents are brought into contact, while it 
is being passed into the blood from the stomach, conveyed in this fluid 
to the heart, and from thence, in the one case, to the capillary vessels 
of the lungs, and in the other, to the vessels of the uterus, until the 
very vesseb themselves are reached, which are the seat of the hemorr- 
hage? Certainly no one who exercises his reason can conclude that 
in this way astringents may arrest a hemorrhage of the kind we are 
ooaaidering. The ground that these medicines increase the coagula- 
hility of the blood, is equally untenable. Indeed, there are no facts 
that give plausibility to the assumption, while all the knowledge that 
we have in relation to their direct action upon the blood, is inconsist- 
ent with this supposition. ^'^Mitscherlich, having partially immersed 
firogs in a solution of tannic acid, so that their blood became impreg- 
nated with it) found that the circulating fluid grew darker in color, 
coagulated more slowly than usual, and formed an imperfect and pastj 
clot." This experiment, which has been performed by others with a 
like result, positively contradicts the theory that astringents exereiae 
any influence in the way of increasing the coagulability of the living 
blood. ' 

To suppose that when taken into the blood in a state of solution, 
they pass through the walls of the capillaries to the muscular tissues, 
and stimulate the muscular fibres to contraction, is to believe with Mr. 
Headland, that as they form peculiar insoluble compounds, both with 
albumen and fibrin, it is '* probably by virtue of their action on the 
latter that they are able to cause the contraction of muscular fib^, 
which is a fibrinous tissue," and that 'Hhe contraction thus set up 
chemically, is continued and propagated by the vital force of the mus- 
cle." While this view may serve well as a theory to explain the 
supposed action of astringent medicines, it is merely an assumption, 
it not even being proved that they constringe capillary vessels, or 
eontract muscular fibres, except when they can be brought into direct 
eontact with them. This view requiies, First — ^That we assume the 
capillary vessels to be contracted by the action of astringents. Sec- 

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umasAh ADinNiBTSATioif oy AstmrnexNTB. tn 

and — Thttt this is owing to the contraction of moscnlar fibres. Third'^ 
That while these substances are passing through the blood on their . 
way to these muscukr fibres, their natural chemical tendencies are 
suspended, "being constrained by rarious forces;" and, Fourth — That 
"on the exit by secretion from the blood, they resume their original ae- 
tiTity." Can we yield our assent to a doctrine based on such eyidence? 
Certainly not. Although it is true that when astringents are applied 
to the web of a frog's foot, under the microscope, the capillary vessels 
are seen to become constringed, and the muscular fibres contracted, it 
does not follow that they ever act in a similar manner after having 
been received into the blood. Indeed, if we correctly understand 
their modus operandi when locally applied, it seems impossible to con- 
elude that they ever can do so, for it seems to be pretty well estab- 
Inhed that the phenomena they are seen to produce when thus used, 
are the result of the strong affinity of the astringent substance fbr 
water, which it therefore abstracts from the tissues with which it is 
brought into contact, the constringent effect seen being actually the 
result of a partial desiccation of the part. It seems legitimate to con- 
clude, that when an astringent substance is taken into the stomach in 
a caee of pulmonary or uterine hemorrhage, this affinity will be grati- 
fied long before the medicine reaches the pulmonary or uterine capil- 
laries. 

If an appeal is made to clinical experience to substantiate the 
assumption, that astringents do, despite these theoretical objections, 
control these hemorrhages by virtue of their astringency, no positive 
and unequivocal testimony is obtained. If it is maintained that there 
are many medicines — quinine for instance — whose precise mode of 
action is unknown, yet whose curative influencf is positively estab- 
lished, the truth of the claim will be unquestioned ; but to my mind, 
the.same kind of evidence has never been presented in favor of this 
reputed curative action of astringAts as has been in the case of qui- 
nine and some other medicines, and I am so fully convinced that care- 
ful observation and dispassionate judgment will lead to the conviction 
diat a negative result will follow, when they are administered inter- 
nally in oases of pulmonary and uterine hemorrhage, in so far as such 
effect must depend upon their astringency, I am willing to submit the 
case without further argument, simply stating that I never administer 
them, in the kind of cases I have been considering, in the hope of 
obUiniBg curative results from this power. 

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2H WlBVBBll ^OOBMAL OW MBMCDnk 

CASE OF APHASIA. 



BY 0. W. H. KXMPS&, X. D., MUKaS, IHD. 



On January 3d, 1869, 1 was called to see, in conBultation with Dra. 
Jump and Kerr, Mr. Thomaa Stanford, residing near New Bnrlingtoa, 
in this county. 

Mr. S., at the time of hia death, was seventy-four years old. His 
life had been characterised by extreme vigor of body and mind. For 
several years he was a member of our State legislature, and at various 
times has held minor county offices. 

During the latter part of last December, he noticed that he had 
some trouble about taking the proper length of steps in walking. 
Sometimes he would, contrary to his will, step too far, and at other 
times not far enough. He noticed this irregularity and spoke of it to 
his family, but nothing serious was anticipated, until Tuesday, Decem- 
ber 29th, when he sat down to breaki&st and commenced saying grace, 
but kept repeating the same word for some little time. Finally, his 
wife spoke to him and asked what was the matter. He replied, nothing, 
and exclaimed '^how singular,'' and then proceeded to eat. During all 
this day, his memory of words would fail him, and he found much dif- 
ficulty in making known his wants. Desiring a younger son to start 
to school, he said, /'Go to— to — to—,'' and seemed puazled that he 
could not finish the sentence. Some one said, "To school, father?" 
and he replied yes. On Wednesday morning, having some business to 
transact with a neighbor, he attempted to write a note, but kept wri- 
ting the same word, r^ He tried for half an hour, but was compelled to 
give it up, although an excellent penman. 

At this period. Dr. Jump was called to see him, and found his con- 
dition as follows: No pain in a% locality, pulse one hundred, full 
and regular, tongue furred, pupils unchanged, temperature normal, 
appetite good as usual, no paralysis* nor even numbness. Dr. Jump 
prescribed a mercurial cathartic, to be followed with oil or a saline 
cathartic in four hours, if the bowels were not moved, a warm pedi- 
luvium with mustard, restricted diet, and potass, iod. in five grain 
doses three times a day. Dr. Kerr, a son-in-law, who lived some dis- 
tance, came on Friday and remained with him until his death. 

We saw him, in consultation, at twelve m., on Sunday, January 3d. 
His condition was similar to what it had been since Wednesday. He 



PEioRiTT nr ns frax <w wsian sznNsioN. STT 



seemed obearfal and lively, and desirous of ooiiTersiiig, but forgot so 
manj words that it was impossible, frequently, to understand bim. 
He would smile at bis inability to call words, and seemed mucb per- 
plexed. Pointing to Dr. Kerr, I asked bim if be knew bim. He re- 
plied yes. Wbat is bis name? He smiled conj^sedly, and said, "It's 
—oh — ^it's— oh — .*' I named over several fictitious names, but be 
would reply no. I then said Kerr. He replied, "That is right." I 
was shown some of bis writing, in which be attempted bis own name 
ss follows: "Tbos. Thom. Stans." He remained in about the same 
condition until January 4tb, at ten A. M., when be was seized with a 
convulsive fit, lasting about a minute and a half, and immediately ex- 
pired. If o post-mortem Mas made. 



"PRIORITY IN THE USE OF WEIGHT EXTENSION. 



BY QSO. 0. BLAOKMAN, H. D., 
Tpokmm of Borfporj in the Medical College of Ohio; Snrgeon to the SftOurltMi HoiplCal ; < 



In the April number of the American Journal of the Medical Sei- 
eneetj Dr. Edward Hartsborne, of Philadelphia, has published an elab- 
orate and interesting paper under the above title, irom which we ex- 
tract the following: 

** Some extended researches, in which I have been recently engaged for another 
purpose^ have brought to mj notice an interesting effect of second-hand qaota- 
tioD, and of erroneoos compilation, in the European history of weight extension, 
which does not appear to have been noticed either in Edinburgh or London. The 
liict !% that the first European writer, <mt qf the Continent at leattj (italics ours) 
who definitely speaks of this mode of treating fractured thigh, and giyes an unmis- 
taki^le pktiure of the weight and its accessories, is John Bell, {PnneipU$ of 9ur* 
fcry, 4th edition, Edinburgh, 1801 ;) and he eyideatly does lo without the slightest 
idea of snggesting anything new, although what he did present was, so far as the 
weight is concerned, the product of his own active and brilliant imagination." 

Now, the Ckirurgical Oh$ervation$ and Cotes of William Bromfield, 
of St. George's Hospital, London, appeared in 1773. In the seoond 
▼oluoie of this valuable work, at page 111, we find the author extolling 
the adTantages to be derived from the relaxation of the muscles in the 
reduction of fractures and their treatment. He then proceeds: 

** Latdy, indeed^ I hare heard that the practice is adopted by some surgeons of 
other hospitals in London; noTcrtheless, this is of as litUe weight almost as my 

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m 

iaftraclMms ««re lo toag alBoe» for «t«i M ftUi tuM^ ike «|TaBt«fiB of tliit m^ 
are not salfieientlj clear to eome of the profeMors of sugefj, as fAorl epUiito mmA 
itretehed out limbs are, by them, thought the best method of practice; and svcit m 
Utrg€ weight hung from the ankle joint, to keep the mueclee qf the thigh extended^ when 
the femur is fractured, it not every where exploded" 

We have placed in italics, suffioient, we think, to prove that Dr 

Hartshorne is himself in error in his comments on "the interesting 

effect of second-hand quotation, and of erroneous compilation, in the 

European history of weight extension," and it is evident that for manj 

years* prior to the publication of Mr. Bromfield's work, the practice 

which this surgeon condemns, of hanging large weights from the ankle 

joint in the treatment of fractures of the thigh, had been adopted by 

the British surgeons. 

■ ■■ » » ■■ ■■ - ■ 

OPERATION FOR IMPERMEABLE STRICTURE OF THE 
URETHRA. 

BY Q. K. BUBKB, X. P., 8ULPHUB SPfilNOS, INJ>. 



(Oommmiieated by Prof. Blecrkwan, Otnclanatl.) 

Mr. Editor: The operation performed by Dr. Burke is worthy 
of record, not only on account of its success, but for its variety. The 
patient was under my care for a few weeks, at the Samaritan Hospital, 
and I was unable to pass the smallest siied instrument to the bladder. 
In one instance, the patient being fVilly under the influence of chloro- 
form, administered by my fViend, Dr. Schenck, of Reading, I tried with 
bougies and lancetted stilette, for more than an hour, but without suc- 
cess. I then proposed an operation by external incision, but the patient 
left for home on a temporary visit, and there became so much worse 
that he availed himself of the services of Dr. Burke, and with what 
success the report will show. 

The only cases in which so extensive an operation has been per- 
formed, so far as we have been able to discover, are those in which it 
was done by Edward MoKns in 1662, and by Solingen, also, in the 
latter part of the seventeenth century. Wiseman assisted in the first 
eperation, and has given the details in the second volume of his Chu 
rttrgical Trtaim$^ under the head of "The III Consequences of €h>nor- 
rhoea." At first, an incision was made in the perineum, but as wiA 
*^ probes and candles," the urethral passage oould not be found, at 
the request of the patient, a few days afterwards, Molin "slit it the 



vliole length to tibe incinott in perineo." The patieiit reeoreied, but 
% vrmarj Ibtiila reoudned in the perineiim. 

For the notice of Solingen's ease, we are indebted to Dr. Aristide 
Temenil, who published in the Arch. Oen. de Med., Paris, September, 
1857, an interesting paper entitled Note SUiorique et Critique Sw 
T Vhtkroiomie Exteme ou Section de$ Betrecieaementf de dehors en 
iedams, avant C XVIII Sieele. We translate his remarks on the ease of 
SoliDgen: "Planque, in the article Oamont^ haying quoted a suc- 
eesifnl case of cauterixation, adds : ^ Yan der Wiel approves this method 
in preference to that adopted by Solingins (Solingen) in the case of a sol- 
dier. As the Urethra, according to his report, was full of oamosities, a 
Made crenelee, which allowed the urine to pass was used; but all his 
medications were of no avail. For this reason, he introduced a grooved 
ftdr into the bladder, on which he incised the whole canal, even to the 
glans, and then destroyed with caustic all of the callo$itie$^ The lips of 
ilie extensive wound were then brought together and retained by means 
•f the hare-lip suture. The operation succeeded so well, that the 
pstient was able to pass his urine, at first through a small flexible ca- 
tlketer, but afterwards a plein canal.*' It is stated that Solingen had 
peiformed a similar operation with success, at the Livoume. 

The above extract is quoted by Planque firom the BibHoth. de Med,i 
ton viii, page 61, ed. in 8, and he remarks that it is evident that ex- 
tonal urethrobomy was performed during the latter part of the seven- 
teenth ee^tary in several countries of Europe. 

Dr. Yemeuil refers to an operation reported by Van Hoome, and 
wbieh was performed to relieve a patient affected with hypospadias, the 
abftormal orifice of the urethra being just in front of the scrotum. 
The penis was laid open firom this point to the end of the glans, a 
leaden canula introduced, and the whole wound closed with suture. 
Tke operation was successful. 

One word in conclusion. Although the operation just quoted^ like 
thst reported by Dr. Burke, terminated so fortunately, it is probable 
tkat the majority of practitioners would, in similar cases of stricture, 
ftel disposed to try, first, the effect of opening the membranous por- 
tion of the urethra, relieving the retention of urine, and diverting the 
channel for a time, in order to give the indurated portion of the urethra 
IB opportunity of becoming softened and more dilatable. Mr. Cook, of 
Ony'a Hospital, Hr. Simon, of St Thomas', and Mr. Wormald, of St. 
Bertholomew's, London, and others, have furnished us with much evi- 
(90) 

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280 tmnur jomorAZ* cv MBHanu. 



denee of the softenisg inluenoe thut {nrodneed over striotnrefl, when 
once relieved of the irritation passing over them, or to ose the lan- 
guage of Mr. Wormald, by gLving "the diseased ureiihra a holiday/* 
{Medical Time$ and Grazeiie, December, 1856.) We confess, that had 
Dr. Burke's patient returned to the city, as contemplated, that was the 
eourse we intended to pursue, and failing in this, quoting from Wise- 
man, "eo 9IU it the tohole length to the incmon inperineoy Certain, it 
IB, howeyer, that in the hands of no surgeon could a more brilliant 
tesult haye been obtained than has been aohieyed by Dr. Burke. 

Youre truly, 
OnidNNATi, April 14, 1869. Gxo. C. Blackman. 



^ Wm. 8. Mo , age thirty-mx, traveling agent for wholesale boot 

and shoe house, Toledo, Ohio, was thrown ttom a wild horse, at age of 
nineteen years, fhlling on his back; horse striking him on the privates; 
he was carried home in a ikinting condition ; parts swelled enormously, 
and were very painftd; was confined to house for five weeks; during 
the time suffered severe pain in urinating ; two years after was riding 
a colt, and was thrown on to the horn of the saddle, causing a severe 
and sickening pain ; parts swelled up again and it was difficult and pain- 
fttl to pass nis urine; was eonftned to the house for three weeks, under 
treatment; sise of stream passing from penis was diminished greatly; 
it became smaller after first accident than it was in good health before 
tie accident; shortly after my recovery from second accident, was com- 
pelled to use a bougie to keep urethra dilated, and have continued to 
make use of an instrument of that kind for fifteen years, up to present 
time, and lately have suffered severe pain in introducing one into urethra ; 
on December 16th, 1868, 1 rode horse-back twenty-nine miles; suffered 
an unusual amount of pain during the trip, and continued suffering 
pain in urethra and parts adjoining, until December 22d, 1858; tried 
ten times to dilate the urethra as usual, but failed in every attempt; 
being fourteen hours without passing my urine, bladder was distended 
and very painAil, and in that condition called on a surgeon in Ander- 
son, Indiana; he called in two other doctors to assist him; I waa then 
put under the influence of chlorofbrm three times, and they as oflen 
fhiled in introducing the smallest instrument into the bladder; but in 
their efforts, they did not iail in making a passage from urethra into 
the scrotum, to which place my urine escaped, oauiing me to suffer 

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DCPXKMSABLS STBIOXUBI OV THB I7BXTH&A. 281 

extreme pain; it became enlarged by the urine, and waa then punc- 
tared, and urine escaped with considerable blood; on morning of 23d 
December, was sent to Cincinnati, requiring twelve hours to make the 
tdp bj railroad; urine escaping by scrotum, by being squeezed out by 
By hands." 

I was called to the oase, January 11th, 1869, half-past eleyen, p. 
M., two days after his return from Cincinnati; I fbund him suffering 
extreme pain fr(Hn retention of urine, caused by stricture of urethra; 
he was, in fact, mad with pain ; bladder enormously distended; tongue 
i; bowels constipated; fever; unimpaired appetite; I w.as in- 
that chloroform had no effect upon the pwrts to facilitate the 
atroduction of a catheter into the bladder; I applied extract bella* 
dona to penis and perineum, and placed him in tub of hot water, 
palieBt and all covered by a quilt, excepting his head; kept him in 
that condition until profuse perspiration ensued ; patient suffering ex- 
tcene pain all the while ; administered four grains of powdered opium; 
before taking him from the bath, I introduced a small catheter down 
io stricture, and made gentle pressure upon it for about ftve minutes, 
sad had him taken from bath ; and on withdrawing the catheter, it was 
foDowed by urine in a small stream about the siae of a small knitting 
■eedle; with great straining by the patient, his bladder was partly 
emptied. He offered up a fervent prayer for his safe delivery from ' 
death, got into bed and went to sleep from effect of anodynes. 

January ISth, 8 A. M, — ^Resting easy; ordered extract belladonna 
to parts; saline cathartic and opium to quiet him; stated his condi- 
iMu; the only manner of reli^; the danger attending the operation 
ad the result, and to consult his friends concerning it and his con- 



Jamnary ISth, 8 P, M. — Called and found him in same condition 
as before; same means resorted to for hb relief as on former occasion. 

Jamuary 14^ ^ P ^* — Called again, and found him in same con- 
dion as on two previous occasions; same means were instituted for his 
rdief ; he nmde up his mind to be operated on, and consent of his 
seialivca and friends. 

Jamuary ISih, 9 A. if.— patient very restless during the night, and 
awoke unrefreshed; he was in any condition but favorable for the 
omllest operation in surgery on him; pulse weak and firequent; tongue 
heavily coated and inclined to dryness; great thirst; no appetite; 
V system very much impaired ; scrotum enormously swollen, indu- 



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282 wmnuf iojmmjkis <ur hsdigiiis. 



rated and painftil; bladder distended and pain in left spermatic cord; 
testiole drawn up on pnbic bone. 

He was prepared as for lithotomy, on the operating table; after 
drinking four ounoea of strong ^^-nog with grain of morphine, he 
was put under influence of chloroform and brought down to edge c^ 
the table; I seated myself on a low stool, and oommenoed my incision 
immediately oTer the end of the staff, which had been previously in- 
troduced into the urethra until it eame in contact with the stricture, 
(and intrusted to an assistant), which was an inch and one-fourth from 
meatus urinarius ; the mesian line as my guide, laid the urethra open an 
inch and a half, and failed in passing instrument beyond my incision; 
another incision of two inches, down to urethra, opening two urethral 
abscesses, one on each side of urethra, urethra being laid open for 
three and a half inches, renewed our efforts to advance the instrument, 
and failed ; another incision, splitting the septum scroti to deptii of 
three inches, laying open urethra, and failed to advance the staff; next 
incision was made from the urethra downwards, backwards and out- 
wards, until the sound and sensation to operator changed from that of 
cutting a green pear or soleleather, which did not cease until the 
urethra was laid open through its membranous portion; the change 
in the cutting and appearance of urethra, gave evidence of the stric- 
ture being divided, and with some difficulty, a No. eight catheter was 
introduced into the bladder, and urine escaped by the catheter and 
around it, to the amount of a quart. 

Patient recovered from influence of chloroform, without any unto- 
ward symptoms; he was placed in bed on his right side; catheter 
secured by a T bandage; a large dose of morphine was administered; 
sides of wound brought in apposition, with cold mucilage of elm bark 
applied ; urine escaping by catheter into a receptacle, as it accumulated 
in the bladder; he lost but little blood during the operation. 

Januaty 16th^ 7 P. JIf.*- Besting very well; urine escaping by 
catheter, drop by drop. 

January 17 thy 8 A, M. — ^Wound looks very well after being thor- 
oughly washed with castile soap suds; tongue coated; pulse weak and 
frequent; wound was dressed with elm bark mucilage; nourishing diet 
ordered; drink rain water and elm water. 

January 17th, 4 P. M. — Tongue dry and coated; appears weak and 
prostrated; grave c. c. pills; milk punch occasionally. 

January 18ihy 8 A. M. — Tongue dry; pulse weak and irregular; 

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iMPBBasABiiB ansonms or nm uMrraiA. ttS 



pftin in bowels; wound looks well; oonliiined d foaring ; g»Te snlph* 
mmg. $88., which Tomited. 

January ISthj 2 P. Jf.— -Pulse weak and frequent; left Bpermatic 
eord and teetiele swollen and painftil; applied tincture iodine, and gare 
Beidlita's powder; wonnd snppnrating. 

Janwary l^h, 8 A. M. — ^Yery restless during night; tongue moist; 
pain in bowels and swollen; pulse regular and weak; some appetite; 
testicle and cord not so painful; some pain oyer region of bladder. 

Jaimary 19th, 4 P. M. — ^Bowek moTod freely ; considerable griping; 
erysipelas over pubes and left testicle ; continued treatment, with addi- 
tion of S chlorate potass, gr. iii, sulph. quinine gr. ii, powd. opii gr. ^, M.t 
one powder every four hours. & tinct. ferri, chlorid. gtt. z, cTcry 
six hours. 

January 2(Hky 9 A. M. — ^Pulse ninety; wound looks well; tongue 
moist and coated; appetite not good; erysipelas extending up left side 
and orer abdomen ; urine escaping from catheter freely ; abscess formed 
in left side of scrotum; opened, and a discharge of a dark bloody 
matter ensued. 

January 2Utj 8 A, M, — ^Pulse eighty-four; tongue dry and coated; 
wonnd discharging healthy looking matter; discharge from left side of 
serotom continuous; erysipelas extending over abdomen and up right 
side; continued treatment. 

January 22d, 8 A. M. — ^Pulse ninety; tongue moist and brown 
coated posteriorly; bowels moved freely; wound doing well; discharge 
fh>m left side of scrotum continuous; erysipelas extending up right 
side; continued treatment. 

January 28d, 8 A, if.-^Pulse seventy; tongue moist posteriorly 
and dry tip; erysipelas extended up right side as far as floating ribs, 
and is now arrested; wound looks well; continued treatment. 

January 24th, 8 A. M. — ^Pulse seventy; tongue moist; rested tol- 
erably well during night; appetite pretty good; some pain about neck 
of bladder and spasm; appears as if the catheter is rough: urine not 
running freely from catheter ; pain in region of bladder, and swollen ; 
catlMter removed, cleansed and returned without any difficulty or pain : 
small holes filled with alkaline deposits; first time the instrument has 
been removed since it was introduced day of operation, it being eight 
days. 

January 2Sthy 8 A, Jf.^-^Pulse sixty*five : tongue inclined to dry- 

i; urine passing by catheter free; rested well during the night; 

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tt4 

appetite geod; wovad UnAsvvU; BtrriUBg vi^er regkm of bk4def eab- 
nding; eontinned treatment. 

Jamuary Sdthf 8 A. Jf.— Boweb moTed freely during night; eonnd- 
enble griping and pain during operation; pnhe aUty-foar; appetite 
good; discharge from left side of eerotuoi continnee ; oonlinioed treat- 
ment. 

January BTthj 8 A, M. — ^Bested well during night; continued treat- 
ment. 

January f^th, 8 A. jlf«— Bowek moved freely; tongue red, moist 
and clean; discharge from abscess in scrotum free; continued treatmMit. 

January £9ihj 8 A. if.— Bested inely during night; continued 
treatment. , 

January 29th, S P. M. — Dressed wound ; complained of pain about 
neck of bladder; remored catheter, cleansed it and returned it with- 
out any difficulty or pain; appetite good; tongue red and moist; eon- 
tinned treatment. 

January SOth, 8 A. M. — ^Bested well during night; feels strong; 
appetite good; pulse sixty-nine; tongue clean and moist; removed 
catheter nine A. M.; replaced at twelre H., without pain or difficulty; 
continued treatment. 

January Slsi, 8 A. if.*— Bested well during night;* tongue moist 
and clean; appetite good; wound discharging but little; abdomen 
swollen; catheter remoTod for two and one-half hours; returned with 
ease ; continued treatment. 

February lit, 8 A. M. — Tongue red, moist and clean; pulse sixty- 
nine; abdomen swollen; some tympanitis; wound looks well; urine 
passing freely by catheter, ft turpentine emulsion erery four hours. 

February M^ 8 A, M. — Bested well during night; tongue moiat, 
redness disappeared; bowels not so distended; no pain; appetite good ; 
continued treatment. 

February Sd, 8 A. if. — ^Bested well during night; urine passes by 
urethra, without aid of catheter; tongue moist; appetite good; able to 
rit up; can walk across room by assistance; wound about healed. 

February ^A, 8 A. M, — Sitting up; gaining strength; rests well; 
walks about his room; passes urine by urethra, and draws it ocea- 
Bionally with catheter. 

He was discharged from constent attention on February 5th, with 
instructions to introduce instrument every day, aUowing it to remain 
for two or three hours, with other injunctions to be strictly observed 
for his ultimate recoyery. ^^^^^^^ ^^ GoOglc 



w ism junm and maowM. M 



Bo is BOW mdkiBg About, aUe for baunnem, aad eftn poii hk wribo 
withoitt pain or difficulty, in a stream near the size of No. 8 eatheter; 
00 indications of the size of urethra diminishing; snfTering no pain 
oraaeasinew of the parts, or along coarse of urethra; eontinues use 
of No. 8 inatnuaent CTory daj; he ia ei^oying good health and a fair 
prospect to liye to a good old age. 



ON FISSURES OF THS ANUS, AND ULCBBfi AT THE LOWBB 
EXTREMITY OF THE RECTUM. 



BY HOI.1IS8 OOOTEy F. A. C. 8., 
BurgMNi to St BartliolMiMW** Hoipltal. 



The amount of pain which the presence of flssares of the anas or 
osall alcers at the lower extremity of the rectum may cause to the 

ritient, is often so great as to excite the surprise even of the surgeon, 
may mention in illustration, the case of a lady lately under my care, 
who, without knowing exactly the cause, assured me tnat she had been 
for the last eighteen months, worn out by suffering, and was unfit for 
the performance of any domestic duty. The pain was not confined to 
the bowels, but extended to the loins, hips, and thighs. During the 
daj she often felt as if "her legs would give under her," and at night 
tiBte, the rest was disturbed with cramps. More than all, she complained 
of sadden irritability of the bladder and urethra, rendering the desire 
at once to expel the urine almost uncontrollable, and this was followed 
by a feeling of tenesmus, perhaps, by a slight escape of fbcal matter, 
tad by an access of pain in the region of the fissure. 

These pains are not fanciful or exaggerated. I have had under mv 
ave strong and otherwise healthy men, and delicate women in all 
Btationa of life, and sooner or later, with them all, the suffering caused 
by this apparently slight affection, is such as to render them prostrate 
and willing to undergo any operation for relief. 

When the surgeon examines the patient, he- may at first see but 
little to attract his attention; one of the folds of integument about 
the anus seems a little fuller than the other ; upon closer inspection, 
the skin will be found red, excoriated, and superficially ulcerated, the 
parts, however, packed together so as to constitute a "fissure." It has 
none of the appearance of a " tuberculous " ulcer, and possibly, the 
explanation usually given bv the patient is the correct one, namely, 
that it came on by the act of straining in defssoation. Such patients 
are, for the most part, inclined to constipation of the bowels, and many, 
as is well known, show great neglect in matters of this sort, which are 
all-important to health. 

It ia fortunate for the patient, that in these cases, relief may Imui 



S86 WIBTIRir lOWKAL OF 

adForded pitMnptlj and oomplelel j, All iiuti b needed, is to throir ihe 
parts into a state of rest, when the pain disappears and oicatrisation 
18 soon completed. The mere stretching of the ulcerated stnictnre bj 
introduction of the finger, or of the small speculum into the anus, is 
often followed by immediate alleviation of all the symptoms. Indeed, 
Beeamier recommends this method of treatment; he stretohes the fis- 
sure until he lacerates it, and thus, perhaps, a state of the most per- 
fect rest — muscular as well as otherwise — is temporarily produced. It 
has found favor with some of our own surgeons (vide Duigan, Dublin 
Homital GazeUe, September 15th, page 2^, 1860.) 

1 prefer the division of the fissure by means of a straight knife 
introduced along the finger. The loss of blood is trifling, the pain 
momentary, and the relief at onoe complete. Indeed, the very aspect 
of the patient is changed when the surgeon re-visits him. 

The bowels had better be kept quiet by opium for a few days, and 
then relieved by mild aperients, such as sulphur and senna. * 

Nelaton and Trousseau reoommend for the treatment of nssnree of 
the anus, enemata of ezt. kramerisd, gr. 75, to water, ^iij., used morn- 
ing and evening, and retained fifteen to twenty minutes, as long there 
is pain on returning the injection. When the pain has ceased, they 
may be used once a day or once every two days. It is also useful to 
apply locally a magma of bismuth, one part to three of glycerine. 

In cases where patients have declined the usual operations, I have 
obtained benefit from the use of carbolic acid. 

Some extremely interesting cases, illustrative of this affection, have 
been described by Mr. Hilton, surgeon to Guy's Hospital " On Rest 
and Pain.'* In one case, an anal ulcer produced retention of urine 
and symptoms of pregnancy. The patient, a young lady, aged twen- 
ty-two, withdrew from society, and passed her days lyins on the sofa. 
l!n former times this would have been called "hysteria.* By careful 
examination, however, the seat and nature of the disease were discov- 
ered, and complete relief given by the usual operation (page, 291 op. 
oit.) In another case, an anal ulcer was accompanied by pain along 
the sciatic nerve, over the left hip and loin, with pain in the right leg^ 
(op. cit., page 932.) Arterial haemorrhage has been cured by division 
of the ulcer. In a case under my care, the state of morbid irritabili^ 
of the vagina, now called vaginismus, was kept up by a similar morbid 
condition, and was also relieved by the division of the ulcer. 

These remarks do not apply to cases of extensive ulceration of the 
mucous membrane of the rectum, but to those conditions which bare 
been well arranged under three heads. Fint — The crack or fissure d 
the anus. Second — A superficial ulcer, almost invariably co -existent 
with varicosity of the veins of the rectum. Third — ^An excaTated 
ulcer situated between the external aud internal sphincters. — SrtHA 
Medical Joumah 



Digitized by VjOOQ IC 



PROCEEDINGS OF MEDICAL SOCIETIES. 



PROCEEDINGS OF THE UNION MEDICAL SOCIETY OP 
KNIGHT8T0WN. 

The Society net aooording to adjournment, at the office of Dr. 
Sparks, in Knightetown, on the 4th of March, 186&, at one p. m. 

The minntea of last meeting were read and approyed. 

Dr. Wilson Hohhs, of Carthage, was chosen a member of the Society. 

Dr. BawUngs asked and obtained permission to introduce a patient 
before the Society: The patient, a male, »t. nine, American, with a 
history and appearance something as follows: He had a sore hand 
abont harvest time of the past year, which he thought had been pois- 
oned. The doctor was called to see him during the autumn, and found 
him laboring under what he supposed to be an attack of erysipelas of 
the lower extremitiee. About the time he recovered from this, there 
appeared a swelling on the right side of the neck, which soon resulted 
in an abscess, which is at this time discharging a thin, whitish, puru- 
lent liquid. The aspect of ^e patient is of a dusky paleness, and the 
whole scalp has been and is yet considerably oedematous. Much of 
the hair has fallen off, and the patient has a bloated look. 

The treatment has consisted of Fougera's cod liver oil, two table- 
spoonfuls a day, quinine, iodide of iron, iodide of potass, and stillingia, 
whisky, and a generous diet. 

Dr. Hobbs said there was yet a quantity of fluid contained at cer- 
tain points near the old abscess, and he would make openings for its 
exit, and keep the openings patulous. He approves of the Doctor's 
treatment. 

Dr. Sparks thought the case scrofulom in its eharacter. There are 
three articles of materia medica that he would rely on, to-wit: Peru- 
vian bark, iron, arsenic, (Fow. sol.) He thinks the tincture of the 
bark much better than the salts. He would wash the abscesses with 
carbolic acid. 

Regular business being in order, Dr. Stuart was called on and read 
an essay on '^What will the coming doctor give his patients?" He 
spoke of the great latitude there is now in the choice and modes of 
administration of remedies, and asked what, from this, are we to expeet 



S88 wisnaii joubxal or wBOfoam. 

<of the coming doctor ? He traced cursorily tbe history of the scieaoe 
of medicine from ita inohoatiye state to the present; how it grew under 
the doTeloping care of such fathers in medicine as Hippocrates, Cel- 
sul, Areteus, Galen, Paracelsus, and others; and how it has suffered 
in the intervals in the hands of charlatans, quacks, empirics and big- 
ots — men superstitious as well as ignorant 

He spoke of the extravi^ant use and abuse of certain remedies, 
suoh as opium, sulphur, mercury, and tartar emetic, when thej were 
iBrst introduced, or when their use was as at certain times reyiTed. 
He noted the horrors of the history of surgery, such as cording a limb 
and allowing it to rot off, and smearing bleeding surfaces with hot 
pitch and searing them with hot irons. Eyea in the sunniest days of 
medicines, there are extreme yascilations, or as we significantly term 
them, '^fashions" or ^^runs," first in one direetion and then in the 
opposite. We hope we shall have a knowledge of remedies more exact 
than anything we possess to-day. 

Bennett says, " we have only seven drugs of positive known thera- 
peutie value.*' *' That there are eight other articles of great and often 
signal help in correcting diseased aoUon, but they are often fallible." 
^^All others than these fifteen are only palliative." Perhaps our esti- 
mate of the therapeutic value of all articles of our materia medica is 
to be materially changed. Of wine, ale and liquors, Parton says, hav- 
ing read much on the subject and talked with eminent physiciaas, he 
thinks the ^' truth of the matter is, that sometimes when the patient is 
at a low tide of vitality, he may turn the tide and borrow at four o'clock 
enough of five o'clock's strength to enable him to reach five o'clock," 
'^That the coming doctor will give his patients alcoholic mixtures about 
as often as he will give them laudanum, and in doses of about the same 
nagputude, reckoned by drops.'* 

The indications are strong, that the coming doctor, if he give mer- 
cury at all, will give it in very moderate doses. That the coming doo* 
tor will be much better acquainted with the foundations of the science, 
anatomy, physiokgy and pathological conditions, as well as the thera« 
peutio value of remedial agents. That he will labor to keep the peo« 
pie in health and to teach them to "occupy themselves with the phys- 
ical welfare of the race, without which no other welfare is possible." 

Dr. Sparks endorses the essay in the main. Through ignorance, 
we misapply our remedies. We administer them too indiscriminately, 
and can't tell which does the good to the patient. We combine too 

ay in our prescriptions. We should give fewer and watch their 



PBOOtDDDISS or WmiflAT. H CKM H l tf . 889 

•fbeto more closely. He thinks die oatalogtie of remedies will be 
iineh reduced — that sbont twenty are all we need. He has foand no 
ese who says mercury ia not a great eliminator, and that is all he claims 
fcrit 

Dr. McGavran has but little confidenoe in medicine, and thinks 
ttat swallowing so many drugs ia a mistake. 

Dr. Hobbs thinks medicine needs an advocate in the Society. He 
las much confidenoe in medicine. We should understand it is not 
aa exact science. A science is a collection of truths methodically 
snaaged so they may be learned. An exact science is a collecUon of 
poBlhre truths or facts. The science of medicine is made up of col* 
btted truths. Physiology is made up of much more positiTe knowU 
sdge. The action of drugs is not exact, and is not attained by exae4 
pie e ca s cs or figures. This is because we know not all the forces at 
work in*ourselTe8; but we know much and we haye a right to use out 
knowledge. Medicine has its age and honors — ^it was bought with 
man brains and claims men of move labor and honor than Sir Isaac 
Newton. It is of no less value, though it be not a positive knowledge. 
The coming doctor will use his best judgment — this we do not use cor- 
letOy. 

I>r. Lewis says the practice is unsatisfactory because we don't un» 
ientand the disease or the drugs we administer. Medicino will be 
■ere exact. The coming doctor will be so well acquainted witii drugs 
and disease, that he will not put in a whole handful of shot, but sim- 
ply one for the bird. He has used bromide of potassium, and so studied 
ilseffectB, tiiat he knows when to apply it and what to expect. If the 
■errouB disturbance is central, he expects good efiects, but if periph- 
md, he expects little from its use. 

Or. Sparks heii^ called on, reported as follows: 

On the 15th of September, 1866, he was called to see Miss B , 

a good looking young lady, who was insane and had been for two 
MDths, and was kept tied to the fioor. She would have a few hours 
of comparative quiet, but no lucid moments. She was well oared for 
aad of a fkmily well to do in the world. She had been careless of 
bar health— exposed herself a good deal*--was something of a ^* tom- 
boy.'* She had been under the care of three physicians, who thought 
tke insanity was caused by the death of her father, which occurred at 
ABdersonville. There was no &mily predisposition to insanity. Fovnd 
tke patient sitting on the bed, quiet, untied, with wild look. She had 
■ot tteastruated for four months, pain in hypochondriac region. Oo«M i 



290 wsmm jovnAL or hsdiciiib. 

learn nothing from the girl ; she gare only nonsenBieal answers to Ue 
questions. Tongue dear, bowels regular and circulation natural. 

Diagnosis — Hysteria connected with genital organs. At first 
thought she might be pregnant, without a bint — masked an examination 
— ^made it per vagnam. Found the uterus unimpregnatedy but little 
aboTC the natural site, os patulous, organ too low in the pelvis; intro-' 
duced a small bi-yalve speculum; all around the os and oerrix was 
granulated ; cervix a dark purple and congested ; a thick, tougb mucus ' 
pathognomonic of disease of the cavity. Scarified the os and cervix 
with a probe coated with nitrate of silver; cauterised the os, cervix 
and cavity; (prepared the cauterising probe by pulverizing the argent, 
nit. and rolling the beated probe in it); sluiced (f) well the parts 
with warm water; put her to bed; gave no medicine; repeated the 
operation once a week for two months. Patient recovered her mind 
and continued in health for two years or more, and perhaps till now. 

Dr. Hobbs thinks the treatment rather remarkable ; that so mucb 
cautery is very heroic. Don't know whether it has been done by odiers 
or not. 

Dr. Stuart said be had used in one case repeatedly, injections of 
saturated solution of nitrate of silver into the cavity of the uterus 
Ibr monorrhagia, and it having failed to check the bemorrhage, he had 
used Monsel's sol. per. sulph. iron, full strength ; but be took the pre- 
caution to dilate well the os and cervix with sponge tents. The ii^ee- 
tlons must be recurrent 

Dr. Lewis thought the result justified the means. That the revul- 
sion did good, (if the term revulsion might be applied here.) The 
womb will stand almost anything. 

Dr. Sparks — ^No author hesitates to cauterize the cavity when he 
thinks it necessary. If we can't cure the cavity of the cervix without 
injections, so we can't the cavity of the uterus. The cervix should be 
well dilated to prevent the fiuid passing through the Fallopian tubes. 
Agent nit. is applicable to all inflamed surfaces — of the womb as well 
as the conjunctiva. 

Dr. McGavran has no report. States he has attended five or six 
J0osl-morfems since he came to the place, in all of which the patholog- 
ical condition has been opposite the diagnosis. Beports a poMi-mortem 
of an epileptic patient at the Soldiers' Home. Patient had been 
■flieted five or six years — ^mind and voice had &iled. The examina- 
tion showed that the left parietal bone was thickened ; calvarium rough- 
ened ; space half the sise of his hand without diplod ; dura mater tiiick- 



^iyiuz.cu uy ■ 



PBOCfXEDIHOS or JfSDIOAL 8001X118. 29} 

e&ed and attached to the araehooid ; brain aataral ; about three otuiceB 
of fluid in the Tentrioles. Patient had used medicine six years, which 
did him no good. 

Dr. Hobbs thinks the case only shows the uncertainty of otir sci* 
eaee. There is much that is conjectoral — ^not always confirmed in the 
eadaver. Special pathology has thrown much light on diseased con- 
ditions. We should be diligent in the application of what knowledge 
we possesa, and we will be armed as never men were before. Truth 
still invites us to be diligent and not to become discouraged. We muat 
sot treat disease wholly by the books, but use common sense. The 
most important means against disease, is good^ hard common teme. 

Dr. Lewis being called on, reported as follows: 

On Uie 12th of December, 1865, half^past eight p. k., he visited a 
patient— a female — ^and found her quiet in bed. Pulse, skin, and gen- 
end condition, normal. A child, newly IxMm apparently, was lying in 
the lap of the patient's mother, who was sitting by the fire. She stated 
lliat the ohild had been born about one-half hour. On examiufttion, 
be found a placenta in the vagina of the patient, which he removed. 
Tbe general condition of the generative organs of the patient, was that 
of a newly delivered woman. The babe was a male. Left the patient 
comfortable. Question: How should a physician testify before court 
inder such circumstances? 

Cask II— On December dOth, 1867, Mrs. was found by the 

Doctor lying on the bed dead. The appearance of the body was natural ; 
a leather strap was around her neck, some two feet long, with the re- 
Bote end cut smooth; her age was thirty-six; she was married and 
bad given birth to her fifth child i she was of melancholic tempera- 
aent; several of her anceslers had taken themselves off; she lived 
uihappily with her husband, and her hair was prematurely grey; 
die had probably reasoned coolly and well on the matter of taking 
banelf off, but reached wrong conclusions. The Doctor read Ham- 
let*8 soliloquy — the inimitable expression of a great mind contemplat- 
ing self-destruction. 

Dr. Hobbs, concerning Dr. Lewis' first case, would teslafy that the 
woman had been delivered of a child, but could not testify that the 
obild in the woman's lap was that child. He could also testify firom 
the placenta and its position, whether the child was viable. 

Dr. Sparks — ^Hight a placenta be plaoedin the vagina for impom- 
tien, as where the question of property is involved? 

Dr. Hobbs thinks it is not possible to have the vagina, the os, and^ 
external parts, in the condition in which they were, without a real birth. 



tSC VBBTiatN IGUBHiiL OF MSDSGDIfti 

Dr. RowHbs reported tiro oasea of priauparons pataenta, in botliof 
which the head of the ohild waB well engaged in the superior stnh, 
but all progress seem stayed. To one he gave ergot, and the ehiU 
was quickly expelled. The other he treated similarly, and the patient 
went to sleep. The Doctor aska an explanation of the disorepanoy. 

Dr. McGavran reported two eases of retarded labor, which weft 
speedily brought to a termination by warn bath. 

Dr. Lewis had quit the use of ergot, but gave quinine freely, aad 
if there be irritebilility, he added morphine. He has unbounded ooi? 
fidence in quinine, and thinks it acts on the spinal nenroua centen. 

Dr. Hobbs has had a remarkable experienee in obstetric praetiee. 
During nineteen years, with a reasonable share of obstetric practice, 
he has neyer lost a single case in child bed or any of ite accidente. 
He uses the powder or a decoction of ergot, and always preparei it 
in eyery case, through fear of post partum hemorrhage, but does not 
always use it. 

Dr. Sparks fears hemorrhage, and giyee ergot a little befoxe the 
birth of the child. 

Dr. Hobbs asks if it l>e the uniform experience of those present^ 
if the labor is more tedious when the cord is around the child's neck; 
and whether labor is more tedious when the child is '* gummy.'' All 
who replied, answered in the affirmative. 

Dr. Lewis — When the liquor amnii is abundant, the child is not 
i'gummy," and vice ver$a. 

Dr. Hobbs moved that an abstract of the proceedings of this meet- 
ing be offered to the Western Journal for publication. 

Dr. Rawlins seconded the motion, and it was carried. 

On motion, the Society adjourned to meet at the same place, on 
the first Thursday in April, at one o'clock P. M. 

J. H. Stuabt, Secretary. John Lbvis, PremdenL 



BRAINARD MEDICAL SOCIETY. 



Pursuant to adjournment, the Society met in the oftoe of Dr. Kit- 
tinger, in Winamac, Indiana, April 7ih, 1869. 

Minutes of last meetimg read and aceeptod. 

Doctors William Perry, of North Judson, A. R. Thompsoa, Ke- 
wvna, and P. H. Leavitt, Winamac, were admitted to membenkip. 



PBOOKSpmOS OF MEDICAL aOdSRBS. 29S 

The ihird antmal election of oftcen wmB held, wlikk resulted a» 
follows: 

/VeMden<--J. W, G. B^toh, Paliiski. 

Secrttary^l. B. WASEBimH, Stor Citj. 

TVeomrer — J. H. Smith, Kewftoa. 

CenacTs-^¥, B. Thomas, WIjuuiim, P. H. Lxatitt, WiiuuiMc, B. W. Jackbos, 
Kewaoa. 

The following were selected as delegates to the State Medical As- 
soeiation : J. H. Smith, L. D, Glazebrook, Wm. Kelsey, J. B. Hoag^ 
and W. S. Cleland. 

Dr. Hoag reported a case of abscess of the Inng, supposed to have 
been caused by swallowing a pin. 

Doctors F. 6. Thomas add A. R. Thompson, reported cases of con- 
tinued feyer, which assumed a typhoid condition and resulting very 
fatally, five of seven patients having died of hemorrhage of the bowels. 

The etiology, semeiology, pathology and treatment, were discussed 
at lengthi by Doctors Thomas, Hoag, Smith, Eaton, Washburn, Thomp- 
son and Beddiok. 

Brainard Medical Society was organised two years ago. It now 
numbers twefUy-ieven members, who are located in Pulaski, Starke, 
Fulton and Cass counties. I. B. Washbubn, M. D., Secretary. 



ALLEN COUNTY MEDICAL SOCIETY. . 



Four Waynb, Apbil 6, 1869. 

Meeting was called to order by President, Dr. H. P. Ayers. Mem- 
bers preeent. Doctors Ayers, Sen., S. G. Ayers, Thacker, Smith, Gregg, 
MeCullough, Rosenthal and Fitssimmons. 

Ifinutefl of tiie previous meeting were read by the secretary, ap- 
^oved by the Society and ordered to be placed on record. 

A case of carcinoma was then presented to the Society for exam- 
ination, by Dr. Bieliart, of Roanoke, the history of which, as given by 
ike Dootor, was as follows : 

Mr. h^*~ m forty-five years of age. Eight or ten years ago a 
small brown spot wae noticed in the skin on the left cheek, which 
attracted but little attention, however, until about two years sinoe, 
when it was obstrved that something like a wart was growing out of 
the brown spot, and was attended by sharp, darting pauis . Aetiag 



^iyiiiz.cu uy ■ 



"«3 



le 



284 WBATXKN JOURNAL 01* MIDKHNX^ 

upon the soggestion of friends, Uie patient had this wart '< plucked out 
by the roots at the dark of eyerj moon/' thinking thus to destroy it 
The results, however, were always to the oontrary, each sucoeBsive 
plucking being followed by an increase in the sise of the wart. The 
patient then sought the aid of several noted cancer doctors, who lay- 
ished their skill upon the persistent little wart in vain, for instead of 
yielding to their treatment, it flourished luxuriously under the stimulus 
of their caustics and other irritants, which conyerted it, howeyer, into 
an extensiye ulcerating sore, presenting at present, rather a formidable 
appearance. The surface of the ulcer is irregularly eleyated above 
the surrounding surface of the cheek ; is oval in shape, and measures 
about two by two and a half inches; the upper margin of the ulcer 
approaches to within about three-quarters of an inch of the external 
angle of the eye, in which direction it is rapidly extending; the paro- 
tid, thyroid, and other glands in the vicinity, are enlarged, which has 
been the case, however, only since the application of eaustics, and 
hence it is thought to be sympathetic only. 

Upon examination, the members present were agreed as to the 
malignancy of the disease, and advised excision as the only admissable 
treatment. 

Dr. Thacker expressed the opinion that attachment to the perios- 
teum would be found, but thought excision the only moans of sav- 
ing the eye, for a time, and at least retarding the advance of the dis- 



Doctors Ayers, Sen., Gregg, Bosenthal, and others, thought thai no 
attachment had yet been formed. 

The patient's father died of cancer located in the epigastric region. 

Dr. Thacker presented an interesting pathological specimen, being 
a case of ectropium of the liver, in a male foetus of about seven months, 
found by workmen on the railroad bridge over the St. Mary's river, 
near the city. The liver was considerably enlarged, and protruded 
through an opening in the abdominal walls of about two and a half 
by three inches, which corresponded to the aiie of the liver. This 
organ occupied the umbilical region and was covered by the peritoneum 
and cuticle only, which had been ruptured, presenting an appearance 
as though the umbilicus had been forcibly torn away, tiie umbilical 
vein and hypogastric arteries being traceable from the oenter of the 
tumor. 

Upon motion by Dr. Rosenthal, Dr. C. 8. Ayert was inatruotod to 
procure copies of photograph of Sommera, showing the large tonor 

..yitized by Google 



OOBBSSPONDBMCK. 296 

oa the occiput, (a case heretofore before the Society,) in numbers suf- 
fieient to supply the members. 

Proposed amendments to the constitiition were then called for, and 
being read, were adopted. The amendments are as follows : 

Section first of article fifth, amended to read — 

**Anj person becoming an active member of this Society, shall be required to 
mgn the constitation and by-laws thereof, pay an annual fee of one dollar, and 
iball attend not Use than four regular meetings during the year. 

Section second amended to read — 

•• 

"A member may be suspended or expelled by a two-third vote of all active 
members, charges and specifications haviog been preferred one month previous to 
the time of trial. 

After the adoption of the amendments, the members present paid 
the annual fee of one dollar to the secretary. 

The following delegates to the State and American Medical Asso- 
ciations were appointed : State — Doctors H. P. Ayers, 9. C. Ayers, 
Gregg, Thacker and Rosenthal. American — Dr. H. P. Ayers. 

Dr. Rosenthal moved that the proceedings of this Society be pub- 
lished in the Western Journal of Medicine. Motion was carried, and 
the Society adjourned to meet the first Thursday in May. 

P. G. Kblsey, Secretary, 



CORRESPONDENCE. 



DERMATOLOGY IN VIENNA, 



YiSMNA, Mabch 15, 1869. 
Howerer true it may be in the world of politics, as the present 
Napoleon would assure us, when he introduces his uncle in Cassar's 
guise, in his biography of the latter; or, however true, in the realm of 
poesy and the fine arts, as we are all almost forced to acknowledge, 
diat there does oeeasionally appear on the stage of life, a genius which, 
by superior endowments fVom birth, is able to disregard or neglect 
the weary labor of preparation, moulding or creating oireumstances 
to its will, by one grand stride to reach success, in the sphere of 
medieme there is, there can be no such power. The master minds 
of Bnrope, aa fkr as wa hate been able to obsenre them, htM in no 

(11) L^ytized by Google 



296 WS8TBBN WUBMAL OV MKBIOINX. 

instance presented the brilliant scintillations of unearthly fires as io 
OUT fancy we painted them; without hitherto a single exception, they 
haye been none other than simple plodding laborers in the great har- 
Test field; and although in many instances, a quickness of concep- 
tion and skill in diagnosis, might seem to the uninformed a qualifica- 
tion of almost omniscient character, yet it is always eyident to the 
student, that this knowledge is only the result and the reward yielded 
to the rich experience in positions attained by unceasing toil. Prof. 
Hebra offers no exception, either in appearance or address. In person, 
of short, solid build, hair and heayy mustache already frosted by some 
fifty odd, face full, round, rather prominent cold gray eye, square, de- 
termined chin, duplicated by a fold beneath, character in full accord, 
sharp, decisiye, and perhaps occasionally a little stubborn, certainly a 
little too seyere in his criticisms on his fellow specialists. His clinic 
is always rendered interesting, aside from its real yalue, by occasional 
sallies of wit, with which he spices his lectures and which are always 
terse and relishable. Were it not for these, when he chuckles all oyer 
with a jest which only adds to the general effect, and which foreyer 
precludes the idea, he might be regarded, and we mean no irreyerence 
whateyer, as a typical personification of a little fat country judge in 
the dispensation of the law, duly impressed with the responsibilitiea 
of his position. Hebra is a man, too, who has not plunged so pro- 
foundly into the recesses of science as to haye become Newton>like 
utterly obliyious to corporeal wants ; his rotundity alone is eyidenoe 
enough to the contrary; his jocundity, too, in a measure, and if there 
should still linger a doubt, it will be dissipated by the purchase of his 
ticket of admission, which is nearly triple the price of other chairs, 
still it is cheap enough at that, about twelve dollars currency for si 
three months course. 

The lectures are all deliyered in the ward, a half-dozen bencheft 
arranged around a small enclosed arena, accommodating the thirty or 
forty students in attendance. Male patients are stripped perfectly nude 
and required to stand on a chair or table in the center, while the female 
are permitted to preserye a portion of their attire. On the wall, at the 
side, hnigs a 1^11 length portrait of the professor, painted by sobsorip- 
tion from his students. The material is partly out-door, the ambula- 
torium, partly patients in the house, and as you may well imagine, 
eyery yariety and form of cutaneous disease are presented. By fiar, the 
great majority are scabies, ecsema, prurigo and syphilis, though, ef 
course, ihe yarieties are duly exhibited. As you »re aware, his claaai* 

..yitized by Google 



ficadon depends neither on the appeaninoe of the disease nor the phys- 
iology, nor the effeet of therapy, but on the anatomy. This is the 
fiiTorite mode of oiassification now-a-days, not only of skin diseases, 
bat of other forms. Yirehow's division of tnmors after this rule, is 
■ow everywhere adopted, and Hebra's of cntaneoos diseases is rapidly 
gaining ground. It certainly simplifies the matter wonderfully, for 
skin diseases have long ago been removed from the opprobria they 
once were. Why should we call a disease which is to-day papular, 
to-morrow vesicular, and the day after pustular, each time by a differ- 
ent name, observes Hebra time and again, when all the time it is the 
same disease? A scabies is now one or the other, according as the sur- 
face is scratched. In almost all oases, pustules hii only the effects of 
Bcratehing, and consequently, nearly the whole file of pustular disease 
is swept away. Scabies presents at the clinic in every variety of 
appearance, among the fearfully degraded poor which this land pro- 
duces. In all cases, the treatment is the so-called "cure salve.'' We 
were led into the room a few days ago, to witness its application ; a 
balf-dozen men and boys, perfectly naked, were drawn up in line, and 
the old nurse, a regular n^jor domo, took his position before them, 
with a large pot of the semi-solid salve at his feet. A small quantity 
was presented to each for the hands, then the foreanns, arms, abdo- 
men, lower extremities, &6., and finally, for the back, the conipany then 
fsced to the right, standing in company file, when each officiated for 
the man before. It was a singular sight and ludicrous in the extreme, 
each man of a dark mahogany color, toiling with might, and main, for 
the discipline is strict, on the back of his neighbor, who in turn labored 
upon the one before. After the friction, each individual is laid in bed 
sad rolled in a blanket from head to foot, and there he lies for two 
days. He is then inspected ; should he not require another applica- 
tion, he is now rubbed off with fine clay. Prof. Hebra insists strongly 
that he shall not bathe for four or five days, as the concomitant eczema 
is always aggravated thereby. After this latter friction, he is dismissed 
— cured of his scabies. Should the eczema require treatment, he is 
famished with ol. cadini, a preparation of tar, which he is instructed 
to use. The Professor has tried all the various plans of treatment, 
but always returns to the all-healing salve. Its composition is the fol* 
lowing: Sulphur, tar, each six ounces;, soap, fat, each one pound; 
chalk, four ounces. Of course, in private practice, other finer prepa- 
raliona are employed. Eczema is treated according to its form. In 
a most exquisite case in the acute form, which occurred a few days 

..yitized by Google 



296 WE8TSBN JOCBHAL OV MSmciNX. 

ago, wberein tlie entire trank was oovered with Tesicks on an inflamed 
base, pulverized starcli was applied, and in fo«r or fiye days the cure 
was complete. Incrustations are softened and removed by the appli- 
cation of clotlfs saturated in cod liver oil ; when either the oil is con- 
tinued, or preparations of tar united with it, or alone maintained, or 
in obstinate forms, caoutchouc glove or stocking is worn. 

Prurigo, he pronounces an incurable disease. The intense itchiBg 
may always be mitigated, and the papules may even disappear for a 
time, but they always inevitably and unezceptionally return. The 
best treatment of obstinate cases is, maceration by fourteen day baths, 
application of the so-called smear soap and futty inunctions. Some- 
times tar is of decided efficacy. Prurigo is a disease of the horny 
tissue, like ichthyosis and lichen pilaris. In children, it is best 
treated by warm baths of an hour's duration, and subsequently, appli- 
cation of spiritus alkalinus. Syphilis in all its forms and ravages, is a 
daily visitor. The treatment is the mercurial inunction generally, com- 
mencing with the forearms for one day, the arms for another, and ao 
on over the body, to avoid ecsema, until its e£fects are obtained. Aa 
to whether a soft chancre may produce general contagion, the question 
is, still, after manifold experiment, sub judice. The mercurial treat- 
ment is only employed for existent symptoms. 

To attempt even a synopsis of therapeutics, would be a task as 
useless as endless, for Hebra's work, the first volume, has been already 
^translated into English, is within your possession. Had we time 
and permission, we would gladly translate the condensed work of Dr. 
Neumann, Docent of this department, which contains everything that 
the general practitioner requires. 

The baths of the Hospital are conducted on a scale which merits 
notice. A long row of chambers on the ground floor are divided into 
small apartments, containing the requisites of baths, simple, medicated, 
steam, douche, &c., with every facility for use, the great peculiar feature 
is the treatment by continual baths. In cases of extreme burns, and 
in cases of many forms of disease which have obstinately resisted all 
treatment, resort is had to the continual bath. A rope bed is stretched 
along the center of a long tub, and arranged by pulleys so that it can 
be elevated or lowered at pleasure, and the patient, naked, of course, 
with the head on a pillow above the surface, passes a portion of his 
life under water. Day and night he remains in his watery couoh, eate 
there, amuses himself there, sleeps there, and is only elevated for the 

»Both TolumM hATe been translated and publifhed by the Sydenham Society— the socx 
waa iMoed lait year. /^^ T. P. 



CaBmBBPONBENGE. 2£9 

inflertion of « yessel under him to receive discharges. It has proved 
of the most decided efficacy in hums, relieving the intense pain^ spa- 
ring the agony of the change of dressings, and materially abbreviating 
the cure. It has been found, however, that in very extensive burns, 
the mortality is undiminished. A few weeks ago a case of universal 
psoriasis was exhibited, whose history was nine months of aquatic life. 
The surface, before the bath, was so stiff that the slightest motion was 
attended with extreme pain. At one time, during the long treatment, 
at the solicitation of the patient, who was weary of the monotony, he 
was removed and the body was enveloped in cod liver oil, but the dis- 
ease returning in all its former violence, soon induced him to petition 
a return to the bath, which was granted. He is now nearly well. 

Our old friend, carbolic acid, plays quite an important part in der- 
matology. It is used in many cases where the disease depends on 
parasitic formation, e. y., herpes tonsurans, pityriasis versicolor, favus, 
Ac, and has been found of peculiar efficacy in hastening the absorp- 
tion of the indurated bases of ulcers, chancres, &c. It is generally 
applied in solution with glycerine or alcohol, to indurations ; pure 
petroleum is the application to pediculi capitis, vestimentorum, or 
pubis, equally efficacious and far less dangerous than mercury. Even 
these foul cases of plica polonica, where the hair is matted into a 
mass from the product of seborrhea, pediculi, eczema and dirt, from 
extraneous sources, until a cap of nearly an inch thickness is formed, 
and^ which is regarded by some of the credulous as a charm against 
disease, yield readily to the continued application of coal oil, and fre- 
quent ablutions, without even cutting the hair of women, which is, in 
general, for no disease, seldom or ever removed. 

The rapidity and accuracy of diagnoses, seem at first but little less 
than miraculous ; patient's histories, to their profound amazement, are 
revealed to them firom the commencement of their disease to their 
appearance here. 1. There are no diseases in which their subjective 
symptoms are so little needed. 2. Very seldom is a question neces- 
nry, or when desired, it seems only in corroboration of a previous 
statement. 3. The type of the affection is written upon the body in 
characters which utterly set at nought any equivocations or direct false- 
hoods from the patients themselves. 4. Characters, too, which, like 
the hieroglyphics of archoeologic love, have been and are being deci- 
phered by the priests in the temple of science, and their discoveries 
likewise, but in a far higher and nobler manner appropriated to the 
benefit of their fellow man. Whittakeb. t 



300 we8tsen joitrkal of hediciks. 

New York City, April 10, 1869. 
Dear Journal: After the bustle and excitement of the past win- 
ter at the various schools, male and female, of our city, we are once 
more enjoying a period of comparative rest. The numerous lectures, 
clinics and operations of the winter course, are over, and the dissect- 
ing rooms closed for six months. The college halls present a deserted 
appearance indeed, afler having been so crowded for the past half year 
with the several hundred students who have recently been among us. 
To each and to every one who is this spring commencing the real strug- 
gle of life, we would wish a hearty God -speed, and extend the right 
hand of fellowship. May bright success and happiness be theirs. And 
yet, we never attend a medical commencement, and see the enthusias- 
tic young student, with beaming eye and high hope upon his brow, 
receiving his coveted diploma, without a feeling of sadness creeping 
over us. And this, because we can not help looking forward into the 
mysterious future, and picturing to ourselves how many of these, now 
80 bright and buoyant, will, ere many years have flown, fall by the 
wayside, overcome by the turmoil and strife, and be trampled and for- 
gotten, long ere the goal of their ambition is attained. Many a noble 
man has closed his weary eyes in death, no longer able to keep up the 
struggle, and sunk into an unknown grave, no hero on the pages of 
the world's history, but none the less a martyr to the glorious science 
that he loved so well. And yet, notwithstanding the hardships, and 
the difficulties, and the disappointments, that so often await those of 
our profession, we would never offer a single word of discouragement 
to any who have entered into it or who contemplate its adoption from 
proper motives ; but would the rather say to them, if you would sue- 
ceed, be enthusiasts in the profession of your choice. None is nobler, 
none more God-like. Enthunaam, as in all other things, so in our 
calling, to a certain degree, is the soul of success. Not sentimental 
fanaticism, which is the dream of success, but a living, an energetic 
enthusiasm, which is the realization of success. Words, like men, 
often lose their reputation, from evil connection ; so, by associating the 
word enthusiast with the teaching of the false and sickly doctrines of 
the day, it has lost caste. Yet, what is enthusiasm, but the earnest 
life-devotion to an end, the absorption of a man's being in some idea 
and purpose? Until the mind and the heart have become interwoven 
with the purpose, and thus separated from all ulterior objects and 
influences, no great end has ever yet been truly accomplished. Listen ! 
And as you tread the memory vaults of the illustrious dead, everj 



^iyiiiz.cu uy ■ 



0OBBSflEV(Hn>BllOB. 801 

vererberation speaka of the deatbless energy and pasaioiiate derotioii 
— a life-long enthnaiasm. What could be more grand than onr life- 
work — ^to relieve hnman suffering and to prolong hnman life? It is 
mira to aoothe the brow of anguish; oura to drive the demon pain 
away; ours to raise the prostrate sufferer; ours, relying upon a Higher 
Power! 

Bui pardon us, dear Mr. Editor, we meant not thus to wander, but 
such was the current of our thoughts. 

The spring courses of lectures are now quietly progressing, and 
the younger men of the profession have once more an opportunity 
of ventilating their views upon the various branches of our art. 
The lectures, for the most part, are not delivered by the regular pro- 
fessors, but by their assistants, or by those who have been fortunate 
enough to secure positions as summer lecturers. Many of the regular 
professors, however, still appear at the clinics, which are again in full 
and active operation ; and the course this season is particularly fine. 
We never lack for material in this city. Tho following is the pro- 
gramme for each day, (the clinics being held at the three medical col- 
leges, New York, Bellevue and Charity Hospitals, and at the New York 
Eye, and Cosmopolitan Eye and Ear Infirmary:) 

Monday — ^Two surgical, three eye and ear, one venereal, one skin 
diseases, one obstetrical, and one medical. Tue9day — Three surgical, 
^ree medical, two eye and ear. Wednesday — ^Two medical, and one 
eye and ear. Thurtday — ^Two surgical, one eye and ear, one medical, 
and one obstetrical. Friday — Two surgical, one eye and ear, one 
medical, one skin diseases, one obstetrical. Saturday — Two medical, 
one eye and ear, one children's diseases, and one surgical. 

Amidst such a variety, it would seem that the student ought to 
acquire much practical information, and so do those who make a proper 
use of their eyes and ears. In its &cilities for the practical study of 
disease. New York city is rapidly distancing all competitors. 

Week before last, the mortality of this city amounted to four hun- 
dred and eighty-three, of this number, two hundred and fifty-five died 
in tenement houses, one hundred and two in public institutions, and 
one hundred and twenty-six in private houses and hotels. The health 
of the city, on the whole, is good. The excitement in relation to small- 
pox is abating. Great vigilance, however, is exercised at the quaran- 
tine and emigrant landing, on account of the prevalence of this fear- 
ful disease in several of tiie European cities. It is spreading widely 
in Montreal, and is still on the increase in California The Medical 



8tt WKSTUII MmrAL OV XSDIGim. 

Oamite mjb: "The Cbb/omta Medkal ChuUU snggaflta Oiat ear&ol>r 
otfuJ ahould haye a thorough trial as a proieetiTe againat snudl-pox. 
<Let the air of the room in which the small-pox patient is Ijing, be 
saturated with it; let a solution of it be sprinkled on the floors, from 
which the earpets should be taken up; let large woolen cloths, sata- 
rated with it, be hung about ; let some of it be put in every close stool 
nnd ohamber utensil, so that all the excreta, as soon as passed from the 
patient, may be modified and disinfected by it; let the sewers and cess- 
pools belonging to the premises, be flooded with even a weak solution, 
for one one-thousandth or even one fifleen-hundreth part of carbolic 
aeid, will prevent the decomposition, fermentation, and putrefaotimi of 
urine, blood and fmces for monUis, while one ten-thousandth has been 
fbund sufficient by Dr. Letheby to keep sewarage sweet or nearly deodor- 
ised. Let every piece of clothing, and all bedding that has been in con- 
tact with the disease, be washed in it; let the body of the sick person 
be sponged off with it; let all attendants wash in it, or sprinkle their 
clothes with it; and let it be sprinkled about, both in and outekle the 
house.'" 

The anniversary exercises of the Women's Medical College of the 
New York Infirmary, were held on April 1st) and were of a very inter- 
esting nature. A large and fashionable audience was present, and 
evinced much interest in the proceedings. The report of the institu- 
tion was read by Emily Blackwell. "That the infirmary met a want, 
was shown by the readiness with which both patients and stndenta 
resorted to it. Its value as a charity, is proved by its growth from 
two hundred and fifty, the record of its first year's practice, to seven 
thousand, two hundred, the number of its last year's patients. Its 
value to students is proved by looking over its record, and seeing how 
many of our most successful and women phyuoians have been con- 
nected with it as physicians and students. During the last twelve 
years, a succession of young women, three or four at a time, have come 
to the infirmary, and for varying periods of from one to four years, 
have devoted themselves to medical work, taking care of the patients 
in its wards, prescribing for them in the dispensary and vlsiUng them 
in their own houses. More than seventy thousand patients have been 
attended by them, hundreds of poor families look to them for aid, and 
hundreds of children are growing up who know no other medical care. 
The liberal sentiment of the city has given our students advantages 
which they can not obtain elsewhere. New York has the credit of 
first admitting women as students to the different city charities^ and 



ooKuiMnmnics. M8 

Ae medieal pTofeeeion of New York Iim been the first to give bqS- 
deiit Bopport to their efforts to carry out entirely their new undertake 
ing. Those engaged in this matter, will long remember the lead New 
York has taken." 

At the annual meeting of the Nnrsery and Child's Hospital, Utae 
report showed that there were admitted during the year, from March 
Ist^ 1868, to March Ist, 1869, three hundred and ninety-nine children; 
bom in the institution, sixty-seyen; remaining at the present time, 
two hundred and thirteen children and one hundred and two adults. 
During the past year, there have been under treatment one thousand 
and thirty patients, ezclusiye of many cases of slight ailments common 
to infancy ; of these, seven hundred and ninety -eight haye recoyered, 
fifty -four remain under treatment, and one hundred and seventy-eight 
have died. The most prevalent diseases have been those of the respir- 
atory organs and of the alimentary canal. There have been twelve 
eases of scarlet fever, and eleven of diphtheria, two of each proving 
fatal, and considerable whooping cough, but no measles. 

Just as we are ending this letter, there has been handed to us a 
pamphlet on "The Treatment of Paralysis by Eleotrtaation, with an 
explanation of a New Oalvanic Apparatus," by Dr. A. D. Rockwell, 
well known in medical circles in our city, but neither time nor space, 
aor ability, as we have not yet had an opportunity of looking over it, 
allow us to speak of its merits in this communication. In our next, 
we may have something to say of it. Tours, very truly, 

James B. Burnst. 



OUR POLL-TAX. 



Springfibld, Ohio, March 29, 1869. 

Mt Dear Editor: Supposing that when fourteen years of age, I 
quit the common school, having education enough to begin "life for 
myself," as the saying goes. Those who quit with me go to learn a 
trade, or stand in a grocery, or "onto'' the farm, but I determine to 
finish my education and be a doctor. 

In the first place, I attend a high school or academy for three 
years, at an expense of, say two thousand dollars. I then go to eol- 
lege for four yean, at an expense of four thousand dollars. Then I 
study medicine during the three requisite years, costing with lectures, 
about thirty-five hundred dollars. Leaving me at the ten year's emL 



'gie 



9M WBSTEEV MVaVAl OV XXDICmB. 

with a diploma and a oaah deficit of nine thoufland, five hundred dol- 
lara. 

Had I used this capital and the labor and care of mj ten years, ia 
any trade or bosineBB, I could have been by this time a rich man ; bat 
here I am at last, ready for practice. 

I buy books, instruments, drugs, a horse, harness and buggy, build 
an office, and have my shirts washed, at an expense of fifteen hundred 
dollars. If I buy the practice of some ''old man,*' I pay more (than 
it is worth.) I pay ten dollars for a physician's license. I hare pri- 
vate means which bring me an income of one thousand dollars. I 
git in my office, wear out my clothes, my patience, and the first year 
of my new life I collect two hundred dollars. The United States taxes 
are five per cent, on that. Five per cent, on two hundred dollars is 
ten dollars. Ten dollars tax and ten dollars for license, twenty dol- 
lars. Twenty dollars tax on two hundred dollars is steep. 

That is the goTernment tax on brains. Does it pay to cultiyato 
ihem? Does it pay a free government to discourage the culHvatum oj 
themt Yours, very truly, H. S. P. 

P. 6. — I wore the blue, and am probably as patriotic as is tbe Cbainnaa of 
the Committee of Ways and Means at WasbiDgton, bat I feel at liberty to gnunbfo 
at this imposition. 



BIBLIOGRAPHY. 



PROCEEDINGS OF THE AMERICAN PHARMACEUTICAL 
ASSOCIATION AT THE SIXTEENTH ANNNAL MEET- 
ING, HELD AT PHILADELPHIA, PENNSYLVANIA, SEP- 
TEMBER, 1868; ALSO, THE CONSTITUTION AND ROLL 
OF MEMBERS. 

PUhiddphte : IfMrrihaw * Son, Frintwa, S« Arch StiMt, 18«. Ft«w «W ; tf*- 



This is a bsndsome volnme, and mach larger than that of last year, 
and presents ample evidence of the fact that the Association is com- 
posed of earnest, hard-working and learned men, who care more for 
the discossion of scientific and professional qoestions than of trivial 
aad unimportant ethical ones. We repeat what we said when notieiag 



BmjoQftmr. 905 

tbe proceedings last year, that some of our medical societies would be 
beneiitted, did they take a hint from the manner of doing business 
adopted by the American Pharmaceutical Association. 

"The renewal of prescriptions without authority previously obtained 
from the prescriber — a subject that has vexed some of our eastern 
brethren during the last two years — ^was fully discussed, and certain 
resolutions in relation thereto unanimously adopted. The substance 
of these resolutions is, " that the Association regards the pharmacist 
as the proper custodian and owner of the physician's prescription 
once dispensed," and that "the restriction of the pharmacist to a sin- 
gle dispensing of a prescription without the written authority of the 
prescribing physician for its renewal, is neither practicable nor within 
the province of the Association.'' The indueriminate renewal of pre- 
scriptions, especially when intended for the use of others than those 
for whom they were prescribed, is regarded as neither just to the phy- 
ncian nor to the patient, "and that such abuses should be discouraged 
by all proper means." 

Many other interesting matters are contained in the phonographic 
report of the proceedings, that we have not space to notice. 

The report of the committee on the progress of pharmacy is quite 
lengthy, occupying one hundred and fifty-eight pages, and seems to be 
full and complete. 

In that portion of the report on the "Drug Market" devoted to 
secret remedies, it is maintained that some kind of legislation is required 
for public protection aga^inst patent and proprietary medicines. The 
following quotation is made from this portion of the report, for the 
purpose of showing that the better class of apothecaries hold correct 
views on this subject, and will cooperate with the medical profession 
in devising means for the suppression of these evils: 

''The market list of secret proprietary medicines in ase in onr country, tkr ex- 
ceeds in nnmber of articles, that of tbo list of officinals in all our materia medica. 
It is generally conceded by our apothecaries, that about one«half of all their sales, 
ia amount, to customers, is deriyed firom this source, and if it were possible to obtain 
idiable statistics of the per capita or total consumption of these compounds within 
tha Union, the American people would awake, and put in chains a traiBc that 
paadera to many yices, that seldom hesitates at any imposture, and as a rule, con- 
siders the deception of the public to be a legitimate business. Hair washes, called 
dyes or restoratives, are sold in immense quantities as purely vegetable prepara* 
tions, when lead and other deleterious minerals make the substance of these. Quiet- 
ing aad soothing syrups are recommended and largely sold as harmless cordials 
or sedatives (ur inftunti, which are composed in good part of morphine, opiates or 



S06 WESTEEN JOUBHAt. Of MEDICIKE. 

otbsr powerfiil a&dAtires, whieh should neT«r be admiaistered without the knovl- 
edge of the parent or some competent pecsoiu The child, whoso onlj defease oon- 
sists in the power to cry, for whom resistance is a necessity for protection and lor 
deyelopment, is drugged to sleep, growth is retarded, and the brain and nenrous 
system permanently injured, because of the ignorance of the parent, alike of the 
laws of health and of the deleterious remedy which is misrepresented in all iU 
component parts. No restriction of any kind is imposed upon ignorant qaackery, 
while the physician, before he can prescribe or practice medicine, must be educated 
and pass one examination, as also the regular apothecary, in most of the Statai^ 
is obliged to label carefully, under stringent laws, all similar preparations. Our 
newspaper press, which in a country like ours, is the source of almost all the polit- 
ical and religious education of the country, for which reason it should know and 
feel the yast responsibility of its power for good or for evil, to a considerable extent, 
is filled with adyertisements of compounds for the basest purposes, under pretense 
of remoying periodical irregularities, as they are called; and, as the fashion of the 
day, bitters and tonics of all sorts are persistently adyertised as restoratiyes for all 
classes, when any pharmacist knows they are made to fill the place of tbe dna 
shop, which is no longer respectable ; and there is no effectual remedy for this hot 
proper legislatiye enactments forbidding the sale of secret remedies of all kinds.*^ 

And, as should liaye been added, all proprietary medicines. Other 
remarks equally as pertinent are contained in this report, as well as in 
the ^'Report on legislation regulating Pharmacy." 

A number of interesting and valuable ^^ special reports and essays'' 
are presented, as Well as volunteer reports. Aviong the latter is .a 
valuable one on carbolic acid, by Dr. Squibb. 

The next meeting of the Association will be held in Chicago, on 
the first Tuesday of September, 1869. 

The address of the Permanent Secretary is, John M. Maisch, 1G07 
Bidge Avenue, Philadelphia. J. R. W. 



SECOND ANNUAL REPORT OF THE BOARD OF STATE 
CHARITIES TO THE GOVERNOR OF THE STATE OF 
OHIO, FOR THE YEAR 1868. 



Colnmbns : Columbiu Printing Company, State Prlntera, 1869. 



The Board of State Charities of the State of Ohio, consists of five 
persons, who are required by the act providing for their appointment, 
to 'investigate the whole system of the public charitable and correc- 
tional institutions of the State, and they shall recommend such chaagM 
and additional provisions as they may deem necessary foi: their eeo- 



nonioal and efficient admiaiBtration." In this report, the variooa State 
inaiitations are notieed, and generally in terms of commendation. 
The Secretary's report on the condition of county jails and infirmaries, 
is of much interest and demonstrates the necessity existing for a hoard 
of this kind. It has been said that an abuse exposed is half corrected. 
That there is much to expose and correct in these institutions, is shown 
by this report which makes clear the fact, that, " in the midst of com- 
munities noted for intelligence, virtue and wealth, cruelties haye been 
practiced which would have disgraced the dark ages, and human beings 
who have been simply unfortunate, have, for weary months and years, 
been confined in pens so filtby and wretched as to be almost beyond 
belief." Let us hope that these abuses will soon cease, now that they 
are exposed. 



AN ADDRESS ON EDUCATION PREPARATORY TO THE 
STUDY OF MEDICINE, READ BEFORE THE GEORGIA 
MEDICAL ASSOCIATION, AT ITS NINETEENTH ANNI- 
VERSARY MEETING, IN AUGUSTA, APRIL 8, 1868. 



BT W. M. 0HABTEB6, M. D., RBTIBING PSSBIBENT. 
SftTBiiiuih : Bepnblicaa Book and Job Ofloe, IM9. 



Dr. Charters, in speaking of education generally, after attempting 
to show that the present systems of education are inadequate to the 
demands of a civilization in all other respects so greatly advanced, 
proceeds to consider the subject, '^chiefly in its relation to our own 
profession." Dr. C. believes that the most important deficiency in the 
preparatory education of young men desiring to enter the medical pro- 
fession, lies in the direction of natural science. To remedy this, the 
prominent place should be given to science which has so long been 
occupied by classical literature. "Mathematics being taught along 
with, and as an adjunct to, the natural sciences ; the classics being, by 
no means, denied the full amount of attention in the course of study 
to which they have a legitimate claim.'' 

No one will doubt the correctness of the position held in this 
address, that a preliminary examination should \>e instituted in every 
case, in order to determine whether the UHmtd-he doctor possesses the 
amoiuit of knowledge necessary in order to begin tiie study of medi« 
cine intelligently. 

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BBS WXSTXBN JOOBMAL OF MSDIOINX. 

CONSTITUTION AND BY-LAWS OF THE MEDICAL SOCI- 
ETY OF THE CITY OF WHEELING AND COUNTY OF 
OHIO, INSTITUTED OCTOBER 17, 1869. 



Wheeling : W. J. Johnfon» Book and Job Printer, Ko. 32 Monroe Street, UM. 



The constitution prescribes that the Society shall hold monUilj 
meetings, and these, we are sure, will be interesting and valuable to 
the members, if the provisions of the constitution and by-laws are car- 
ried out. The fee-bill adopted by the Society is also presented. 

The Society makes a distinction between ministers, and very prop- 
erly, we think, decides not to dead-head them all alike. The members 
will attend gratuitously, " such ministers as have a stated charge and 
are dependent on their salary for support, but in no case will thej do 
so where ministers have means of living ontside of their profession, or 
in any way countenance quackery." J. R. W. 



THE STRUCTURAL LESIONS OF THE SKIN— THEIR PA- 
THOLOGY AND TREATMENT— ILLUSTRATED. 



BT HOWARD F. DAMON, A. M. M. D., 

FeUow of the MMMchneette Medical Socie^, etc., «tc. PhiUdelphU : J. B. Uppincott M Co.,iea. 



This is a beautiful volume of two hundred and fifty-lEive pagos^ 
printed in large, clear type, on tinted paper, and is intended as a brief 
exposition of a large and important class of cutaneous diseases, and 
as such, it will undoubtedly be of practical advantage to the student 
aad physician. 

According to Dr. Damon, " the structural lesions of the skin coa- 
sist in hypertrophy, atrophy, and pathological new formations," and 
the usual form in which these alterations are produced is, first tlie 
nutrition of the part is affected, then the functions, and finally, tlio 
structure. In the first class are placed the diseases that are the result 
of "a slight excess in the nutrition of the skin," among whiok are 
oallositas, or callus, cutaneous horns, ichthyosb, warts, condylomali, 
weas, n»vi, etc. In the second, those depending on "a deficiency in 
the*growth or a part or the whole of the tissues of this membrane,'' u 
linear atrophy, alopecia, albinism, leucopathia, etc.; and in the third, 



BIBUOCttAVKT. 809 

the pathologieal new-formations observed in the skin, as lupus, sole- 
remia, elepliantxasis, lipoma, epithelioma, etc. 

While the classification may be " in accordance with the prevail- 
ing ideas in cellular pathology,'* we are not sure that it is either the 
best or the most natural. 

The individual diseases are, usually, briefly and clearly described, 
and the treatment recommended, suoh aa is approved by the best 
authorities. 

Thirty-two pages at the end of the book are devoted to "brief 
historiea of human horns," from 1599 to 1869. Many interesting 
esses are reported. 

The bibliography of skin diseases, with which the volume closes, 
is valuable and complete. J. £. W. 



ADDRESS BEFORE THE BOYLE COUNTY MEDICAL SOCI- 
ETY OF THE STATE OF KENTUCKY, AT ITS THIRD 
ANNIVERSARY MEETING, HELD AT DANVILLE, KEN- 
TUCKY, JANUARY 5, 1869. 



BT JOHN D. JACKSON, H. B. 
foMifliMd \>r <xrd« •f *^ Soctoty. Looimrme : BeU A Ooi^ Printon, 1809. From the aiitlior. 



We think the Boyle County Medical Society acted wisely in order- 
ing this address to be printed, as it is creditable alike to its author 
and the Society. Dr. Jackson, addressing the members of the Society, 
^eavors to answer the questions: ''Have we by our organization, 
sdyantaged ourselyes beyond what would have been were we unorgan- 
iied? What is our present status compared with our past, and what 
are our prospects for the future?" A Uyely picture is painted of the 
condition of the profession in a locality where no organised medical 
aoeiety is in existence, which seems to show in strong contrast the 
benefits flowing from such an organization. The necessity of contin- 
ued labor, and the direction in which this labor is. most needed, in order 
to attain the highest excellence in our profession, is shown in forcible 
and well chosen words. 

If the Society is imbued by the spirit that animates the author of 
this address, it will certainly attain to the highest uae^lnesa possible 
to Boeh an aaaoeiatioB. 

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MISCELLANY. 



TBXACLS.--^(The subjoined is an eztvMt from a long article vitk 
the above title, fonnd in Good Words, December, 1868.) 

Much of late years has been done in what may be called the geol- 
ogy of language. Philologists have been diligently at work witii 
their hammers, splitting open dull and unpromising-looking blocks of 
words, and finding many curious fossils within them, that tell a tale of 
themselves as wonderful as any Ooioon or Oldhamia of the Laurentian 
or Pevonian formations. In some of the most fkmiliar terms they 
have found a mine of historical interest, bringing down to us the mem- 
ory of some obsolete custom or long forgotten incident. Among the 
most remarkable of the words derived from ancient languages, and 
now naturalised in our English tongue, which have brought with them 
some historical association or memorial, is the subject of my paper. 
The word treacle is derived from the Greek word therion, which meant, 
primarily, a wild beast of any kind, but was afterwards more especially 
applied to animals which had a venomous bite. By many Greek wri- 
ters, the term was used to denote a serpent or viper specifically. In 
this sense, it is employed in the last chapter of the Acts of the Apos- 
tles, where we are told that '^when Paul had gathered a bundle of 
sticks and laid them on the lire, there oame a viper out of the heat 
and fastened on his hand. And when the barbarians saw the venom- 
ous beast hang on hb hand, they said among themselves, No doubt 
this man is a murderer, whom, though he hath escaped the sea, yet 
vengeance suffereth not to live. And he shook off the beast into the 
fire and felt no harm." The Greek word translated '"beast" in the 
fourth and fifth verses, is therion; and though the word rendered 
'Wiper'' in the preceding verse is different, being echidna, it neverihe* 
less specialises the meaning of therion, and proves that it refers to this 
species of serpent. But what connection, it may well be asked, can 
there be between a viper and treacle? How came such a sweet sub- 
stance to have such a poisonous origin? Here comes in by way of 
explanation, one of those stranee superstitionB that were exceedingly 
common in ancient times, when little else but foolish marvels filled the 
pages of natural history. It was a popular belief in those days, that 
the bite of the viper could only he cured by the application to the 
wound of a pieoe of the viper's fiesh, or a decoction called vtper's «uie, 
or Venice treacle, made by boiling the flesh in some fluid or other* 
Galen, the celebrated physician of Pergamos, who lived in the second 
century, describes the custom as very prevalent in his time. AtJ 
Aquileia, under the patronage of the Emperor Marcus Aurelius, be^ 
prepared a system of pharmacy, which he published nader the naimi 



811 

ef Tieriaeaj in alhtnon to thn superstition. The naBM giren to the 
eztnordinary ^eotuarj of Tiper'a-fleah, was theriaki, from <^berton, a 
fiper. By the usual process of alteration whieh takes plaee in the 
eonrse of a few generations in wcMrds that are oommonly iised, theriahi 
beeame theriac. Then it was transformed into a diminntive ikeriacU^ 
afterwards triacle^ in which form it was used by Chancer; and finally 
it assumed its present mode of spelling as early as the time of Milton 
and Waller. It changed its meaning and application with its varions 
eluuiges of form, signifying first the confection of the viper's flesh 
applied to the wound inflicted by the viper's sting; then any antidote, 
whatever might be its nature, or whatever might be the origin of the 
evil it was intended to cure. Dr. Johnson, in the edition of his die- 
lioBaiy published in 1805, defines treacle as ^^a medicine made up of 
many ingredients," and quotes, in illustration of this definition, a sen- 
leiiee from Boyle : *' The physician that has observed the medicinal 
virtues of treacle, without knowing the nature of the sixty odd ingre- 
dients, may cure many patients with it;" and another from Fleger: 
^'Treacle-water has much of an acid in it." Afterwards, medical pre- 
•eriptioBS came to be prepared in some vehicle intended to cover their 
taste or disagreeable look; and this vehicle was generally 



«nne kind of sweet syrup or sugary confection, to which the name of 
trtOicU was applied. When the viscous stuff known as "molasses" was 
imported from the West Indies, it formed a welcome addition to the old 
buted list of vehicles for medicine. The tea-spoonful of honey or 
j«IIy used to take the taste out of the mouth, could not always be pro- 
cmed; but here was a cheap and efficient substitute that could be had 
11 every shop in the country. The tears and groans under which 
nany a household formerly suffered, were now quieted ; and the refrac- 
toij, unreasoning child, who dreaded the remedy more than the dis- 
ease, was made to look kindly on those formidable medicines, castor 
iQ, salts and senna, or rhubarb pills, and even to swallow them hur- 
riedly, when disguised in the syren sweetness of the syrup, or accom- 
fanied with a liberal dose by way of counteraction to i^iegoilL Hence, 
dtt molasses which came so opportunely to the aid of amicted human- 
ilfy was in gratitude designated by the time honored name of treacle; 
SM BO completely did it usurp the title, that very few are aware that 
a had ever any other meaning or application. 

Throughout our English literature, we find frequent allusions to 
teaele in this symbolical sense of an antidote against evil ; allusions 
which, without the foregoing explanation of the origin of the word, 
Wold he utterly unintelligible to the great majority of readers. In 
eae of the early editions of the English Bible, the familiar text in 
Icnmiah, "Is there no balm in Gilead?" is rendered, "Is there no 
teaele in Gilead?" Sir Thomas Moore has this expression, "A most 
rtnmg treacle against those venomous heresies." Cnaucer says of our 
Lord, "Christy which that is to every harm triacU;'^ and Lydgate, the 
"»onk of EbuxT," a poet whose writings are now all but forgotten, 
haa a kindred idea, which is expressed in these lines : 



(m 



< Vhciv fa BO ■ W W M pMTlloai In •harnMH, 
At wken it liath of IrMcIt* Uk«p«^^^ 



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US WBSTKRN jrmMMAh 4» MKDICINK. 

Waller wi<ote m poem oa the oeoMioo ef the netonittoii ef Cbmrim 
II, in whioh he speaks of the iBArrelous ohunge that would be oawied 
hy the event upon the yiews and conduct of the former enemies of hie 
rojal mastmr. He thus addresses the king: 

"OAnden now, the chlefevt, do begin 
To ttriTe for grace Mid expiate their ilii ; 
All wiode blow fliir that did the world embrofl, 
Toor vlpen *M«le ylold, and wcMpkmt oU.*' 

As if he had said in plain prose, that even those who had riain the 
king's father, had now repented of their sin and become loyal to the 
son, like vipers which had inflicted a painful wound, but now yielded 
by their flesh a medicine to heal it. Milton, too, who made everything 
subservient to his purpose, employed this curious old legend to point 
his language, for he speaks of "the sovran treacle of sound doctrine.*' 
Many other instances might be quoted ; but these are sufficient to show 
how familiar the early English writers were with the symbolical use of 
treacle, and how admirably they extracted the moral from the once 
popular superstition contained in it. 

The fundamental principle that gave origin to treacle, was one that 
Was extensively adopted and acted upon in ancient times. Simila ttmi?* 
ihuB curantur — "Like cures like" — ^was the motto of nearly all the 
medical practitioners from Oalen downwards. What were called gyvn- 
pathetic ointmentB, supposed to cure wounds if the weapon that inflicted 
them were smeared with them, without any application to the wounds 
themselves — were everywhere greatly in request. Prescriptions, as a 
rule, were founded upon some real or fancied resemblance between the 
remedy prescribed and the organ diseased — almost never upon its own 
inherent curative property. Lichens, which lead a mysterious mes- 
merized or suspended existence, and growing in curious situations 
where enchanters might weave their unhallowed spells, were favorite 
remedies for mysterious complaints. The lung-wort, a kind of lichen 
which grows in immense shaggy masses on trees and rocks in subal- 
pine woods, was highly recommended as an infallible cure for all dis- 
eases of the lungs, owing to the resemblance between its reticulated 
and lobed upper surface, of a greyish brown color, and these delicate 
human organs. Hundreds of similar instances might be given, in which 
the color and shape of a remedy ^as everything, apd its medicinal vir- 
tue nothing. The object, whether animal, vegetable, or mineral, that 
caused the disorder, contributed the proper medicament for its cure. 
In the writings of Paracelsus and Aldrovandus, who combined the 
study of alchemy and other occult sciences with that of medicine, we 
find constant reference to such nostrums; and numerous recipes are 
given for ointments, draughts, and applications made up according to 
this rule of the most extraordinary substances, which were sold for 
very large sums, and were said to have effected remarkable cures. In 
short, almost all the drugs of the medisdval pharmacopseia, were se- 
lected and administered entirely upon this principle of mutual simi- 
larity and disease. A perusal of the medical treatises of our ances- 
tors, leaves upon our minds a very decided impression of the power of 
the human imagination, and the strength of ^e human constitution, 

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18 well as quiokem our gratitade tliat we lire in times when treacle in 
gtnstk as treacle, and not as yiper's iesb, or aoAe abomination more 
diagvsting still. The only relic of the old superstition that surviTOS 
now, may be recognijEcd in the well known advice frequently giyen by 
tibe seaaoned topers to those who are snfTering from the effects of their 
first drunken excess, **Take a hair of the dog that bit you." 

Th3B O. M, Sooibtt of Bkllbvttb Hospital College. — ^The nu- 
merous members of this society throughout the country will be pleased 
to learn that the last annual reunion, held on Uie 26th of February, 
was more than usually brilliant and successful. The addresses were 
peculiarly appropriate to the occasion, and were received wHh marked 
satisfaction by the audience. We give below Professor Elliott's re- 
ply to the toast of ^^ Woman," which strikes us as a peculiarly happy 
handling of so delicate a subject : 

A Bineere friend said to me to-day: "My dear fellow, I hear that jon are to re- 
spond for the ladies this ereniiig. Ton hare my sympathy/' I thanked him, and 
acknowledged that I needed it; and so do I confess, confidentially, to yon all, that 
I bare need of yonrs, and especially now when my friend Sayre has included my 
tMBt with his own in his comprehensive gfraap. 

It is a serious thing to speak for woman just when she is about to break that 
loDg silence which has distingrnshed her through the lapse of ages, and to speak for 
kenel£ Let us hope that, if she bring to future diseussions the terrible earnestness 
sad directness of purpose which she displayed in the apple question, at least she will 
select topics less fraught with woe to man. 

Perhaps this may be one of the last toasts to woman to which a man may re- 
spond. The time may be at hand when this is to be superseded by one which will 
eren now, we trust, cause their veins to tingle, and when we may hear, in soft, 
melodioQS cadence, from the lips of beauty — "The gentlemen, God bless them ! " 

With woman arguing metaphysics in the palpit^ managing political minorities, 
direetmg the pcess, and wielding the scalpel in sick-rooms there is but a step to the 
remaining fields of labor, and there may be some girlish fiice here present, covered 
only with mantling blushes, which may groove its fhrrows amid the responsibilities 
of the senate chamber, or in expounding the mi^esty of the law. 

Who shall paint the dawn of this era, so fttU of the fruition of woman's joys 
and privileges? The palette of another Guido must frirnish the brilliant colors. 
StOl Aurora, with rosy-tipped fingers, will marshal the procession; still the femi- 
niae eocirdittg hours will keep their aocustomed places, but the male Apollo will 
he hailed from the central place of honor, and some bright eyed goddm, typical of 
woman's future, will seize the reins with no reluctant hand. Love will reign sur 
preme. A new miUenium will shed its ben^nant rays upon the land. Man, shorn 
of his supremacy, and abnegating even claims to military distinction, will still, we 
trust, bask in the sunshine of woman's favor, and wish that all the Yenuses shall 
enjoy the rights and privileges of Mart. 

With such a ftitaxe, well may a man shrink from responding to-night to such 
a toasL Bnt I am here with a herald's privilegeS| though net in a hexald's garb. 



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81# WBRVRir JMWIAI. W. lODKSVK. 

I flin in a repreBentatiTe capadty; I qieak for my constitneiitf. Foot ^iuidrt4 
nanly heartSi not satisfied with hearing me lecture on woman for fiye or six moothi, 
demand a final word before we pari. Ladies, I preeent these four hundred hearts 
for yonr most distingoished consideration. Fonr hundred, did I say? Jost as in 
that suffrage, soon to be aboliidied by woman, the male Toter deposits a ballot that 
represents the united wishes and conyictions of himself and wifo, and daaghteia, sd 
do these four hundred hearts hare each fonr separate pulsating chambers, throbbing 
so harmoniously now that methinks you must aU be able to hear them. And so, 
instead of fonr hundred, do I preeent sixteen hundred palpitating caadidatea fv 
faror. 

What aspirations does my feeble advocacy present! What longings for honti 
and firesides avaiinterlinked with these emotions I What delicious courtships, what 
rapt elysium of engagements, what calm enduring matrimonial joys do these long' 
ings prefigure! Let us hope that four hundred girlish hearts awaken in hastening 
rhythm to respond to the tumultuous beatings of my constituents. 

What matters the language in which these longings are conreyed ? What mat- 
ters the man who presents them 7 Doremus brings from the mystic arcana of bis 
labratory a long black wire to meet another long black wire. Who can foretell the 
wondrous result? At once, on meeting, an Intense flame starts into being, in which 
solid bars of iron melt in fenrent heat and illumine the hall with lurid ^are aad 
iridescent sparkles. Why may I not do as well as a long piece of black wire— I, 
who bring into this arena the concentrated heat of four hundred manly hearts ? The 
result will not astonish the world, but will sparkle in separate matrimonial para- 
graphs in the daily papers, and light up many a happy home. For the enduring com- 
fort of these happy homes, I must say that, although my four hundred have no Tenny* 
son to hymn their praises in stately stanzas, yet, in the simplest and sternest prose 
do I declare that the immortal six hundred at Balaklava never charged as my four 
hundred will.— iVew York Medical Journal^ April, 1869. 



EDITORIAL AND MEDICAL NEWS. 



*Ons of th£ ablest contributors to the Western Journal of Medi- 
cinty appears in a new role. He is to be congratalated upon haTiiig 
won an honorable prise; but still more, upon haying written aa easaj 
well deserving such recognition. 

Within a few days, we have been reading a review in a French 
journal of Thes^ Prtentia et Soutenne$ au Ooncour$ dCAgreation pour 
la Midectne^ en 1868-^, in which the writer, referring to their authors 

«TlM part taken b7llatiir9aDdIlmai& tbeOaraolDiMaaM. A4ifltertatloaftrvhi^ aSriw 
was awarded to Jamoa F. Hibberd, M. D., bj tbe MaaaachoMttB Mwlical Society. Boston : Darid 
Glapp k Sod, Mi Wadiington Street, ISSS. 



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ia>ITOBIAL AND MKDIOAL NIWS. 815 

in general terms, sa js : Youtbliil in years, yontbfVil in scientific ardor, 
the candidates d Yagr^gation represent, in a degree almost extreme, 
the tendencies of their times. And thns it seems to ns in reference 
to Br. Hibberd's essay — it represents the tendencies of our epoch; 
nay, it is more than a sign of the course toward which the advance 
guard of Medicine is moying, more than a piece of drift-wood upon 
the current of medical progress — it moves with that guard, it oon- 
tributes to that current. Greater praise we could not bestow; loss 
would fall below desert. 

And now, while admitting, as all must, the inevitable tendencies of 
this age of Medicine — ^whether we lament or rejoice, whether we en- 
deavor to promote or to retard such tendencies — ^we give ourselvaa 
briefly to some particular observations upon this essay. On many 
points, we shall be fully in accord with its esteemed author; in regard 
to others, we shall entirely dissent from his views. 

In the first place, we object to the introduction of Time as one 
id the factors in the cure of disease. He seems to make of it an 
entity, a positive force quite as much as any of those that have 
thns considered disease. What is time? Simply measured duration. 
Daring its flow certain events can transpire, certain processes be com* 
pleted; but per se it has nothing to do with such events or processes — 
DO more to do in itself with the recovery of a man f^om rheumatism 
in six weeks, than with the hatching of a hen's egg in three weeks, 
no more to do with either than with the Declaration of Independenoe 
on the 4th of July, 1776. The Cunard Steamer which takes our friend 
to Europe, will require a certain number of days in which to cross the 
Atlantic ; but those days simply constitute a period during which the 
mighty power of steam, guided by the genius of man, can do a certain 
work. A boy learns a lesson in an hour, but the hour has no influenoe 
upon his mental processes. We would not esteem it a judicious title 
for a thesis upon the action of aloes — Aloe9 and Time as a Caiha/r- 
fCe. We would rather have written the title of Dr. K.'s Essay, Nature 
m the Cure, Time for th« Cure of Disease. 

One thought in reference to the etymology of the word ewre — h 
word so often upon our lips that we sometimes forget its true meaning. 
One who enret, simply takes care of his patient. Cure is from curo^ 
to take care of, to see to, to look after, etc. 

On page eight of the essay, we read, "when a surgeon has distorted 
embers Cf^ the body to restore, nature and time must be his chief 

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316 WBSnBV JOUBITAL OF XXDICDTS. 

retianoe, and his appliances, whatever tbey may be, only serve to guide 
and enconrage the physiological forces." As Tennyson sings — 

*• Wlwt drag can make 
The withered paIbj oetM to fhake T " 

So we ask, what amount of physiological forces will restore a limb 
flexed from anchylosis? Here we beg leave to claim that a Stxou- 
eyer's screw or gam elastic bands are worth more than natare. So too, 
the cicatrices from burns, causing deformity and hindering the usefol* 
ness of a member, frequently may be removed, and healthy integn* 
ments placed upon the denuded sxirface. Here the surgeon's art is of 
primary importance — ^nature and time but secondary, only capable of 
accomplishing what he gives them the opportunity of doing. 

It dees seem to us, and we say this with becoming hesitation, for 
we freely concede Dr. Hibberd's superior ability, he pushes his views 
too far, makes too wide, too universal a generalisation as to the reepeo* 
live parts taken by nature and art in the cure of disease. When he 
lays it down as a universal law, that a pathological stimulant beiqg 
withdrawn pathological activity ceases, does he not go too far? Has 
every case of conjunctivitis subsided uposi the removal of the foreign 
body, for example, whioh ex<uted it? Nay, may not some such cas^ go 
on to incurable blindness, without intelligent intervention? 

Our author asserts that ^'generally the cause of disease is unknown." 
True, undoubtedly, that we do not know the causes of very many dis- 
eases; but on the other hand, the physician daily sees cases of diseaee 
of which he does know the cause. For example, he meets with a ease 
of convulsions in a child, which he traces to indigestible food in the 
stomach or intestines; or again, a case of epilepsy dependent upon 
ohlorosis; or a case of cirrhosis resulting from the use of alooholie 
Uquors; or a case of menorrhagia from sexual excess, Ac, &6. Now, 
will the good dame Nature with her faithful attendant, Time, see to 
the removal of the offending matter from the child's gastro-intestinal 
^nal? She probably will iu five cases, but in the sixth the sufferer 
may die before the process is completed ; and the physician does wisely 
who administers what our firiend would call a perMtrbtUinff medieimej 
an emetic or a cathartic, under such circumstances. In €ttd second 
case, we remove the epilepsy by restoring the blood to its normal con^ 
dition. In the third, we interdict the use of the agent which has pro- 
duced the trouble, and endeavor to supplement at least a part of 
the hepatic function by ox-gall, et cei., and we at least prolong the 
patient's days. In addition to the removal of the cause in the fourth 



imoBiAL Ana m^mAh lonro. 117 



niaslmtton, we eadeaTor, botli by kygienie and tk6ni{>6«lao m«Mi0, Hb 
i^ange the excessiTe detenainatioB of blood toward the vtems aad 
oTariea. 

Dt. Hibberd'a remarks as to the ^xeatment of feTers, eipeoially «f 
tjplraa and of typkoid, will meet die keartj endoraement of erery 
oatelligent phyaieian. 

The same may be said, in tbe main, as to those in refereaoe to 
infiamatttion. Wken, however, he states that whm a part is inflamed^ 
we hace no pcwer to jug^drnte the dueoMe; aU tos eon do with mtdiea- 
fmaUM tif to ccmduct it fo a aq/e termimatiifm^ tkro^h a$n8Hnff a material 
froeag hy the aid of time, {IBbbaj, page 25), we beg leave to ask whether 
he has no faith in the oeeasional sooeess of theabordve treatment of gon- 
orrhoda, and whether cases of dysentery have not been cured by ipeeao^- 
aanha in two or three days, whioh, so far as opinion foonded upon the 
history of other cases presenting similar symptoms, wonld otherwisift 
have continued for one or two weeks ? We confess that we are not 
so deeply in the eclipse of medical faith that we could give other 
than afirmative answers to either of these questions, were they ad- 
dressed us. So too, in reference to pertusM — by some considered an 
iailammation — but whether regarded as a neurosis, or an inflammation, 
the power of belladonna to diminish its ordinary duration is main- 
tained by eminent authority. 

Dr. H. gives a London surgeon as the author of the "six weeks" 
preacription as the cure for rheumatism; but we believe the credit of 
Ihia is due the elder Warren. 

In that portion of the Essay relating to Materia Medica, we And 
much with which our own opinions are quite in accord. Especi- 
ally do we desire to commend all that the author says in reference 
to the influence of the mind in promoting the recovery of the sick. 

We are not sure that Pr. Hibberd is right in denying to Medicine 
any credit for the inoreaaed duration of human life; nor in founding 
an argument for the power of '^ Nature and Time " to cure, upon the 
large consumption of quack nostrums^ and proprietary medicines, the 
ammmers not only getting well but honestly believing their cure to be due 
to the use of the nostrums, for many of these consumers are not really 
sick — ^only imagine they are — while many others actually die uncured; 
and, finally^ we are quite willing to believe in some cases some of these 
•oatnuoa may have a positive therapeutic value. 

Did space permit, we should be glad to refer to other portions of 
this Bsaay. In general, we can speak of it as written with great abil- 



18 WVRSBW AMHAI. OF 



%; its author kaows right well A9 uiM of the Ba^irii laa^aggy 
iad presents his thoughts clearly sad foreibly. We wish his produs- 
tion could be placed in the hands of ererj physician who would ears- 
Mly read and ponder It; for to«uoh an one^ it would be a light to 
guide, a power to quicken and strengthen his thought and iavestiga- 
tion ; but in the hands of the lazy and the stupid, men who have not 
eonseerated their whole soul, with all its intelligent grasp, its deep 
sympathy, its Tiyid conscience to Medicine, who are mere tradesmen 
and money changen in its sacred temple, we can easily oonceiTe that 
the Essay may be wrested from its high purpose into an exouse for 
neglecting scientific study, and for trusting with a blind confidence in 
Nature and Time, while their patients are deceired with sham thera- 
peutics. 

It is but justice to Dr. Hibberd, jus^e, too, to our readers, to give 
his "Conclusion" and "Summary:" 

CoNCLUBioK — Let no one for a moment imagine that the views herein promul- 
gated have a tendency to undervalae the importance of Medicine in the manage- 
ment of disease, or detract one iota from the reeponsibility, the dignity, or the ose- 
AilnMB of the acoompUshed physician. 

If edicinea hare a positive power that can be, and should be, made available to 
assist nature in the removal of pathological stimalants, and in the arrest of patho- 
logical activity. No one doubts the power of ansesthetics to abolish sensibiiitj; of 
opiates to allay pain ; of aloes to evacuate the bowels ; of veratrnm to lessen the 
heart's action ,* or of quinia to arrest malarial periodic disease. All these, and manj 
more, are in constant demand for proper and prudent therapeutic purposes; and that 
all of them, not nutrients, and forcible enough to make an impression, ate patho- 
logical stimulants and of themselves an evil, militates nothing against their legiti- 
mate use, or their positive value. It only signalizes that a wise Judgment, a sound 
discretion, and a just discrimination should dictate and control their prescription, 
to the end that one evil should be brought into requisition voluntarily, only when 
it will, with certainty, assist to abate a greater evil. It is the training, the skill, 
the acumen, that is necessary to the exercise of a sound discretion and a wise judg- 
ment in the selection and administration of medtcinea, that distinguishes the good 
physician from the presumptuous pretender. One can not attain to this aocom- 
plishment without a clear and intelligent insight into biology, both normal and 
abnormal. 

While the faith is that medicine is paramount, and the rule under it is to give 
active remedies continually, and the perturbations which accompany their opera- 
tion, are deemed an essential and desirable service preliminary to improvement, 
almost any numbskull can claim to be a physiciaa and have the daim allowed bj 
the populace ; because they can not discriminfite between the naans and the reanlt 
in his practice, and in that of the eduoatod man of scieooe. Bat when an appn- 
cialive conception of what uatuie is doing and can aooompUsh, must precede the 



SmrOBIAL AND MBDIOAL MEWS. tl9 

\ of wist aid can and ahimld be rendtted faw, md bow and when, tka 
pRteader amrt stand back afaaahed, wbUa th« maa pioirerly trained and with nal 
knowledge, will sta^ forth in ail the glorj of a high priest of natnre, offering 
aeeeptable serrlce at her ahrine ; and all who witness his labor shall know tiiat it 
is good, and saj, well done. 

ScMMABT. — The prominent points presented in the foregoing dissertation, may 
be cflQmerated as follows : 

1. All vitalized matter is the subject of a law of development peculiar to its 

2. Tltal organizations ar^ not active per m, but are endowed with a capabiUtf 
sf aetivitjr under stimnlation. 

3. Normal stimnlants produce physiological activity or health; abnormal 
itiniolants produce pathological actiyity or disease. 

4. Human maladies are always the result of abnormal stimulants acting on 
the histological elements of the body. 

6. Disease in any part continues as long as the pathological stimulant is ope- 
nliTe; when this ceases, the part returns to ita physiological state. 

6. To care disease, it is only necessary to remove the stimulant exciting it 

7. This stimulant is rarely known, and still more rarely can it be removed. 

8. In most diseases, we only recognize the grosser symptoms, after the initial 
processes have completed their course. 

9. After the stage of recognition, most diseases must pursue their course 
ttnngh a series of phenomena under an inexorable biological law. 

10. The duty of the physician is to watch nature and assist her as opportu- 
Bty may offer, 

11. All perturbating medicines are themselves pathological stimulantS| and 
Aoald not be administered except under a certainty of abating a great evil. 

12. The present popular professional estimate of the medical virtues of drugs, 
rests mainly on the vicious logic of post hoe ergo propter hoe, 

13. That this estimate is erroneous, is proven by : 

a. Curable diseases are recovered from in the absence of all kinds of drugs. 
h, Onxable diseases are recovered from under the most diverse treatment. 
e. The adulteration of drugs makes tiieir strength uncertain. 
d. The state of the patient's mind makes the operation of even pure drugs 
iBccrtain. 

14. A recognition of the doctrine of the vie medieatrix natyrce, must underlie 
all rational therapeutics. 

15. The principle involved in this phrase has been recognized and deferred 
t% since the earliest historical era of medicine^ and is likely to be immortal, 

16. It derogates nothing from the physician, or tiie agents he ub««, that 
aatine is predominant, and art opiferous. 

Boston has a GrNiSCOLoaiCAL Sogzsty, Dr. Winslow Lewis being 
Preeidenty and Dr. Horatio E. Storcr, Secretary. One of our ootempo- 
laries, who will not publish the laudations that may be written him of 

Digitized by VjOOQ IC 



Zt§ wsMKir 4Qimuii«r 



Umself or of his •zeollant jovaai, 4oe» not kmtftte la Mftte ui kk 
paper thai he, the aforesaid editor, haa been eleeted a cerreepondiBg 
■tember of Uiie Society, and retarn hil^ thanks for the honor; but «e 
ooaiRBss we shrink from such public acknowledgment on our part. We 
are glad to chronicle the organisation of this Society, and we honestlj 
wish it useful success. Our Boston friends have done one good thing 
— settled the orthography of gynaecology — ^for the word flowing throngh 
a Qallic channel had lost its diphthong with many of our authors, and 
these wrote e instead <^ «. Now will Boston have the goodness to give 
us a pronunciation as it has an orthography of the word more in accord* 
anee with its etymology? Eren the poorest Grecian would be aston- 
ished to find, after declining j'uuTji, ft)nae*o^ etc,, that when an English 
word was formed from it, it became jinny ^ thus jinnycology^ he would 
be apt to declvM again. If anj of our readers point to the analogy 
between this word and gym»aKtic, we acknowledge the force of the 
reasoning, but suggest ikaJtt the two consonants immediately following 
the y iday change its quantity, and furthermore inquire what is to he 
done with gyrati&M — must the y be short there too? At any rate, we 
don't see why, with a christian tongue, when we take woman out of a 
heathen language we should make a jinny of her : 

Dr. Bishop, of Sheridan, New Tork, writes to the Medical amd 
Surgical Reporter, April 10th, the following in reference to the use of 
artenic in hemorrhoid*. Some of our readers will remember our first 
calling attention to this therapeutic value of arsenic, (^CincinnaH Jour- 
nal of Medicine), March, 1866 : 

" I will say for the benefit of the RtpwrUr, that I have tried the above reaedjr 
in twenty cases of piles, and in not a single case have I been disappointed in remor- 
Ing the difiSculty. The dose, of course, is to be varied to suit the age and const!- 
taUon of the patient. I hope physicians will try it" 

Db. T. W. Bblcher, of Dublin, well known to the profession as a 

dermatologist, is about entering the Episcopal ministry. 

Mr. James, of Exeter, England, died on the 17th of March last. 

He had been a most able and industrious contributor to surgical litera- 
ture, and was quite advanced in years. 

BoBLEY DuNOLiBON, emeritus professor in Jefferson College, died 
on the Ist of April. Professor Dunglison was in his seventy-secoiMl 

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Tbb wdLUBmn^ Amge» kaT» roocntty imksn pkee m tke Meiioftl 
Oollege of Obio. Prof. M . B. Wrigkl^ who tkntj years ago waa fint 
called to a eliair in the College, and whose name is a household word 
n ohatetries, with the profeaaion of the West, has resigned the profes* 
sotship of ohBtetrieSy and has been appointed ** Emeritus Professor, 
aad Clinioal Leotnrer on Obatetries and Diseases of Women/' Prof. 
Oomegys retires from the chair of "Institotes/* and accepts that of 
"'Clinieal Medicine." A professorship of "Physiology" is substituted 
for ^Institntes," and Dr. Edward Bires is appointed to it. Dr. B. is 
the Bom of one whose name is faniliar to many of the older graduates 
«f tiie School, to whose instruction they had the pleasure of listening 
Imig years ago, Prof L. Bires, and has himself lectured with great 
acceptance during the past winter, in the Dental College, Cincinnati, 
We anticipate for him in his new field of labor, eminent success and 
useMness. The chairs of "Obstetrics," and of the "Medical and Sur- 
gical Diseaaes of Women," hare been consolidated, and the reeent 
iaeombent of the latter been selected to fill this new position. Dr. 
James T. Whittaker, whose letters from Europe our subscribers read 
with so much interest, and whom w^ regard as one of the ablest young 
men it has eyer been our good fortune to meet in the profession, will 
be hi0 assistant. Dr. Whittaker, we wish to say in addition, has talent, 
Iraming, industry and sterling principle, and will one day, if his life 
is spared, be known wherever Medicine is known. 

De. Lionel S. Bbalb has resigned his chair — ^Physiology and Pa- 
thology — in King's College. It is almost as remarkable that he should 
retire from ihm poeition when still in the vigor and prime of his days 
— for if we are not greatly mistaken, he is but about forty years of age 
-Hw that he was called to it when but twenty-four years of age. Few 
men, at even three-score years and ten, have done more for medical 
science than has Dr. Beale, and we trust that his work as a teacher, 
by no means terminates with the termination of his connection with 
King's College. 

M. YoisiN has observed several forms of eruption to follow the ad* 
mimiatration of bromide of potassinm. They have been, acne; large, 
indolent, and painfbl pustules; an eruption resembling that of urtica- 
ria or erythema nodoeum ; pnnetes; andeciena. He describee the first 
two with great care, as having oheracteristie symptoms and appear- 
ances — British Medical JoumaL ^ y 

Digitized by VjOOQ IC 



VKt VWfMHll JOVMAL OF MMIIUIMM. 

M. MATTKt, Acadimie de Mideeiney read a paper upon tiie aman af 
urinary retention after confinement To the two oanaes genendl j recog- 
nized, Tie: The swelling of the urethra, conseqae&t upon contnsioii, 
and yesical atony, the author added a third, the abrupt ahortening of 
the urethra; and he thus explains the occurrence of thia cause of re- 
tention : During the last months of pregnancy, the bladder being drawn 
up with the uterus, the urethra is elongated, while after aocouchemeiit, 
the uterus at once descending, the urethral canal must become shorter 
by tortuous and irregular folding upon itself — ^thenee the retentioB of 
urine. It is difficult to always prevent this accident; however, from 
fifteen to thirty grains of ergot, given after accouchement, will aug- 
ment the vesical as well as the uterine retraction. When catheteriaai 
is necessary, always permit the instrument to follow the temporary 
tortuosities of the canal. — Arch, (?^., April, 1869, 

H. PKasoNNB, before the same body, as we learn from the ArchiKi, 
proposes oil of turpentine as an antidote for phosphorous. From ex-* 
periments upon animals, he was convinced of the efficacy of this remedy 
when taken immediately or very soon after the ingestion of the poiaon. 
He says phosphorous does not exert its toxic power until abeorbed; 
then by depriving the blood of its oxygen, it prevents haematoeis. 
The oil of turpentine prevents phosphorus from burning in the eooBomy 
in the same manner as it prevents its combustion in the air at the ordi- 
nary temperature. 

Now, this may be a valuable discovery; but we almost think it a 
pity that the poor woman, whose case is recounted below, as we find it 
one of our English exchanges, and who met with a punishment in kind, 
though not in degree, similar to that of the eagle which stole meat 
firom the altar of the gods, did not know it — ^she might have taken a 
bottle of turpentine, and thus kept her phosphorous andher body intaei: 

"An elderly widow, while waiting in the surgery of Mr. Leslie, at Nine Bins, 
stole a piece of phosphorous from a bottle and placed it in her pocket. It ignitod 
and burnt her so badly in the side that, by the adtice of a surgeon, she was oob- 
reyed to the nearest hospital.'' 

Maurice H. Collis, Surgeon to the Meath Hospital, Dublin^ Am 
author of a valuable work upon Cancer and Tumors, died a few weeks 
nnee firom pyaemic poisoning consequent upon a slight snatch recelTad 
by him whilst removing an upper jaw in the operating theater of kk 
hospital. Mr. Collis was in his forty-fifth year. 

..yitized by Google 



AJSD JBDiOAL MWMMt 



Pbof. BowLme, of the NathmihJ^wmal, whoee intelligeAt d»TO* 
tini to Medioine no one ^an question, ejtpresaea himself thus as to the 
""Ohio Doctor Later' 

* What medieine can aot do for itself wlH go undone. Iverj now and then an 
idiBitusle doetor finds himself out of piactice and ta a Legislature; and fteling 
Mi of plaosi and that his former brethren will think so, oondodes to 'bring in a 
liiU' to * derate' the profession he has abandoned, so that his old friends maj see 
tlat he is 'still working for them,' and who ought to continue to think well of 
him. Our Legislature here in Tennessee has done many queer things, but it has 
kt the teamed professions alone to take care of themselves. When did law erer 
bnefit religion? It has been hammering on it many centuries — for about eighteen 
iMudred years — and the more it hammered the worse it made the job. ]^inally, the 
GoTeniment of the United States was made by a people wise enough to see this, 
ad they said in ihdr government religion shouldn't be hammered at all by politi- 
eim, bat that as the people were dviUy free tJiey should be religiously free, and so 
tUs Government started, to the astonishment of all christendonk 

*^i8 Ohio law that so tickles many of the Ohio doctors, Georgia enacted a long 
taie ago — every practitioner should be a graduate. Immediately all sorts of Trus- 
tea to all sorts of Institntions were chartered, who made all sorts of faculties, and 
dipIoBSB were as plenty as old dothes in slop-shops, and about as good and as 
cheap. Regular medicine received a blow by that law that it will never recover 
ftoB in that State. The law made all sorts of quackery not only legal but re* 
^cctaUe— respectable like liquor shops— becanse sanctioned and protected by law I 

"One fellow opened a college there, and filled all the professorships himself; held 
munencements opened by prayer, and dosed by benediction in the most fashionably 
Woved style. The £^duated were 'charged' to the brim 'upon that occasion,' 
od bore away their diplomas in triumph. It is devoutly to be wished that here* 
■ficr, ihoiild any legislative M. D. essay to tinker with the profession of medicinsi 
thit he would take a fit — ^to the dismay and utter consternation of his 'fellow- 
arraats' of the 'people.' " 

Db. a. G. White, of Springfield, Tennessee, (Richmond and Lou- 
ttnZZe Medical Journal^ ^P'^)> mentions the case of a negress, thirty- 
bv yean of age, who has given birth to twentj-fonr children. 

Ths Leqislature of Minnesota passed a law, March 4th, deter- 
■iniiig the qnalifications of those who are permitted to engage in med- 
ieai or sni^cal practice in that State. The law is, in some respects, 
ta improyement upon, while in the main, similar to the Ohio law. 
lUa whole question of medieal legisUtion has not, as yet, been so 
thoroughly canvassed in our State societies and in our journals, that 
Ae profession have arrived at any community of opinion as to what 
ssrt, if any, legislation would be both just and practicable. Only the 
sther day, we read in one of our foreign exchanges of a fellow in New 



324 wmmm smmMSL ov 

Zealand, oaUing bimself a hoBMeopalliio doctor in entile of a diploma 
conferred upon bim in ahtentiSL^ by a Pbiladelpbia bomoBopatbic sohool, 
tbrougb a London agent of tbe diploma-pedlars, for tbe trifling eon- 
aideration of fifty pounds, wbo wis anreated and fined ten pooada and 
eo0t8, for practicing witbont "being duly qualified and regiaterad." 
Now, a general medical law for tbe United States, wbicb would be as 
stringent as tbis wbicb prevails in a British colony, would be a great 
blessing to tbe people and to tbe profession. 

An Ohio correspoDdent makes tbe following suggestion: Allow 
me to suggest to your subscribers tbat tbey can bind, and tbereby pre* 
serve their medical journals, witb no expense and but little trouble, by 
procuring from a tinner strips of tbin brass or copper, (tin is too brit- 
tle), about six incbes long by one-fourtb of an incb wide, tben bend- 
ing it double so as to make a shoulder in tbe middle, tbe two «Bda 
meeting; tben with the pointed blade of your knife punch two boles 
tbrougb tbe journal, one near the upper and one near tbe lower mar- 
gin, pass a strip tbrougb each hole; then on the receipt of every jour- 
nal, attach it to those already accumulated, turning down tbe enda of 
the strips each time, until the end of the year, when tbe enda of tbe 
strips can easily be fastened. A volume will thus have been preserved 
— ^not neat, but in a form handy for reference and as replete witb good 
practical suggestions as any of tbe standard octavos. For fifteen years 
past, I have thus preserved all my medical periodicals, and I find tbia 
part of my library quite as useful and more interesting than any otkcr, 

James Wardrop, Esq., F. R. S., who died in London last Febru- 
ary, in his eighty-seventh year, won bis first professional fame as an 
oculist; but will be especially remembered as having, in a work on 
aneurism, proposed trying the artery on tbe distal side of tbe aneuris- 
mal tumor, and having successftilly carried tbis into practice : Proft 
Valentine Mott, so states tbe British Medical Journal^ said tbat ibis 
improvement had conferred on Wardrop the highest honor and the 
most lasting fame. 

Dr. Alexander H. Stetxns, one of the most eminent of Ameri- 
can physicians, wbo died in New Tork on tbe 30tb of last Ma^rii|*^ 
was eighty years of age. 

A U^icXL Journal, we learn from the Michigan University Jtf^y- 
omney will probably be established by the Faculty of tbe Medical De- 
partment of the University. r^^^^T^ 

"^ ^ Digitized by LjOOgle 



*WllOnA.L AIQ^ JWUMOAL 1IX1V9. 

I^lougsd ANtTBiA. — Cases of sappression of the uriaarj secre- 
tioo, as in eholera, persislang for weeks and months, are not frequent, 
tad their raritf equals their gra^itj. 

A woman of twenty-seyen years of age, nuirried, but childless, after 
fire months' suffering from amenorrhoea and leucorrhcea, consulted Dr. 
QaUina, becsmse she had not passed urine for twenty-four hours. Ca* 
Uieterism only yielded a few drops of ooffse-eolored liquid, and for 
the sueeeedixig eight days no more of it appeared. Applications of 
keehes to the perineum, nitrate of urea internally, and warm baths 
iwe administered up to the twenty-fifth day. No effect having been 
piodueed, the patient consulted Dr. Albertini, at the Milan Hospital, 
lAe, after two hours' minute examination, fownd absolutely no lesion 
to explain this failure of secretion, nor any alteration resulting from 
it Her general health had suffered in no respect. Prof. Kodolph 
hstng called into consultation, considered that the suppression was due 
to amenorrhces. Emmenagogues were administered, and the menses 
ifpeared. At the same time, six hundred grammes of urine were 
tttneted by catheterism on the fbrty-third day, and the normal secre- 
tion became established without the least injury to health. — Gazette 
MUUale de Lombardia. 

YiYisoKmoif. — ^The subject of rivisection has again been brought 
en the Umis, owing to some remarks made by Prof Bernard, in the 
fovrih of his present course of lectures at the Goll^ de France. In 
tliis, after pointing out the requirements of a properly conducted 
Khool of pnysiology, and after snowing how well those requirements 
tie fulfill^ in Kuhne's kboratorr at Amsterdam, and Ludwig's in 
Ld^sic, in each of which, admirable arrangements are made for viyi- 
aeetion, physiological chemistry, and histology, he goes on to remark 
tkat, as we can not adopt the plan of the physicians of the time of 
Henry II — ^who when the King had received his death-blow in the eye 
from the lance of Montmorency, coolly performed the same experiment 
on four convicts who had committed capital crimes, and were thus 
Mabled to study the effects at their leisure— we must impress animals 
iato our service, am<nigst whieh dogs, rabbits and f^gs, are the most 
STiikble. He admits on one occasion having operated on an ape, 
hit never repeated the experiment, the cries and gestures of the ani- 
■al too closely resembling those of man. As the Fall Mall Oa- 
tetk remarks, M. G. Bernard expatiates on this subject with a com- 
plaeency which reminds us of Peter the Great, who wishing, while at 
Stockholm, to see the wheel in action, quietly offered one of his suite 
as the patient to be broken on it. Our owif opinion has long been 
Bade xii^ on the point. We consider vivisection constitutes a legiti- 
nate mode of inquiry, when it is adopted to obtain a satisfactory solu- 
tion of a question that has been fairly discussed, and can be solved by 
ao other means; but even then it should be conducted with as little 
paua to ihe am&al as it is possible to infiiot, and the cases are rare 
where chlovoiponn Mn not h^ employed, at least for the first incisions. 

We hold, th&t for the mere purpose of curiosity, or to exhibit to a 
ckfls what may be rendered equally, if not far more, intelligible by 



^iyiiiz.cu uy ■ 



3M wimniBN joitmial of Msmoiiis. 

diagrams, ot may be asoertained by aatronomieal investigation or indnc* 

tijOD, Tivisection is wholly indefensible, and is alike alien to the feelings 
and humanity of the christian, the gentleman, and the physician. — Lan- 
cety April 10th, 1869. 

Crsasotb in Typhoid Fsvsr. — M. P^eholier, of Montpellier, has 
been condncting a series of interesting researches on the action of oie« 
asote in typhoid fever. Conceiving the disease to be one, toHut Bub- 
itantuBy depending on certain changes in the blood caused by the action 
of an organised ferment which £raws from the blood the materiak 
necessary for its nutrition, and exhales those thrown off by its decom- 
position, M. Pecholier has been led to employ creaaote as an antifer- 
mentive agent. Sixty patients, at the Hdpital St. Sloi, were chosen 
as the subjects of the experiment. Every day, a draught, contain- 
ing three drops of creasote, two of essence of linie, ninety grammes 
of water, aad thirty grammes of orange-flower water, was administered 
to the patients. At the same time enemata were given-, containing from 
three to five drops of creasote. M. P^holier states, as the result of 
his experiments, that creasote employed in weak doses, either in 
draughts, injections, or in the form of vapor, at the ontset of typhoid 
fever, acts powerfully in diminishing the intensity of the disease, and 
shortening its duration. M. P^holier adds, that the employment of 
the remedy as a prophylactic agent in schools, garrisona, hospitals, fto^ 
during epidemics, would be of extreme efficacy. — Xonee^ April, 1869. 

Oua Indiana readers will please remember the annual meeting of 
the State Medical Society, on Tuesday, the 18ih of May. We hope to 
see a larger gathering than ever of the men who love truth, and science, 
and humanity. Let the profession of the State make it their Society, 
and worthy of them. 

Fob Sals. — An order for an artificial limb. 

LOCATION FOR SALE 

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IndiMM OeBtral Bidlwaj. 



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COMFORTABLE ONE STORY FRAME HOUSE OP SIX ROOMS, 

OELLAM ASD OFFiCM ATTAOamD, 

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AtfBere, cood pay, good prices. Baaaoa for eeHiag, gateg ^reet. Ttnm, eirt^ Woold exchtte* 
for wild land m Iowa. Addreea, 

DR. J. LEWIS, 

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THE WESTERN JOURNAL OF MEDICINE, 

(^ormeHlsr, "Cikoiwkati Joubkal of IfoDiciNS.") 



Am it will 1»6 teen that if man has pawioni which impel him to the destraction of man, If 
htht Noilly animal who, deepising his natural means of attack and defmce, has devised new 
MBiof destraetlon, he Is also the only animal whe has the desire, or the power, to reliere the 
nfetiacsor his Allow citizens, and in whom the co-existence of reason and beneTolenoe attests 
•Mnl ss well as an intellectnal snperiority.— Gbatm* Guvigai* Mssicxm. 



Vol IV. INDIANAPOLIS, JUNE, 1869. No. VL 



ON OBSTINATE HICCOUGH. 



BT J. W. MOORMAN, M. D., HARBIN8BUK0, KY. 



Hioeongb, thongli always yiewed as amere symptom, wonld seem 
tokaTe as mncli right to a separate consideration as many other affec- 
tioiis of a symptomatic nature. 

Stills, in his justly celebrated work on Materia Medica, says : 

*^3iea^, it is well known, is sometimes exceeding obstinate, and cases of its 
fild termination hare been recorded." 

Within the past few years, several cases of severe hiccough, inde- 
pendent of any other affection, save the disordered state of the nerv- 
ott system, which is part and parcel of the affection, have cottie under 
My notice. 

By some mishap, the full notes of the cases have been mislaid or 
led, and I will be compelled to draw on my memory for the facts in 
tie single case which I shall report. 

Miss £ , aged about twenty years, of weakly habit and of nerv- 

ou temperament, rather anemic, had been suffering with menstrual 
derangement, from which, however, she had been free for about six 
weeks. Her appetite had been poor for some time, and the bowels 
were habitually constipated. 

Some time in July, of 1866, 1 was called to see her, and found her 

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WXSTX&N JOTTENAL OV UEDICINS. 

MccongbiiiK continually at the rate of fifty -six to the minute. The 
continuous diaphragmatic action interfered materially with respiration; 
the catamenial discharge had been natural in quantity and quality 
two weeks before ; the pulse was irregular, weak and soft — eighty to 
ninety to the minute; tongue moist and flabby, indicative of anemia; 
no appetite; thirst continued; the quantity of any liquid swallowed 
was small, owing to the violent regurgitant action of the hiccough; 
skin moist and cool; extremities below natural temperature; slight 
nausea; bowels constipated for several days past. Ordered 

R. RheiPnlv. 

Bxt. Colocynth Conip. aa grs. r. 

To be given every fourth hour until bowels were moved freely. 
Eighteen hours afterward, her bowels not being moved, she was or- 
dered an enema, which brought away a copious stool of hardened 
fecal matter; no abatement of the hiccough; has had no sleep for 
forty -eight hours past. 

Ordered one-fifth grain morphia every two hours until rest wm 
obtained. For twelve hours she took the morphia as directed, and 
not inducing sleep, the dose was increased to one-third of a grain. 
On inquiry, I learned that heretofere she had been extremely suscepti- 
ble to the influence of opiates. The third dose after increasing pro- 
duced a kind of stupor, from which she was aroused by the slightest 
noise. The hiccough continued without abatement during the stupor. 
Almost the whole list of antispasmodics was tried, but availed nothing. 

On the fifth day, she complained of soreness over the epigastrium, 
and the hiccough caused intense pain. The tongue became dry and 
cracked in the centre and of a fiery red at tip and edges; stomach 
extremely irritable and would retain nothing; thirst was insatiable^ 
but liquids were retained no longer than it took to drink them ; they 
were not vomited, as there was no retching, but simply regurgitated in 
small quantities at each act of hiccough. Pressure over epigastrium 
caused much pain. Ordered blister to epigastrium, four by six inches, 
to be dressed with morphia and kept open for several days. Ice to he 
swallowed in small lumps ad libitum^ and a simple enema every third 
day, to remove any accumulation of fecal matter. 

On' the seventh day, the hiccough was reduced thirty-seven to 
forty per minute; and from the ninth to the eleventh, there was an 
intermission of twenty-four hours, during which time she rested well, 
sleep being sound and refreshing. The tongue again became mobt; 

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OBMIKATS HiaOQU«H« 

8DTeiiefl0 disappeared from the epigastrium to some extent, and the 
thirst was maeh more tolerable. 

After an intermission of twenty-four hours, the hiccough returned 
fiftj-six to the minute, and continued for four days without iniermis* 
aion. During this time, she took the following prescription: 

B. Asafoelidao, grs. zxz. 
Creuote, gtts. Ti. 
H. fU piL No. tL 

Sig. One to be giyen erery foarth hour. 

At same time, she took three grains sulphate quinine, three times 
daily. 

On the fifth day after commencing this treatment, and fifteenth from 
date of attack, the hiccough ceased, and did not recur again irith suf- 
ficient sererity to attract attention. 

She convalesced slowly, and is still very nervous. 

Subsequently, (summer of 1868), she had another attack of a ner- 
vous character. Being absent, I was not called to treat the case, and 
am not aware of its exact nature. 

She is now, (March, 1869), suffering with exophthalmic goitre, 
or Basedow's disease. 

The causes of idiopathic hiccough are very obscure, having their 
origin, undoubtedly, in the nervous system. 

Jones, (^JFkinctional Nervow Diiorders^ page 246), refers it to obscure 
nervous disorder, ^'such as is loosely called hfiterical^*^ and to mala- 
rial infection. Of the latter class, he cites a case recorded by Widal : 

**The patient was admitted at first, suifering under the consequence of cerebral 
congestion. Fire or six days after having committed excess in drinking, he was 
seized with violent hiccough, the 'incessant spasms of which compelled him to re* 
main in bed, and resisted all treatment by antispasmodics. The hiccough was so 
intense and noisy, that it was heard outside the hospital. The number of diaphrag- 
matic contractions reached fifty-five to the minute, and their energy was so great 
that all the muscles of the trunk participated in them. There was considerable 
dyspnoea, short inspirations, red face, whits tongue, loathing of all kinds of food, 
pulse small— eighty. 

"Opii gr. one-sixth, was given every two hours, and a blister to the epigas* 
trium was dressed with morphia, but no improvement ensued. The patient had no 
deep and his strength was fisiiling. At last, quinine in pretty full doses was given, 
which speedily put an end to the disorder, after it had lasted nineteen days." 

Jones (op, cit.') thinks the seat of the disorder central, but thinks 
it difficult to say precisely what nervous centre is affected; thinks 
it is about the origin of the fourth cervical nerve. Copland ascribes 



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If ssTBftir joxnaxAL of tmicncB. 

it io irritation of phrenic nerve. WilEami (PHneiple$ of Medieiney pag9 
126), ascribes it to irritation of the medulla oblongata. Bomberg denies 
that the phrenic nerve has any agency in producing it He thinks it is 
caused by reflex irritation originating in the alimentary canal, liver or 
uterus, but admits that it is sometimes caused by disorder of nervous 
centres. From my o^rn observations, I am inclined to think it origin- 
ates in disorder of the nervous centres ooBstiinting a true neuronsy 
while I can not doubt that many cases can be traced to the causes 
enumerated by Bomberg. 

As to the treatment of non-malarious cases, the various antispas- 
modics are of use; and of these, asafcetida and valerian have been of 
more service to me than any others. In mild cases, mental influence, 
as sudden fright or withdrawing the attention by interesting conversa* 
tion, may prove effectual. In the case reported as coming under my 
observation, swallowing pounded ice formed no unimportant part of the 
treatment. Every one is familiar with the domestic remedy so often 
prescribed— drink as much cold water as possible between inspirations. 
Cruveilhier mentions two cases treated successfully in this way. A 
more pleasant domestic remedy is a drachm of refined sugar in powder, 
to be swallowed at once. This is especially useful in hiccough, which 
infants are subject to ftom over-feeding, {StilU Mat. Med., volume I, 
page 352.) An ounce of sherry wine, taken without dilution, will 
sometimes put a stop to a troublesome hiccough. I have found this 
useful in hiccough occurring in inebriates while passing from under 
the influence of alcoholic liquor. It may not be amiss to state that 
stimulants were used in the case reported; principally, however, ethe- 
real, and although partially under the anesthetic influence of chloro- 
form, the hiccough was not abated. Jones cites a case cured by tak- 
ing three ounces of blood from the foot. He thinks we should mingle 
with our treatment as much of the ^^medicina mentis" as possible. 
Williams mentions hydrocyanic acid as a very efficacious remedy. 
Stille speaks of cajuput as a remedy of marked utility in some cases. 

In malarious cases the treatment is obvious. Stille speaks of such 
a case after resisting all ordinary methods of treatment, yielded to a 
dingle dose of twelve grains of quinine. 

Throughout the treatment, the mind of the patient should be 
diverted as much as possible from the contemplation of its ills. Even 
in bodily dijsorder, it is well known that the mind exercises much influ- 
ence for good or ill, and in cases where the whole nervous system is, 
as it were, uu^ti^ung, the influence is much more noticeable. 



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KABB OASE or HIPWXVXBT. 331 

Tlie idea is preyalent among tlie aneducated, that hiccougli us 
always a sign of approaching dissolution, and being communicated to 
the patient, will do much toward lengthening the case, which might 
erentuallj end in death from pure exhaustion. Such tattling busj- 
bodies should always be excluded from the sick chamber if possible. 

% 



RAKE CASE OF MIDWIFERY, IN WHICH THERE WAS PRO- 
TRUSION OF THE OS UTERI EXTERIOR TO THE VULVA, 
DURING LABOR, AND PREVIOUS TO PARTURITION. 



BT C. S. MU8CR07T, H. D., cmOIKNATI, OHIO. 



Was called this morning, January 2d, 1867, at seven o'clock, to 
see Mrs. S , aged thirty-five years, of nervous-sanguine temper- 
ament^ of active habits and general good health, in labor with her 
fourth child. 

The membranes had been spontaneously ruptured four days pre- 
fious, firom which time until ten o'clock last night, she had no pain 
of a serious character; but from then until I saw her, thought she 
was in active labor, and more decidedly so for the last three hours, 
having strong '' bearing down pains." She had been waited on during 
the night previous by a German midwife, who told me " the labor did 
not advance as it should on account of there being a good deal of 
swelling of the privates.'' Upon making an examination by the touch, 
ike statement of the midwife appeared to be correct, but on ifieeting 
an obstacle which seemed to be great swelling of the external and 
internal labia, had much difficulty in bringing my finger in contact 
with the head of the child. The head was low down in the pelvis and 
pressing firmly against the perineum, and I thought at this time was 
extruded entirely beyond the os uteri, as no part of it could be reached 
by the touch in any direction that I could detect. There was also 
present that puffy condition of the scalp of the child, forming a tumor, 
presenting itself at what appeared to be the orifice of the vagina. 
The swelling of the scalp was such as is frequently met with when the 
head of the child has been detained for a considerable time by rigidity 
of the external parts. 

Having at first fallen into the same error as the midwife in respect 
to the swelling externally, waited a sufficient length of time before 

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832 WESTERN JOVKNAL OV ICBDICtNE. 

making another examination, witli the expectation that strong expul- 
sive efforts would soon relieve the patient On making the second 
examination, no perceptible change could be noticed, although the 
pains were strong and frequent. This absence of change induced me 
to make a more thorough examination of the external organs, which 
I had at first thought to be an Unusually swollen condition of the 
njmphsB, so much so that the anterior portion protruded at least an 
inch or inch and a half through and beyond the external labia at the 
superior commissure, the protrusion becoming less on each side toward 
the posterior commissure, until it was quite natural at thi^ part. The 
protruded portion had a puckered feel so as to resemble a frill around 
the anterior part of the vulva, and was (edematous. Introducing the 
finger between what I had regarded the mucous fold of the internal 
and external labia, to my great astonishment the connecting tissue was 
wanting, and the finger passed readily between the puckered fold 
and external labia without resistance, far under the pubes, and vras 
easily carried round to the posterior commissure on either side, reveal- 
ing the true condition present, and that which I had at first supposed 
to be a swollen and oedematous state of the internal labia, was a pro- 
truded, puckered and oedematous os and cervix uteri, wedged firmly 
between the pubes and presenting head of the child, thus pressing, 
accommodating and retaining it so as to give it the exact feel of the 
internal labia much swelled, protruded and oedematous. 

Having ascertained the real condition, the following method was 
adopted to remedy it: 

While the patient lay upon her back, the right hand was intro- 
ducecT through the protruding os and cervix uteri, during the absence 
of pain, and the head of the child gently pressed up above the pubes, 
by the end of the separated finger and thumb, where it remained long 
enough for me to grasp the mouth and neck of the womb and return 
them through the labia and vagina to their proper position. After 
this much was accomplished, in the absence of pain, pressure in an 
upward direction was constantly applied to the os and cervix uteri by 
rotating the hand with the fingers and thumb separated, as if pushing 
the 08 and neck over the child's head. During pain, the child's bead 
was constantly held above the pubes with the fingers and thumb out- 
side of the uterine neck. About an hour's unremitting attention was 
required for the reduction of the mal-position described. From tbe 
commencement of the manipulation until the parts were brought into 

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&AKB CAfll OF MnywifXBT. 338 

Aeir nataral relation, tbe patient found berself yery mncli benefited, 
and often exclaimed, "Doctor, yon are relieying me bo much.'* 

After the parts were returned to their proper place and retained, 
the labor progressed natnrally. The os uteri, after reduction and hav- 
ing its normal situation to the child's head, was dilated to about an 
inch and a half or two inches in diameter. The child was bom dead, 
as it eyidently had been for some days previous to birth, as it was in 
an advanced state of decomposition. I attended this patient in her 
confinement previous to this one, when there was no complication of 
any kind, nor had there been, she said, during any other of her con- 
finements. M 

Not having seen any case of this description reported in the jour- 
nals or elsewhere, and not leaving the case to its own destiny, so as to 
ascertain how it would terminate, the fgllowing question presented 
itMlf to my mind : If it had not been recognized and relieved, what 
might have been the result to the patient? I think one or any of the 
three following results would have occurred, namely : First — Inver- 
sion of the uterus. Second — ^Rupture of the organ; or. Third — ^A 
cutting off the cervix immediately behind the os. I will venture one 
more question : Has not this condition occurred in other cases where 
it has not been recognized, and been the cause of the three complica- 
tions above named? 

The above very interesting report from Dr. Muscroft, absence in 
New Orleans prevented our seeing until just before it was placed in 
the printer's hands ; and hence, we have not had the opportunity of 
consulting the literature of the subject to any great extent. Never- 
theless, the few references to accidents similar to that which the Doe- 
tor recounts, we have met in a hurried and partial search, we proceed 
to give : • 

Boivin and Duges, (tome I, page 93), ftate that in some cases of 
prolapsus uteri in pregnancy, " the womb has remained partly within 
and partly without the basin, even to the termination of gestation; 
such was the case of Wagner and that of Chopart. The suffering and 
inconvenience in such cases would be great; nevertheless, in both these 
cases, the termination was, by the aids of art, conjoined with the natu- 
ral efforts, favorable, even without obtaining reduction of the dis- 
placed organ, for that had become impossible." 

Jacquemier, Manuel des AccoucKementSj tome II, page 191, says: 
" Harvey reports the case of a woman whose uterus was completely pro- 
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834 WWnMMM MJiMMAL OW MSDXGINX. 

lapsed, delivered at full term without assistance; but she died sabso- 
quently. In a simihtr case. Portal dilated the os nteri with his fingers, 
and removed a living child, the mother recovering. Fabricins snc- 
ceeded similarly in a case of complete prolapse. There are several 
recent observations similar to these. Devon ter has seen the head and 
neck of the foetus enveloped by the uterus, escape completely from the 
pelvic cavity. In the cases of Duchemin and Pietsch, the expulsion 
of foetus did not take place until rents occurred in the uterine neek 
after several days' labor." 

Courty, Traitd PraUqus det Maladies de V Vtenu et de ie$ Af^ 
netesj page 739, uses th^ following language in speaking of the import- 
ance of attempting reduction in a case of prolapsed uterus: ^'The 
swelling consequent upon congestion supervening in the tumor, or re- 
sulting from inflammation, or from constriction at the vulval ring, ia 
not the only reason why the practitioner should be prompt in attempt- 
ing reduction. A still stronger reason is the complication of preg- 
nancy. Although, in this ease, the irreducible uterus may be sup- 
ported by a suitable bandage so that it shall complete its development, 
and expel a living foetus from its cavity," &c., &c. 

The Lancetj April 18th, 1846, quotes the following case from the 
British American Journal: 

"In April, 1829, a negro woman was taken in labor. She was about forty 
years of age, of good constitation, the mother of sereral children, and, so fkr as is 
known^ not subject to any prerioos prolapsus or other disease of the womb. Some- 
thing nnnsual and anomalous harlng occurred daring the progress of the labor, Dr. 
Harris was sent for. He found her, on his arriral, in the following condition: 
She was lying on her back, with the whole gravid uterus between her thighs, re- 
tained only by the ligaments, which were much stretched, but not ruptured, and 
discharging from its external snrfkce a serous or sanious fluid. The woman had 
been in this condition for about twenty-four hours. She had had no pain since 
the descent of the uterus, and was complaining of none^t this time The liquor 
amnil had been discharged. After a carefUl examinatioa, no motion or other sign 
of life in the foetus could be peroeiyed. The uterus appeared to be in a perfectly qui- 
escent state, without any disposition to contract. The os tincse was barely dilated 
sufficiently to allow the introduction of two fingers. Finding it absolutely neces- 
sary to relieve her as soon aa possible, the Doctor proceeded to deliver her by arti- 
ficial means. He opened the head of the child with a suitable instrument, and 
then, having an assistant to hold and support the uterus, he introduced his hand, 
and by careful traction succeed in removing its contents. There was very little 
pain during his manipulations. He now returned the womb, which had scarcely 
contracted at all, and advising the recumbent position, left her. She had a very 
good 'getting up; * and two years ago, as the Doctor learned, was in good health." 



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In tbe Lanceij March 22d, 1%1, under tke beftding On a date of 
Labor foith Pmsidentia Uteris we read as follows : 

"7*he wife of a laborer, who had been subject to a prolapsed state of the 
vteros^ and on one occasion to a profuse uterine haemorrhage, during her preg- 
Bttkcj, was attended in her labor, In Norember last, by Dr. Hjnes, who found, 
on examination a large substance, of the sixe of a fcetal head, projecting from the 
TidT% which, from its elastic feel, he at first thought to be the placenta. Upon 
closer examination, he discoYcred an oblong aperture capable of admitting three 
fingers, through which he was able to feel the membranes protruding. The pro- 
jecting tumor he discorered to be a large portion of the uterus, dragging with it 
the inferior part of the bladder. As the expulsive pains were yiolent, Dr. Hjrnei 
eren feared the inversion of the whole pelvic contents ; he, therefore, without 
delaj, ruptured the membranes, and while maintaining steady support to the pro- 
jecting substance, extracted a foetus of about six months, which survived a few 
liours. Little or no haemorrhage ensued, and the patient progressed satisfactorilj 
at first, but having imprudently got up within thirty-six hours from the labor, in 
contravention of the directions of her medical attendant, she became delirious and 
feverish, and sank eight days, afterward, the pulse, that ^rt9 /aUacitamOf^ having 
Biaintained regularity throughout her fever." 

Mr. Houghton, Dublin Quarterlif Journal of Medical Science, ^^Jy 
1863, reports a case of Prolapse of the Uterus and Vagina during 
Pregnancy and Labor: 

" JCrs. S , aged about twenty-six, was taken in labor with her second child, 

on the 13th November, 1851, 4 p. u. The pains continued feeble and infrequent 
tin 2 p. M. on the following day, and I saw her about four. * The head presented 
nataiallj; the os uteri was dilated to the size of a crown-piece; the passages were 
moist; and the membranes had been ruptured about twenty-four hours previously. 
However, on examining more carefully, I found that the os uteri was close to the 
ontlet; that the walls of the uterus, from the margin of the os uteri to that part of 
the nteroa against which the head of the child pressed, formed a cone about three 
iaehea long, the apex downwards, as though the neck of the uterus had dilated 
simultaneously instead of becoming obliterated before the dilatation of the os com* 
menced. The lips of the Oa were exceedingly thick, rigid, and unyielding, and 
indeed, the whole of the cone above described, presented the same unyielding char- 
acter. The pains were regular and tolerably strong. As the labor proceeded, the 
whole mass, uterus and head, came down together, dragging with it the anterior 
wall of the vagina, and at length obliterating the anterior culde toe of the vagina; 
and the considerable tumor thus formed, dilated the vulva. The descent continn- 
iag, and the dilatation of the os uteri hardly progressing at all, the uterus came so 
low down that the anterior lip of the os uteri was pushed outside the vulva, and 
the anterior half of the os uteri, and the posterior half of the vaginal orifice to- 
gether, formed an elliptical opening, through which the head of the child could be 
readily felt, and if necessary, could have been seen. Still the os uteri continued 
firm, hard, and unyielding, and eventually the whole of the os, with an extraordi- 



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336 ynaawMM jromuiAL or wuncan. 

narjr cftp«t BuccedAnenm, protruded flrom the raglna. Still the rigiditj continued, 
and I began to lose all hope of the dilatation being effected by natural meana. 

*'The above is a prettj fair account of what took place until about eight o'clock 
p. u., and then things were much in the state described. The patient being a pale, 
delicate, little womaUi renesection was not performed, but tartar emetic in nausea- 
ting doses, was given, and nausea was kept up for about three hours. After this, 
two scruples of laudanum were administered. 

"At this time the condition of the patient was much as follows: Os uteri 
rather larger than a five shilling piece; caput soccedaneum protruding through the 
os; bones of the head pressing on the margin of the os, which was thick, bard, 
and very unyielding; pains strong; anterior eul de t€ie of vagina obliterated with 
each pain, and a disposition for the whole os uteri to pass externally at every pain. 
For some time after the laudanum was given the pains became more moderate, but 
they never ceased, and at about ten o* clock they returned sharply, the os, if any- 
thing, showing more disposition to dilate, though all very firm, hard, and rigid; 
and 1 had serious fears that incision of the os uteri would become necessary. 

"All things considered, I determined to see if the fhint hope of dilatation which 
seemed to present itself, would be realized, and, whilst waiting to continue the 
same course of treatment which I had hitherto adopted, and which consisted in 
preventing the total inversion of the vagina, and entire protrusion of the head of 
the child and uterus en nuuae during each pain, this accident threatening with each 
contraction of the uterus, indeed once happening to a considerable extent when I 
had been late io watching a pain. To effect my purpose, I proceeded in the fol- 
lowing manner: Having replaced the uterus and vagina as well as I could, I 
watched carefully for each pain, and when it was about to commence I passed the 
fingers of my right hand into the anterior of the eiU de $ae of the vagina, and the 
thumb of the same hand into the posterior etU de sac; my fingers and thumb thus 
embraced the os uteri and child's head, and whilst it allowed the latter to press 
against and dilate the former, I supported the whole mass in its proper position, 
or nearly so ; and thus, as I conceived, imitated nature to the best of my abili^ 
by keeping the uterus artificially suspended in the cavity of the pelvis, and main- 
taining a point of support to the uterus, to allow of the pressure of the child's 
head upon the os, and hence its farther dilatation. For some time the dilatation 
continued very slowly, and 1 could feel, from time to time, that some abrasion of 
the anterior and posterior lips of the os had taken place. The os now very tightly 
embraced the head, the posterior lip being softish, the anterior very hard and thick. 
At about half-past eleven o'clock, during a very strong pain, and whilst I was pur- 
suing the same plan, I felt something suddenly give way, and the child was almost 
immediately born alive ; in fact, laceration of the posterior lip of the os uteri had 
taken place to, I suppose, an inch in extent. No flooding followed, and the pla- 
centa came away without any difficulty, except that with it down came the uterus 
and vagina. The laceration was then distinctly seen, and the whole of the os 
uteri swollen and tumid ; this was easily returned ; the patient was, as might be 
expected, much exhausted ; a stimulant and dose of opiam were given, and she was 
allowed to rest. 

"November 16th; a good deal exhausted and very sore; countenance good; 



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AT WHAT TIMES IB TABIOUL OONTAeiOUS. . 39^ 

loogne moist; pulse eight j—wott', no ftrer; pAsoed her water twiee, and bad' two 
motions; no swelling or tenderness in the abdomen ; she is in good spirits; she 
mx up when her bowels were relieved ; the uterus then came down, and remains 
down now \ the laceration and the abrasions on the anterior lip can be seen. I r&- 
tnmed the uterus, and desired that it might be returned as often as it came down, 
and supported by a perineal bandage, first, however, fomenting it well. 

" 17th. Some diarrhcea and pain in the utems, but no distention or general 
hardness of the abdomen; for this, a poultice and some grey powder, with Dover's 
powder, was given; and under this treatment these symptoms gradually subsided. 

*On the 27th, 4he pain and tenderness in the abdomen have <]iaite subsided, and 
her health is much improved.' To-day, she told me that she was much neglected 
in her first confinement, and has had prolapsus ever since. About a year since she 
bad retroversion of the uterus, followed by a miscarriage at the fourth month; 
riuce this time her uterus has descended daily, and has prolapnd every day dmriny 
hir yre^wtncy^ even to the day of her deUveryy when it had been down to a conaidereMe 
ertent^formmg a large tumor exiemaUy. At times, she had considerable disclwrge 
from it^ and was aware that ulceration existed round the os. It has frequently 
been down as large as her two fists; and although she has been a great sufferer 
during pregnancy, she has not consulted any medical man about it, but allowed it 
to progress without interference." 

With these references, increasing, as ve hope, the interest and 
instmctiveness of Dr. M.'s case, we leave the subject for the present, 
merely adding that his manipulations were, in some paxtioulars, simi- 
lar to those of Mr. Houghton, and that his inquirr as to the possi- 
bility of rapture of the uterus, occurring in such ^ complication of 
labor, finds its answer, at least so far as such rupture involyes the neck 
of the organ^ in some of the cases quoted. T, P« 



"AT WHAT TIMES IS VARIOLA CONTAGIOUS?"— (A EE- 
PLY TO AN ARGUMENT.) 



BY DE. D'HUT, OWENSBOKO, KENTUCKY. 



¥ 



There are various opinions held by medieal men, in regard to the 
above question. Oflentimes we have been questioned, and seldom 
found that our precise opinion on the subject was entertained. There- 
fore, as it is, we feel inclined to explain before the forum of your 
many readers, confident that our appeal will be sustained. 

We presume that contagion in the sick room exists, prima faciQ, 
at the same time when the disease exists, and we would say more 

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888 mmaam joubkal ov xsDMCDrB. 



pkinlj, oontagton is oo-ezbttDg with the disease. Contagion derel- 
<^>e8 progressirelj firom the time of generation to its ultimate prox- 
imity. Henee, it cam not be inferred or admitted, that contagion exists 
not in any degree dangerous at the beginning, and commences only 
with the eruptive stage, when desquamation deyelopes and continues. 
Nor does our reasoning pause here. The danger of contagion, per k, 
exbts in all oontagious diseases as soon as the disease is readily diag- 
nosed, and even prior to that time. 

To explain our yiews in a practical manner, let us suppose a case 
of variola, or of varioloid. 

The very moment we have diagnosed a case, and as such, pro- 
nounced to be contagious, we proceed to prescribe such medicines, dis- 
infectants, etc., as are indicated, and give careful instructions to the 
fkmily, or nurse, applying to a disease of a contagious nature. 

Why we should be so very careful, circumspect and guarding 
against a dreadful disease, is simply because we apprehend the situa- 
tion, the danger impending, and appreciate the measures instituted, 
and to enable ourselves to be of good service to all, the sick and the 
healthy. If we would omit all these ''little items'* properly belong- 
ing to the mode of treatment, we would'nt be doing our duty, and at 
least, would 4ay ourselves liable to censure within our own mind, 
although we might escape professional criticism, or be unnoticed by 
those around us, and ignorantly be supposed to be all right. 

While time rolls on, and our case is developing, we still continue 
our watchfulness and cares in a prudent manner, and do so until the 
time of dismissal. Our watchfulness is certainly not misplaced, be- 
cause we are aware that the one afflicted with a disease of the conta- 
gious class, is liable to the incidents attending such disease. And 
thus, there exists the same reason for continuance of precaution, and 
of a peculiar treatment of a peculiar disease, as at the beginning. This 
would show, conclusively, that, wherever contagion exists, it should 
be treated considerate, until it is existing — ^no more ! And any devi- 
ation from this rule may be the cause of a great deal of trouble and 
mischief, and involving difficulties which we might not be able to over- 
come, or to answer for. 

Indeed, we are surprised to observe how some medical men become 
so professionally destitute as to advance teachings which are foreign 
to common observation, foreign to all practical experience, and un- 
known to the established doctrine of the wide world I Men, who by 



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word %ni Mtion do the wtong thing, and wlio are trifii^ with them-^ 
aelTee, our sacred ealling, and the public at large. 

Ho^ is it, for instance, if a profeeaional man, wlio lays claim to 
the title of a eitj physician, would dismiss ''a case of Tariola,'' with- 
out ordering for his patient '^a last cleaning," neither haying ordered 
his ^Mnfected clothes" cleaned and changed, thongh they had been 
worn /or /aw weeJu^ dag and wightf How is it, if in our days of 
light and progress, Tariola is simply treated by whisky until whiri^ 
has Idllod the patient? How is it, we ask ? Facta, as the above, almost 
Mem to be incredible, and slill they ocenr in our midst, little talked 
of, hut not amended. I think we need "a liule recomtructum on the 

m of oound doeerine$" 



CIRCUMCISION. 



BT JAH18 THOMPSON, HARRISOW, OHIO, 
LMa SuBBon Ml O. a. Llsbt Arlflltiy. 



A large number of yenereal cases came under my notice while oon- 
neeted with the army. And as many of the patients had chancres in 
the prepuce, it seemed to me, that by remoring the local lesion, a cure 
eouM be more speedily effected, more especially if this could be done 
early in the disease. 

The first patient operated on had an indurated chancre almoft en^ 
tirely encircling the prepuce; his prepuce entirely coTcred the glans, 
gifing hiB organ the appearuiee of a pig's snout; he also had gov- 
OErhoBa. 

Opxraiion — He was placed on the edge of a low seat; his knees 
weie widely abducted and firmly held by assistants; the prepuce was 
irmly grasped behind the chancre in front of the glans, with a gullet 
foieeps, and given to an assistant; a long amputating knife was placed 
against the forceps, with the heel applied to prepuce, which was ampu* 
tated by one sweep from heel to point of knife; one blade of a pair of 
sdsaors was then inserted beneath the mucoua membrane, which was 
slit up and afterwards cut off in an anular direction parallel to the 
corona glandis; the dorsaUs penis artery was ligated; two small 
branches twisted, and five sutures introduced for the purpose of hold- 
ing the dermoid and mucous membrane together; cold water dress- 
ings were need until after suppura^on was fairly established, then dii* 

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aiA manxBx noMAh of vsDicnnB. 

contiAaed, «nd na mMUcftttoa wluttoTer mwd. As 8i»on a6 smppuratioa 

oommeDced, the discharge from the urethra ceased; and in six weeks 
f^om date of operation, the patient was returned to duty eured, with a 
very elegant serriceable organ. 

In a period of less than one year from the above date, upwards of 
two hundred others were operated on in the same manner — some for 
ohaneres in the prepuce, others for chancres on the glans, some for 
gonorrhcaa, gleet, &g. They all recovered in a period averaging about 
four weeks, excepting one, who was attacked on the sixth day afWr 
c|>eration with erysipelas of an adynamic type, and died on the twelftJi 
day from date of operation. 

The question arises, why excise one's prepuce incases of gonorrhosa 
and gleet? Permit me to state that most of the operations spoken of 
were performed upon colored men, seventy per cent, of whom have 
remarkably long foreskins, which almost invariably cover their glana. 
Several of the cases, however, occurred amongst the white men, one 
of whom presented himself to me with a gleet of nine months dura* 
tion, which was rebellious to all medical treatment, local or constitu- 
tionaL He was circumcised, and his gleet was arrested as if by magic. 

Next came a captain of volunteers of the quarter-master's depart- 
ment, a church member, who was looked upon as a "Paragon." He 
represented himself as having been poisoned with ''some abominable 
poison vine while picking blackberries." I told him that he was poi- 
soned, but that it was from the animal instead of from the ve^eiable 
kingdom. He had a villainous looking penis, the foreskin of which 
projected in front of the glans at least three-fourths of an inch, caus- 
ing the organ to resemble the noasle of a bellows, from which a nasty, 
muco-purulent matter was discharged. He consented to circumcision, 
after which he was no longer troubled frt>m the effects of the ^^ahom- 
inaile pattern vine.** He was quite elated with the altered shape and 
improved appearance of his member. 

Several cases could I add, which I have had to treat during the 
last two years, in private practice, wherein circumcision has been suc- 
cessfrilly practiced in cases of gleet, after having failed to benefit said 
oases, with either local or constitutional medication, blistering, cauter- 
isation, injections, and so forth. 

Two cases of spermatorrhoea have also been successfdlly treated 
within the last year, one of which was of ten years standing, and had 
been treated by a "homoeopathist" for one year prior to his foiling 
under my notice, without the least benefit whatever. He was treated 



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csBmnummi. Bit: 

by me for four nontiiaY with tomes of every desoriptioD; qainiiie, kon, 
Btryohnine, eleetricity, &o.; with bromide potass., belladonna, camphor, 
cpiomy canabis indioos, &c., but in spite of all, he reported two or 
three noctamal and fonr or five diurnal emissions every twevty-fetur 
hours. He had a long prepuce, but wonld not be persnaded to part 
with it until I informed him that every remedy short of oironmcision 
had been tried, and as he was well convinced, with no benefit, and- 
strongly urged upon him the security of the operation. After much 
peksoasion, I procured his consent, and operated about the 2d of Jan- 
nary, 1869. The first week after the operation, he had three noctamal 
emissions, but had perfect control of his member during the day. At 
this date, May 5th, he tells me he has not had over five emissions since 
the operation, and considers himself cured. 

In accordance with the above facts, I am convinced that gleet and 
spermatorrhosa can be cured by circumcision alone; and that many 
cases of gonorrhoea and syphilis will yield to the same treatment. 
These facts have, I think, been tested in a sufGicient number of in- 
stances. 

It is further my opinion, that every person whose foreskin covers 
the glans, ought by all means to be circumcised ; then would there be 
less liability of his contracting the various venereal diseases, or herpes 
pieputiftlis. 

Again : We should consider the effect which a nozzle ended penis 
has on the minds of some persons; some are ashamed to be seen bath- 
ing by their fellow man, or to be examined for the army or for life 
assurance, and no doubt, in many instances, to contract matrimonial 
ailiances. In such cases, circumcision is one of the greatest boons 
that can be practiced on suffering humanity, and should be urged upon 
the people. 

It is further my opinion, that in the diseases above mentioned, oir- 
eumeision is beneficial in cases even where the patients have not a 
redundancy of tissue forming the prepuce. 

Most practitioners have had to do with some very obstinate cases 
of gleet of very long standing, which have been rebellious to all med- 
ieal treatment, local and constitutional. In my opinion, all such cases 
yield to circumcision. But, one may ask, how can a patient afford to 
lose a portion of his foreskin, when it is already well retracted and 
the glans entirely uncovered? My answer is, that I never have seen 
one who could not spare a small anular slice, in order to tiie cure of 
sneh a troublesome and rebellious disease. 

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an WI8T1RN jmnUTAL OV MSDIODIl, 

Again : When w« oireumoiie oar patients, we seevYe for them ^ta% 
rmt whieb all the advioe in ike world witilioiit the knilb would MIL to 
aoeompliBh, and it is well known, that bo long aa a patient afflicted 
with the gleet, keeps walking or riding about, a cnre may be looked 
upon as oat of the qnestion. 

In the performance of the operation, I woold eschew ''ibftuws of 
stone," bnt would recommend a long knilfo, in order that the pre- 
pnee be taken off at one sweep, thereby avoiding a notched and ane?«i 
oioatrix. A firm, sharp scissors, in order to make a clear ineinoa 
throogh the mucous membrane, the pinching of which, with a slender 
or dull instrument, is very unpleasant and painM. 



DB. COHNHEIM'S RB8EAR0HES ON C0NGB8TI0N. 



Tiwaktad turn an Article by Dr. Wnar, In toIvm CI of the JVivir ygMljjr^hmfcf^ 

BT SAMXL NICKLB8, M. D., 

mmonitnior of AjMHoay la tke Modicat Ooll«i» of Ohio. 

; 

Cohnheim publishes, ( Virch. Arok.^ XLI, page 227), an inTSStigap 
tion on venous congestion, which is closely related with his researelies 
on inflammation and suppuration. The object of the inquiiy was to 
aseertain why, in passive hyperemia, a plasmatic fluid (osdemn), trann- 
udes very copiously, while, on the contrary, lymphatic elemeata 
(phlegmon), find egress in but limited amount 

C. selected for his observations, the web of frogs which had beoa 
treated with curare poison, and in which, by means of a simple and 
suitable contrivance for regulating the firmness of a ligature, he oonid 
absolutely control the circulation of the femoral vein. He found thai 
soon after the ligation of the crural vein, the movement of the blood 
in all the vessels of the web became j^uhative and r^thmioal^ while, at 
the same time, the rapidity of the cii^en^ gradtuUl^ dimini$hed^ ao 
that| finally, one gets the impression of a resting mass pressed onward 
only at intervals, by the pulse-move. The cause of this phenomenon 
is, that the resistance in the veins and capillaries has become so great 
from the sudden closure of the crural vein, that it can be overctHao 
only by the systole. (Edemateu§ infiltratioH ai the web begins werj 
early, while the xadcU eharaeter of the current dUappeore in the arteiiaB 
and veins, and soon, with but moderate dilatationy all the vemeb faa- 



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&E8SARCHSB ON OOMQBBTION^ 343 

eome dmuely filled voiih blood corpuscle^ of which, the red ones are so 
placed in the capillaries that not the edge but the surface is struck by 
Ike cnirent. The accumulation of the red corpuscles increases gradu- 
ally to such a degree that their outlines seem to blend with one another, 
and a few minutes later the capillary vessel presents a homogeneous, 
red, immovable cylinder, which soon changes its color from a light yel- 
lowish or greenish red to a bluish red, the color of venous blood. 
Without any marked alteration in the interior of the capillaries, one 
aiay now observe on their outer periphery the protrusion of tmall redj 
rounded eleoatunUy which form lateral offshoots, not unlike little mul- 
berries, and their collapse and change into ordinary red blood corpus- 
eles. If the ligature of the femoral vein is now removed, the normal 
conditions are soon reestablished^ the red corpuscles, one by one, becom- 
ing separated in the direction of the veins from the apparently homo- 
geneous cylinders. Of course the red masses already exuded into the 
tissues are not effected by this restorative process, whereas, the intra- 
eapillary part of cells about passing through the walls, is lashed by 
the current of blood until it is torn off and carried away. 

In case of prolonged closure of the principal vein, a marked dila- 
tation of the veins and capillaries supervenes. During the first hours 
after the ligation, the dilatation is, however, as stated above, at its 
■inimum, and C. believes that he has found the cause of this phenom- 
enon in the activity of the contractile elements of the walls of the 
vessels, which are stimulated to contraction by the immensely aug- 
mented pressure. As a result of the violent pressure must be regarded 
the apparently complete blending of the blood corpuscles which pre- 
vents the emigration of the colorless blood cells, as it takes place in 
inflammatory processes. For while the colorless blood corpuscles are 
compressed between the red ones, it is impossible for them to perform 
amcsboid movements, which must form the necessary commencement 
of their emigration. In the veins, there is this additional circumstance, 
that in congestion a resting peripheral layer of colorless corpuscles 
can not be formed, without the previous development of which emigra- 
tion likewise does not occur. That, on the contrary, the red corpus- 
des do indeed pass through the unbroken tcall of the vessel, that, in 
etiier words, really a hasmorrhage per diapedesin and not per rhexin 
presents itself, is shown by the circumstance that as soon as the circu- 
lation again becomes free and the pressure upon the capillaries remits, 
not a dngle corpuscle follows those already exuded. According to 

(34) 

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344 WESTERN JOURNAL OF MEDIOINS. 

C.'s views, it is again the natural pre-formed openings in the wall of 
the capillary, the stomato existing between the epithelial scales through 
which the corpuscles make their escape. But the power forcing out 
the corpuscles is the greatly increased pressure which prevails in the 
disturbed vascular district. The whole process is promoted partly bj 
the however slight dilatation of the capillaries which increases the 
size of the stomach ; partly, also, by the changed posture of the blood 
corpuscles which turn their borders toward the wall of the capillarj, 
and therefore, need but stray into one of the stomata with one of their 
poles. The spherical form of the colorless blood corpuscles, which 
they must always maintain under these circumstances, is adverse, being 
illy adapted to be pressed through the still diminutive openings. Fi- 
nally, it must be pointed out that the increased pressure of the blood 
in the capillaries produced by dilatation of the small arteries, as obtains 
in all inflammatory processes, can never even distantly reach that height 
to which it advances from impediment to the venous flow. 

From the experience gained in this inquiry, 0. cautions against the 
conclusion that there is a rupture of the vessels when blood corpus- 
cles are found external to them, and in cases of ecchymosis and bsemor- 
rhagic points, advises that the conditions of pressure of the blood he 
considered as those &ctors which, as has been shown with certainty, 
exert an essential influence in the production of the diaptdetU. In 
this light, the congestions caused by impediments to the venous circu- 
lation are to be considered, unquestionably those which are developed 
with more or less rapidity, and in some respect, also, such as are pro- 
duced by chronic processes. 

In conclusion, C. alludes to a paper of Dr. Prussack's read before 
the Academy of Vienna, according to which, the Doctor observed the 
imigration of red blood corpuscles through the unbroken wall of the 
capillary in f^ogs, the lymphatic vessels of which he had injected with 
large doses of a solution of culinary salt. This would also show a 
form of diapedesis which is independent of the pressure of the blood, 
and which is to be placed in the same category with these hsmorrliages 
which have from ancient times been attributed to alterations in the 
composition of the blood, as for instance, in scurvy. 



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CARBOLIC ACID IN GONORRHGEAL CONJUCTIVITIS. 



BY JOS. G. ROGERS, M. D., MADISON, INDIANA. 



I. B , aged twenty-five; healthy, generally; presented himself 

with gonorrhoea! conjunctiyitis in severe form, with chemosis, great 
swelling of lids, profuse purulent discharge, photophobia, &c. — of sev- 
eral days' standing — gave this prescription : 

R. Acid, carbolic, (Calverts), gr. i. 
Atropis sulphatis, gr. ss. 
Zinci salphatis, gr. ii. 
Aqos destil, §i. 
M. Signa. Drop in eje every two hours, and apply constantly with 
moist compreEses externally. 

The patient was directed to return the next day, but not appearing, 
OD the third, I went in search of him. Found him in a dirty, dark 
rodm, in a poverty-stricken neighborhood, with every circumstance 
around him of a sort to prevent success in treatment. Among the 
most potent for ill was a female circumstance, with the same disease, 
affecting other organs as well as the eyes — she was his nurse. It was 
with much misgivings that I removed the compresses, and was agreea- 
bly surprised to see a marked improvement. His eyes presented the 
appearance of a mild form of simple conjunctivitis; there was no 
purulent discharge, no photophobia, no swelling; the conjunctiva 
simply appeared slightly congested. I remarked, also, that there was 
scarcely any dilatation of the pupils, and but little effect on the accom- 
modation. This fact well illustrates the law that congestion greatly 
diminishes the absorbing powers of mucous membranes. The treat- 
ment was continued, and a week sufficed for a complete cure. 

This treatment was adopted on theoretical considerations. Its 
Ksults as compared with that by powerful astringents, considering, 
also, that it is almost painless, are certainly sufficiently satisfactory to 
reeommend it. This case was treated in 1867. Since that time I have 
proved its uniform efficacy in numerous cases, and have adopted it as 
preferable to all others in this affection. Within the last year, the 
excellent effect of carbolic acid, even in the simple non-specific forms 
of conjanctivitis, has been publicly noted in certain foreign journak. 

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^6 WESTERN JOURNAL OF MEBICINB. 

Dr. E. L. Holmes, of Cbicago, in the American Journal of Medical 
Sciences, for October, 1868, also gives his dictum in fay or of this agent 
in all forms of conjunctivitis, both specific and simple, and especiallj 
refers to its influence in checking the purulent discharge. 



"COMPETITION DOWNWARD." 



The recent graduation of so many medical students from our 
various collegeis, gives a point to the following remarks by the Med- 
ical Mirror of London : 

The profession of medicine in the United States is suffering most 
acutely from a perfect deluge of licensing medical bodies, which ire 
manufacturing to the utmost of their bent, full-blown medical men. 

The American Medical Association intends to take this matter into 
its serious consideration. 

It is, doubtless, difficult to steer clear between the Scylla of in- 
fringing the liberty of the subject, of licensing bodies, on the one 
hand, and the Charybdis of a profession swamped by men possessed of 
the extreme minimum of medical knowledge, on the other. 

The remedy is easy, and it is one that before long must be applied 
to our English licensing institutions. 

The American Medical Council, supposing such a council to exist, 
must reexamine all the candidates possessed of the degrees of tbe 
various licensing bodies, and then ratify or annul the diplomas of 
candidates. 

The English Medical Council must, to protect the profession fro] 
the "competition downward" of our various licensing bodies, af 
institute a Central Board of Examiners, to inquire into the diploi 
and the actual knowledge, general and medical, of the individuab pi 
senting themselves for registration. 

In America, the competition between licensing bodies is on 
gigantic scale. When two or three doctors happen to be gathers 
together, it is perfectly competent for them, not merely to found 
teaching institution, but it is permitted to them to grant licenses i 
practice, as the various State local governments permit the freest exe 
cise of any and every medical doctrine, whether eclectic, hydropatk 
or homoeopathic. 

The United States' medical profession stands a chance of havii 
as many licensing medical and surgical bodies as we have hospili 
and dispensaries. The mulUplioation of teaching bodies can not 
considered an evil, for every general practitioner ought to be coi 
tent to educate his successor; but the indiscriminate multiplicaUoi 
diploma-giving bodies is quite another question. The innumeral 
teachers spread knowledge broadcast, but there should be one cenf 
portal of every high standard established^ not permitted to teach 



spiti 

lOtI 
0D» 

lou 
eral 
enti 



FHTHI8I8 AB HiBMOFTTBI. 347 

all, but simply formed to examine any and all candidates of a proper 
age who might present themselves before it. 

In England, we have fewer licensing bodies, and, therefore, the 
competition downward, although severe, is not nearly so ruinous to the 
seientific status of the profession as in the newer country. 

In England, we have long sought the one portal system as regards 
the granting of professional diplomas, and although, as regards med- 
ical practice, the United States' doctors may be considered to be more 
advanced than the jog-trot practitioners of Britain, yet, in the matter 
of reforming the tendency to a lowering of the diploma examinations, 
the shrewd business talent of the English profession will not be found 
wanting. — iVew? York Medical Journal^ May, 1869. 



PHTHISIS AB H^MOPTYSI. 



BY J. BURDON-SANDBBSON, M. B., 
Pbysieian to the CoDfumptioii Hospital, Brompton. 



*' Ex sangnlnlf fpnto, purls fpntnai et flnor.**— HmoosAnSi Aphor. t11., 81. 

The doctrine embodied in this aphorism, formerly believed in and 
received with the unquestioning submission once accorded to the say- 
ings of the Father of Medicine, is now universally denied. Some 
thirty or forty years ago, Laennec, guided by what seems to us now-a- 
days a rough kind of pathological anatomy, taught that, in those 
numerous cases in which cough, expectoration, and all the other symp- 
toms of consumption are preceded and ushered in by spitting of blood, 
the haemorrhage had, in reality, nothing to do with its apparent con- 
sequences ; in short, that hsemoptysis, although it might appear to be 
antecedent to the phenomena of phthisis, could never be its cause. Now 
we seem to be in the way of returning to the divine Hippocrates ; not, 
certainly, from renewed faith in his teaching, for there never was a 
time when men were less disposed to retrace their old courses in this 
respect; but because the progress of pathological knowledge leads us 
to apply to Laennec's ideas as to the origin and nature of phthisis the 
same kind of scepticism that he applied to the notions of his prede- 
cessors. Laennec's disbelief of the possibility of consumption origin- 
ating from haemoptysis, although founded on observation, was essen- 
tially theoretical, and formed part of his general doctrine of tubercle. 
It was not the immediate offspring of facts, but of the notion enter- 
tained by him, and accepted by his successors up to the present time, 
that phthisis consists in the infiltration of the lungs with a particular 
kind of substance, which infiltration can only take place in persons 
whose blood is impregnated with a special taint, or otherwise altered 
in composition. So long as the fact of constitutional ability to con- 

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348 WESTEBU JOURNAL OF XIDICINE. 

sumption can be accounted for in no better way than that of referring 
it to a dyscrasia or to a morbid poison, visibly represented by the ma> 
terial with which the diseased organs are filled, all reasoning about the 
etiology of the disease must be restrained within a yery narrow circle. 
But if, on the other hand, we can succeed in so entirely divesting our 
minds of this notion of dyscrasia as to forget it, and content ourselyes 
with regarding the material with which the phthisical lung is consol- 
idated, not as endowed with some specific malignity, but merely as un- 
absorbed residue of common inflammatory processes, most of the diffi- 
culties disappear. For if by phthisis we mean only consolidation 
followed by disintegration of the consolidated parts — if the consolid- 
ating material is, in most forms of the disease, nothing more than a 
product of catarrhal inflammation of the minute bronchioles, and of 
the air-cells into which they lead — and if such inflammation may be, 
and is, constantly produced by the introduction of foreign substances 
into these cavities, what reason is there for doubting that coagulated 
blood may act in the same way as other irritants? 

This question is now being asked by various pathologists. In Ger- 
many, it has been brought into prominence by the lucid and practical 
lectures of Prof. Niemeyer on Consumption, who, on clinical grounds, 
maintains that hsdmoptysis occurs more frequently than is generally 
admitted in persons who are neither consumptive nor ever become so j 
and, on the other hand, that, although \n most cases the haemoptysis 
of early phthisis is a consequence of organic change, the cases are far 
from being rare in which pulmonary haemorrhage is not only the ante- 
cedent, but the cause of chronic inflammatory processes which result 
in softening and the formation of cavities. It will be remembered 
that at a recent meeting of the Clinical Society, a series of cases were 
communicated by Dr. Baiimler, having the same bearing as those of 
Niemeyer. At the next meeting, (April 23d), another and more com- 
plete paper on the same subject is announced from .Dr. H. Weber. 
The question is one of great difficulty as well as of great importance. 
Of course there is nothing easier than to say with Louis *4t is infi- 
nitely probable" that in every case the lungs are tuberculous before 
the hsemoptysis occurs, but much more difficult to prove it, for there is 
no reason for assuming that haemoptysis affords any stronger evidence 
of organic change in the bronchial or alveolar mucous membrane, than 
epistaxis does as regards the mucous membrane of the nares. On the 
other hand, there is nothing more difficult than to prove the absence 
of pre-existing disease in any given case. If, however, it can be shown 
in a sufficient number of instances, that an individual to all appearance 
healthy, may suddenly spit blood, and then, after an interval of a few 
days, become feverish, and that in such a patient the rise of bodily 
temperature is associated with the appearance of the physical signs of 
lobular consolidation, and that the consolidated parts eventually soften, 
we shall be inclined to believe that the doctrine taught at Cos, four 
centuries before the Christian era, is one which, at all events, requires 
at the hands of modem pathologists more critical and more impartial 
examination than it has yet received. — The Lancet, April 17th, 1869. 



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PROCEEDINGS OF MEDICAL SOCIETIES. 



PROCEEDINGS OF THE AMERICAN MEDICAL ASSOCIA- 
TION, MAY, 1869. 

LIST OP OFFICERS OF THE ASSOCIATION. 

The following is the list of officers of the Association for 1869: 

President — Wm. 0. Baldwin, M. J)., Montgomery, Alabama- 
Vice Presidents — George Mendenhall, M. D., Cincinnati, Ohio; Noble Young, 

II. D., Washington, B. C; N. P. Moore, M. D., Portland, Maine; S. M. Bemiss, M. 

D^ New Orleans, Louisiana. 

Permanent Secretary — W. B. Atkinson, M. B., Philadelphia. 
Assistant Secretary — A. J. Semmes, M. D., Savannah, Georgia. 
Treasurer — Gasper Wister, M. D., Philadelphia. 

The officers of the Association are elected annually, on the recom- 
mendation of a nominating committee, composed of one from each 
State delegation represented, and one from the Medical Staff of the 
Army and Nayy. The individuals so recommended are, on motion, 
elected by tlie Association before each annual adjournment. The offi- 
cers of the present year were elected at the meeting of the Associa- 
tion held last May .in Washington City. 

PE0CEEDING8 OP THE OPENING DAY. 

The American Medical Association met in the Mechanics* Institute, 
at eleyen A. h. 

The President, Dr. W. 0. Baldwin, of Alabama, occupied the chair, 
assisted by Vice-Presidents, Drs. George Mendenhall, of Ohio, and S. 
M. Bemiss, of Louisiana. 

Th« Permanent Secretary, Dr. W. B. Atkinson, of Pennsylvania, 
and Assistant Secretary, Dr. A. J. Semmes, of Georgia, were present. 

The President invited to seats on the platform, Drs. "Warren Stone 
and Lopez, of New Orleans, and ex-Presidents, H. P. Askew, of Del- 
aware, N. S. Davis, of Illinois, and Alden March, of New York. 

The session was opened with prayer by Rev. Mr. Gallaher, of New 
Orleans. 

Dr. T. G. Richardson, of Louisiana, chairman of the Committee 



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350 WESTXBlf JOITBlf AL OF MEDICINE. 

of Arrangements, welcomed tbe delegates to tlie city in an eloqnent 
address. 

The President then delivered the annual address. 

Letters were read by the Permanent Secretary from Dra. 8. D. 
Gross, of Pennsylvania, W. Byard and W. Canniff, of Canada, and R. 
A. Kinloch, chairman of the Medical Society of South Carolina, ex- 
pressing regret at their inability to be present on this occasion. 

On Motion of Dr. Mussey, it was resolved that each State Medical 
Society be requested to prepare an annual register of all the regular 
practitioners of medicine in their respective States, giving the name of 
the college in which they may have graduated, and date of diploma or 
license. 

Special reports of committees were then made as follows : 

On Deyislng a Plan for the Relief of Widows and Orphans of Medical Men, Dl 
H. Grlscom, New York, chairman, reported, which was referred to the Committee 
on Publication. 

On Veterinary Colleges, Br. Thomas Antisell, District of Columbia, chairmin, 
reported progress, and was continued. 

On Specialties in Medicine, and the Propriety of Specialists Adrertising, Dr. E. 
Lloyd Howard, Maryland, chairman, reported and made the special order for Wed- 
nesday at twelve m . 

On Library of American Medical Works, Dr. J. M. Toner, District of Columbia, 
chairman, reported, and was, on motion of Dr. Dayis, made special order for Wed- 
nesday at one p. m. 

On the Best Method of Treatment for the Different Forms of Cleft Palate, Dr. J. 
R. Whitehead, New York, chairman, reported and referred to section on surgefy- 

On Rank of Medical Men in the Navy, Dr. N. S. Dayis, of Illinois, chairman, 
announced that their last year's report was final, and committee was discharged. 

The report on Medical Ethics, hy Dr. D. Francis Condie, Pennsjl- 
vania, chairman, was read by Dr. Davis, and adopted. 

On American Medical Necrology, Dr. C. C. Cox, Maryland, chairman, reported 
, progress, and was continued on motion of Dr. Dayis. Dr. Cox was authorised ta 
fill all yacancies on his committee. 

Voluntary communications were presented by Dr. Jos. Jones, of 
Louisiana, on Mollities Ossium, and referred to section on surgery. 

On Cases of Lead Palsy firom use of Cosmetics, by Dr. L. A. Sayre, referred to 
section on Hygiene. 

On the Philosophy and Chemistry of Longeyity, by Dr. Cutler, of Mississippi, 
referred to section on Hygiene. 

On the Protectiye and Preyentiye Vses of Quinine, by Dr. S. Rogers, of New 
York, referred to section on Practical Medicine. 

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PBOCXKDIKGS Or MXDIGAL 80CUETIX8. 3&1 

Ob the Toiifi:iu in llalarioos Disease, bj Dr. Osborn of Alabama, referred to seo- 
lion on Practical Medicine. 

On the Warm Cerebro-Spinal Bath in the Treatment of Congenital Apnoea, and 
on a New Method of Artificial Respiration, bj £. D. McDaniel, of Alabama, referred 
to section on Practical Medicine. 

Reports on climatology and epidemics were received from Drs. 
Thomas, of New York; T. J. Heard, of Texas; F. W. Hatch, of Cali- 
fornia; E. A. Hildreth, of West Virginia, which were referred to the 
section on Climatology and Epidemics. 

On motion of Dr. Davis, the report on the revision of the plan of 
organization was made the special order for Wednesday at ten A. M. 

Near the hour of adjournment to-day, Dr. Eve suggested that the 
many papers on education, ready to he offered, he laid before the As- 
sociation on the next morning at nine o'clock. 

Dr. Davis of Chicago, moved that all such papers be referred to a 
special committee of five. 

Dr. Eve seconded this motion, which being carried, the President 
appointed Drs. Davis, of Illinois, P. F. Eve, of Tennessee, E. S. Gail- 
lard, of Kentucky, E. Lee Jones, of New York, and J. K. Bartlett, of 
Wisconsin. 

On Motion, adjourned until Wednesday at nine A. H. 

The special feature of this day's proceedings was the delivery of 
the President's address, which was universally commended and admired. 

SECOND day's PROCEEDINQS. 

The attendance yesterday was much larger than on the first day. 
A number of arrivals had increased the personnel of the Association 
to near three hundred. The hall was well filled, and the same digni- 
fied deportment which had marked the deliberations of the members 
on the opening day was displayed on the second day. Much of the 
&cility with which the deliberations wore conducted yesterday, and the 
promptness with which action was taken upon the various resolutions, 
was, undoubtedly, due to the tact and practical knowledge displayed 
by President Baldwin. 

At nine A. M., Dr. W. 0. Baldwin, the President, in the chair^ 
called the meeting to order. 

A paper on ^'Canula and a new mode of Applying Ligatures," 
was submitted by Dr. P. F. Eve, Tennessee, and was referred to the 
section on Surgery. 

Dr. J. M. Bush, of Kentucky, offered the following resolution: 



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352 'VnfiSTEIlN JOURNAL Of MEBioims. 

Resolved, That a committee of five members be appointed hj tbe chair, to take 
into consideration the subjects alluded to in the President's address, and report at 
this meeting. 

This resolution haying been adopted, the President selected as 
members of the committee, Dr. Parvin, of Indiana, chairman, Dr. To- 
ner, of the District of Columbia, Dr. Pollock, of Pennsylvania, Dr. 
Welch, of Texas, Dr. Seeley, of Alabama. 

Dr. McPheeters, of Missouri, offered a communication from the 
Medical Association of that State, in reference to medical education. 

On motion of Dr. Toner, District of Columbia, it was referred to 
the special committee on that subject. 

Dr. Eve offered the minutes of the Medical Society of Tennessee, 
which was similarly referred. 

Dr. G-aillard, of Kentucky, offered the following preamble and reso- 
lutions, which were referred to the same committee : 

Whebkas, The medical teachers of America have, after a trial of twentj-two 
years, failed to meet satlsfactorilj and efficiently, the requirements of the great 
body of the profession in regard to medical education ; and 

Wbbbbas, The condition of tbe profession is yearly becoming more deplorable 
on account of the antagonistic and oljectionable policy of medical schools, in ma- 
king the amount of fees charged, rather than scientific teaching, the basis of com- 
petition; and 

Whebbas, To obtain professionally competent graduates, sound and efficient 
teachers are indispensably necessary ; and 

Whebbas, Such teachers, to be found throughout the country, can not be in- 
duced to leave their homes without the assurance of competent remuneration ; and 

Whebbas, Such remuneration can only be obtained by adequate fees charged, 
unless by a system of low fees the number of students be relied upon to make up 
the inevitable pecuniary deficiency ; and 

Whebbas, Reliance upon numbers of students for this purpose deplorably 
crowds the already overcrowded professional field, diminishing thereby individual 
income, judgment, experience, and skill, thereby compelling practitioners to resort 
to other avocations as a source of supplemental income; and 

Whebbas, This devotion to other pursuits destroys opportunity for study and 
improvement, degrading thereby the status and standard of American physicians; 
and 

Whebbas, The schools of New England, New York and Pennsylvania, Mary- 
land, Virginia, South Carolina, Georgia, Missouri, Tennessee, Louisiana, Alabama, 
and District of Columbia, now charge comparatively remunerative fees; and 

Whebbas, The low eyttem of fees is charged only in a few of the middle States, 
and can, with advantage, be made to conform to the rate of fees charged elsewhere; 
and 

Whebbas, It is as unethical for colleges to underbid each other pecuniarily, as 
it is for practitioners to do so ; 



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PBOCBXDINGB OF MXDICAL 800IXTIES. 363 

JSuohedy That hereafter, no medical school in this coantrj, other than those 
fully endowed, be entitled to representation in this Association, if the amonnt 
charged by such schools for a single course of regular lectures be less than one 
hundred and forty dollars. 

Resolved^ That all schools charging less than this sum are earnestly requested 
by this Association to advance their rate of fees to the amount mentioned. 

The report of Dr. Lee, of New York, the delegate to the Associa- 
tion of Superintendents of Insane Asylums, was offered and referred 
to the section of Psychology. 

The report of Dr. Gross, of Pennsylvania, delegate to British Med- 
ical Association, was presented, together with the letter to Dr. Ehren- 
berg, was read and referred to the Committee of Publication. 

The time having arrived for the consideration of the revision of 
plan of organization, it was on motion, taken up. 

A recess was taken to allow the selection of members of the Com- 
mittee on Nominations. 

On reassembling, the Permanent Secretary announced the following 
as the Committee on Nominations : 

New York, J. C. Smith j Delaware, H. F. Askew ; Pennsylvania, A. M. Pol- 
lock; Kentucky, H. M. Skillman; Tennessee, J. B. Lindsley; Mississippi, W. Y. 
Gadhnry; Alabama, J. Cochran; Ohio, Jno. Townsend; Indiana, B. S. Wood- 
worth; Illinois, T. D. Pitch; Wisconsin, H. Van Dusen; Missouri, J. S. Moore; 
Michigan, J. B. White; Georgia, R. D. Arnold; Louisiana, S. Logan; Texas, S. H. 
Welch; Minnesota, C. N.Hewitt; Arkansas, R. G. Jennings; West Virginia, W.J. 
Bates; Rhode Island, G. L. Collins; District of Columbia, L. W. Ritchie; United 
States Army, J. J. Woodward ; United Spates Navy, F. E. Potter. 

Pr. Chaille, of Louisiana, submitted a proposition for a common 
medical nomenclature in the United States, taking as a model an offi- 
cial publication on the subject by the Royal College of Physicians of 
London, and ojQfered the following resolutions, which were adopted : 

Resolved^ That a committee of five be appointed by the President, to report as 
loon as practicable to the present session of this Association, upon the following: 

1. The propriety of adopting and using its influence to have adopted by the 
entire medical profession in the United States, the provisional <* Nomenclature of 
Diseases of the Royal College of Physicians." 

2. On the practicability of having this nomenclature published in such man- 
ner as may render it easily and cheaply accessible to every member of the profes- 

SiOD. 

3. To recommend such other practical measures for the action of this Associa- 
tion Bs may be necessary to introduce this nomenclature into official (military, 
naval, etc^) and general use. 

The chair appointed the following gentlemen as the committee: 

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354 WS8TKBN JOUBNAL Or MSDICINS. 

Dn. Woodward, U. S. A., Heustis, of Alahama, F. G. Smith, of PennsjlTaaiaf 
and Ghaille, of Louisiana. 

The reports of the Committee of Publication, and the Treasurer, 
were read, accepted and referred to the Committee of Publication. 

On motion, the Committee on Nominations were permitted to re- 
tire for consultation. 

The special order for twelve being the report on Specialists, it was 
read by the Secretary, and on motion of Dr. Sayre, the resolutions 
were adopted and the report referred to the Committee of Publication. 

The large number of arrivals has increased the personnel of the 
Association to near four hundred. 

Dr. L. P. Yandell, Jr., of Kentucky, introduced the following res- 
olution : 

JReMolvedy That private handbills addressed to the members of the medical pro- 
fession, or advertisements in newspapers, calling the attention of professional 
brethren to themselves as specialists be declared in violation of article — of section 
— of the code of Ethics of the American Medical Association. 

Dr. N. S. Davis, of Illinois, said it had been the practice to pub- 
lish cards in medical journals for the purpose of informing the medical 
fraternity that the advertiser devotes himself to special diseases. 
These cards were not so much for the information of the public, as 
for the medical fraternity. He hoped that, now the question was up, 
it would be discussed fully. 

Dr. L. P. Yandell, of Kentucky — We have allowed physicians to 
violate the code of ethics by advertising in our medical journals that 
they are specialists in the treatment of certain diseases. In Europe 
they are stricter in regard to specialists than here. There, where a 
physician wins a reputation in the treatment of certain diseases, hb 
professional brethren send cases to him for treatment, but adverdse- 
ment is prohibited. If we are allowed to resort to advertisements not 
as a question of merit, but of money, this Association should so de- 
clare. I am sure I am right in this principle, and I want to get an 
expression from this Association. 

Dr. Sayre, of New York — Let those who understand the best mode 
of treatment in special diseases, instruct their professional brethren 
through the proper channels, as the honorable way of preferment, not 
by advertising as a matter of dollars and cents. Let us look the mat- 
ter square in the face and sustain the resolution of Dr. Yandell. May 
my hand be paralyzed if I make any attempt to profit by advertising 
knowledge I have attained in my profession. 

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PROCXBDIHGS OF MSBICAL SOCnETIKS. 366 

Dr. Hassej, of Ohio, moved to amend by inserting " or in medical 
journals." 

This amendment was accepted. 

Mr. Davis, of niinois — The question before us is one to settle the 
interpretation of the existing statute. The question is whether that 
role of ethics shall be enforced prohibiting publication of cards calling 
attention of individuals laboring under particular diseases. 

Dr. Tandell stated that he had preferred charges' against a prac- 
titioner of Louisville, for advertising himself as a specialist in the 
newspapers, and for sending hand-bills to physicians, but that the 
medical societies of that city not having sustained him, he brought 
this subject up for the action of this Association. The question is, 
shall we associate with professional prostitutes and medical out-laws? 

Dr. Tandeirs resolution was unanimously adopted. 

The Committee on Prize Essays reported as follows, their report 
being adopted : 

They have received but two essays— one upon "The Physiological Effects and 
Thenpeutical Uses of Atropia and its Salts ; " the other upon "Quinine as a Thera- 
peutic Agent." They agree to present both of these essays to the Association, and 
to recommend the award of a prize of one hundred dollars to each of them. 

S. M. Bbmibs, Chairman, 

G. Beaed. 

Joseph T. Scott. 

S. A. Smith. 

The Secretary broke the seals, and announced that Dr. S. S. Her- 
rick, of New Orleans, was the author of the paper on quinine, and Dr. 
Roberts Bartholow, of Cincinnati, was the author of that on atropia. 

Dr. Booth of Mississippi, offered the following preamble and reso- 
tion: 

Retolotd, That the proper construction of article four, section one. Code of 
Bthics, A. M. A., having been called for, relatire to consultation with irregular 
practitioners who are graduates of regular schools, 

Se$olvedj That said article four, section one, Code of Ethics, A. M. A., excludes 
all such practitioners from recognition by the regular profession. 

This resolution was unanimously adopted. 

On motion, the Association adjourned until Thursday, at nine A. H. 

THIRD DAY, THURSDAY, MAY 6, 1869. 

The proceedings of yesterday were, undoubtedly, the most import- 
ant held since the opening of the session. The reports of special oom- 

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356 WS8TXAN JOURNAL OF MSDICINX. 

mittees — ^some of them bcAring upon questions vital to the interest of 
medical science — ^were read and appropriately acted upon. Among the 
ablest reports was that on President Baldwin's address, and one from 
the Committee on Medical Education. We give the former ; but we 
regret that the great length of the latter prevents us from publishing, 
at this time, even a summary. We should judge that much was done 
yesterday toward defining clearly the position to be assumed during 
the coming year by the Association. Many of the technical reports 
are of a high order of ability. 

Dr. Baldwin, President, in the chair. Dr. S. M. Bemiss and Dr. 
Mendenhall, Vice-Presidents. 

Reading of the minutes was dispensed with. 

Dr. Parvin presented the following report of Committee on Preu- 
dent's Address : 

We can not refrain, before entering upon the consideration of the plan recom- 
mended bjr the President for the improvement of medical education, gladly express- 
ing our high appreciation of the general tone of this address, of the broad and 
catholic spirit which pervades it, finding expression in earnest and eloquent words 
— in brief, we believe the address worthy the perusal of every member of the pro- 
fession, in that it was worthy the memorable occasion, and is worthy the annals of 
medicine. 

On the other hand, we can not refrain, with sadness be it said, from acknowl- 
edging the truth of the terrible allegations made against the present condition of 
medical education, and the little success attending the efforts for improvements in 
such connection, made during a score of years. 

The special recommendation made by the President Is in these words: 

'< I would advise that we appoint a committee of our wisest and best men, to 
digest a plan for one or more National Medical Schools, and to memorialize Con- 
gress in behalf of the enterprise. Let the plan embrace, as a basis, the features 
presented by the Cincinnati Convention of Teachers ; let these schools or universi- 
ties confer such distinctions and privileges as will be proportionate to the superi- 
ority they demand, and such as will make the attainment of their diploma an object 
of the ambition of those who engage in the study of medicine ; let the choice be 
open to all aspirants, and the appointment or election of professors so guarded as 
to secure the very highest talent, the most profound learning, with the most fully 
demonstrated capacity for teaching. Make the salaries of the professors large, and 
not depend upon the number of students ; and let the Federal Government assume 
a proper share of the expenses incurred." 

Your committee express their hearty approval of this general plan, but suggest 
that the effort at first should be for the establishment of a single school, as more 
feasible; and beside, one such institution would be a model which other medical 
colleges might, in time, be induced to imitate in extent, duration and thoroughness 
of teaching, and in rigidness of requirements for the degree of M. D. 

We likewise desire to say that when the details of this general plan are thrown 

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PR0CSIPINO8 OF XXDICAL 80CIETII8. 367 

ioto form, there should be the amplest security against the places and the power of 
lucfa a medical college as designed, ever falling into the hands of politicians or 
the proteges of politicians. Medicine is higher than politics, broader than political 
creeds and party platforms. 

In conclusion, your committee reiterate the recommendation of the President 
IS to the appointment of a committee for the special purpose referred to* 

The President appointed this committee as follows : 

Dr. y. 8. Davis, of Chicago, Dr. F. Gumey Smith, of Philadelphia, Dr. D. H. 
Slorer, of Boston, Dr. E. S. Qaillard, of Louisville, Dr. Joseph Jones, of New 
Orieans. 

On motion, Dr. W. O. Baldwin, of Montgomery, was added to the 
eommittee. 

The President appointed as delegates to the British Medical Asso- 
ciation : 

Dr. N. Pinckney, U. S. N., R. B. HcIlTain, Ohio, J. F. Eibberd, Indiana, B. 
Lindsey, District Columbia, G. C. Blackman, Ohio. 

To the Canadian Association: 

Dr. Alden March, Albany, New York. 

Dr. Davis presented the following from the Association of Ameri- 
can Medical Editors : 

To the American Medical Auociation: I have been instructed to announce to- 
joor honorable body, that those members of your Association in attendance on this 
umnal meeting, alter proper consultation, have effected a permanent organization, 
with the title of "The Association of American Medical Editors." The objects of 
tkis organization are the cultiration of friendly relations, mutual assistance, com- 
nonity of effort and means, where possible, in a system of receiving foreign ex- 
changes, and sending our own journals abroad, concert of action in support of im- 
prorement in the present system of medical education, and of a higher standard of 
preliminary attainments for those who propose to enter upon the study of medicine, 
in proposing laws for the proper registration of births, marriages and deaths, in 
collecting the names of all the regular practitioners in the several States, and in 
promoting generally the yalue and efficiency of our periodical medical literature. 
The Association thus formed is to hold its annual sessions on the day preceding 
the annual meetings of this body, and in the same localities. Dr. Mitchell, of Kew 
Orleans, is the Permanent Secretary, and Dr. J. B. Lindsley, of Nashville, Tennes- 
■ee, the Assistant Secretary. Congratulating your honorable body on the estab- 
lishment of another organized power within the ranks of your noble profession, 
« I remain yours, most truly, N. S. Datu^ Editor^ 

President of Association of American Medical Editors. 

Referred to Committee on Pnblication. 

Dr. Parvin read the very able report of Dr. J. C. Reeve, of Ohio, 



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358 WESTE&N JOURNAL OF MEDtCINS. 

upon Medical Educatioii. The report was referred to tlie Publication 
Committee. 

In the case of a special violation of the code in Loaisville, Ken- 
tncky, Dr. Gaillard desired to remoTe an unfortunate and incorrect 
impression created in the minds of the members of the Association by 
one of the delegates from Louisyille (Dr. Yandell), in regard to a 
failure on the part of two medical societies in that city to meet 
promptly and fully an alleged breach of the code of ethics on the 
part of the members of these societies. 

Dr. Gaillard stated that he was satisfied Dr. Yandell had no inten- 
tion of creating a false impression in this connection. The gentleman 
against whom charges had been preferred, was a German of profes- 
sional proficiency, who recently arrived, and ignorant of the code of 
ethics, had advertised himself as a specialist in the daily papers, and 
sent private hand-bills to professional men. As soon as this gentle- 
man was apprised of his fault, he had promptly withdrawn his adver- 
tisement from the daily papers, and had ceased sending the hand-bills 
mentioned. The medical societies of Louisville decided that though 
there had been a breach in the letter of the code of ethics, the gentle- 
man arraigned had no intention of doing what was professionally 
wrong. These societies, therefore, declined to expel the member 
against whom these charges had been preferred. Dr. Gaillard thought 
it due to those societies and to the gentleman offending, that this ex- 
planation should go upon the records. 

The Committee on Nominations, Dr. J. J. Woodward, U. S. A.) 
President, reported the following names : 

&epobt of ths nominating committee. 

New Orleans, Louisiana, Mat 6, 1869. 
The Committte on Nominations unanimously report as follows : 

For President — Geo. Vendenhall, Ohio. 

For Vice-Preaidenta — "Warren Stone, Louisiana, Lewis A. Sayre, New Tork, 
F. Gurnej Smith, Pennsylvania, John S. Moore, Missouri. 

For Assistant Secretary — Wm. Lee, District Columbia. 

For Treasurer — Casper Wister, Pen nsy Iran ia. 

For Librarian — Robert Reyburn, District Columbia. 

Committee of Arrangements — Thomas Antisell, chairman, Robert Reybum, C. 
M. Ford, L. W. Ritchie, W. J. C. Duhamel, D. R. Hayner, C. F. Nally. 

Committee on Publication — ^F. Gurney Smith, PenDsylvania, chairman, W. B. 
Atkinson, Pennsylvania, A. J. Semmes, Georgia, Robert Reyburn, District Colum- 



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FBOCnDIKOfi OF MBDICAIi 80CIXTIBB. 359 

Im, GbBper Wistar, PennsjlTaiiU, H. F. Askew, Delaware, Wm« Majbury, Penn- 
lylTaiua. 

Gommittae on Xedical Litaratara~J. J. Woodward, U. 8. A., chairman^ W. 
H. Anderson, Alabama, Theophilu Farrin, Indiana, Hosmer A. Johnson, Illinois, 
€. W. Parsons, Rhode Island. 

Committee of Prise Bssajs— Grafton Tjler, District Colombia, chairman, N. R. 
Lioeola, District Colambia, N. R. Smith, Maryland, G. W. Hiltenberger, Maryland, 
W. R. Dnnbar, Maryland. 

Committee on Epidemics — Add the following to fill racandes: J. K. Bartlett, 
Wisconsin, J. D. Jackson, Kentucky. 

Committee on Bdncation— T. G. Richardson, Louisiana, chidrman, B. W. Jenks^ 
JGdiigan, B. S. Oaillard, Kentucky, W. M. McPheeteit, Missouri. 

Time for meeting, in Washington, first Tuesday in May, 1870. 

J. J. WooDWABD, U. 8. A„ Okaimum. 

The report was QnanimonBlj adopted. 
Dr. D%7iB offered the following: 

Seioioedf That a special committee of three be appointed by the President to 
pment copies of the resolutions adopted before the seTeral State medical societies 
It tt early a period as possible. 

Ad<y>ted. 

Dr. Chaille, of Louisiana, cliainnan of the committee, presented a 
report on medical nomenclature, which was received and adopted, and 
referred to Committee on Pnblication. 

The Committee on the Nomenclatare of Diseases have the honor to report that 
it has examined the *' Prorisional Nomenclature of the Royal College of Physicians " 
of London, and is of the opinion that it is desirable for this Association to recom- 
aend and adopt the same for general nse in this country, with such modifications 
tt, on deliberate consideration, may appear to be necessary. The following reso* 
hition are therefore submitted: 

1. RuoUf^d^ That a special committee of fifteen be appointed by the President 
to take this subject into deliberate consideration, and to report at the next annual 
Ksnon what alterations, if any, are necessary to adapt the proposed nomenclature 
to general use in the United States. 

2. That this committee be authorised to fill up any Tacancies which may occur 
upon it 

8. That the Committee on Publication be authorised to publish for geueral 
diatribution, one thousand copies of the English and Latin portions of this nomen- 
ckture, under the designation of the Proposed Nomenclature, prefacing the same 
with such remarks as may be deemed necessary to secure the criticism and co-ope* 
ntion of as large a number of American medical men as practicable. 

4. That the committee hereby appointed be directed to draw the attention of 
the Surgeon Qeneral of the army, of the Ohieir of the Bureau of Medicine and Sur- 
gery of the nary, and of tl|e Superintendent of the Census, to the qtiestion of their 
eflkisl adoption of the Proposed Nomenclature; to invite them to appoint whom 

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360 mSBTEBN JOUBNAL Of XKDIOINX. 

they 866 fit to represent them on this committee; and to solicit snch co-operstioQ 
as maj be necessarj to accomplish the purpose desired, tIs: The final adoption of 
snch nomenclature and classifieation as will receiTe the oonjoinrt approral'of the 
official medical bureaus of the goTerament and of the general ptoftaaon. 

Stamfokd E. Chailli, If. D^ CAstnium. 
CovviTTn.^S. E. Cbaille, Louisiana, J. J. Woodward, U. S. A., A. B. Palmer, 
Michigan, F. G. Smith, Pennsylrania, J. F. Heustls, Alabama. 

Tho following committee of fifteen was appointed : 

Francis G. Smith, chairman, J. J. Woodward, U. S. A^ B. F. Michel, Alabama, 
A. B. Palmer, Michigan, S. B. Ghaille, Louisiana, L. P. TandeU, Jr., Kentucky, 
Austin Flint, New York, Alonzo Clark, New York, George B. Wood, Pennsylyanim, 
S. H. Dickson, PennsylTania, E. Jarris, Massachusetts, Theo. Parria, Indiana, W. M. 
McPfaeeters, Missouri, E. M. Snow, Rhode Island, N. Plnknej, U. S. N. 

The Committee on Medical Education having referred matters 
at issue to State medical societies, Dr. E. S. Oaillard, of Louisville, 
offered the following motion: 

Movedj That the adoption of a uniform rate of collegiate fees, one hundred 
and twent7 dollars, being the minimum, be accepted as the sentiment and desire of 
this Association. 

Dr. (Jaillard stated that he would not trespass upon the time of the 
Association in speaking upon this motion; that all of the members 
present were fully informed upon this subject. He said the profession 
desired to learn the wish and decision of the Association upon this all 
important question, and he asked a full expression of opinion and a 
full vote in regard to it. 

Dr. Sajre, of New York, opposed the resolution, but on under- 
standing that it did not prohibit an increase of fees, withdrew his 
objections. He spoke against cheap medical colleges, which allured 
young men to an imperfect medical education, who were afterward 
turned back to the plow. 

An amendment was proposed by Dr. Logan, of Louisiana, to make 
the minimum one hundred and forty dollars instead of one hundred 
and twenty dollars. 

Dr. Mussey, qf Ohio, opposed the amendment, and stated that the 
fees of Ohio had to be kept down to accord with the fees of the Michi- 
gan college. The location of the college and the cost of living made 
the difference. A hundred and forty dollar college is considered good, 
simply because one hundred and forty dollars is the fee, while other 
colleges were equally as good where the fees were only eighty dollars. 
It is impracticable to accomplish this change at once. A new college 
starts and comes up to the full standard of the old college in the 



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PBOOXEDINQS OF UIDIOAL BOOIXTHB. 361 

Tieinity, and the latter comes down with its fees. The new college 
mnflt come down, also, in order to maintain itself. 

Dr. McPheeters, of Missouri, did not agree with Dr. Mussey that 
it was impracticable to fix the collegiate fees at a minimum of one 
hundred and twenty dollars. He favored the original resolution, with- 
out amendment. 

Dr. Palmer, of Michigan, alluded to the remarks of Dr. Sayre, of 
New York, disparaging one-horse and cheap colleges. The Uniyersity 
of Michigan was established and allowed a donation from the general 
goTcmment of two townships of land, and it has husbanded its re- 
sources and can maintain itself with moderate fees. Under the organic 
law of the State, citisens were entitled to the benefits of the Uniyer- 
sity free of charge, and, as a liberal donation had been made by the 
general goyernment, students had been admitted from other States on 
the same terms. Lately, howeyer, a small fee had been charged for 
students from other States who receiyed the benefits of the lectures. 
We come up in fees just as far as we think is for the adyantage of the 
institation, and we do not go beyond that point, because it will dimin- 
ish the numbers. We are willing to put up the fees for students from 
other States to one hundred and forty dollars, if neighboring States 
will make the same requirements from their students as we do. 

Dr. Palmer then commenced describing the great advantages of this 
school, when Dr. Gaillard called him to order, stating that we were 
present to discuss principles inyolyed and not to listen to eulogies upon 
special schools. 

Dr. Dayis, of Illinois — I do not object to discuss the fees, but I do 
claim that it is out of place to adyertise the superior claims of State 
colleges here. We have had no more illiterate students in our Illinois 
college than haye come to us after one course in the Uniyersity of 
Michigan. 

Dr. Paryin, of Indiana — I move to amend by striking out one hun- 
dred and forty dollars and inserting one hundred. If we make the fees 
of colleges uniform, the next step will be to make the fees of practi- 
tioners uniform — ^the same in the yillages of the west as iu the city of 
New Tork — and that is not equitable or practicable. It is not possi- 
ble for the schools of Ohio to keep eyen their present classes, and 
charge one hundred and forty, or eyen one hundred and twenty, while 
they may at one hundred dollars, notwithstanding the competion of 
Ann Arbor, with its low fees. Why then grasp after unattainable 



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362 WBSTBRR JOURNAL Of HIDIOINI. 

good, and reject tlie poBsible ? Make the minimuiB one Imndred dol* 
lars, and the two principal schoola of Cincinnati may come up to it 

Dr. Logan of New Orleans, adyocated the sum of one hundred and 
forty dollars, as the minimum of collegiate fees, and urged the adop- 
tion of his amendmeut. Lost. 

The amendment of Dr. Parvin, to fix the minimum at one hundred 
dollars, was also lost. 

The resolution was then, as originally presented, unanimously 
adopted. ' 

Special Committee on the Relatiye Advantages of Syme*B and Piro* 
goff's Mode of Amputating at the Ankle, Dr. O. A. Otis, U. S. A., 
chairman, Dr. G. M. HoUoway, of Louisville, Kentucky. 

Proposed by J. J. Woodward. Approved. 

Dr. Bemiss presented fVom Dr. John Watters, of St. Louis, Miasouri, 
a Y&per on the Doctrines of Force — ^Physical and Vital. 

Dr. Toner, District Columbia, moved that a Committee on Yariola 
be appointed — Dr. J. Jones, chairman. Adopted. 

Dr. Pinckney, U» S. N., made statements concerning relative grades 
of rank. The paper was ordered to be spread upon the minutes. 

Association adjourned to meet at nine o'clock A. m., Friday, May 7tk. 

FOURTH t>A7, FRIDAY, MAT* 7, 1869. 

The Association met at nine o'clock. Dr. Baldwin in the chair. 

Reading of the minutes omitted. 

Dr. Joseph Jones, Louisiana, presented a number of specimens of 
pathology, anatomy, and natural history. The explanations were very 
interesting, and received with applause. 

On motion of Dr. Oarrish, New York, the thanks of the Assoeia- 
tion were tendered to Dr. Jones. 

On motion of Dr. F. G. Smith, of Pennsylvania, the following reso- 
lutions were unanimously adopted by a vote of the members present, 
standing as a mark of respect : 

Ruoloed^ That the thanks of this Association are justly due and are herebj 
tendered to the President for the uniform kindness and oonrteay with which he hit 
presided oyer its deliberations, and to the Committee of Arrangements, the physi- 
cians and citizens of New Orleans, for the generous hospitality and fraternal kind* 
ness with which we hare been reccired and treated since our sojourn in their citj, 
with the assurance that the memories of this risit will always be among the brigbt- 
est and most enduring of our lives. 

lUiolved^ That we also present our thanks to the various railroad and stetm- 
boat companies who hare so liberally extended to us facilities of transportation, 

.,y,u..uuyGOOg.^ 



VBOCKXMVOS OF XlDiQAL 0OOUTIE8. 363 

and to tbe dailj pien for their efficient aid in reportinf the proceedings of this 
meeting. 

On motion of Dr. Moore, of Mississippi, the following preamble 
and resolution were adopted : 

Weebmab, The contmct system is contrsrj to medical ethics, 

Euoloed^ That all contract physicians, as well as those guilty of bidding for 

practice at less rates than those established by a migority of regular graduates of 

the same locality, be classed as irregular practitioners. 

The following reports of tbe sections followed : 

Section on Meteorology, ICedical Tc^graphy and Epidemics, reported. Paper 
accepted and referred to the Committee on Publication. 

Sections on Practical Medicine and Obstetrics, reported and report accepted, and 
referred to Committee on Publication. 

The report on Training of Nurses was accepted, and the accompanying resolu- 
tions adopted. 

Section on Medical Jurisprudence, Hygiene and Physiology, reported. Com- 
mittee continued for next year. Report accepted and referred to Committee on 
Publication. 

Section on Surgery proposed that their report be received without formality 
and be referred to the Committee on Publication. Adopted. 

After being read, the report was accepted and ordered to be published. 

Section on Psychology, the same disposition. 

Tbe President appointed Dr. J. M. Toner a committee of one, at 
Wisbington, D. C, to assist tbe Librarian of Congress to keep tbe 
books of tbe Association. 

On motion for adjournment, tbe President delivered this address, 
whicb was unanimously accepted and ordered to be publisbed in tbe 
transactions of tbe Association: i 

Gutlbxih: Before I submit the motion jnst made, and which, when adopted, 
will practically close my official relations to this body, allow me to return you my 
most cordial and grateful thanks for the uniyersal kindness which I have received 
at your handy. Whateyer my future lot in life may be, the world holds no honors 
which, to me, can equal those conferred by you. The fraternal good will which 
Ins so oonspicuonsly marked your deliberations, has been to me a matter of infinite 
s^is&ction and pride, yd will not be the least among the gratefnl memories which 
will gladden my heart as I may hereafter review the incidents of my official con- 
section with you. 

Tq win your judgment and approval, to hold up the dignity of fellowship, the 
nieliilness of association, and the interest and prosperity of the profession at large, 
hare certainly occupied my most anxious thoughts since my eleiration to this posi- 
tion ; yet, to cherish and promote the intimate and cordial relations of friendship 
between the indiTidaal members of this Association against all sectional distinctions 
or geogtapbiofll linsa, has also been among the chief objects of my ambition and 



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364 WKSTSftN JOmUTAL OF MEDIdNB. 

the earnest desire of mj heart. Goald I now beliere that mj efforts hare contribu- 
ted in the slightest degree to enlarging that harmony of sentiment and fraternal 
feeling which has been so apparent throughout this meeting, I should feel that I 
had commenced at least to make some return for the great honor and kindne aa 
received at your hands. 

It now only remains for me, gentlemen, to again express to you my thanks, to 
wish you a safe return to your homes and labors, a happy reunian with your friends 
and fiEimilies, and to pronounce the sad word, orer which the heart of friendship 
would fain linger, as I bid you an affectionate farewelL 

W. 0. Baldwxv, Pruident A, M. A. 

The Conyention adjourned to meet in Washington, D. C, the sec- 
ond Tuesday in May, 1870. 

(This report of the Proceedings of the American If edical Association, is chiefly 
taken from the Oouritr-JaumiUy a copy of which was received from Dr. GaiUard. 
It eridently w^ condensed by some medical hand from the reports of the New 
Orleans papers, which were very full, especially those in the Time*, We thank Dr. 
Gaillard for his kindness, for it saved us no little work.) 



PEOCBEDINGS OF THE DEARBORN COUNTY MEDICAL 
SOCIETY. 

The Society met at the room of Lient. Vaughan, in Lawrenceborgh^ 
April 13th, 1869, and was called to order by the President, Dr. Sutton. 

Present, Drs. Harding, Kyle, Haines, Lamb, Bond, Walter, Sale, 
Layton, Bobbins, and Miller. 

Minutes of preyious meeting were read, amended and approved. 

Dr. Lamb requested an expression of the members of the Society 
on the treatment of pseudo-membranous croup, upon which subject 
nearly all present gave their views. 

On motion of Dr. Miller, Dr. D. H. Harding being present, wad 
invited to participate in the discussion. 

Dr. Sale reported a case to which he was called and diagnosed in- 
flammation of the trachea. In a few days, in a fit^f spasmodic cough- 
ing, a small chip of wood was expelled, and the symptoms subsided. 

Dr. Sutton reported a similar case in which tracheotomy was per- 
formed, and a grain of corn extracted, with entire relief. 

Dr. Sutton read some interesting facts relating to the meteorolog- 
ical condition of the atmosphere during the autumnal months of 1866, 
1867 and 1868, with its influence on the health. The flrst, remarkable 
for its humidity; the second, for the small amount of rain fall; and 

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wMSMDaeB OF MxraoLL BooaaasB. 366 

jBt, both were extraordinarily healthfU. The last year showing nearly 
« mean, was noted for the onnsnal amount of riokneas, showing that 
oonditioBS of the atmosphere exert leae influence on the health than is 
generally supposed. 

Dr. Miller moved that article sixth of the constitution be so amended 
that the Committee of Arrangements be appointed at each meeting, 
eompoeed of members residing at the place where the next meeting 
is to be held. Also, article ninth, so that fiye members shall consti- 
tute a quorum, which were adopted. 

Dr. Sutton submitted the following preamble and resolution, which 
was unanimously adopted : 

Whsbkas, Dearborn comity has no saitable building or accommodation for the 
medical treatment of onr panper population, neither have we a enitable building 
for the ooofinement and comfort of that daas of insane who can not be admitted 
into the Hospital for the Insane at Indianapolis; and 

WaniAS, Fer want of such accommodation, we haye recently seen one of our 
citixena, while laboring under partial insanity, confined in our county jail, placed 
in irons, and surrounded by criminals, treatment which was not only cruel, but 
well calculated to aggrayate all the symptoms of his disease ; and 

Wbxbias, We beliere that when a county becomes as wealthy and contains 
a population as large as Dearborn, with as may paupers as we now have requiring 
■ledieal aid, and as many insane whoare not properly proTided for, that a county 
hospital, or a building more suitable than the one we now haye, should be erected 
near the county seat or some other point easy of access, and placed under the con* 
trol of an intelligent physician with proper assistants; and 

WnniAS, We belieye such county or local hospital will meet the wants of the 
community better than the erection by the State of a large central hospital, as 
recommended by the Indiana State Ifedical Society at its last meeting, from the 
iiet that a large portion of the cases requiring medical treatment could not be 
transported safely from distant and different parts of the State, such as patients 
laboring under acute diseases, many of whom would die before they could be got 
to the hospital; or those suffering fix>m contagious diseases, the remoral of whom, 
to a distant hospital, would endanger the public ; or those surgical cases arising 
from accidents requiring immediate^treatment, such as the reduction of dislocations, 
replacing of fractures and dressing of wounds, Ac, all of which might be safely 
remored a short distance to a county hospital; therefore 

Boohed^ That a committee of three be appointed to present to our county 
commissioners, at their next session, the importance of haying more suitable 
•ccommodations for the medical treatment of our poor and the comfort and treat- 
ment of the insane within our county, as wants which humanity demands and our 
community require, and report at our next quarterly meeting. 

Drs. Sutton, Harding and Kyle, were appointed the committee. 
Lieut. J. P. Yaughan, who lost a leg at the battle of Cold Harbor, 

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366 WE8TKBN JOUBIf AL OF VJWIOUIJB. 

June Iflt, 1864, whicli was re-amputated at Chicago, bj Prof. Bninard, 
October 10th, 1864, kindly came before the Society aad smbmitted hia 
stump for examination. This is a case of necrosis which has gradn* 
ally been extending itself up the shaft of the bone, and discharging 
from seyeral openings. 

On motion of Br. Lamb, the Secretary was requested to fvrnish a 
synopsis of the proceedings for publication in Hie We$tem Jommal of 
Medicine and Oincinnati Lancet and Ohterver, 

Drs. Harding, Miller and Sale, were chosen delegates to the Indi- 
ana State Medical Society. 

Dr. Bobbins read a history of a case of spina bifida, occurring in 
the. practice of Dr. Walter, in which amputation was resorted to, but 
the child only liyed a few days. 

Dr. Sutton reported a case occurring in his practice some years 
ago, of a tumor on the back of the head, so large as to give rise to the 
rumor in the city of a child born with two heads. He introduced a 
trocar and drew off a large quantity of serous fluid; the sack re-filled 
and he punctured it again; the child died some fifteen months after- 
ward, of hydrocephalus. 

Drs. Walter and Haines, each reported a case somewhat analogous. 

Drs. Sutton, Haines and Lamb, were appointed Committee of Ar- 
rangements for next meeting. 

On motion of Dr. Miller, a vote of thanks was tendered Lieutw 
Yaughan for the use of his room for this and future meetings. 

On motion of Dr. Haines, a yote of thanks was tendered the phy- 
sicians of Lawrenceburgh for their hospitable entertainment. 

The Society then adjourned to meet at Aurora, on the last Tuesday 
in May, at ten o'clock A. m. C. B. Miller, Secretary. 



JOHNSON COUNTY MEDICAL SOCIETY. 



This organization held its annual meeting at the Court House, in 
Franklin, ou Tuesday, May 11th, beginning at ten A. M. 

The following named members were present, viz: W. C. Bice, J. 
H. Donnell, J. L. Farris, J. H. Fuller, J. A. Marshall, D. H. Miller, 
A. Miller, J. T. Jones, P. W. Payne, J. B. Ream, J. J. Sadler, J. F. 
Wallace, B. Wallace, W. A. Webb, and R. D, Willan. . 

The record of the last meeting haying been read and approTcd^ 

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PBOOBBBIlfOS or MEDICAL SOCIXTIXB. 367 

ibe Society wm fayored with an essay by President P. W. Payne, on 
"Tbe Duties and Responsibilities of Physicians, as Experts in Cases 
of Crime committed under the Influence of Intoxicating Liquors.'* 
The essayist held that a man is not responsible for acts committed in 
the second stage of intoxication. The reading was followed by an 
saimated discussion, in which the larger number held with the essay- 
ist, but some insisted that criminal responsibility does extend to the 
leeond stage of drunkenness. 
Adjourned to one p. m. 

AFTBBNOON SESSION. 

An essay was read by B. Wallace, on Post Partum Hemorrhage, 
ne discussion of this sulrject was participated in by most of the mem- 
ben present. 

This being our annual meeting, the officers were elected as follows: 

/Voufenl— J. A. Marshall. 
7»c»-iV«ridSml— J. S. Fame. 
&nre/ary— B. Wallace. 
TreatiKrer — J. H. Fuller. 

The Committee on Obstetrics were not prepared to report, and were 
iBstmeted to leaye iheir blanks in the hands of practitioners till olose 
of this year, and then call them in and prepare a report to be present^ 
ti a special meeting in January next. 

A motion prevailed that we hold a special meeting the first Tues- 
day in July, to hear Ihr. Jones' paper on Diphtheria, and also reports 
«f any interesting cases which members may be treating. 

J. H. Donnell, W. A. Webb and B. Wallace, were appointed a 
committee to confer with the present coroner in reference to resigning 
in £iYor of a medical man, and a motion prevailed requesting J. T. 
Jones to accept the office, if his appointment by the commissioners 
can be secured. 

On motion, W. C. Hall was excluded from membership for con- 
tempt of this Society. 

J. L. Kegly was elected a member, having been duly recommended 
by Uie ''Conunittee on Admission of Members." 

A resolution prevailed, that members be allowed to invite their 
friends outside the profession, to attend our meetings. 

The Society was instructed to furnish a copy of these proceedings 
to the WeUem Jowrual of Medicine for publioation. 

Adjourned to July, 6th prox. B. Wallaox, Secretiouty. 

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CORRESPONDENCE. 



Philabslphia, Mat 15, 1867. 

Id my letter of March 15tli, I alluded to ike introduction of tbe 
Earth-Closet into the lower surgical ward of the Pennsylvania Hos- 
pital, and the employment of the dry clay as a surgical dressing by 
Dr. Addinell Hewson, one of the surgeons to the Hospital. The Closet 
has fully realized the expectations of its friends in its working, and 
has demonstrated its value as an appliance in hospital wards. One is 
now in successful use in the Philadelphia Hospital, and for some time 
past the earth has been used as a deodorizer in the urinals at the 
Episcopal Hospital. 

During the past two months, Dr. Hewson has continued his inves- 
tigations in the great variety of cases presented for treatment in the 
wards, to test most thoroughly its value and to determine the nature 
of its action. In order to do this, he has used it to the exclusion of 
all other applications, and has carefully observed the results. This 
fkr, he has found that its action is most decided in those cases in which 
exist high inflammatory conditions and excessive suppuration. Its 
power to prevent putrefactive change, has been shown in a marked 
manner in a case of amputation at the tibio-tarsal articulation. The 
injury was produced by machinery, and the structures were, as a con- 
sequence, very much lacerated. Desiring to give the patient — a work- 
ing man — as serviceable a stump as possible, Pirogoff's method was 
employed. By reason of the lacerated condition of the parts, the 
vascular supply was cut off, and the posterior flap lost its vitality. 
Under the application of the ^earth-dressing, the decomposed tissae 
would not slough off, and in order to accomplish its removal, a fer- 
menting poultice was resorted to. The flrst twenty-four hours of its 
applioation developed the putrefactive process, and the amount of pus 
discharged was quadrupled. When the dead tissue had been removed, 
the earth-dressing was re-applied, and the amount of pus discharged 
decreased in the ratio of its increase under the fermenting poultice. 
The results in this case seem certainly to prove its power to prevent 
the putrefactive process. 

The method of preparation of the clay for surgical purposes, is 



OOBBXeVONDXIICS. 36f 

rery simple. Yellow clay is selected, veil dried, not baked, puWerised 
and finely sifted. Its application is easy, being placed in direct con- 
tact with the surfaces, and kept in position by compresses and band- 
ages. Pr. H. uses exclusively the paper dressings, made of unglaaed 
white paper. For application to the extremities, the paper is used in 
die form of the bandage of Scultetus. In amputations, the stump is 
pacJ^ in the clay, in the ordinary fracture box, or in boxes made of 
binders' board. 

Whatever may be the ultimate verdict as to the value of the dry 
clay as surgical dressing, Dr. Hewson at least deserves credit for the 
thorough manner in which he has prosecuted his investigations. 

It seems that Twitchell, the murderer of his mother-in-law, Mrs. 
Hill, was not satisfied with his efiPorts to pussle the doctors during his 
trial, as to the character of the weapon used in producing the death of 
his victim, but endeavored, in his own death, to leave behind a prob- 
lem for their solution. Early in the morning of the day selected for 
his execution, he was found in ''rigor mortis," lying on the cot in his 
cell, evidently destroyed by some poisonous agent, the nature of which 
could not, at that time, be determined. An empty tin-cup, upon s 
chair beside the cot, gave no evidence as to what it had contained, or 
whether it had been used in the administration of the drug. The posi- 
tion of the body seemed to indicate that spasmodic movements had 
preceded death, as there were slight opisthotonos and flexion of the 
fingers; the pupils were but slightly dilated; the jaws were firmly 
eloeed. In other respects, the appearances were not characteristic of 
the effect of any particular poison. It was, therefore, left for the 
autopsy to decide the question. The examination was made about 
* twelve hours after it is supposed death occurred. On removing the 
ealvarivm, the odor of hydro-cyanic acid was strongly exhaled, and as 
die examination progressed, this odor was found to pervade all the 
tissnea. The mucous membrane of the stomach was slightly reddened, 
and the blood was in a fluid condition. With these exceptions, no 
abnormal conditions were discovered. The fluid state of the blood 
was an unusual condition, and attracted the attention of those present 
at the examination. It is not iioted as a condition by writers on the 
Bubjeci, of the effects of this poison. Taylor, in his work, mentions 
one caBe of poisoning by prussic acid, in which " the muscles were red, 
and gave out^'on sectioft, a good deal of fluid blood." A specimen of 
the blood was presented at a meeting of the Pathological Society, by 
the President, Br. Packard, and referred to a committee for examina- 

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870 WXSTSRK JOtTBMAL OV MSDICXNX. 

(ion. This committee, oonsisting of Dn. Keen and Hare, made Am 
report at the last meeting. They had submitted the speoimen of hlood 
to repeated and carefnl examinattona, but could diaoover no cauae to 
account for its non-coagulability. Appended to the report was a state- 
ment of the results obtained in a series of experiments instituted by 
them, to ascertain the effect of the poison upon the blood of animala 
Babbits were selected for the purpose, and the experiments were con- 
ducted with great care. The poison was administered in varying quan- 
tities, and in difierent combinations, and in no caae waa Uie blood 
found fluid. They propose to continue theii^ inveatigationa, and will 
prepare a full report for publication in the transactions of the Sooie^. 

On Wednesday last, Dr. Washington L. Atlee, the diatinguiahed 
oyariatomist, performed hla two hundred and third operation. The 
oase was one of unusal interest, owing to the involTement of both 
oraries and the existence of extenaire and complicated adheaiona. 

According to the history furnished; the disease manifested itself 
in the right ovary about one year since, and had steadily progressed 
without much constitutional disturbance. The patient, a naliYe of 
Ireland, was the mother of four children, and in fair condition. 

The operation was performed with all the skill and method which 
characterize the doctor, for he ia one of the moat systematic men in 
the profession, and hia operations are models of system and good order. 
I venture, in the hope that it may prove intereatiDg to some of your 
readers, to describe briefly hie method. All preparations for the ope- 
ration are made under his personal supervision. The patient ia placed 
upon the table, with the ahoulders elevated, limba projecting beyosd * 
and supported upon stools. When all ia in readiness, which is tMNiri- 
mbfy at the time appointed, he enters the room where are aaaembled his ' 
aasbtants and the gentlemen invited to witness the operation. In a 
few Words, the history of the case is given, his diagnoaia ia announced, 
and the method of operation explained, accompanied by the statement 
that it will not be completed, if such conditions exist aa in hia judg- 
ment render it improper to proceed. Silence is to be maintained, and 
the assistants are to take the places assigned them, and give strict 
attention to their duties. 

The ansBsthetic used is one part of chloroform to two parts of 
ether — liquid measure. When the patient is anaesthetised, the opera- 
tion is commenced, the Doctor, standing upon the right aide of hii 
patient, an incision, from two and one-half to three inches in length, 
and about three inches below the umbilicufl, ia made in the liaea alba. 

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cosusamcDwci. S71 

Reacbing the sae by caieful dlTision of tbe abdominal wall, be intro« 
dsces a finger and frees tbe margins of tbe wonnd. Introduoing now, 
two or more fingers, tbe extent of tbe parietal adbesions are deter- 
mined and broken np. Tbe cyst is now eyacnated by plunging a larg€ 
troear into it, oare being taken tbat none of its oontents esoape inta 
the abdominal cavity. If oiber oysts exist, tbe perforator is re-intro* 
dnced into tbe canola, forced tbrongb tbe septa, and tbe fluid dvaciir 
ated throngb tbe opening made into tbe large cyst. 

Further explorations are made by tbe band to ascertain whether 
there are omental or intestinal adhesions. If necessary, tbe wound is 
enlarged and tbe points of adhesion brought into view. Omental 
adhesions are carefully separated, and the ends given in charge of an 
issistant, who prevents their return to the cavity, and also oontrols 
any bsemorrhage which may occur from divided vessels. Usually, in- 
testinal adhesions are gently detached by the fingers. If they are 
extensive and firm, a portion of the sao b dissected off, and permitted 
to remnin adherent. In this way, tbe intestine escapes the injury which 
might arise from the efforts made to break up tbe adhesions. Tbe sao 
is, by gentle manipulation, drawn through tbe opening, tbe pedicle 
sought for and secured by the clamp. Tbe pedicle being secured, tbe 
sac is detached, and attention is given to tbe bmmorrbage — ^if any occur 
from the omental vessels, they are ligated after being retrenched — 
hsBmonrhage from the parietes is controllled by means of torsion acu- 
pfessure, or if necessary^ tbe ligature is resorted to. Tbe abdominal 
eavity iB now carefully sponged, tepid water and soft sponge being 
used for tbat purpose. Tbe pedicle and the ends of ligated vessels 
are placed between tbe edges of tbe incision. The clamp holds tbe 
pedicle in position, and pins are used to secure tbe ends of tbe vessels. 
The edges of the incision are brought together by tbe introduction 
of interrupted wire sutures, and adhesive strips are applied. A com- 
press, covered by a mass of raw cotton is applied, tbe whole being 
secured in place by a bandage of soft flannel. Tbe patient is placed 
in bed, and a full dose of McMunn's elixir is administered. Tbe clamp 
is uffoaily detached in four days, and tbe sutures are removed in six to 
eight These are, in substance, tbe steps of the operation, as it is per- 
formed by Dr. Atlee. 

As with all ovariatomists, the treatment of the pedicle has been a 
subject of careful investigation by him. He has employed all methods, 
and his experience warrants him in pronouncing tbe clamp the best, 
and to be preferred above all others. In two successful cases, where 

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872 WI8TXBK J0I7BNAL OV MSDIOINX. 

the pedicle was very small, he employed simple torsion. The ecrasenr, 
the ligatnre, thread and wire, and the aotal cautery, have all failed to 
produce the favorable results obtained by the use of the clamp. In 
hifl operations, as in those of the English oyariotomist, Mr. Spencer 
Wells, increasing experience has been followed by diminishing mor- 
tality. In the two hundred cases, the mortality is about thirty per 
oent. As reported in the transactions of the Royal Medical and Chi" 
rurgical Society^ June 25th, 1867, the mortality in the first two hun- 
dred cases of Mr. Spencer Wells amounted to thirty-one per cent. 

Considering the character of many of his oases, for he does not 
select them as is sometimes done, and the circumstances under which 
the operation is frequently performed, without the seryices of compe- 
tent nurses, and lacking those appliances so essential to the proper 
care of the patient, the results are certainly extremely fayorable, and 
establish his reputation as a skilled and succsssftil operator. 

He is now arranging the immense amount of material accumulated 
during the past twenty-five years, and proposes to issue a work upon 
the subject of ovarian disease. It will be a valuable contribution to 
the science of medicine. 

As you may know, this city has an excellent record as to the sue- 
cess which has attended amputations at the hip-joint. 

In the American Jowmal of Medical Science$, for July, 1866, Br. 
Thos. G. Morton reported eleven cases, seven of which had terminated 
successAilly. Three operations have been pMbrmed since that time, 
two of which have been unsuccessful, and the result in the third is yet 
undecided. It was performed at the Philadelphia Hospital, by Dr. H. 
H. Maury, one of the surgeons, in the presence of a large class of stu- 
dents and a number of the most prominent surgeons of the city. 

The method of amputation selected, was that known as the cutane- 
ous-muscular, the anterior flap being composed of the integument and 
superficial fascia, made by cutting firom without inwards, and the poste- 
rior flap of the gluteal muscles. The circulation was controlled by 
means 6f Signouroni's abdominal tourniquet, compressing the aorta just 
before its division into the iliacs. Not more than an ounce of blood 
was lost; the patient bore the operation well, and is at this writing 
progressing favorably. The cause of the operation was a tumor of 
the upper portion of the femur, involving all the structures about the 
trochanters. In a clinical point of view, it had all the features of « 
malignant growth. 

Last wee^, \ had the pleasure of examining one of Dr. Thos. G. 

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OOBKKVOHDllfOI. 87S 

Morton's hospital wagons, or ward dressors, as ihey are properly oalled. 
It had been made, in response to an order from Bellevue Hospital, and 
was rery completely furnished. A description of the wagon, accom- 
panied by a drawing, is given in the last number of the Fenn^lvatUa 
Hotpiial Reportt. 

Br. M. informs me that two are in vse in Surope, one in London 
and one in Paris. It is the most complete apparatus that could be 
devised for the purpose, and should ba¥e a place in the surgical wards 
of every hospital. 

Prof. Francis G. Smith, of the University of Pennsylvania, has 
just returned from New Orleans. He speaks in the highest terms of 
the courtesy with which delegates to the National Medical Association 
were received by the citizens of New Orleans and by the members of 
the profession throughout the south. 

During the past week, Dr. F. S. Newcomer, of your city, has made 
US a short visit. 3, E. M. 



CLINICS AND CLINICIANS OF VIENNA— No. 2. 



Vienna, Mat 3, 1869. 

Not many years ago, before the chastisement and resulting chasten- 
ment of Austria by her haughty neighbor, when her police regulations 
were much more severe than at present, every stranger, on entering 
her borders, was subjected to rigid scrutiny. Not content with his 
nativity, age, avocation, religion and destination, as now, they deman- 
ded, also, the object and intention as well as the probable duration of 
kis stay, and it was not long before the great influx of young men 
from America, England and France attracted the attention of these 
worthies to a suspicious and alarming degree. 

Everywhere the answer to their interrogatories was, we have come to 
kear Skoda. Who and where is Skoda? In a little while he was fer- 
reted out, an obscure lecturer on auscultation and percussion in the 
general hospital, comparatively unknown, outside of the profession, of 
course, in the city wherein he dwelt. The report reached the ears of 
those in authority finally, one of the principal wards of the hospital 
▼as allotted him, they honored him, or rather they did themselves the 
honor to vouchsafe him certain decorations of honor, and thus was 

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$74 wnrrsuN jourkal ov MnoiGxmL 

placed in high distinction the chief liying authority in this department 
of science in the world. 

To Skoda are we indebted for the thorough exposition and interpre- 
tation of the many symptoms which, in Laenneo's theories, are inexpli- 
cable and second only to him, the great father of science, is Joseph 
Skoda, of Vienna, entitled to rank. His doctrines are now in general 
acceptance orer nearly all Germany, and are rapidly gaining ground 
in Bngland, while France, with the prejudices against CTerything 
which does not emanate within her boundaries, still adheres to Laen- 
nec. 

The corner stone to the entire edifice of Skoda's doctrines is the 
discorery, in direct contradiction to all the laws of physics which 
were formerly inculculated, that air is a better conductor of sound 
than a solid body. Grant this as a law and his Tiews are all simple 
enough. To prove this he resorts to a number of interesting experi- 
ments. A normal lung is placed between two stethoscopes, the voice 
of one individual, at the free extremity of one, is better heard by the 
ear of another at the free extremity of the second instrument than if 
a condensed or infiltrated lung be interposed. The noise of two 
iltones clashed together under water is appreciated more faintly by the 
ear, likewise under water, than if ear and sound be out of water: 
audition with the tubular stethoscope is better than if the tube be 
closed, by a tightly fitting rod of the same material. Niemeyer for- 
warded Skoda a solid stethoscope on his (Skoda's) last birthday, 
turned from the fir wood and in the proper direction with the grain as 
proof that his last statement was untrue, but the universal testimony 
of every unprejudicial ear, and his assistant in his private course, sub- 
jects it to trial by every student, is to the effect that the tubular b 
still far the better. Why do we hear better in the open air than if a 
wall be interposed, and why is the auditory canal a tube, inquires 
Skoda, if air be not the better conductor? The reason that sound is 
better appreciated by the ear applied to the end of a rod, metal for 
instance, struck at a remote distance than in open air at the same dis- 
tance, is not because the solid is the better conductor, but because 
nearly all the sound is conducted, but little of it escapes ; substitute a 
tube of the same length and the sound will be still louder heard. And 
so the reason why sound is more intense over a condensed lung is not 
because the more solid lung conducts the sound better, but because the 
bronchial tubes are surrounded by a more or less solid wall which pre- 
vents its dispersion and intensifies it by reverberation, and thus it is 



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€0R&SSFOMDXNC£. 379 

lieard better in q>ite of and not on accoaot of the increased eolid- 
ity, etc., etc. 

You may well imagine that an innovation of this character excited 
00 little attention, and various were the explanations, especially from 
the physicists, to meet these points. The best objection raised is, that 
the better conduction through a tubular stethoscope is due to the dif- 
ference in conducting power betw^een the condensed lung and the solid 
stethoscope, and the consequent interference with uniformity, which 
difference tiiey claim Skoda has altogether neglected. 

Space precludes a further history or report, suffice it to say that 
Coda's views are gradually extending over the continent and bid fair 
some day te become the prevalent doctrines everywhere. All the good 
eld terms and technicalities are being rapidly supplanted, and we can 
assure you that it was with feelings of no peculiar character that we 
hear them spoken of for their hUioric interest. So go by the board 
the mucous and sub-mucous, sonorous and sibilant rales, which are 
simply eoTMonan^ rales; crepitation once the gn.ndpathos noma, ceases to 
be of much value — that is, of course, in differential diagnosis; aegoph- 
eny yields the ghost, bronchial respiration and broncophony become 
synonymous with consonant respiration amd consonant voice sounds; 
iumsonance is rung in our ears by day and by night until we might 
fancy a grand coordinative and coexistent harmony universal. And 
now what is consonance? In respiration it is the sound of the air 
from a healthy or less diseased portion passing over and into the tubes 
of a non-diseased portion, awakening a vibration there which is con- 
sonant with its primary sound. The consonant sound, hence, is a sec- 
ondary sound and a dependant sound. Plug the tubes of the diseased 
pordon with mucus, and consonance of course ceases. How explain 
ihe wudden cessation of abnormal sounds which occurs daily on the old 
iheory when the solidity is, by necessity^ the same f Should the mem- 
brane of the tubes be inflamed, the air in its passage is more or less 
obstructed, and hence we have consonant rales (consonirendes rassein,) 
which are subdivided according to the size of the vesicles ruptured 
tato hirge vesicle rales (groszblaschen), small vesicles (kleinblaschen), 
and vesicles of medium size (mittelgroszblaschen), or if dry into con- 
sonant piping rales (consonirendes pfeifen rassein). J^W respiratory 
sounds must oome under one of the three following divisions, conso- 
nant rales (consonirendes rassein); indistinct or undecided respiration 
(unbestimmles athmen): consonant respiration (consonirendes athmen). 
The first embraces the dry and moist rales, crepitation, etc., etc., the 

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376 WXSTKRN JCftRKAL OT MSBICIKI. 

second as its name implies possesses no definite eharacter, and the 
third includes bronchial respiration, the so called tabular, etc., etc. 
The grand fundamental law is that no one symptom or featnns of aus- 
cultation is pathognomonic. The consonance of sound is explained in 
the same way. 

Tou must know also, my dear Editor, it is no longer modeme tcr 
speak of compression of the lung either from the abdomen by meteor- 
ismus, or enlargement of any of its organs, or even from* plefnritie effu- 
sions, unless of great accumulation. The retractility of the lung- 
tissue explains it all in a mnch more scientific way. This said power, 
like the centrifugal force, is constantly at work, and is only balanced, 
as by the centripetal in nature, by the atmospheric pressure in inhala- 
tion ; and it takes advantage of every infringement on the cavity of 
the chest to reduce the size of the lung. Hence the displacement of 
the heart's apex becomes a valuable symptom as one of the first in any 
affection which may have this effect. In pleurisy, for instance, of the 
left side the apex beat may be recognized nearer the sternum than 
normally long before the small amount of effused material would afford 
any dullness on percussion. The protruberances of the intercostal 
spaces are not due to the mechanical pressure of the fluid which is im- 
possible when the fluid is small in quantity, and which is further dis- 
proved by the fact that spaces may be protruded above the Uvel of 
effusion, or further, by their permanence in any position of the patient, 
but which are due to the paralysis of the intercostal muscles from in- 
flammation of the pleura costalis, just as deglutition is impaired by par- 
tial paralysis of the pharyngeal muscles from inflammation of their 
lining membrane, or as intestinal peristalsis is weakened or nullified by 
the paralysis of the muscular coat induced by catarrhal diarrhea^ 
Now this retractile power is the same normally on each side ; should 
the left cavity then, for instance, be infringed upon, the left lung will 
be drawn over towards the right, for the center of attraction is always, 
of course, at the root of the lung, and the heart can not but follow. 
This is the beauti^l theory of Bonders, which is now daily inculcated. 

In a bronchitis the muscular coat of the tube may be lamed, and 
often is, and thus a dilatation of the tube occurs, bronchectasis, which 
is, of course, assisted by accumulations of mucus. Should the bronchi 
be surrounded by an inflamed lung tissue, this too, in contraction, 
would tend to forcibly dilate the tube, and since the tissue does not 
exert its force circularly, but rather between the tubes where the cen- 
tar of attraction lies, the bronchi would be dilated in a corresponding 

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CORRSSPONDSNCK. 377 

direction. For an eztensiTe dilatation, however, it is necessary tliat the 
cartilage should soflen, which does occur when the inflammation is 
BCTere, and then even the ordinary contractile power of the lung 
would influence the calibre of the tubes. The periodic cough, or 
rather the cough and expectoration of a large quantity at long inter- 
vals, is due to the fact that mucus slowly accumulates in tubes, which 
are in a state of partial anaesthesia either from disease or consuetude, 
until it overflows into an unaffected tube, when reflex action is excited 
it once with the powerful contractions of severe cough and the whole 
collection is thrown off. The same explanation answers for the 
morning cough of phthisis. 

The pathology of this disease, Tuberculosis, has undergone many 
changes. On one point, however, the German schools are united. 
Tuberculosis Pulmonalis means only and means always, what is known 
at home as miliary tubercle, while all those cases, by far the great ma- 
jority, which lead to the formation of cavities are now known by the 
name Caseous Pneumonia. Niemeyer, who first promulgated this doc- 
trine, devotes a number of pages in his work on Practice, which is the 
present standard, to a full description. Caseous pneumonia then is a lo- 
cal dbease, the result sometimes of ordijiary catarrhal pneumonia 
nearly always of the croupous form. Virchow explains the process, 
in Berlin, on his theory of cellular pathology; here in Vienna, except 
by Rokitansky who still adheres to the old doctrine, it is explained on 
Coknheim's theory of the migration of the white blood cells, which has 
spread like wild fire over the land, so that it is now again fashionable 
to speak of a dyscrasia which term Virchow and his disciples with 
pyemia', etc., ridiculed out of existence; and in Wurzberg it is ex- 
plained on the bran new theory of Recklinghausen, the pathologist 
there and also one of Virchow's former students, which ascribes all 
these changes as originating in the epithelial cells lining the lymph 
vessels. Cohnheim's migration theory has the most numerous sup- 
porters, as well as some of the most able, and it posesses the additional 
merits of simplicity and beauty. Some remarkable experiments are now 
being made upon these same white blood cells with various coloring 
materials. Should they ever succeed in bringing their vagrant tenden- 
cies under human control, we promise to inform you. 

Skoda's clinic is not confined, however, to thoracic diseases — ^he 
ranges over the whole territory of internal medicine, generally devo- 
ting an hour to each of the two patients which form the text of dis- 
course. In the course of his remarks on a case of meningitis a few darro , 

u'lyiuz.cu uy -^—j v_/ V7pi L V^ 



378 WESTERN JOURNAL OF HEDICINE. 

ago, he mentioned some points in the differential diagnosis between 
this disease and typhus fever* which are worthy of note. Typhus and 
meningitis are frequently confounded, indeed cases exist in which a 
separation is impossible. In meningitis the delirium is more markod 
and the mental disturbance more decided when the patient is half 
comdtose ; a rational answer then would be more likely obtained from 
a half comatose typhus than from a fully awake meningitis patient and 
vice versa. The mutterings of typhus evidence a constant change of 
ideas and words, of meningitis, often only one idea is constant or even 
one word chains the mind; the constant repetition of one word then, when 
this symptom exists, establishes the diagnosis of meningitis, though, 
unfortunately, there are many cases in which this symptom is absent. 
If the fury of the delirium has any weight it speaks rather for typhus 
than meningitis, as formerly believed. Sopor is the same or absent in 
both. A typhus patient is more easily awakened out of a slight ^rade 
o